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Geriatr Gerontol Int. 2014 Jul;14(3):695-701. doi: 10.1111/ggi.12155. Epub 2013 Sep 11.

Incidence of certified need of care in the long-term care insurance system and its risk factors in the elderly of Japanese population-based cohorts: the ROAD study.

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Department of Clinical Motor System Medicine, 22nd Century Medical & Research Center, Graduate School of Medicine, University of Tokyo, Tokyo.



To examine the incidence of certified need of care in the national long-term care insurance (LTCI) system, and to determine its risk factors in the elderly of Japanese population-based cohorts of the Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study.


Of the 3040 participants in the baseline examination of the ROAD study, we enrolled 1773 (699 men, 1074 women) aged 65 years or older who were not certified as in need of care level elderly at baseline. Participants were followed for incident certification of need of care in the LTCI system. Associated factors in the baseline examination with occurrence were determined by multivariate Cox proportional hazards regression analysis. Muscle dysfunction was defined in accordance with the European Working Group on Sarcopenia in Older People algorithm for screening sarcopenia.


A total of 54 men and 115 women were certified as in need of care level elderly during the average 4.0-year follow up. The incidence was 2.0 and 2.5 per 100 person-years in men and women, respectively. Identified risk factors were region, age, body mass index <18.5 or ≥ 27.5 kg/m(2), grip strength, knee extension torque, usual gait speed, chair stand time and muscle dysfunction.


Both underweight and obesity, as well as low muscle strength and physical ability, are risk factors for certification of need of care. Considering muscle dysfunction is a risk factor for occurrence, screened individuals are recommended to receive early intervention programs regardless of muscle volume.


activities of daily living; certification of need of care (youkaigo-nintei); disability; long-term care insurance system; prospective cohort study

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