title: Assessment of vulnerable older adults' physical function according to the Japanese Long-Term Care Insurance (LTCI) system and Fried's criteria for frailty syndrome.
abstract: This study aimed to evaluate the physical frailty status of vulnerable older adults as classified in the Japanese LTCI system and to compare this with Fried's definition. A total of 444 older adults were classified based on the LTCI system as independent, vulnerable, or dependent, and 400 of these participants also fit Fried's criteria for not frail, pre-frail or frail. We evaluated their physical function with a 12 item physical function test. We derived a physical function score (PFS) from these 12 items and a principal component analysis was used to make comparisons. The receiver operating characteristic (ROC) curve analysis was performed to identify the sensitivity and specificity of the PFS cut-off points to distinguish the dependent category from the other categories. We found significant differences and a hierarchical order for the PFSs among the three groups of the LTCI system (the independent, 0.41 ± 0.54; the vulnerable, -0.40 ± 0.76; and the dependent, -1.49 ± 0.73) and of Fried's definition (not frail, 0.50 ± 0.51; pre frail, -0.11 ± 0.63; and frail, -1.25 ± 0.98). The optimal cut-off value (OCV) was -0.593. This study showed that the range of physical function of people considered frail category (pre-frail, vulnerable, and frail) is wide and overlapping. That is, the physical function of vulnerable older adults is worse than the pre-frail, but better than the frail. To better recognize older adults in need of greater support, the vulnerable should also receive assessment of their frailty status according to Fried's definition.
authors.affiliation: Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan. n-miyuki@stat.taiiku.tsukuba.ac.jp
authors.forename: Miyuki
authors.initials: M
authors.lastname: Nemoto
authors.forename: Noriko
authors.initials: N
authors.lastname: Yabushita
authors.forename: Mi-Ji
authors.initials: MJ
authors.lastname: Kim
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Matsuo
authors.forename: Satoshi
authors.initials: S
authors.lastname: Seino
authors.forename: Kiyoji
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003858:Dependency, Psychological; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D015577:Geriatric Assessment / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D007353:Insurance, Long-Term Care / Q000706:statistics & numerical data; D007564:Japan; D008297:Male; D008875:Middle Aged; D012372:ROC Curve