• S Chen, T Honda, K Narazaki, T Chen, H Kishimoto, and S Kumagai.
• Dr. Shuzo Kumagai, Center for Health Science and Counseling, Kyushu University, 744 Motooka Nishi-ku, Fukuoka, Fukuoka Prefecture 819-0315, Japan, Telephone number: +81 92-802-5112, Fax number: +81 922-802-5112, E-mail: shuzo@ihs.kyushu-u.ac.jp.
• J Nutr Health Aging. 2019 Jan 1; 23 (9): 856-861.

ObjectiveTo 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 SettingA 6-year prospective cohort study of community-dwelling older adults in a west Japanese suburban town.Participants1,554 older adults aged 65 years and over who were initially free of long-term care needs at baseline.MeasurementsPhysical 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.ResultsDuring 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.ConclusionsPhysical 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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