Escalation on Kihon Checklist Scores Preceding the Certification of Long-Term Care Need in the Older Population in Japan. A 9-Year Retrospective Study.

The present population-based study investigated the predictive ability of the Kihon Checklist (a self-reported frailty questionnaire) and the cognitive domain therein for incident long-term care need certification. This is the first large population-based study to investigate an association between the Kihon Checklist and the outcome measure, long-term care need certification. The study population consisted of community-dwelling citizens aged >65 years who responded to the Kihon Checklist in Kobe City. The Kihon Checklist is a simple 26-item questionnaire to identify frail citizens, including three items (Q18-20) on subjective cognitive function (the cognitive domain). A total of 182 099 citizens were included for statistical analysis. The overall incidence of long-term care need certification was 1.6%, 3.5% and 5.4% at 1, 2 and 3 years. Associations were found between the Kihon Checklist questions and long-term care need certification. Furthermore, each unfavorable answer on the cognitive domain was associated with the risk for long-term care need (HR 1.493 for Q18, 1.285 for Q19, 1.321 for Q20, all P < 0.0001), independent of age, sex and other items on the Kihon Checklist. Also, after 3 years, as the number of unfavorable answers to the cognitive domain increased from 0 to 1, 2 and 3, the incidence of long-term care need certification progressively increased from 3.5% to 6.4%, 12.6% and 29.6%. The Kihon Checklist, especially the cognitive domain therein, appears to be predictive of long-term care need in community-dwelling citizens, suggesting the potential utility of the questionnaire for early detection of high-risk individuals. Geriatr Gerontol Int 2019; 19: 598-603.

IntroductionThis research project addresses the lack of screening tools for the early detection of high-risk individuals for long-term care, through four individual studies.Study 1 investigates the predictive ability of the...

BackgroundHow community-based group resistance exercises affect the transition from robustness to frailty remains unclear. Thus, we conducted a retrospective cohort study to determine whether the trajectory from robustness to frailty over age differed depending on the duration of participation in group exercises.MethodsWe analyzed the Kihon Checklist (KCL) score of community-dwelling elderly residents of Sumoto city, Hyogo prefecture, who participated in community-based group resistance exercises between April 2010 and December 2019. Finally, 2567 older individuals were analyzed using multilevel modeling. The explanatory variables of interest were the frailty score measured using the KCL for each individual, where 0–3, 4–7, and ≥8 points denoted robustness, pre-frailty, and frailty, respectively. We considered age, sex, systolic blood pressure, pulse, duration of participation, and change in KCL score from baseline as possible confounders. Participants were classified as follows based on the duration of participation in the exercises: <3 times, short-term participation group; 4–6 times; mid-term participation group; and 7–13 times, long-term participation group. The mean duration from the baseline physical test for the total sample was 2.35 years (SD=2.51).ResultsThe participants’ mean total KCL score at baseline was 4.9±3.7. Multilevel modeling analysis revealed that the KCL scores changed by 0.82 points for each additional year of age (p<0.001) and changed by − 0.93 points for long-term participate group (p<0.001). The Estimated Marginal Means (EMM) of the KCL score was 3.98 (95%CI: 3.69, 4.28) points in the short-term participation group and was significantly worse than that of the long-term participation group at 70 years of age (p=0.001). The EMM was 4.49 (95%CI: 4.24, 4.74) at 75 years of age in the mid-term participation group and was significantly worse than that of the long-term participation group. The EMM was 3.87 (95%CI: 3.57, 4.16) in the long-term participation group and significantly better than that of the short-term (p<0.001) and mid-term (p=0.002) participation groups.ConclusionParticipation in community-based group resistance exercises prolongs the transition from robustness to frailty. The improved KCL scores at baseline in the long-term participation group remained in the robust range at 75 years of age, which suggests the importance of initiating participation before the onset of functional decline.

