Long-term Care Costs Research Articles

An NDC approach to helping pensioners cope with the cost of long-term care

AbstractThis paper explores a notional defined contribution (NDC) approach aimed at helping pensioners to cope with the cost of long-term care (LTC). It develops the necessary technicalities to fully integrate an LTC benefit, graded according to the annuitant's degree of disability, into a generic NDC retirement framework with a minimum pension benefit for both contingencies. It also discusses the policy implications of various issues that should be taken into account before any decision is made to put the model into practice. Finally, to enable policymakers to better understand how the proposal would function, the paper includes a realistic numerical example.

Association of Trajectories of Higher-Level Functional Capacity with Mortality and Medical and Long-Term Care Costs Among Community-Dwelling Older Japanese.

Higher-level functional capacity is crucial component for independent living in later life. We used repeated-measures analysis to identify aging trajectories in higher-level functional capacity. We then determined whether these trajectories were associated with all-cause mortality and examined differences in medical and long-term care costs between trajectories among community-dwelling older Japanese. 2,675 adults aged 65-90 years participated in annual geriatric health assessments and biennial health monitoring surveys during the period from October 2001 through August 2011. The average number of follow-up assessments was 4.0, and the total number of observations was 10,609. Higher-level functional capacity, which correspond to the fourth and fifth sublevels of Lawton's hierarchical model, was assessed with the Tokyo Metropolitan Institute of Gerontology-Index of Competence (TMIG-IC). We identified four distinct trajectory patterns (high-stable, late-onset decreasing, early-onset decreasing, and low-decreasing) on the TMIG-IC through age 65-90 years. As compared with the high-stable trajectory group, participants in the late-onset decreasing, early-onset decreasing, and low-decreasing TMIG-IC trajectory groups had adjusted hazard ratios for mortality of 1.22 (95% confidence interval: 1.01-1.47), 1.90 (1.53-2.36), and 2.87 (2.14-3.84), respectively. Participants with high-stable and late-onset decreasing higher-level functional capacity trajectories had lower mean monthly medical costs and long-term care costs. In contrast, mean total costs were higher for those with low-decreasing trajectories, after excluding the large increase in such costs at the end of life. People with a low-decreasing aging trajectory in higher-level functional capacity had higher risks of death and had high monthly total costs.

Ageing, limb-loss and military veterans: a systematic review of the literature

ABSTRACTThe impact of losing a limb in military service extends well beyond initial recovery and rehabilitation, with long-term consequences and challenges requiring health-care commitments across the lifecourse. This paper presents a systematic review of the current state of knowledge regarding the long-term impact of ageing and limb-loss in military veterans. Key databases were systematically searched including: ASSIA, CINAHL, Cochrane Library, Medline, Web of Science, PsycArticles/PsychInfo, ProQuest Psychology and ProQuest Sociology Journals, and SPORTSDiscus. Empirical studies which focused on the long-term impact of limb-loss and/or health-care requirements in veterans were included. The search process revealed 30 papers relevant for inclusion. These papers focused broadly on four themes: (a) long-term health outcomes, prosthetics use and quality of life; (b) long-term psycho-social adaptation and coping with limb-loss; (c) disability and identity; and (d) estimating the long-term costs of care and prosthetic provision. Findings present a compelling case for ensuring the long-term care needs and costs of rehabilitation for older limbless veterans are met. A dearth of information on the lived experience of limb-loss and the needs of veterans’ families calls for further research to address these important issues.

Aspirin for Evidence-Based Preeclampsia Prevention trial: effect of aspirin on length of stay in the neonatal intensive care unit

