Subtypes of Older Adults Starting Long-Term Care in Japan: Application of Latent Class Analysis

Objectives

Older adults requiring long-term care (LTC) exhibit heterogeneity in physical and cognitive functions; however, an established classification is lacking. We aimed to identify distinct subgroups of older adults with LTC needs and to examine differences in their prognoses.

Design

Retrospective cohort study.

Setting and Participants

Using survey data for care-need certification (linked to LTC and medical claims) in City A, Japan, we identified community-dwelling adults aged ≥65 years who started LTC. Data from City B were used to examine the validity of clustering.

Methods

We applied latent class analysis to group the participants in City A based on all 74 items [20 on body function/bed mobility, 12 on activities of daily living (ADLs), 6 on instrumental ADLs, 9 on cognitive functions, 15 on behavioral problems, and 12 on medical procedures] from the standardized care-needs certification survey. Then, we examined associations between identified subtypes and 4 outcomes, including death, hospitalization, admission to LTC facilities, and care-need level deterioration, using regression models.

Results

Among 3841 participants in City A (median age: 83 years; 59.3% female), 5 subtypes were identified: (1) mild physical, (2) mild cognitive, (3) moderate physical, (4) moderate multicomponent, and (5) severe multicomponent. The results of clustering were validated in City B. Compared with the mild physical subtype, the severe multicomponent subtype showed the highest risk of death [adjusted hazard ratio (aHR), 2.56; 95% confidence interval (CI), 2.02–3.24] and admission to LTC facilities (aHR, 5.91; 95% CI, 4.57–7.63). The moderate physical subtype showed a higher risk of hospitalization (aHR, 1.32; 95% CI, 1.16–1.49), and the moderate multicomponent subtype was more likely to experience care-need deterioration (adjusted odds ratio, 1.67; 95% CI, 1.26–2.22).

Conclusions and Implications

This study identified 5 subtypes of older adults requiring LTC. These findings inform individualized care decisions and tailored planning of medical and LTC services.