Objectives The first aim of this study was to develop risk prediction models based on age, sex, and functional health to estimate the absolute risk of the 3-year incidence of long-term care certification and to evaluate its performance. The second aim was to produce risk charts showing the probability of the incident long-term care certification as a tool for prompting older adults to engage in healthy behaviors.Methods This study's data was obtained from older adults, aged ≥65 years, without any disability (i.e., they did not certify≥care level 1) and residing in Yabu, Hyogo Prefecture, Japan (n=5,964). A risk prediction model was developed using a logistic regression model that incorporated age and the Kihon Checklist (KCL) score or the Kaigo-Yobo Checklist (KYCL) score for each sex. The 3-year absolute risk of incidence of the long-term care certification (here defined as≥care level 1) was then calculated. We evaluated the model's discrimination and calibration abilities using the area under the receiver operating characteristic curves (AUC) and the Hosmer-Lemeshow goodness-of-fit test, respectively. For internal validity, the mean AUC was calculated using a 5-fold cross-validation method.Results After excluding participants with missing KCL (n=4) or KYCL (n=1,516) data, we included 5,960 for the KCL analysis and 4,448 for the KYCL analysis. We identified incident long-term care certification for men and women during the follow-up period: 207 (8.2%) and 390 (11.3%) for KCL analysis and 128 (6.6%) and 256 (10.2%) for KYCL analysis, respectively. For calibration, the χ2 statistic for the risk prediction model using KCL and KYCL was: P=0.26 and P=0.44 in men and P=0.75 and P=0.20 in women, respectively. The AUC (mean AUC) in the KCL model was 0.86 (0.86) in men and 0.83 (0.83) in women. In the KYCL model, the AUC was 0.86 (0.85) in men and 0.85 (0.85) in women. The risk charts had six different colors, suggesting the predicted probability of incident long-term care certification.Conclusions The risk prediction model demonstrated good discrimination, calibration, and internal validity. The risk charts proposed in our study are easy to use and may help older adults in recognizing their disability risk. These charts may also support health promotion activities by facilitating the assessment and modification of the daily behaviors of older adults in community settings. Further studies with larger sample size and external validity verification are needed to promote the widespread use of risk charts.

ABSTRACTObjectives:This study investigated the relationship between frailty as assessed using the Kihonchecklist (KCL) and rheumatoid arthritis (RA) status.Methods:In total, 626 consecutive patients with RA were enrolled in this cross-sectional study.We examined the patients’ KCL scores, characteristics, and clinical data. The patientswere grouped according to their KCL scores as follows: robust (scores of 0–3),pre-frailty (scores of 4–7), and frailty (scores ≥8).Results:Frailty, pre-frailty, and robust groups accounted for 36.9%, 30.5%, and 32.6% of thepatients, respectively. Significant factors comparing frailty and robust groups were age(P < 0.001), Health Assessment Questionnaire Disability Index (HAQ-DI)(P < 0.001), and habitual exercise (P = 0.004). Significant factors comparing thepre-frailty and robust groups were age (P < 0.001) and HAQ-DI (P = 0.041).Conclusions:In patients with RA, HAQ-DI and exercise should be managed to prevent frailty and avoidthe need for long-term care. Our results will help identify those patients who can mostbenefit from aggressive management of RA.

This study aimed to compare the predictive abilities of three frailty assessment tools-the Clinical Frailty Scale (CFS), Kihon Checklist (KCL), and Dementia Assessment Sheet for Community-based Integrated Care System 8-items (DASC-8)-for new long-term care certification among older adults with cardiometabolic disease. Participants aged ≥ 65 years who visited a frailty clinic between July 2015 and December 2024 were included. The primary outcome was new certification of long-term care needs within 5 years. Predictive performance was assessed using the area under the curve (AUC) from receiver operating characteristic analysis and Harrell's C-index from multivariable Cox models adjusted for age, sex, baseline support level certification, and comorbidities. Among 482 participants (mean age 78.9 years; 62.7% female), 86 (17.8%) were newly certified during a median follow-up of 1253 days. AUCs were 0.68 (95% confidence interval [CI]: 0.62-0.73) for the CFS, 0.68 (95% CI: 0.62-0.74) for the KCL, and 0.66 (95% CI: 0.59-0.73) for the DASC-8. Multivariable Cox regression analyses showed that CFS ≥ 4 (hazard ratio [HR]: 2.64, 95% CI: 1.64-4.26), KCL ≥ 8 (HR: 1.68, 95% CI: 1.04-2.71), and DASC-8 Category II or III (HR: 1.74, 95% CI: 1.05-2.88) were independently associated with new certification of care needs. Harrell's C-indices were 0.76 (95% CI: 0.71-0.81) for the CFS, 0.72 (95% CI: 0.67-0.78) for the KCL, and 0.73 (95% CI: 0.67-0.78) for the DASC-8. The CFS, KCL, and DASC-8 all demonstrated useful and comparable predictive ability for new long-term care certification in older adults with cardiometabolic disease.

