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In Japan, it is estimated that one third of hospitalized aged patient stay in the hospital because of social reasons not by medical needs. This type of hospitalization has long been criticized as the hospitalization by social reason, and been required to be solved for the appropriate use of medical resources. In order to solve this problem, we have conducted a patient survey in September 2006. We have developed a questionnaire and distributed it to all long term care hospitals in Fukuoka in September 2006. The number of investigated facilities is 220. All aged patients who had stayed in the institution more than 180 d were investigated. The total number of investigated frail aged is 9,115. Among them the aged patients who were evaluated as “possible to discharge” were included into the analyses in order to investigate factors associated with their long LOS (Length of Stay). The number of cases for analyses was 4,862. The content of questionnaire is as follows: 1) Basic demographical data: age category, sex, family status (live alone or not), place of institution, 2) Health and ADL (Activities of Daily Living) status: Level of medical care needs, Level of ADL care needs, existence of dementia, medical diagnosis, 3) Social factors: willing to discharge, existence of fulfillment in life, comfort at home, economic status, social support from community. According to the results of logistic regression analysis, female, lack of assistance from social network, lack of comfort and safety at home, lack of meanings in life at home, address in Fukuoka region were associated with reluctance of discharge with statistical significance. Persons with dementia, lower ADL level, higher medical care needs showed a statistically significant positive wish for discharge. The present research has clarified that the aged with longer LOS are not necessarily persons with lower ADL level or severer dementia. They prefer to stay in hospital because they can expect a safe and comfortable daily life there. Therefore, in order to solve the problem of hospitalization by social reason, we have to organize a quality home care services as well as safety and reliable community environment.

Why does the Japanese Frail Aged Prefer to Stay in the Long Term Care Wards?