A retrospective cohort study on the risk assessment of newly certificatedlong-term care need of elderly individuals in a community: Basic checklist and specifichealth checkup

摘要

>Objective: This study aimed to examine the factors influencing the requirement of a certificate of long-term care using a basic checklist and items listed in the Special Health Checkup.>Method: This study included 7,820 individuals living in Uji city, who were selected from among 8,000 elderly individuals who, in 2008, underwent a specific health checkup (hereafter referred to as the ‘specific health checkup for the old-old elderly individuals’) for those aged 75 years and above. They answered questions from basic checklists at the time, and 180 individuals were excluded as they had already qualified for requiring the certificate of long-term care at the time of the checkup. The follow-up period extended from the day of the specific health checkup for the old-old elderly individuals to March 31, 2013. The data were analyzed using the certificate of needing long-term care as the response variable. The explanatory variables were the basic attributes, items listed in the specific health checkup for the old-old elderly individuals, interview sheets, and basic checklists. Cox proportional hazards regression analysis was conducted.>Results: In total, 1,280 elderly individuals qualified for requiring the certificate of needing long-term care. The risk factors for the young-old elderly individuals aged 65 to 74 years were as follows: hepatic dysfunction (hazard ratio {HR}=1.69), the presence of subjective symptoms (HR=1.41), an above-normal abdominalcircumference (HR=1.36), old age (HR=1.13), a reduced frequency of going out since theprevious year (HR=1.87), the use of support for standing up after being seated on a chair(HR=1.86), no deposit or withdrawals made (HR=1.84), the anxiety of falling down(HR=1.50), an inability to climb stairs without holding a railing or wall (HR=1.49), aswell as an increased difficulty in eating tough food items compared with 6 months prior(HR=1.44). The risk factors for the old-old elderly individuals were as follows: apositive reaction on proteinuria (HR=1.27), anemia (HR=1.18), old age (HR=1.10), inabilityto travel on a bus or train by themselves (HR=1.53), the inability to climb stairs withoutholding a railing or wall (HR=1.48), weight loss (HR=1.36), a reduced sense ofappreciation of the activities they had previously participated in, over a span of 2 weeks(HR=1.30), the use of support for standing up after being seated on a chair (HR=1.23), andthe anxiety of falling down (HR=1.20).>Conclusion: The items listed in the specific medical checkup as well as thebasic checklists were found to be risk factors for both the young-old elderly individualsand the old-old elderly individuals, indicating the need to utilize these lists for theprevention of nursing even in the late stages of life. Moreover, these results suggest theimportance of screening elderly individuals suffering from hyperkinesis using the basicchecklist and conducting preventive interventions in order to maintain and improve theirphysical functions.