Supplementary Material
One-year functional outcomes after invasive mechanical ventilation for older adults with pre-existing long-term care needs
Hiroyuki Ohbe, MD1, Kei Ouchi, MD2,3,4,5, Yuki Miyamoto, MD6, Yuichiro Ishigami, MD7, Hiroki Matsui, MPH1, Hideo Yasunaga, PhD1, Yusuke Sasabuchi, PhD8
1Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
2Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
3Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
4Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
5Serious Illness Care Program, Ariadne Labs, Boston, MA, USA
6Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
7Department of Transitional and Palliative Care, Aso Iizuka Hospital, Fukuoka, Japan
8Data Science Center, Jichi Medical University, Tochigi,
Supplementary Table S1. Details of the 74-item questionnaire on current physical and mental status in Japan’s long-term care insurance system
Physical function (20 items)
1 Do you have left arm paralysis?
2 Do you have right arm paralysis?
3 Do you have left leg paralysis?
4 Do you have right leg paralysis?
5 Do you have paralysis in other body parts?
6 Can you move your shoulders easily?
7 Can you move your hip joints easily?
8 Can you move your knees easily?
9 Can you move your other joints easily?
10 Can you roll over?
11 Can you raise your upper body from a lying position?
12 Can you sit upright for about 10 minutes?
13 Can you stand on both feet for 10 seconds?
14 Can you walk about 5 meters?
15 Can you stand up from a sitting position?
16 Can you stand on one leg for about 1 second?
17 Do you wash your own body?
18 Do you cut your own nails?
19 Can you see objects that are about 1 meter away from you?
20 Can you hear voices at a normal volume?
Daily activity function (12 items)
21 Can you move from a bed to a wheelchair?
22 Can you move to places you need to in daily life?
23 Can you swallow food?
24 Can you eat by yourself?
25 Do you urinate by yourself?
26 Do you defecate by yourself?
27 Do you brush your teeth by yourself?
28 Do you wash your own face?
29 Do you comb your own hair?
30 Do you change your shirt, jacket, etc., by yourself?
31 Do you change your pants, etc., by yourself?
32 How many times a week do you go out?
Cognitive function (9 items)
33 Can you communicate your intentions in some way?
34 Do you know your daily routine?
35 Can you say your own birthday or age?
36 Can you remember what happened immediately before this?
37 Can you say your own name?
38 Do you know the current season?
39 Do you know where you are right now?
40 Do you move around aimlessly?
41 Do you occasionally find yourself unable to return by yourself when going out?
Behavioral disorders (15 items)
42 Have you been victimized, such as having your items stolen?
43 Do you make up stories and tell them to people around you?
44 Do you occasionally cry or laugh and become emotionally unstable?
45 Do you have nighttime insomnia or day/night reversal?
46 Do you repeat the same story?
47 Do you ever shout?
48 Do you resist advice and care?
49 Do you occasionally feel restless and suggest that your are going home?
50 Do you occasionally want to go out by yourself and have to be watched?
51 Do you occasionally collect various objects and bring them back without permission?
52 Do you occasionally break objects or tear clothes?
53 Have you ever had severe forgetfulness?
54 Do you occasionally talk or laugh to yourself for no reason?
55 Do you occasionally act selfishly?
56 Do you occasionally struggle to focus on a topic or have a conversation?
Adjustment to social life (6 items)