Preeclampsia is a major pregnancy complication with adverse short- and long-term implications for both the mother and baby. Screening for preeclampsia at 11-13 weeks' gestation by a combination of maternal demographic characteristics and medical history with measurements of biomarkers can identify about 75% of women who develop preterm preeclampsia with delivery at <37 weeks' gestation and 90% of those with early preeclampsia at <32 weeks, at a screen-positive rate of 10%. A recent trial (Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-Based Preeclampsia Prevention) has reported that in women identified by first-trimester screening as being at high risk for preeclampsia, use of aspirin (150 mg/d from the first to the third trimester), compared to placebo, reduced the incidence of preterm preeclampsia, which was the primary outcome, by 62% (95% confidence interval, 26-80%) and the incidence of early preeclampsia by 89% (95% confidence interval, 53-97%). The surprising finding of the trial was that despite the reduction in preeclampsia the incidence of admission to the neonatal intensive care unit, which was one of the secondary outcomes, was not significantly affected (odds ratio, 0.93; 95% confidence interval, 0.62-1.40). We sought to examine the effect of prophylactic use of aspirin during pregnancy in women at high risk of preeclampsia on length of stay in the neonatal intensive care unit. This was a secondary analysis of data from the Aspirin for Evidence-Based Preeclampsia Prevention trial to assess evidence of differences in the effect of aspirin on length of stay in neonatal intensive care. Bootstrapping was used for the comparison of mean length of stay between the aspirin and placebo groups. Logistic regression was used to assess treatment effects on stay in the neonatal intensive care unit. In the trial there were 1620 participants and 1571 neonates were liveborn. The total length of stay in neonatal intensive care was substantially longer in the placebo than aspirin group (1696 vs 531 days). This is a reflection of significantly shorter mean lengths of stay in babies admitted to the neonatal intensive care unit from the aspirin than the placebo group (11.1 vs 31.4 days), a reduction of 20.3 days (95% confidence interval, 7.0-38.6; P= .008). Neonatal intensive care of babies born at <32 weeks' gestation contributed 1856 (83.3%) of the total of 2227 days in intensive care across both treatment arms. These occurred in 9 (1.2%) of the 777 livebirths in the aspirin group and in 23 (2.9%) of 794 in the placebo group (odds ratio, 0.42; 95% confidence interval, 0.19-0.93; P= .033). Overall, in the whole population, including 0 lengths of stay for those not admitted to the neonatal intensive care unit, the mean length of stay was longer in the placebo than aspirin group (2.06 vs 0.66 days; reduction of 1.4 days; 95% confidence interval, 0.45-2.81; P= .014). This corresponds to a reduction in length of stay of 68% (95% confidence interval, 20-86%). In pregnancies at high risk of preeclampsia administration of aspirin reduces the length of stay in the neonatal intensive care unit by about 70%. This reduction could essentially be attributed to a decrease in the rate of births at <32 weeks' gestation, mainly because of prevention of early preeclampsia. The findings have implications for both short- and long-term health care costs as well as infant survival and handicap.

Abstract WMP7: Cost-Effectiveness of Combined Thrombectomy with Intravenous Thrombolysis vs Thrombectomy Alone for Acute Ischemic Stroke

Introduction: Meta-analysis of 13 studies suggested that combined mechanical thrombectomy (MT) with intravenous thrombolysis (IV-tPA) is more effective than MT alone. Limited economic analyses have explored this topic. We aimed to determine the cost-effectiveness of combined vs MT alone therapy in patients with large-vessel occlusive stroke. Hypothesis: Combined MT with IV-tPA is more cost-effective than MT alone. Methods: Markov model was constructed to simulate health outcomes and costs of two therapies (combined MT with IV-tPA, MT alone) over a 20 years lifetime horizon. The model incorporated an acute phase (0-90 days) and a rest of life phase (&gt;90 days) with modified Rankin categories at 90days as the primary health states. Probabilities, utilities, and cost data were obtained from published sources. Incremental costs, quality-adjusted life-year (QALY), net monetary benefits, incremental cost-effectiveness ratio (ICER) were derived from the models. The willingness-to-pay was set to ICER $50,000/QALY. Results: Table 1 summarizes the base-case values and cost-effectiveness outcomes. Combined MT and IV-tPA led to improved quality-of-life and increased life expectancy; however, it was at slightly higher costs compared to MT alone. Combined MT with IV-tPA yielded 13.5 QALYs and accrued $220,227 in lifetime costs, whereas MT alone yielded 12.5 QALYs and accrued $185,714 in lifetime costs. Combined MT with IV-tPA costs $1,468 per QALY higher than MT alone group. The higher costs in combined therapy were driven by the costs of long-term care in stroke survivors with severe disability. Net monetary benefit was higher in the combined therapy by 14,988 points suggesting that combined MT with IV-tPA was more cost-effective than MT alone. Conclusions: Combined MT with IV-tPA is more cost effective than MT alone in patients with large vessel occlusive stroke. Randomized clinical trials to directly compare between combined MT with IVT vs MT alone seem warranted.

An Investigation of Factors Influencing High Usage of Medical and Long-Term Care Services in an Aging Society in Japan.