Objective: Physical frailty has been considered a risk factor for certification of long-term care needs (hereafter referred to as Certification) under Japan’s long-term care insurance (LTCI). Therefore, assessment of frailty in elders should be studied from multiple perspectives. The Kihon Checklist (KCL) is widely used to identify need for support/care among Japanese older adults. This study aims to examine the relationship between changes in KCL items and Certification among Japan’s young-old and old-old.Material and Methods: The KCL responses of 7,092 participants were assessed in April 2012 and March 2016, along with gender, age, and living environment. Deaths, Certifications, and relocations were tracked until March 2018. Changes in KCL items were categorized as bad, worse, improved, or good.Results: Between March 2016 and March 2018, about 7.3% of respondents obtained Certifications. KCL item changes increased the risk of new Certification for bad and worse groups, while improved cognitive function among the old-old possibly reduced the risk of new Certification.Conclusion: Therefore, rather than administering the KCL once, identifying KCL changes among people at risk could help prevent or delay their need for long-term care.

Wearable devices have the potential to promote a healthy lifestyle; however, studies on the use of wearable devices in monitoring health in older adults are limited. We aimed to investigate the relationship of sleep and activity data with health status among older adults. Fifty-five community-dwelling older adults were asked to wear a wristwatch-type wearable device (the Pulsense [PS]) and measure home blood pressure (HBP) over a period of 5-7 consecutive days. Deep-sleep duration, physical and mental activity duration, and body-movement duration were obtained from PS data using special software. We also collected data on demographics and physical and mental health status. We found that the body-movement duration in women was longer than that in men. Among men, body-movement duration was strongly and negatively correlated with the Kihon Checklist (KCL) score. It also showed moderate correlations with the Geriatric Depression score, physical functioning, bodily pain, vitality, social function, and role emotional scores from the Medical Outcomes Survey Short Form-8 questionnaire, as well as with hand-grip strength. There was no significant correlation between monitoring data and health status in women. In the multiple linear regression analysis, body-movement duration was negatively associated with age and the KCL score. KCL is a common questionnaire for screening frailty in Japan. Our results showed that body-movement duration was negatively associated with age and the KCL score, suggesting the potential of PS in guiding personalized health management of older community-dwelling adults with risks of frailty.

Cardiac surgery in frail patients has been reported to be associated with increased mortality and morbidity but may improve functional status of frail patients. Few studies have investigated the impact of cardiac surgery on the trajectory of postoperative frailty. We hypothesized that cardiac surgery in frail patients would improve frailty postoperatively. This study included 71 patients over 65years old who were scheduled for cardiac surgery via sternotomy or thoracotomy. Frailty was prospectively evaluated using the Kihon Checklist (KCL) at 1 and 3months postoperatively. Patients were divided into three groups based on the preoperative KCL score: nonfrail, prefrail, and frail. The interaction between the degree of preoperative frailty and the trajectory of postoperative KCL scores was assessed. The KCL score changed significantly over time (P < 0.001), and the KCL score trajectory differed significantly according to the degree of preoperative frailty (P for interaction = 0.003). In the frail group, the KCL score was significantly lower 3months postoperatively than preoperatively (median 8, interquartile range [5, 9] versus median 9, interquartile range (9, 13), P = 0.029). The trajectory of postoperative KCL scores differed significantly depending on the degree of preoperative frailty. At 3months after cardiac surgery, the KCL score of frail patients was significantly improved, while that in nonfrail patients was significantly deteriorated.

Objective In this study, we investigated the status of polypharmacy among community-dwellingolder adults and comprehensively examined background factors, including social frailtyand Kihon Checklist (KCL) scores, based on the presence or absence of polypharmacy.Materials and Methods We conducted a survey using self-administered questionnaires distributed via mail to319 participants. Information on demographics, comorbidities, highest educationalattainment, medication status, social frailty, and KCL scores was collected.Results Using propensity score matching, 75 and 71 patients with and without polypharmacy,respectively, were selected for analysis. A comparison between the two groups indicatedno differences in social frailty; however, significant differences were observed in thetotal KCL scores (P=0.002), motor dysfunction(P=0.045), oral hypofunction (P=0.023), socialwithdrawal (P=0.032), and depression (P=0.034).Conclusion Among community-dwelling older adults with polypharmacy, attention should be paid tothe potential for decreased motor and oral functions, social withdrawal, anddepression.

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.

