2.1. Study Design and Participants

The study population consisted of community-dwelling elderly people who were ≥75 years old (late-stage elderly people) in Ikoma City, Nara Prefecture, Japan. In 2015, the population of Ikoma City was approximately 120,000, and the population density of the community was approximately 2000 people/km2, with an aging rate of approximately 25.0%. As a baseline survey, a postal survey was conducted by the community-based integrated care division of Ikoma City using the Kihon Checklist (KCL), which was sent to 7691 people over the age of 75 in 2015 who were not certified as requiring long-term care. The baseline survey included 6517 older people who responded to the KCL with a response rate of 84.7%, and it excluded 1467 participants who did not provide their responses or had missing data for the outcomes and covariates. A total of 5050 participants (2512 men and 2538 women) were included in the final analysis (Figure 1).

A flow chart of participants in the study cohort. LTC; long-term care.

This study was approved by the Ethics Committee of the Kio University (approval number: H28–57). Additionally, the study was conducted in accordance with the provisions of the Declaration of Helsinki and the “Ethical Guidelines for Epidemiological Studies” issued by Ministry of Health, Labour and Welfare, Japan. Personal information was removed from all data by a unique anonymization process performed by the community integrated care section of Ikoma city, which kept researchers blind to all participant personal data.

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