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Impact of disease severity on quality of life, activities of daily living, and medical costs for people living with dementia in Japanese nursing home
Author(s) -
Ashizawa Takumi
Publication year - 2020
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.038365
Subject(s) - activities of daily living , dementia , quality of life (healthcare) , medicine , severe dementia , gerontology , barthel index , medical record , nursing homes , disease , physical therapy , nursing , pathology , radiology
Background Japan has the highest proportion of elderly aged 65 and over in the world, which accounts for 28.1% in 2018, and expected to reach 30.0% in 2025 and over 20% of those will suffer from dementia. This study aimed to evaluate the impact of severity of dementia on quality of life (QoL), activity of daily living (ADL), medical costs and caregiving costs in Japan. Method People living in nursing home under the Life Company Limited (N=2,114) were enrolled. Their QoL, ADL, and the severity of dementia were assessed by staff working in the facilities by using Euro‐QoL 5 dimension (EQ‐5D), Barthel Index (BI) and Mini‐Mental State Examination (MMSE), respectively. The medical and caregiving costs were derived from payment records and claim data between December 2018 and September 2019, respectively. All participants were sub‐categorized by MMSE score into three dementia groups of mild (21≦MMSE≦30), moderate (11≦MMSE≦20), and severe (0≦MMSE≦10). All results were assessed by using Shirley‐Williams test. Result Survey was conducted on Mar. 2019 and 1,491 people completed the entire questionnaires, of which, 592 used medical cares and 1,424 records for caregiving activities. Using MMSE scores, 561 were classified to mild group with mean age (SD) 84.9±8.7 years old and 67.7% accounted for women, 491 to moderate (87.3±6.9y, 73.9%) and 439 to severe (87.4±7.7y, 73.1%). Mean EQ‐5D scores for three groups were 0.75, 0.63 and 0.40, respectively. Mean BI scores were 78.5, 62.4, and 24.9, respectively. Significant decrements for both EQ‐5D and BI scores were observed for severe against mild or moderate groups. Annual out‐of‐pocket medical costs were not statistically differed by severity, or JPY11,445, 12,548 and 10,764 for mild, moderate and severe patients, respectively(not significant), while annual caregiving costs were increased as dementia becomes severer, or JPY2.1Mil, 2.4Mil and 2.8Mil for mild, moderate and severe patients, respectively (p<0.05) Conclusion Severity of dementia significantly impairs QoL and ADL, as observed from score decrements in EQ‐5D, BI and caregiving costs when severity worsened, while no significant difference was observed for medical costs.