Background: China has the largest number of aging people in need of long-term care, among whom 70% have chronic diseases. For policy planners, it is necessary to understand the different levels of needs of long-term care and provide long-term care insurance to ensure the long-term care needs of all people can be met. Methods: This study combines the 2013 wave of CHARLS survey and the Life Course Survey of 2014. The combination allows us to factor in both childhood and adulthood data to provide life-course analysis. We identified 7,734 older adults with chronic diseases for analysis. The need for long-term care is defined by the presence of functional limitations based on the performance of basic activities of daily living (ADLs) and of instrumental activities of daily living (IADLs). Two dummy variables, ADLs disability and IADLs disability, and two count variables, ADLs score and IADLs score, were defined to measure incidence and severity of long-term care need, respectively. The concentration index was used to capture the inequality in long-term care need, and a decomposition method based on Probit Regression and Negative Binomial Regression was exploited to identify the contribution of each determination. Results: At least a little difficulty was reported in ADLs and IADLs in 20.44% and 19.25% of respondents, respectively. The concentration index of ADLs disability, ADLs score, IADLs disability, IADLs score were −0.085, −0.109, −0.095 and −0.120, respectively, all of which were statistically significant, indicating the pro-poor inequality in the incidence and severity of long-term care need. Decomposition analyses revealed that family income, education attainment, aging, and childhood experience played a significant role in explaining the inequalities. Conclusions: The long-term care need among older adults with chronic disease is high in China and low socioeconomic groups had a higher probability of needing long-term care or need more long-term care. It is urgent to implement long-term care insurance, especially for the individuals from lower socioeconomic groups.

Ensuring healthy aging and extending health span is critical, particularly in aging societies. This study analyzed patterns of risk for long-term care (LTC) certification within 3 years in rapidly aging areas of Japan using the Kihon Checklist (KCL) and machine learning models. Data from adults aged 65 years or older in Iiyama City (aging rate 37.0%) were analyzed using Exhaustive Chi-squared Automatic Interaction Detector decision trees. The dependent variable was LTC certification, and independent variables included age, sex, and six KCL domains: physical strength, nutrition, oral function, isolation, memory, and mood. Three risk patterns demonstrated consistent results across training and evaluation datasets. Age was the strongest determinant of LTC certification. Among those aged 80 years or older, low cognitive function and depression were key risk factors, while younger groups showed stronger associations with physical weakness. Results suggest age-specific segmentation of populations is crucial for designing effective interventions to prevent LTC certification.

Older adults in Japan are tackling health-related challenges brought by comprehensive geriatric symptoms, such as physical and cognitive problems and social-psychological issues. In this nationwide study, we mainly focused on the Kihon checklist (KCL) as certificated necessity of long-term care for Japanese older adults and investigated whether the KCL score was associated with geriatric depression. In addition, we aimed to identify critical factors that influence the relationship between the KCL score and geriatric depression. This survey was a cross-sectional observational study design, performed from 2013 to 2019. A total of 8,760 participants aged 65 years and over were recruited from five cohorts in Japan, consisting of 6,755 persons in Chubu, 1,328 in Kanto, 481 in Kyushu, 49 in Shikoku and 147 in Tohoku. After obtaining informed consent from each participant, assessments were conducted, and outcomes were evaluated according to the ORANGE protocol. We collected data on demographics, KCL, physical, cognitive and mental evaluations. To clarify the relationship between the KCL and geriatric depression or critical factors, a random intercept model of multi-level models was estimated using individual and provincial variables depending on five cohorts. The KCL score was correlated with depression status. Moreover, the results of a random intercept model showed that the KCL score and geriatric depression were associated, and its association was affected by provincial factors of slow walking speed, polypharmacy and sex difference. These results suggest that provincial factors of low walking performance, polypharmacy and sex difference (female) might be clinically targeted to improve the KCL score in older adults.

ObjectiveOlder adults in Japan are tackling health-related challenges brought by comprehensive geriatric symptoms, such as physical and cognitive problems and social-psychological issues. In this nationwide study, we mainly focused on the Kihon checklist (KCL) as certificated necessity of long-term care for Japanese older adults and investigated whether the KCL score was associated with geriatric depression. In addition, we aimed to identify critical factors that influence the relationship between the KCL score and geriatric depression.MethodsThis survey was a cross-sectional observational study design, performed from 2013 to 2019. A total of 8,760 participants aged 65 years and over were recruited from five cohorts in Japan, consisting of 6,755 persons in Chubu, 1,328 in Kanto, 481 in Kyushu, 49 in Shikoku and 147 in Tohoku. After obtaining informed consent from each participant, assessments were conducted, and outcomes were evaluated according to the ORANGE protocol. We collected data on demographics, KCL, physical, cognitive and mental evaluations. To clarify the relationship between the KCL and geriatric depression or critical factors, a random intercept model of multi-level models was estimated using individual and provincial variables depending on five cohorts.ResultsThe KCL score was correlated with depression status. Moreover, the results of a random intercept model showed that the KCL score and geriatric depression were associated, and its association was affected by provincial factors of slow walking speed, polypharmacy and sex difference.ConclusionsThese results suggest that provincial factors of low walking performance, polypharmacy and sex difference (female) might be clinically targeted to improve the KCL score in older adults.