Medical and long-term care costs are increasing all over the world. In this study, we investigated the characteristics of groups with high cost of medical and long-term care to define targets for curbing social security costs. As a result, for the population covered by the National Health Insurance, a large portion of medical costs were incurred for mental disorders, malignant neoplasms, and lifestyle-related diseases. For those covered by the Late Elderly Health Insurance System, most medical costs were incurred for lifestyle-related diseases, femoral fractures, neurological diseases, mental disorders, pneumonia, malignant neoplasms, and Alzheimer's disease. From multiple regression analysis, the hospitalization days, use of advanced medical treatment, outpatient days, and high long-term care level influenced the increased costs. On the other hand, disease characteristics had only a very low effect. These findings suggest that the target population has complex medical and long-term care needs because they have multiple diseases.

Cost of shifting from healthcare to long-term care in later life across major diseases: analysis of end-of-life care during the last 24 months of life.

Aim: To evaluate the costs associated with healthcare and long-term care during the last 24 months before death according to major disease groups.Methods: Individual data regarding healthcare and long-term care costs according to public insurance schemes during the last 24 months before death among all decedents older than 75 years reported in a city in Japan between April 1, 2010 and March 31, 2014 were identified; the data for nine major diseases were then analyzed.Results: For the 2149 decedents studied, the average healthcare costs per capita in the last 24 months of life for moderately-old (75 to 84 years) and extremely-old (85 years and older) decedents was 4,135,467 JPY and 2,493,001 JPY, respectively, while the average long-term care costs per capita for 24 months was 1,300,710 JPY and 2,723,239 JPY, respectively. The total costs (healthcare and long-term care combined) ranged from 9,169,547 JPY for chronic kidney disease to 5,023,762 JPY for ischemic heart disease. In all the diseases studied, the moderately-old decedents incurred higher healthcare costs while the extremely-old decedents incurred higher long-term care costs. However, for the care costs of chronic lower respiratory diseases, this pattern was not observed.Conclusion: A shift in expenditure from healthcare to long-term care as the decedents’ age increased was observed in major diseases, with some exceptions.

Patient vs. Provider Incentives in Long-Term Care

How do patient and provider incentives affect mode and cost of long-term care? Our analysis of 1 million nursing home stays yields three main insights. First, Medicaid-covered residents prolong their stays instead of transitioning to community-based care due to limited cost-sharing. Second, nursing homes shorten Medicaid stays when capacity binds to admit more profitable out-of-pocket payers. Third, providers react more elastically to financial incentives than patients, so moving to episode-based provider reimbursement is more effective in shortening Medicaid stays than increasing resident cost-sharing. Moreover, we do not find evidence for health improvements due to longer stays for marginal Medicaid beneficiaries.

Decubitus Ulcer Development: An Investigation on Its Effect and Evidence in Home Care Patients.

Background and Aims:Decubitus ulcer (DU) is one of the commonly observed health problems among home care patients. As well as deteriorating social, physical, and psychological conditions of the patients, it is a cause of severe economic loss due to long-term bed occupancy and high care costs. This study aimed to examine the factors which affect the development of decubitus ulcer among home care patients and provide extensive data to the literature.Patients and Methods:This study was conducted with on home care patients aged over 40 years old who were registered at Etimesgut Ankara Sehit Sait Erturk State Hospital. Following the face-to-face interviews with the patients at home, the scores of Subjective Global Assessment (SGA), Mini Nutritional Assessment (MNA), Daily Life Activities (DLA), and Geriatric Depression Scale (GDS) were recorded. Development of DU was monitored through routine examinations in the home care patients. It was encountered how SGA, MNA, DLA and GDS functioned in predicting the development of DU using logistic regression during effort and also how status of equipment and presence of comorbid diseases affected its development.Results:It was determined that malnutrition affected development of DU by decreasing mobility while the presence of psychological problems increased the risk for development. Furthermore, number of comorbid diseases and status of health equipment used by the patients were found effective in the development of DU.Conclusion:It is obvious that decreased inability of independent mobility in DLA increase the risk for malnutrition and consequently two assessments show a negative impact on psychology of the patient.

The Burden of Acute Kidney Injury and Related Financial Issues.

