Physical Frailty and Risk of Needing Long-Term Care in Community-Dwelling Older Adults: A 6-Year Prospective Study in Japan

S. Chen, T. Honda, Kenji Narazaki, T. Chen, H. Kishimoto, Shuzo Kumagai

Research output: Contribution to journalArticle

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Abstract

Objective: To examine the association between physical frailty and risk of needing long-term care, and compare the predictive value and clinical usefulness of a simple frailty scale (FRAIL) with that of the original Cardiovascular Health Study (CHS) criteria. Design and Setting: A 6-year prospective cohort study of community-dwelling older adults in a west Japanese suburban town. Participants: 1,554 older adults aged 65 years and over who were initially free of long-term care needs at baseline. Measurements: Physical frailty was defined by the CHS criteria and the FRAIL scale. The onset of needing long-term care was ascertained using national records of certification of long-term care needs. Cox proportional hazard models were used to estimate the association between physical frailty and risk of needing long-term care. Decision curve analysis was performed to compare the clinical usefulness of the two physical frailty criteria. Results: During a median follow-up of 5.8 years, 244 were ascertained as needing long-term care. Baseline physical frailty was significantly associated with elevated risk of needing long-term care, with a multivariable-adjusted hazard ratio (HR) of 2.00 (95% confidence interval [CI], 1.32–3.02) for being frail and 1.50 (95% CI, 1.10–2.03) for being pre-frail as defined by the CHS criteria, compared with being robust (p for trend = 0.001). Similar results were found for physical frailty defined by the FRAIL scale, with a multivariable-adjusted HR (95% CIs) of 2.11 (1.25–3.56) for being frail and 1.73 (1.28–2.35) for being pre-frail vs. being robust (p for trend < 0.001). The two physical frailty criteria had similar net benefits in identifying individuals at high risk for needing long-term care. Conclusions: Physical frailty is significantly associated with an increased risk of needing long-term care in community-dwelling older adults in Japan. Compared with the original CHS criteria, the simple FRAIL scale has comparable predictive value and clinical usefulness for identifying individuals at risk for needing long-term care.

Original languageEnglish
Pages (from-to)856-861
Number of pages6
JournalJournal of Nutrition, Health and Aging
Volume23
Issue number9
DOIs
Publication statusPublished - Nov 1 2019

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Independent Living
Long-Term Care
Japan
Prospective Studies
Health
Confidence Intervals
Decision Support Techniques
Certification
Proportional Hazards Models
Cohort Studies

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)
  • Nutrition and Dietetics
  • Geriatrics and Gerontology

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Physical Frailty and Risk of Needing Long-Term Care in Community-Dwelling Older Adults : A 6-Year Prospective Study in Japan. / Chen, S.; Honda, T.; Narazaki, Kenji; Chen, T.; Kishimoto, H.; Kumagai, Shuzo.

In: Journal of Nutrition, Health and Aging, Vol. 23, No. 9, 01.11.2019, p. 856-861.

Research output: Contribution to journalArticle

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abstract = "Objective: To examine the association between physical frailty and risk of needing long-term care, and compare the predictive value and clinical usefulness of a simple frailty scale (FRAIL) with that of the original Cardiovascular Health Study (CHS) criteria. Design and Setting: A 6-year prospective cohort study of community-dwelling older adults in a west Japanese suburban town. Participants: 1,554 older adults aged 65 years and over who were initially free of long-term care needs at baseline. Measurements: Physical frailty was defined by the CHS criteria and the FRAIL scale. The onset of needing long-term care was ascertained using national records of certification of long-term care needs. Cox proportional hazard models were used to estimate the association between physical frailty and risk of needing long-term care. Decision curve analysis was performed to compare the clinical usefulness of the two physical frailty criteria. Results: During a median follow-up of 5.8 years, 244 were ascertained as needing long-term care. Baseline physical frailty was significantly associated with elevated risk of needing long-term care, with a multivariable-adjusted hazard ratio (HR) of 2.00 (95{\%} confidence interval [CI], 1.32–3.02) for being frail and 1.50 (95{\%} CI, 1.10–2.03) for being pre-frail as defined by the CHS criteria, compared with being robust (p for trend = 0.001). Similar results were found for physical frailty defined by the FRAIL scale, with a multivariable-adjusted HR (95{\%} CIs) of 2.11 (1.25–3.56) for being frail and 1.73 (1.28–2.35) for being pre-frail vs. being robust (p for trend < 0.001). The two physical frailty criteria had similar net benefits in identifying individuals at high risk for needing long-term care. Conclusions: Physical frailty is significantly associated with an increased risk of needing long-term care in community-dwelling older adults in Japan. Compared with the original CHS criteria, the simple FRAIL scale has comparable predictive value and clinical usefulness for identifying individuals at risk for needing long-term care.",
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AU - Kumagai, Shuzo

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