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Global Health Econ Sustain Effects of community-based activities on LTC needs

A B

Figure 2. Histograms of the predicted variable (A) for the ZIP model and (B) for Poisson model.
Note: Requiring care took the value of zero if the predicted value was below zero. The predicted ratio of non-zero values of the ZIP model was higher than
that of Poisson model.
Abbreviation: ZIP: Zero-inflated Poisson.
with a 13% greater need for home nursing care (Joe by living arrangements. Two major findings were obtained.

et al., 2020), and women living alone were more likely to First, the magnitude of the impacts of SAPH on requiring
receive moderate- or high-volume home support services care of older adults living alone was five times that of older
(Rahman et al., 2019). These studies show that those older adults cohabiting with other family members. Second,
adults living alone in industrialized countries are less likely participation in community-based care prevention has a
to maintain good health by themselves. positive effect on reducing the need for LTC among older

Our major finding, that participating in community- adults living alone. Thus, routine subjective health check-
based care prevention can reduce the LTC needs of older ups for those living alone seem to be an important public
adults living alone, can be added to the existing literature. health policy for older adults.
This finding is associated with a higher ratio of refraining Although older adults tend to refrain from going
from going out. Studies have shown that participation in out when their subjective health is poor, promoting
salons was associated with a halved incidence of LTC needs participation in community-based care prevention
(Saito et al., 2019); therefore, we recommend promoting should be the top priority to reduce LTC needs for older
the participation of older adults living alone in community- adults living alone. In addition to milder classification,
based care prevention, such as salons. attention should be paid to the SAPH of those who live
Moreover, we should pay attention to the classification alone in public housing because their ratio of requiring
of target groups when preparing to promote participation care was the highest compared with the control group.
in community-based care prevention for older adults living In future studies, it is recommended to investigate the
alone. Screening high-risk individuals, Shinkai et al. (2016) causal relationship between SAPH and participation in
showed that frailty prevention classes extended healthy life community-based care prevention using longitudinal
expectancy; at age 70 years, it was extended by 1.2 years for data.
women and 0.5 years for men. However, their classification Acknowledgments
limited the number of participants in a frailty prevention
class. With milder classifications, such as living alone, we None.
can expect an increase in the number of participants in
community-based care prevention. Funding
Due to the cross-sectional nature of this study, we This work was supported by grants from the JST FOREST
could not examine the impacts of community-based Program (Grant Number: JPMJFR205J) and JSPS
activities on the LTC needs of older adults in the long run. KAKENHI (Grant Numbers: JP20H00563, JP20K01739
This is a limitation of our study. However, the ZIP model and JP19K21590).
is considered useful for fitting the data with excess zeros Conflict of interest
when analyzing the use of LTCI service of older adults
living alone. The authors declare that they have no competing interests.
5. Conclusions Author contributions

We estimated the ZIP models using the 2SRI approach and Conceptualization: Narimasa Kumagai, Haruhisa Fukuda
compared the impacts of SAPH on requiring care measured Formal analysis: Narimasa Kumagai

Volume 1 Issue 1 (2023) 9 https://doi.org/10.36922/ghes.0891