[Association between coexisting health risks identified by the Questionnaire for Medical Checkup of Old-Old and the Kihon Checklist and the onset of long-term care certification].

Abstract

Objectives　In most Japanese municipalities, the Questionnaire for Medical Checkup of Old-Old (QMCOO) is administered during annual health checkups for older adults aged ≥75 years to screen for frailty, whereas the Kihon Checklist (KCL) is used within the long-term care (LTC) system to identify individuals who may be eligible for services aimed at preventing loss of independence. Few studies have examined whether the combination of these two tools is associated with subsequent LTC certification. We examined the association between coexisting health risks identified by both tools and the onset of LTC certification.Methods　This retrospective cohort study used data from Chiyoda-ku, Tokyo, Japan. Fiscal year (FY) 2020-2021 data from the National Health Insurance's "Kokuho Database" were linked with FY2020 data from a postal survey that incorporated the KCL. The participants comprised individuals aged ≥75 years with no LTC certification at baseline, who had completed the annual health checkup (including the QMCOO) in FY 2020, and who had responded to the postal survey. Frailty risk was defined as ≥4 of 12 frailty-related QMCOO items, and individuals eligible for LTC prevention services were identified using the KCL's standard criteria. Participants were classified into four groups (QMCOO + or - /KCL + or -). Incident LTC certification cases were identified from the health checkup date until March 31, 2022. Cox proportional hazards analysis was performed to calculate the hazards for LTC certification across groups, with the QMCOO-/KCL- group as the reference.Results　Among the 527 participants (mean age: 80.6 years; men: 41.9%), 50 (9.5%) received LTC certification during the 1013.5 person-years of follow-up. The LTC certification incidence rate per 1000 person-years was 33.1 in the QMCOO-/KCL- group and 85.7 in the QMCOO+/KCL+ group (log-rank P = 0.006). Cox proportional hazards analysis that adjusted for covariates (sex, age groups, living arrangement, years of education, and medical history) showed that the hazard of incident LTC certification in the QMCOO+/KCL+ group was significantly higher than that of the QMCOO-/KCL- group (hazard ratio: 2.55, 95% confidence interval: 1.21-5.38). Neither the QMCOO+/KCL- nor QMCOO-/KCL+ groups were significantly associated with LTC certification.Conclusions　Using both tools to identify older adults at high risk of LTC certification may help improve the efficiency of preventive interventions within Japan's healthcare system for older adults.