Acute kidney injury (AKI) is one of the most common complications in acutely ill patients. The epidemiology, clinical presentation, and outcome vary between patients and countries. Patients with AKI often exhibit multiple organ dysfunction that is caused, in part, by marked cross-talk between the kidney and other organs and tissues. These deleterious interactions arise, at least in part, from systemic inflammatory changes, an increased cytokine load, increases in leukocyte trafficking and activation of neurohormonal processes. Typical short-term complications of AKI include acute lung injury, liver dysfunction, cardio-renal syndrome, brain dysfunction, systemic inflammation, and increased mortality. Survivors of AKI are at risk of chronic kidney disease, cardiovascular morbidity, strokes, infections, bone fractures and increased mortality. AKI is associated with high healthcare costs as a result of a longer stay in hospital, increased costs for investigations and interventions and the development of long-term complications including dialysis dependence, chronic comorbidities and re-hospitalisations. The outcomes and financial implications are worse in low-income countries compared to high-income countries. Key Message: AKI is common among hospitalised patients and associated with serious short- and long-term complications, increased mortality, and high health care costs. There are important differences in epidemiology and outcomes between low- and high-income countries.

Estimating Long-Term Care Costs among Thai Elderly: A Phichit Province Case Study.

Background Rural-urban inequality in long-term care (LTC) services has been increasing alongside rapid socioeconomic development. This study estimates the average spending on LTC services and identifies the factors that influence the use and cost of LTC for the elderly living in urban and rural areas of Thailand. Methods The sample comprised 837 elderly aged 60 years drawn from rural and urban areas in Phichit Province. Costs were assessed over a 1-month period. Direct costs of caregiving and indirect costs (opportunity cost method) were analyzed. Binary logistic regression was performed to determine which factors affected LTC costs. Results The total annual LTC spending for rural and urban residents was on average USD 7,285 and USD 7,280.6, respectively. Formal care and informal care comprise the largest share of payments. There was a significant association between rural residents and costs for informal care, day/night care, and home renovation. Conclusions Even though total LTC expenditures do not seem to vary significantly across rural and urban areas, the fundamental differences between areas need to be recognized. Reorganizing country delivery systems and finding a balance between formal and informal care are alternative solutions.

An Ndc Approach to Helping Pensioners Cope with the Cost of Long-Term Care

The aim of this paper is to analyse whether it would be possible to provide retirement and long-term care benefits using the same unfunded notional defined contribution scheme. We extend the multi-state overlapping generations model developed by Pla-Porcel et al. (2016) to include two new features: a long-term care benefit graded according to the annuitant's degree of disability and a minimum pension benefit for both contingencies. This brings the model closer to the reality of social insurance and enhances its political attractiveness. The paper contains a numerical example to show how the model functions and focuses especially on the mortality rates for dependent persons, the inception rates from a healthy state to (any) disability state, and the probabilities of transition between one health status and another. The numerical example proves that the model works reasonably well and makes it clear that it has practical implications that could be of interest to policy makers. It also provides us with some useful values regarding the impact of introducing a minimum pension on the system's financial equilibrium and reinforces the fact that biometric assumptions need to be estimated accurately before any decision is made to put the model into practice.

Practical Applications of Will Long-Term Care Ruin Retirement Plans?

<h3>Practical Applications Summary</h3> As the American population ages, many families are encountering the expense of long-term care (LTC). While there are different types of care, nursing-home care is particularly expensive, with an average cost of more than $92,000 per year. Those costs heighten the risk of running out of retirement assets in old age, yet it’s impossible to know exactly how much long-term care will be needed as individuals age. In <b>Will Long-Term Care Ruin Retirement Plans</b>, published in the Winter 2017 issue of <b><i>The Journal of Retirement</i></b>, <b>Michael Crook</b> and <b>Ronald Sutedja</b> of <b>UBS Wealth Management</b> developed health-status simulations to predict the probability of needing long-term care after the age of 65. Next, they developed a model that assessed the financial impact of LTC costs on retirement plans ranging from $1 million to $10 million.

