Clinical status and dependency of the elderly requiring long-term care in Japan.

More than 4 million of the elderly receive long-term care services using the public long-term care insurance in Japan. In order to use the insurance system, the insured person needs to be classified in one of the six care levels according to his/her clinical status. Though each level is defined in terms of the total amount of estimated care time needed per day, the clinical status of each level is not precisely defined. This study aimed to compare the clinical status of the six levels in order to suggest indicators of deterioration for each care level. We analyzed the clinical status for 7,222 cases who applied for care-need certification in a rural area of Japan. Sixty-seven items were used to determine physical function, activities of daily living, and cognitive and sensory status. Even in the mildest care level (Support Required), more than 50% of the individuals were dependent with regard to standing and sitting, while weakness of the lower extremities and dependency in walking were identified in Care Level 1, dependency in dressing and toilet habits in Care Level 2, dependency in grooming and transferring in Care Level 3, dependency in communication and feeding in Care Level 4, and dependency in swallowing, orientation and limitations of joint movement in Care Level 5. Care providers should be tracking these changes to estimate and prevent the decline of care level because more than 20% of the individuals assessed in 2004 belonged to the worse care level one year later.