What Should Be Assessed Next After a Positive Screening Test for the Long-Term Care Needs?: A Comparative Analysis of...

The Kihon Checklist (KCL), Clinical Frailty Scale (CFS), and Dementia Assessment Sheet for Community-Based Integrated Care System-8 items (DASC-8) predict incident long-term care needs (LTCN) certification. We aimed to identify additional factors associated with incident LTCN certification among older adults who screened positive on any tool.

In this retrospective observational cohort study, we included patients aged ≥ 65 years attending a frailty outpatient clinic and had no LTCN certification at baseline. Positive screening was defined as CFS, KCL, and DASC-8 scores ≥ 4, 8, and 11, respectively. Within each screening-positive group, Cox proportional hazards models adjusted for age and sex were used to examine associations between incident LTCN certification and secondary assessment variables: gait speed, timed up and go (TUG), cognitive function, psychosocial factors, nutrition, and polypharmacy.

Among 647 participants, 198, 137, and 112 screened positive on the KCL, CFS, and DASC-8, respectively. Slower gait speed and longer TUG time were associated with incident LTCN certification across all screening-positive groups. Cognitive impairment, defined as Mini-Mental State Examination and Montreal Cognitive Assessment-Japanese version scores ≤ 23 and 25, respectively, predicted incident LTCN certification in CFS-positive and KCL-positive groups, respectively. Polypharmacy (≥ 6 medications) was associated with incident LTCN certification in KCL-positive and DASC-8-positive individuals.

Physical function tests were additional factors associated with incident LTCN certification in all screening-positive groups. As the association between incident LTCN certification and cognitive impairment or polypharmacy varied per screening tests, further evaluations should be tailored to the specific characteristics of each instrument.