Aging-in-place preferences and institutionalization among Japanese older adults: a 7-year longitudinal study

Abstract

Background: In Asia, where autonomous decision-making is not well accepted, little is known about whether and how individuals' preferences are considered when deciding where they receive care. This study examined whether individuals preferring to age in place if confined to bed were less likely to be institutionalized, using longitudinal data of Japanese older adults.

Methods: We analyzed nationally representative data of 1,290 community-dwelling older adults aged 70 and above. Baseline data were collected in 1999, shortly before the long-term care insurance system was introduced. The outcome was measured as self- or proxy-reported years of institutionalization over seven years. The explanatory variable was whether individuals preferred to age in place if they were confined to bed. Participants were asked about their desired place of care (facility, home, or other) if confined to bed. Covariates were sociodemographic and health-related factors. We used Cox proportional hazards models and calculated hazard ratios (HRs) with 95% confidence intervals (CIs) to evaluate the association of aging-in-place preferences if confined to bed with institutionalization. We applied multiple imputation to deal with missing data.

Results: Seventy-eight respondents (6.0%) were institutionalized during the follow-up period. Compared to individuals preferring to reside in long-term care facilities if confined to bed (48.7%), those preferring to stay in their homes (39.6%) were less likely to be institutionalized, even after adjusting for relevant covariates (HR = 0.47, 95% CI 0.27-0.79 for model 1 including residential status; HR = 0.45, 95% CI 0.27-0.76 for model 2 including marital status and co-resident children).

Conclusions: Our findings suggest that individuals' aging-in-place preferences tend to be considered under the long-term care insurance system. Individuals' preferences should be shared with families and clinicians when deciding the place of care.

Keywords: Community-dwelling adults; Decision-making; Hospitalization; Long-term care; Nursing home admission; Older adults.