title: Association of physical activities of daily living with the incidence of certified need of care in the long-term care insurance system of Japan: the ROAD study.
abstract: BACKGROUND
  The present study aimed to investigate association of physical activities of daily living with the incidence of certified need of care in the national long-term care insurance (LTCI) system in elderly Japanese population-based cohorts.
  
  
  METHODS
  Of the 3,040 participants in the baseline examination, we enrolled 1,773 (699 men, 1,074 women) aged 65 years or older who were not certified as in need of care-level elderly at baseline. Participants were followed during an average of 4.0 years for incident certification of need of care in the LTCI system. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used assess function. Associated factors in the baseline examination with the occurrence were determined by multivariate Cox proportional hazards regression analysis. Receiver operating characteristic curve analysis was performed to evaluate cut-off values for discriminating between the occurrence and the non-occurrence group.
  
  
  RESULTS
  All 17 items in the WOMAC function domain were significantly associated with the occurrence of certified need of care in the overall population. Cut-off values of the WOMAC function score that maximized the sum of sensitivity and specificity were around 4-6 in the overall population, in men, and in women. Multivariate Cox hazards regression analysis revealed that a WOMAC function score ≥4 was significantly associated with occurrence with the highest hazard ratio (HR) for occurrence after adjusting for confounders in the overall population (HR [95 % confidence interval (CI)] 2.54 [1.76-3.67]) and in women [HR (95 % CI) 3.13 (1.95-5.02)]. A WOMAC function score ≥5 was significantly associated with the highest HR for occurrence in men [HR (95 % CI) 1.88 (1.03-3.43)].
  
  
  CONCLUSIONS
  Physical dysfunction in daily living is a predictor of the occurrence of certified need of care. Elderly men with a WOMAC function score ≥5 and women with a score ≥4 should undergo early intervention programs to prevent subsequent deterioration.
authors: Department of Clinical Motor System Medicine, 22nd Century Medical and Research Center, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, akune-ort@h.u-tokyo.ac.jp.
authors: Toru
authors: T
authors: Akune
authors: Shigeyuki
authors: S
authors: Muraki
authors: Hiroyuki
authors: H
authors: Oka
authors: Sakae
authors: S
authors: Tanaka
authors: Hiroshi
authors: H
authors: Kawaguchi
authors: Fumiaki
authors: F
authors: Tokimura
authors: Hideyo
authors: H
authors: Yoshida
authors: Takao
authors: T
authors: Suzuki
authors: Kozo
authors: K
authors: Nakamura
authors: Noriko
authors: N
authors: Yoshimura
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D015577:Geriatric Assessment; D006301:Health Services Needs and Demand; D006801:Humans; D015994:Incidence; D007353:Insurance, Long-Term Care / Q000706:statistics & numerical data*; D007564:Japan / Q000453:epidemiology; D008297:Male; D010003:Osteoarthritis / Q000453:epidemiology / Q000503:physiopathology*; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires