Cognitive Decline Predicts Long-Term Care Insurance Requirement Certification in Community-Dwelling Older Japanese Adults: A Prospective Cohort Study

Abstract

Aim: 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.

Relationships between each category of 25‐item frailty risk assessment (Kihon Checklist) and newly certified older adults under Long‐Term Care Insurance: A 24‐month follow‐up study in a rural community in Japan

“…First, assessing “cognitive function” is regarded to be of high importance for community‐dwelling older adults. Several previous studies showed lower cognitive status was closely associated with overall diminished functioning, the development of dementia and newly certified older adults under the LTCI …”

“…Several previous studies showed lower cognitive status was closely associated with overall diminished functioning, the development of dementia and newly certified older adults under the LTCI. 7,[23][24][25] Second, in 2012, Japanese MHLW notified all local governments of a 5-year plan, the so called "Orange Plan," for people with dementia to be detected early, to be treated and to be cared for suitably, not only in hospital, but also by community-based support. This notification by MHLW is of importance for Japanese local governments and communities as well as academic societies.…”

“…Question 17 was just only a referring question in the houseboundness category. "Lower cognitive function" referred to participants who had at least one or more negative conditions in questions 18-20, and "depression risk" referred to elderly people who had two or more negative responses (questions [21][22][23][24][25]. "Lack of response" was defined as a negative response in any question (Appendix I).…”

Social isolation, cognitive reserve, and cognition in healthy older people

“…While some individuals retain a high level of cognitive ability from mid- to late- life, others may experience decline [ 5 ]. A decline in cognitive function can be detrimental to the independence, wellbeing, and quality of life of older people [ 6 , 7 ]. Understanding the mechanisms underlying differences in cognitive ageing is important to reduce the impact of poor cognitive function in later life.…”

Association between stairs in the home and instrumental activities of daily living among community-dwelling older adults

“…Assessment of cognitive functioning was conducted using the Cognitive Performance Scale [ 33 ]; the total score ranges from 0 to 6, with higher scores expressing a lower level of cognitive functioning. Because a prior study has demonstrated that a score ≥ 1 in the Cognitive Performance Scale can predict the onset of functional disability in community-dwelling older Japanese people [ 34 ], we defined a score of 0 as subjects with intact cognitive functioning, and scores of ≥1 as subjects with poor cognitive functioning. Assessment of depression was conducted using the 5-item short form of the Geriatric Depression Scale [ 35 ]; the total score ranges from 0 to 5, with higher scores defined as more depressed.…”