Association between integrative novel home-based long-term care service, hospitalization, and challenging behaviors in dementia: A secondary analysis of nationwide cross-sectional study.

PURPOSE/AIMS To identify the factors associated with hospitalization of community-dwelling users of nursing small-scale multifunctional home care (NSMHC), a long-term care insurance service grounded in a person-centered, integrated approach.

METHODS Data collected between October and November 2022 in Japan were analyzed. A structured questionnaire about NSMHC was used to collect data. The administrator of each NSMHC agency completed the questionnaire.

RESULTS Of 1936 users included in the analysis, 257 reported a reduction in hospitalizations. Of 440 users with dementia, 112 reported improvements in challenging behaviors. Binary logistic regression analysis revealed that care related to medical procedures, including oxygen therapy (odds ratio [OR], 2.45; 95 % confidence interval [CI], 1.11-5.25) and wound care (OR, 1.99; 95 % CI, 1.17-3.38), was associated with a reduction in hospitalizations. Additionally, service agencies that received support from specialized nurses in the care of elimination disorders (OR, 1.86; 95 % CI, 1.01-3.42) and respiratory care (OR, 2.41; 95 % CI, 1.07-9.43) were significant predictors of reduction in hospitalizations. Among users with dementia, standard nursing care, such as providing education and support for family members (OR, 3.90; 95 % CI, 1.30-11.6), was associated with improvements in challenging behaviors. Service agencies receiving support from specialized nurses for the care of challenging behaviors or delirium (OR, 2.20; 95 % CI, 1.15-4.18) were also associated with improvements in challenging behaviors in dementia.

CONCLUSIONS Policymakers should consider increasing the availability of NSMHC services, as they effectively address the needs of older individuals, enabling them to continue living in their communities.