Characteristics of patients discontinuing outpatient services under long-term care insurance and its effect on frailty during COVID-19

Tamaki Hirose; Yohei Sawaya; Takahiro Shiba; Masahiro Ishizaka; Ko Onoda; Akira Kubo; Tomohiko Urano

doi:10.7717/peerj.11160

Characteristics of patients discontinuing outpatient services under long-term care insurance and its effect on frailty during COVID-19

PeerJ. 2021 Apr 5:9:e11160. doi: 10.7717/peerj.11160. eCollection 2021.

Authors

Tamaki Hirose^#^{1

2}, Yohei Sawaya^#^{1

2}, Takahiro Shiba², Masahiro Ishizaka¹, Ko Onoda¹, Akira Kubo¹, Tomohiko Urano^{2

3}

Affiliations

¹ Department of Physical Therapy, School of Health Sciences, International University of Health and Welfare, Otawara, Tochigi, Japan.
² Nishinasuno General Home Care Center, Department of Day Rehabilitation, Care Facility for the Elderly "Maronie-en", Nasushiobara, Tochigi, Japan.
³ Department of Geriatric Medicine, School of Medicine, International University of Health and Welfare, Narita, Chiba, Japan.

^# Contributed equally.

Abstract

Background: Among community-dwelling older adults who require long-term care and use outpatient rehabilitation services, we aimed to examine the characteristics of patients who discontinued using outpatient rehabilitation services to prevent exposure to COVID-19 and the effects of this discontinuation on patient frailty.

Methods: Participants were 119 older adults (69 males, 50 females; average age 77.3 ± 8.3 years) requiring long-term care who used outpatient rehabilitation services. Our outpatient rehabilitation service involved day care for older adults undergoing rehabilitation including pick-up and drop-off services under the long-term care insurance system. They were divided into two groups: participants who discontinued using outpatient rehabilitation services and participants who continued their use. To find the factors associated with this discontinuation, binomial logistic regression analysis was performed, in which the following independent variables were used: gender, age, height, weight, long-term care level, grip strength, and normal walking speed. Frailty status was investigated in April 2020 and again in September 2020 through interviews and telephone surveys utilizing the Frailty Screening Index.

Results: Women and normal walking speed were independent factors associated with the discontinuation of outpatient rehabilitation due to COVID-19. According to the results of the Frailty Screening Index, similar tendencies were exhibited in both April and September. The discontinued group indicated that they were getting less exercise and having stronger feelings of fatigue than the continuing group.

Conclusions: The findings are in accordance with other studies indicating that women are more likely to employ prevention measures against COVID-19, as seen among the community-dwelling older adults requiring long-term care who used outpatient rehabilitation services. People with higher levels of physical function were also likely to refrain from using outpatient rehabilitation services. Results further suggested that the discontinued group had more frailty-related factors (i.e., low physical activity and strong exhaustion) than the continuing group.

Keywords: COVID-19; Frailty; Japan; Long-term care; Outpatients.

Grants and funding

This study was funded by the JSPS Grants-in-Aid for Scientific Research (20K07789 and 20K23204). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.