Page 98 - GHES-1-1

Global Health Econ Sustain

ORIGINAL RESEARCH ARTICLE
Distinct effects of community-based activities

on long-term care needs: A study using zero-
inflated Poisson regression

Narimasa Kumagai * and Haruhisa Fukuda 2
1
1 Department of Economics, Faculty of Economics, Seinan Gakuin University, Fukuoka, Japan
2 Department of Health Care Administration and Management, Graduate School of Medical Sciences,
Kyushu University, Fukuoka, Japan

Abstract

Social isolation among older adults is a major concern in countries where the
need for long-term care (LTC) has increased. However, no previous observational
study has identified which community-based activities can reduce the LTC needs
of older adults. Our study fills the gap between interventional and observational
studies. Data were drawn from a survey of LTC insurance needs in A city in Fukuoka
Prefecture, Japan. A city is one of the municipalities participating in the longevity
improvement and fair evidence (LIFE) study that provides data from government-
administered LTC insurance enrollees and public assistance recipients. To measure
the precise impact of self-assessed poor health (SAPH) on the needs of LTC by living
Academic editor:
Mihajlo Jakovljevic M.D. Ph.D.MAE arrangements, we adopted the two-stage residual inclusion approach and estimated
zero-inflated Poisson (ZIP) models. We uncovered two major findings. First, the results
*Corresponding author: of ZIP models showed that the magnitude of the impact of SAPH on the LTC needs
Narimasa Kumagai
(kumanari@seinan-gu.ac.jp) of older adults living alone was five times that of older adults living with other family
members. Second, participation in community-based care prevention can reduce
Citation: Kumagai, N. & Fukuda, H.
2023, Distinct effects of community- LTC needs among older adults living alone. The same effect was not observed in
based activities on long-term care older adults cohabiting with family members. Although older adults tend to refrain
needs: A study using zero-inflated from going out when their subjective health is poor, the top strategy for reduction of
Poisson regression. Global Health
Econ Sustai, 1(1): 0891. LTC needs is the promotion of participation in community-based care prevention for
https://doi.org/10.36922/ghes.0891 older adults living alone.
Received: May 2, 2023
Accepted: August 5, 2023 Keywords: Community-based care prevention; Living alone; Long-term care; Two-stage
residual inclusion; Zero-inflated Poisson model
Published Online: September 11,
2023
Copyright: © 2023 Author(s).
This is an Open Access article
distributed under the terms of the 1. Introduction
Creative Commons Attribution
License, permitting distribution, There is strong evidence that social isolation is a risk factor for poor mental and physical
and reproduction in any medium, health; those aged 65 years and older who live alone are thought to be at greater risk
provided the original work is (Courtin & Knapp, 2017). Social isolation among older adults has emerged as a major
properly cited. concern for health policy in an aging society where the number of older community-
Publisher’s Note: AccScience dwelling adults living alone has increased. Japan has the fastest aging population in the
Publishing remains neutral with world, and the need for both long-term care (LTC) and LTC insurance (LTCI) in Japan
regard to jurisdictional claims in
published maps and institutional has recently increased. The Japanese government shifted its primary LTC strategy in 2015
affiliations. by reforming the LTCI Act, focusing on community-based care and social determinants

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