Research during Integrated Care: Acute Hospital to the Community Hospital to Home for Hip Fracture Patients in Singapore

Introduction: Hip fracture is a global health issue, with significant morbidity and ongoing long-term care costs. Since 2016, care-coordinators (CC, nurses who support discharge into the community) from National University Hospital (NUH) and St Luke’s Hospital (SLH), with therapists, integrated their work processes to provide holistic patient support. NUH CCs would review the patient’s premorbid function, social support, and caregiver stress scores while in NUH. This information is shared with SLH’s CC and therapists, who continue to follow up on patients to 100 days post-discharge and intervene as needed. We conducted a 9-month retrospective review on 34 hip fracture patients who were admitted to NUH, then SLH and back into the community. Results: The mean age was 79. 64.7% (22) were female. 1.3% (4) were known to have dementia. 11 of 34 (32.4%) had an AMT ≤7. The mean Charlson Comorbidity Index was 4.4. 97.1% (33) had surgery, and were allowed to full weight-bear. Mean length of stay in NUH and SLH were 8.47 and 35.6 days respectively. Mean premorbid MBI was 93.3. Mean post-fracture MBI improved from 57.1 to 80.2 at 100 days. Number of caregivers with Zarit >8 decreased from 3 to 2 at 100 days. 79.4% (27) patients were independent pre-fracture. At 100 days, 32.4% (11) patients were independent. Of which, 29.4% (10) were cared for by a domestic helper and 26.5% (9) by family. 1 patient went to a nursing home. 2 patients were admitted to an acute hospital, and 1 died. Discussions, conclusions: There was good functional recovery and reduction of caregiver stress from the acute setting to rehabilitation to home (100-days). There was loss of functional independence post hip fracture, resulting in a need for a caregiver. In Singapore’s context, this was a domestic helper or a family member. Lessons learnt: Hip fracture has significant long-term functional and social implications in Singapore. There needs to be better integration of care/support from acute, to rehabilitation hospitals, and into community, to optimise functional recovery, reduce acute hospital length of stay, and reduce caregiver stress. Limitations: The study was limited by patient numbers. Suggestions: Larger and further studies are needed to drive effective integrated care for hip fracture across settings, and also into the community. Predictive factors are needed to allocate resources efficiently.

Where Next for Long‐Term Care?

Where Next for Long‐Term Care?

Trends in the use and costs of round-the-clock long-term care in the last two years of life among old people between 2002 and 2013 in Finland

BackgroundThe structure of long-term care (LTC) for old people has changed: care has been shifted from institutions to the community, and death is being postponed to increasingly old age. The aim of the study was to analyze how the use and costs of LTC in the last two years of life among old people changed between 2002 and 2013.MethodsData were derived from national registers. The study population contains all those who died at the age of 70 years or older in 2002–2013 in Finland (N = 427,078). The costs were calculated using national unit cost information. Binary logistic regression and Cox proportional hazard models were used to study the association of year of death with use and costs of LTC.ResultsThe proportion of those who used LTC and the sum of days in LTC in the last two years of life increased between 2002 and 2013. The mean number of days in institutional LTC decreased, while that for sheltered housing increased. The costs of LTC per user decreased.ConclusionsUse of LTC in the last two years of life increased, which was explained by the postponement of death to increasingly old age. Costs of LTC decreased as sheltered housing replaced institutional LTC. However, an accurate comparison of costs of different types of LTC is difficult, and the societal costs of sheltered housing are not well known.

027Using Clinical Audit to Improve Hip Fracture Care in Ireland: The Irish Hip Fracture Database

Abtract In 2016, 3,610 patients over the age of sixty were hospitalised with a hip fracture in Ireland. The acute hospital care costs are in excess of €45 million and growing. This doesn’t include the long term costs of rehabilitation, convalescence, community care and long term care. The IHFD is a clinically led, web based audit of hip fracture casemix, care and outcomes. It is supported by the Irish Gerontological Society (IGS) and the Irish Institute of Trauma and Orthopaedics (IITOS) and the National Office of Clinical Audit (NOCA) provides governance and operational support for the IHFD. All sixteen eligible hospitals in the Republic of Ireland are included. The most recent IHFD report 2015 published in 2016 is comprised of data from 2,962 hip fracture cases from 16 hospitals. The coverage of the data for 2015 was 81%. The mean length of stay was 20 days and the median length of stay was 13 days in 2015. The 2016 report will be published later this year. Preliminary data for 2016 shows the coverage has increased to 86.5%. In the 2015 National report published in 2016 70% hip fractures were female, 83% patients were admitted from home and 48% were independently mobile, 37% fractures were intracapsular displaced, 36% of arthroplasties were cemented and 30% patients were discharged directly home. Thirty-nine percent (39%) of patients were reviewed by a geriatrician at any time during their admission. The proportion of patients being reviewed pre-operatively is 15%. In 2017, the focus continues to be on improving data quality and increasing coverage nationally to 100% for all sites. To ensure all suspected hip fracture patients should be brought directly to the trauma operating hospital. Each hospital should establish a hip fracture working group to review and utilise the IHFD data locally to improve patient care.

