• Yu Taniguchi, Akihiko Kitamura, Yu Nofuji, Tatsuro Ishizaki, Satoshi Seino, Yuri Yokoyama, Tomohiro Shinozaki, Hiroshi Murayama, Seigo Mitsutake, Hidenori Amano, Mariko Nishi, Yutaka Matsuyama, Yoshinori Fujiwara, and Shoji Shinkai.
• Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
• J. Gerontol. A Biol. Sci. Med. Sci. 2019 Jan 16; 74 (2): 211-218.

BackgroundHigher-level functional capacity is crucial component for independent living in later life. We used repeated-measures analysis to identify aging trajectories in higher-level functional capacity. We then determined whether these trajectories were associated with all-cause mortality and examined differences in medical and long-term care costs between trajectories among community-dwelling older Japanese.Methods2,675 adults aged 65-90 years participated in annual geriatric health assessments and biennial health monitoring surveys during the period from October 2001 through August 2011. The average number of follow-up assessments was 4.0, and the total number of observations was 10,609. Higher-level functional capacity, which correspond to the fourth and fifth sublevels of Lawton's hierarchical model, was assessed with the Tokyo Metropolitan Institute of Gerontology-Index of Competence (TMIG-IC).ResultsWe identified four distinct trajectory patterns (high-stable, late-onset decreasing, early-onset decreasing, and low-decreasing) on the TMIG-IC through age 65-90 years. As compared with the high-stable trajectory group, participants in the late-onset decreasing, early-onset decreasing, and low-decreasing TMIG-IC trajectory groups had adjusted hazard ratios for mortality of 1.22 (95% confidence interval: 1.01-1.47), 1.90 (1.53-2.36), and 2.87 (2.14-3.84), respectively. Participants with high-stable and late-onset decreasing higher-level functional capacity trajectories had lower mean monthly medical costs and long-term care costs. In contrast, mean total costs were higher for those with low-decreasing trajectories, after excluding the large increase in such costs at the end of life.ConclusionsPeople with a low-decreasing aging trajectory in higher-level functional capacity had higher risks of death and had high monthly total costs.

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