Predicting incidence of long-term care insurance certification in Japan with the Kihon Checklist for frailty screening tool: analysis of local government survey data.

BACKGROUND: Predicting incidence of long-term care insurance (LTCI) certification in the short term is of increasing importance in Japan. The present study examined whether the Kihon Checklist (KCL) can be used to predict incidence of LTCI certification (care level 1 or higher) in the short term among older Japanese persons. METHODS: In 2015, the local government in Tokyo, Japan, distributed the KCL to all individuals older than 65 years who had not been certified as having a disability or who had already been certified as requiring support level 1-2 according to LTCI system. We also collected LTCI certification data within the 3 months after collecting the KCL data. The data of 17,785 respondents were analyzed. First, we selected KCL items strongly associated with incidence of LTCI certification, using stepwise forward-selection multiple logistic regression. Second, we conducted receiver operating characteristic (ROC) analyses for three conditions (1: Selected KCL items, 2: The main 20 KCL items (nos. 1-20), 3: All 25 KCL items). Third, we estimated specificity and sensitivity for each condition. RESULTS: During a 3-month follow-up, 81 (0.5%) individuals required new LTCI certification. Eight KCL items were selected by multiple logistic regression as predictive of certification. The area under the ROC curve in the three conditions was 0.92-0.93, and specificity and sensitivity for all conditions were greater than 80%. CONCLUSIONS: Three KCL conditions predicted short-term incidence of LTCI certification. This suggests that KCL items may be used to screen for the risk of incident LTCI certification.

[Effects of a multifactorial intervention for improving frailty on risk of long-term care insurance certification, death, and long-term care cost among community-dwelling older adults: A quasi-experimental study using propensity score matching].

Objectives　To examine the effects of a multifactorial intervention for improving frailty-comprising resistance exercise and nutritional and psychosocial programs-on the risk of long-term care insurance (LTCI) certification, death, and long-term care (LTC) cost among community-dwelling older adults.Methods　Seventy-seven individuals (47 in 2011 and 30 in 2013) from the Hatoyama Cohort Study (742 individuals) participated in a multifactorial intervention. Non-participants were from the same cohort (including people who were invited to participate in the multifactorial intervention but declined). We performed propensity score matching with a ratio of 1 : 2 (intervention group vs. non-participant group). Afterward, 70 individuals undergoing the multifactorial intervention and 140 non-participants were selected. The risk of LTCI certification and/or death and the mean LTC cost during the follow-up period (32 months) were compared using the Cox proportional hazards model and generalized linear model (gamma regression model).Results　The incidence of new LTCI certification (per 1,000 person-years) tended to be lower in the intervention group than in the non-participant group (1.8 vs. 3.6), but this was not statistically significant as per the Cox proportional hazards model (hazard ratio=0.51, 95% confidence interval [CI]=0.17-1.54). Although the incidence of LTC cost was not significant, the mean cumulative LTC cost during the 32 months and the mean LTC cost per unit during the follow-up period (1 month) were 375,308 JPY and 11,906 JPY/month, respectively, in the intervention group and 1,040,727 JPY and 33,460 JPY/month, respectively, in the non-participant group. Cost tended to be lower in the intervention group than in the non-participant group as per the gamma regression model (cumulative LTC cost: cost ratio=0.36, 95%CI=0.11-1.21, P=0.099; LTC cost per unit follow-up period: cost ratio=0.36, 95%CI=0.11-1.12, P=0.076).Conclusions　These results suggest that a multifactorial intervention comprising resistance exercise, nutritional, and psychosocial programs is effective in lowering the incidence of LTCI certification, consequently saving LTC cost, although the results were not statistically significant. Further research with a stricter study design is needed.

Development of risk assessment scales for Needed Support/Long-Term Care certification: A longitudinal study using the Kihon Checklist and medical assessment data.

Objectives　This study aimed to develop risk assessment scales for predicting the incidence of Needed Support/Long-Term Care certification, by aggregating data from the Kihon Checklist, medical assessments, and long-term care insurance certification during a follow-up period (a maximum of 4 years and 2 months) conducted in a municipality.Methods　This retrospective cohort study included 72,127 older adults aged 65 years or older living in K City (an ordinance-designated city) who responded to the Kihon Checklist in 2011. We linked their medical assessment data (examined/unexamined, blood pressure, and five blood biochemical items) from 2011 and information on the incidence of long-term care insurance certification from 2011 to 2015 to the Kihon Checklist data (the 12 essential items and seven optional items from the Needs Survey). We constructed four Cox proportional hazards models as follows: 1) age, sex, and the Needs Survey's 12 essential items; 2) model 1 plus seven optional items; 3) model 2 plus examined/unexamined at medical assessment; and 4) model 3 plus blood pressure and five blood biochemical items, as independent variables. Recent requirement for Support/Long-Term Care certification was included as an outcome with stepwise forward selection. We assigned scores for each item based on the non-standardized regression coefficients obtained (B) and the sum of those scores was used to establish the risk assessment scales for predicting Needed Support/Long-Term Care certification from each model. A receiver operating characteristic (ROC) analysis was conducted to estimate the sensitivity and specificity in order to compare predictive validity of the scales.Results　During the follow-up period, 11,039 (15.3%) individuals required a new incidence of a Needed Support/Needed Long-Term Care certification. A risk assessment scale of 0-55 was established based on age, sex, and the 10 essential items from the Needs Survey's. The incidence of certification were 3.2%, 14.7%, 31.6%, 56.7%, and 75.0% at scores of 10, 20, 30, 40, and 50, respectively. The area under the ROC curve (AUC) was 0.783, and the sensitivity and the specificity were 0.705 and 0.731, respectively (cut-off: 21/22). These values remained almost unchanged despite the addition of optional and medical assessment items (AUC: 0.786-0.787, sensitivity: 0.721-0.730, and specificity: 0.710-0.717).Conclusion　Although the medical assessment data was not aggregated, the scale developed from the Kihon Checklist's 10 items (included in the Needs Survey's essential items) is useful for predicting the incidence of Needed Support/Long-Term Care certification. The scale, which evaluates the risk of needed support/long-term care at individual and community levels, was developed using the existing Kihon Checklist data or the Needs Survey's data collected subsequently by municipalities.

Frailty Status Predicts New Long-term Care Insurance Certification in Hepatitis C Patients Receiving Antiviral Therapy.

BACKGROUND/AIM: Direct-acting antiviral (DAA) therapies for patients with hepatitis C virus (HCV) infection deliver higher cure rates and lower frequencies of adverse events than existing therapies, though DAA treatment costs $45,000-64,000 in Japan. The prognosis of patients who require new long-term care insurance (LTCI) certification is inferior to that of patients who do not. Here, we clarify the factors associated with new LTCI certification in elderly patients with HCV infection who undergo DAA therapy. PATIENTS AND METHODS: We retrospectively surveyed 53 patients aged ≥70 years who were treated with DAAs, and evaluated the factors associated with new LTCI certification. RESULTS: Of 53 patients, 10 required new LTCI certification. Age ≥85 years and a modified Japanese Cardiovascular Health Study index ≥2 were independently associated with new LTCI certification. CONCLUSION: In elderly HCV patients, poor frailty status strongly predicted new LTCI certification after DAA therapy.