管理された長期的サービスとサポートと,二重登録された高齢者の介護
Andrew D Jopson1, Chanee D Fabius1, Jennifer L Wolff1
1Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
JAMA network open
|August 21, 2025
まとめ
管理された長期サービスとサポート (MLTSS) は,高齢者が介護を受けている地域では増加しました. それにもかかわらず,無給の家庭の介護者への依存は依然として高く,より良い監視システムの必要性を強調しています.
科学分野:
- ゲロントロジー
- 医療サービス研究
- 公衆衛生政策
背景:
- マネージド・ロング・ターム・サービス・アンド・サポート (MLTSS) プログラムは,米国のメディケイドプログラムの半分以上に含まれています.
- 高齢者の介護に対するMLTSSの範囲と影響については,理解は限られている.
研究 の 目的:
- 2012年から2022年までメディケアとメディケイドの両方で登録された高齢者のMLTSSプログラム利用度およびケア時間の傾向を調べる.
- MLTSSの存在と,この集団が受けた治療の量との関係を評価する.
主な方法:
- 全国保健・高齢化傾向調査 (NHATS) のデータを郡レベルのMLTSSデータとリンクした横断的な研究を繰り返し実施した.
- 医療保険とメディケイドの両方に登録した70歳以上のコミュニティに住む成人を含め,自己ケアまたは移動に関する支援を受けていました.
- データ分析は2023年12月から2025年6月までの期間を対象とした.
主要な成果:
- MLTSSプログラムが実施されている地域に居住する高齢の二重登録者の割合は39.4% (2012年) から71.4% (2022年) に増加した.
- これらの個人は週平均65.6時間の介護を受け,主に無給の家族介護者 (週平均42.0時間) から受けた.
- MLTSSが継続的に存在している地域は,MLTSSがない地域または新たに追加された地域と比較して,週間のケア時間は (72. 9時間) 高いことが示されました (61. 6, 60. 0).
結論:
- MLTSSのプログラム参加者は高齢者の間で増加していますが,無給の家族の介護者に大きく依存しています.
- 患者とその家族の介護体験を監視する 堅固なシステムの必要性を強調しています
- MLTSSの枠組みの中で介護者を支援するための効果的な戦略をさらに研究する必要があります.
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