57 Do you take your medicines correctly?
58 Do you manage your checkbook and coins?
59 Are you able to make decisions on your own in your daily life?
60 Do you attend neighborhood gatherings?
61 Do you do your daily shopping?
62 Do you do some simple cooking?
Daily use of medical services (12 items) 63 Infusion
64 Central parenteral nutrition 65 Dialysis
66 Stoma (colostomy) care 67 Oxygen therapy
68 Respirator (ventilator) 69 Tracheostomy care 70 Pain nursing 71 Tube feeding
72 Monitor measurements (blood pressure, heart rate, oxygen saturation, etc.) 73 Care for pressure ulcer
74 Catheter (condom catheter, indwelling catheter, urostoma, etc.)
Supplementary Table S2. Details of care-needs levels in Japan’s long-term care insurance system
Care-needs levels Total daily estimated care minutes (minutes)
Maximum benefits covered by LTCI per
month (Japanese yen) Institutional Service
Support level 1 25–32 50,320 Not covered
Support level 2 32–50 100,531 Not covered
Care-needs level 1 32–50 167,650 Covered
Care-needs level 2 50–70 197,050 Covered
Care-needs level 3 70–90 270,480 Covered
Care-needs level 4 90–110 309,380 Covered
Care-needs level 5 ≥110 362,170 Covered
LTCI, Long-Term Care Insurance
Supplementary Table S3. Incidence of invasive mechanical ventilation per 100,000 population per year
Person-years at risk No. of events Incidence* (95% CIs)
Overall 1,974,426 4198 213 (206-219)
Pre-existing care-needs before IMV
No care-needs 1755169 2434 139 (133-144)
Support level 1 27144 127 468 (393-557)
Support level 2 29607 182 615 (532-711)
Care-needs level 1 42875 298 695 (620-779)
Care-needs level 2 38802 348 897 (807-996)
Care-needs level 3 31000 273 881 (782-992)
Care-needs level 4 31100 284 913 (813-1026)
Care-needs level 5 23912 252 1054 (931-1192)
Age category
65-69 years 458985 445 97 (88-106)
70-74 years 371296 552 149 (138-162)
75-79 years 332436 888 267 (250-285)
80-84 years 292199 1059 362 (341-385)
85-89 years 227564 821 361 (337-386)
≥90 years 291945 433 148 (135-163)
Sex
Male 929754 2379 256 (246-266)
Female 1044673 1819 174 (166-182)
*Incidence is calculated as per 100,000 population per year.
CI, confidence intervals; IMV, invasive mechanical ventilation
Supplementary Table S4. Outcomes after invasive mechanical ventilation stratified by pre-existing care need before invasive mechanical ventilation among patients who survived during first hospitalization
Pre-existing care-needs before IMV
Overall Not eligible SL1-2 CNL1-3 CNL4-5
Outcomes N=2,495 N=1,616 N=345 N=302 N=232
Primary outcome
Care-needs at one-year after IMV, No. (%)
No care-needs 821 (32.9) 821 (50.8) 0 (0.0) 0 (0.0) 0 (0.0)
SL 1–2 381 (15.3) 212 (13.1) 149 (43.2) 15 (5.0) 5 (2.2)
CNL 2–3 372 (14.9) 174 (10.8) 58 (16.8) 123 (40.7) 17 (7.3)
CNL 4–5 416 (16.7) 170 (10.5) 67 (19.4) 62 (20.5) 117 (50.4)
Death 505 (20.2) 239 (14.8) 71 (20.6) 102 (33.8) 93 (40.1)
Secondary outcomes
Death during first hospitalization, n (%) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0)
Changes in care-needs, No. (%)
Improved 51 (2.0) 0 (0.0) 8 (2.3) 18 (6.0) 25 (10.8)
No change 1,155 (46.3) 821 (50.8) 119 (34.5) 111 (36.8) 104 (44.8)
Worsened 784 (31.4) 556 (34.4) 147 (42.6) 71 (23.5) 10 (4.3)
Death 505 (20.2) 239 (14.8) 71 (20.6) 102 (33.8) 93 (40.1)
IMV, invasive mechanical ventilation; SL, support level; CNL, care needs level
Supplementary Table S5. Analysis for the associations between pre-existing care needs before invasive mechanical ventilation and the outcomes among patients who survived during first hospitalization
Pre-existing care-needs before IMV
Outcomes Not eligible SL1-2 CNL1-3 CNL4-5
Care-needs at 1-year from IMV, aOR (95% CI) Ref. 2.64 (2.14, 3.26) 5.14 (4.08, 6.48) 9.25 (7.08, 12.09) Death at 1-year from IMV, aOR (95% CI) Ref. 1.12 (0.85, 1.54) 2.21 (1.64, 2.97) 2.93 (2.12, 4.05) IMV, invasive mechanical ventilation; SL, support level; CNL, care needs level; aOR, adjusted odds ratio; CI, confidence intervals
Outcomes were adjusted with age, sex, Charlson comorbidity index, main diagnosis, and treatments during hospitalization.
