Nationwide Descriptive Analysis of Older Inpatients Eligible for Japan's Dementia-Care Financial Incentive in...

In 2016, Japan introduced a dementia care add-on (DCA; levels 1 and 2) to incentivize hospital-based dementia care. However, nationwide characteristics of eligible patients, including care processes and outcomes, remain unclear. We conducted a descriptive national analysis of DCA-eligible inpatients.

We analyzed a national inpatient database in Japan, including patients aged ≥ 65 years admitted between fiscal years 2016 and 2019 who met DCA eligibility criteria-moderate-to-severe dementia without severe consciousness disturbance. Patient characteristics, DCA uptake, care utilization indicators, and outcomes were summarized by year.

Among 1 046 652 hospitalizations, patients were predominantly of advanced age (mean 85.4 years) and functionally dependent, with > 70% requiring full assistance with activities of daily living at admission and discharge. Patient characteristics remained stable over time; approximately 20% were admitted for pneumonia or aspiration pneumonia. From 2016 to 2019, DCA1 and DCA2 billings increased from 6.4% to 20.8% and from 13.2% to 32.8%, respectively. Mean length of stay declined from 33.7 to 27.8 days, and in-hospital mortality from 13.9% to 12.9%. Potentially inappropriate medication use at discharge decreased from 16.2% to 14.0%. In-hospital fractures remained stable at 0.9%-1.0%. About half of patients admitted from home were discharged home.

DCA-eligible inpatients are highly vulnerable. Despite increased uptake, coverage remained incomplete. This study provides baseline data to inform dementia care policy and future evaluations.