# Association of Long-Term Care Risk with Nonresponse to the Annual Frailty Screening Program in Older Adults in Japan: A Retrospective Cohort Study

## TL;DR

This study found that older adults in Japan with higher long-term care risk were less likely to respond to follow-up frailty screening surveys.

## Contribution

The study identifies specific LTC risk factors associated with nonresponse in frailty screening programs.

## Key findings

- Activities of daily living limitation, low physical strength, isolation, memory decline, and depressive mood were linked to nonresponse.
- Frailty status showed a dose-responsive association with nonresponse to the survey.
- Conventional survey methods may be ineffective for identifying older adults with high LTC risk.

## Abstract

This study aimed to determine the association between long-term care (LTC) risk and nonresponse to a subsequent survey.

Community-dwelling older adults aged ≥75 years without certified care needs residing in Hachioji City, Tokyo, who participated in the annual frailty screening program, were evaluated. Among the fiscal year (FY) 2020 survey respondents, those invited to the FY 2021 survey were included. The exposures of interest were LTC risk assessed using the seven domains of the Kihon Checklist (KCL) and frailty status in the FY 2020 survey. Frailty status was categorized based on total KCL scores. The outcome of interest was nonresponse to the FY 2021 survey. We conducted multivariable logistic regression analysis to evaluate these associations.

Among 35,425 participants, 9,456 (26.7%) did not respond to the subsequent survey. Among seven KCL domains, activities of daily living limitation (adjusted odds ratio, 95% confidence interval 1.38, 1.27-1.50), low physical strength (1.17, 1.10-1.26), isolation (1.32, 1.22-1.44), memory decline (1.23, 1.17-1.30), and depressive mood (1.10, 1.04-1.16) were associated with nonresponse to the subsequent survey. In addition, frailty status was associated with nonresponse in a dose-responsive manner (prefrailty: 1.19, 1.12-1.26; frailty: 1.63, 1.53-1.73).

Although the annual frailty screening program aimed to identify those with high LTC risk, older adults with LTC risk were less likely to respond to the survey. Thus, conventional survey methods may need to be modified or different approaches may need to be adopted to identify older adults with high LTC risk.