title: Cognitive decline predicts long-term care insurance requirement certification in community-dwelling older Japanese adults: a prospective cohort study.
abstract: OBJECTIVE
  The purpose of this prospective cohort study is to examine whether cognitive decline is an independent predictor of new long-term care insurance (LTCI) requirement certifications in Japan.
  
  
  METHODS
  A total of 5,765 community-dwelling older Japanese adults who, at baseline, were independent in terms of their activities of daily living participated in this study and were followed up for 18 months. The outcome measure was the number of new LTCI requirement certifications during the 18-month period of the study. We collected demographic information through questionnaires and assessed cognitive skills with the Cognitive Performance Scale (CPS). The participants were divided into 3 groups according to CPS scores (0, 1, and 2 or greater).
  
  
  RESULTS
  During the 18-month period, 399 subjects (6.9%) became newly certified for LTCI services. In a multivariate Cox proportional hazards model, older participants with a CPS score of 1 (adjusted HR: 1.39, 95% CI: 1.08-1.77) and 2 or greater (adjusted HR: 2.27, 95% CI: 1.74-2.96) were significantly more likely to receive an LTCI certification compared to those with a CPS score of 0.
  
  
  CONCLUSIONS
  Cognitive decline is an independent predictor of new LTCI requirement certifications and the severity of cognitive decline in elderly adults is positively associated with receiving an LTCI requirement certification in Japan.
authors.affiliation: Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan ; Japan Society for the Promotion of Science, Tokyo, Japan.
authors.forename: Shu
authors.initials: S
authors.lastname: Nishiguchi
authors.forename: Minoru
authors.initials: M
authors.lastname: Yamada
authors.forename: Takuya
authors.initials: T
authors.lastname: Sonoda
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kayama
authors.forename: Takanori
authors.initials: T
authors.lastname: Tanigawa
authors.forename: Taiki
authors.initials: T
authors.lastname: Yukutake
authors.forename: Tomoki
authors.initials: T
authors.lastname: Aoyama
keywords: Cognitive decline; Long-term care insurance requirement; Older Japanese adults; Prospective cohort study