Municipal Governments' Long-Term Care Prevention Efforts and Homebound Status of Older Adults: A Three-Year Cohort Study in Japan

Abstract

Aim: Homebound status poses considerable risks for adverse health outcomes among older adults. To enhance the comprehensive care system, municipalities have implemented efforts aimed at long-term care prevention. It is assumed that such efforts may help mitigate homeboundness. Therefore, this study examined the association between municipal long-term care prevention efforts and homebound status among older adults. Methods: This 3-year cohort study utilized panel data between 2019 and 2022 from the Japan Gerontological Evaluation Study (JAGES), involving adults aged ≥ 65 years who were not homebound in 2019. As proxies for municipalities' prevention efforts, the Daily Living Support System Development Progress (DLSSDP) scores and Long-term Care Prevention and Daily Living Support Progress (LCPDLSP) scores in 2019 were used as explanatory variables. The outcome was homebound status in 2022. Individual- and municipality-level characteristics in 2019 were included as confounders. Multilevel logistic regression with multiple imputation was performed to estimate odds ratios for the association between each score and homebound status. Results: The study included 89 914 participants (female: 51.6%, mean age: 76.5 years). The overall incidence of homebound status in 2022 was 2.8%, with variations ranging from 1.3% to 6.4% across 49 municipalities. Compared with older adults in municipalities with high DLSSDP scores, those in municipalities with low scores had significantly higher odds of being homebound (odds ratio: 1.22; 95% confidence interval: 1.04–1.44). There were no significant differences in homebound odds across municipalities with varying LCPDLSP scores. Conclusion: Living in municipalities with higher DLSSDP scores was associated with not being homebound.