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Decrease in the usual walking speed and body fat percentage associated with a deterioration in long-term care

Yohei Sawaya1,2, Tamaki Hirose1,2, Takahiro Shiba3

  • 1Department of Physical Therapy, School of Health Sciences, International University of Health and Welfare, Otawara, Tochigi, Japan.

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|June 25, 2024
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Summary

Decreased walking speed and body fat percentage can predict worsening long-term care insurance (LTCI) certification levels in older adults. These sarcopenia-related assessments can help identify individuals at risk for needing more care.

Keywords:
GaitJapanLong-term careSarcopeniaWalking

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Area of Science:

  • Gerontology
  • Rehabilitation Medicine
  • Public Health

Background:

  • Rising long-term care insurance (LTCI) costs in Japan are a growing social concern, particularly with an increasing older adult population.
  • Geriatric rehabilitation plays a crucial role in maintaining physical function and LTCI certification levels among the elderly.
  • Sarcopenia is prevalent in older adults requiring LTCI, presenting opportunities to assess physical function through metrics like handgrip strength, walking speed, and muscle mass.

Purpose of the Study:

  • To identify sarcopenia-related assessments that are sensitive to changes in long-term care insurance (LTCI) certification levels.
  • To determine specific cut-off values for these assessments that can predict transitions in LTCI certification status.

Main Methods:

  • A prospective cohort study involving 98 daycare users aged 78.5 ± 0.8 years, with LTCI certification renewed during the study period (March 2019-2023).
  • Measurements included handgrip strength, usual walking speed, body composition (including body fat percentage), and SARC-F score at baseline and six-month follow-up.
  • Participants were categorized into maintenance, deterioration, or improvement groups based on LTCI level changes. Multivariate and receiver operating characteristic analyses were used to identify predictive factors for LTCI deterioration.

Main Results:

  • No significant baseline differences were found among groups. However, the deterioration group showed significant decreases in usual walking speed (0.64 to 0.53 m/s) and body fat percentage (29.2% to 27.7%).
  • Binomial logistic regression revealed that changes in usual walking speed (P=0.042) and body fat percentage (P=0.011) were significantly associated with LTCI level deterioration, even after adjustment.
  • Cut-off values predicting LTCI deterioration were identified as a change of -0.14 m/s in usual walking speed (P=0.047) and -1.0% in body fat percentage (P=0.029).

Conclusions:

  • A decline in usual walking speed and body fat percentage can serve as early predictors of worsening long-term care insurance (LTCI) certification levels in older adults.
  • These findings highlight the potential of monitoring gait speed and body composition as part of geriatric assessments to anticipate the need for increased care and inform rehabilitation strategies.