Increased Health Care Utilization and Costs Among Veterans With a Positive Screen for Military Sexual Trauma.

The effects of sexual trauma on long-term health care utilization and costs are not well understood due to infrequent documentation of sexual trauma history in health care systems. The Veteran's Health Administration provides a unique opportunity to address this constraint as sexual trauma is actively screened for as part of routine care. We used a retrospective cohort design to analyze Veteran's Health Administration mental health and medical service utilization and costs as a function of a positive screen for exposure to military sexual trauma (MST) among Veterans of recent conflicts in Iraq and Afghanistan. We computed adjusted 5-year estimates of overall utilization and costs, and utilization and costs determined not to be related to MST. The cohort included 426,223 men and 59,611 women. A positive MST screen was associated with 50% higher health care utilization and costs relative to a negative screen. Overall, a positive relative to negative MST screen was associated with a 5-year incremental difference of 34.6 encounters and $10,734 among women, and 33.5 encounters and $11,484 among men. After accounting for MST-related treatment, positive MST screen was associated with 11.9 encounters and $4803 among women, and 19.5 encounters and $8001 among men. Results demonstrate significant and consistent differences in health care utilization and costs between Veterans with a positive relative to negative MST screen. Even after accounting for MST-related care, a positive screen was associated with significantly higher utilization and costs. MST-related needs may be more readily recognized in women relative to men.

Future Costs of Long-term Care in Japan and Sweden.

Population aging is expected to increase long-term care (LTC) costs in both Japan and Sweden. This study projected LTC costs for 2010 through 2040 for different assumptions of population change, LTC need by age group and gender, and LTC provided per level of need and cost in Japan and Sweden. Population data were taken from the official national forecasts. Needs projections were based on epidemiological data from the Nihon University Japanese Longitudinal Study of Aging and the Swedish Survey of Living Conditions. Data on LTC provision by need and cost were taken from nine Japanese municipalities collected by assessments in the LTC insurance system and from surveys in eight Swedish municipalities. Total initial costs were calibrated to official national figures. Two projections based on two different scenarios were made for each country from 2010 to 2040. The first scenario assumed a constant level of need for LTC by age group and gender, and the other assumed a continuation of the present LTC need trends until 2025. For Japan, this resulted in a projected cost increase of 93% for the one and 80% for the other; for Sweden it was 52% and 24%, respectively. The results reflected differences in population aging and health development.

Prevalence of Frailty Assessed by Fried and Kihon Checklist Indexes in a Prospective Cohort Study: Design and Demographics of the Kyoto-Kameoka Longitudinal Study

ObjectiveThe Kyoto-Kameoka Study was launched in 2011–2012 to identify the associations among food intake, nutritional status, physical activity, oral function, quality of life or social capital, the use of long-term care insurance (LTCI) system, and healthy lifespan in community-dwelling older people as a part of the World Health Organization Safe Community program. DesignA prospective cohort study, reporting baseline demographics (cross-sectional data). Setting and participantsWe conducted 2 mailed self-administered questionnaire surveys; one is a complete population survey with a comprehensive survey of needs in the sphere of daily life (NSDL) that included 2 different frailty indexes, the Kihon Checklist (KCL) and the Fried phenotype, socioeconomic status, general and psychological health, and social relationships; followed by the more detailed Health and Nutrition Survey. A slightly modified NSDL survey was conducted again in 2013. Survival time, LTCI certification, and medical and long-term care costs after the baseline survey will be followed. ResultsOf 18,231 NSDL questionnaires distributed, 13,294 people responded (response rate: 72.92%; mean age 73.7 ± 6.4 and 75.1 ± 7.2 years for men and women, respectively; 12,054 people without and 1240 with LTCI certification). In people without LTCI, the proportion of robust, prefrail, and frail were 30.3%, 59.8%, and 9.9% in men and 25.3%, 64.7%, and 10.0% in women, according to the Fried index. The proportion of frail people as defined by KCL ≥7 was 30.8% in men and 33.3% in women. ConclusionsThe study is the first to document frailty prevalence using both Fried and KCL measures with a complete city population survey among older Japanese in the community as a part of World Health Organization Safe Community program. The study is expected to provide valuable evidence of the effects of lifestyle habits on long-term care prevention and healthy life span.