The Japanese government implemented a mandatory social long-term care insurance (LTCI) system on 1 April 2000. Every Japanese citizen aged ≥65 years is eligible for benefits strictly based on physical and mental disabilities. The computer-aided standardized needs-assessment system categorizes older people into seven levels of needs (Support levels 1–2 and Care levels 1–5), and older people not requiring care were assessed as ‘not certified’. In each municipality, the Care Needs Certification Board, which consists of physicians, public health nurses, and other experts in health and social services, then reviews the results and confirms the individual’s care needs [21]. In this study, we defined new onset of disability as the point at which participants were certified as requiring care according to the LTCI system. During the 4-year post-baseline survey, the participants’ information regarding the new LTCI certifications for those in need of care was obtained by the community integrated care section of the local government.

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