[Physical and psychological predictors for the onset of certification of long-term care insurance among older adults living independently in a community a 40-month follow-up study].
OBJECTIVE
To ascertain predictors for the onset of different levels of certification of long-term care insurance among older adults living independently in a community.


METHODS
Out of all residents aged 65 years and over living in Yoita town, Niigata prefecture, Japan (n = 1,673), 1,544 persons participated in the baseline interview survey in 2000 (response rate, 92.3%). Among these participants, 1,229 persons (79.6% of responders) were ranked as level 1, based on the hierarchical mobility level classification. They were followed up for the subsequent 3 years and 4 months to see whether they continued without certification of long-term care insurance or suffered onset of a "mild level", certified as levels "needing support" and 1 for long-term care insurance, or a "severe level" as 2-5. The Cox proportional hazards model with a stepwise method was used to identify the most parsimonious combination of predictors for each type of long-term care insurance certification.


RESULTS
Of those who were followed up, 1,151 persons showed no disability in basic activities of daily living (ADL) at baseline nor died before application for long-term care during the follow-up and thus served for analysis. 1,055 persons (91.7%) remained as "no event", but 49 (4.3%) and 47 persons (4.1%) had onset of the "mild level" and the "severe level" during the follow-up, respectively. The final model for prediction of the "mild level" in both genders included advanced age and poor walking ability (hazard ratio (HR) for either unable or with difficulty: 7.22[95% CI, 1.56-33.52] in males and both unable and with difficulty: 3.28[95% CI, 1.28-8.42] in females). The final model for prediction of the "severe level" in both genders included advanced age and poor instrumental ADL (HR for < or = 4 marks: 3.74[95% CI, 1.59-8.76] in males and 3.90[95% CI, 1.32-11.54] in females). Severe cognitive decline was a predictor only for the "severe level" in males. A history of hospitalization during past 1 year and poor chewing ability were predictive only for the "mild level" in females.


CONCLUSIONS
Among older adults living independently in a community, most predictors for subsequent onset of mild level-certification of long-term care insurance, except for advanced age, may be controlled by preventive strategies. Evaluating effectiveness of programs for this purpose warrants further study.
Fujiwara
Yoshinori
Y
Community Health Research Group, Tokyo Metropolitan Institute of Gerontology.
Amano
Hidenori
H
Kumagai
Shu
S
Yoshida
Hiroto
H
Fujita
Koji
K
Naito
Takahiro
T
Watanabe
Naoki
N
Nishi
Mariko
M
Mori
Setsuko
S
Shinkai
Shoji
S
D000203:Activities of Daily Living; D000368:Aged / Q000502:physiology* / Q000523:psychology*; D002568:Certification; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006304:Health Status; D006801:Humans; D007353:Insurance, Long-Term Care / Q000706:statistics & numerical data; D007564:Japan; D008297:Male; D016016:Proportional Hazards Models; D012111:Residence Characteristics