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This study aimed to determine which instrumental activities of daily living (IADL) are associated with health deterioration from the "support level" to the "care level" among users of the long-term care insurance system in Japan. From April 2017 to March 2020, we conducted a retrospective follow-up survey on 178 Japanese community-dwelling older adults (64 men, 114 women) newly certified as support level. Independent variable was 8 IADL items and the outcome defined as the "support level maintenance time." Cox models were used to assess the risk of health deterioration, with adjustments for age group, family composition, dementia status, and frailty status by gender. Dependence on 5 items, "laundry" (hazard ratio [HR] =2.5; 95% confidence interval [CI]: 1.1-5.8), "cooking" (HR = 3.7; 95% CI: 1.1-12.2), "telephone use" (HR = 2.4; 95% CI: 1.2-4.7), "financial management" (HR = 2.5; 95% CI: 1.2-5.0), and "medication management" (HR = 2.4; 95% CI: 1.2-4.8), was independently associated with a worse outcome among men, whereas dependence on "financial management" (HR = 2.6; 95% CI: 1.5-4.7) and "medication management" (HR = 2.0; 95% CI: 1.1-3.5) was independently associated with a worse outcome among women. These findings suggest that difficulties in "financial management" and "medication management" are common factors associated with health deterioration from the support to the care level among both genders. An association with household tasks was also seen among men, indicating that a paradigm shift is needed to increase the participation of men in household tasks. [ABSTRACT FROM AUTHOR]

Objective: The development of a dysphagia screening test is an urgent issue in the field of frailty prevention among community‐dwelling older people. The purpose of this study was to evaluate the screening performance of a 100‐mL water swallowing test (WST). Methods: The study employed a cross‐sectional design. Participants were 304 (65 men and 239 women, mean age = 80 years) Japanese community‐dwelling older adults aged over 65 years. We investigated swallowing disorder using the 10‐item Eating Assessment Tool (EAT‐10), and compared choking signs, swallowing time and number of swallows, and their combination in the 100‐mL WST. We calculated the sensitivity and specificity of these indices. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut‐off value of swallowing time and number of swallows in the 100‐mL WST based on the Youden Index among participants without choking signs. Results: The sensitivity and specificity of choking signs in the 100‐mL WST were 20% and 91%, respectively. The discriminating ability of swallowing time and number of swallows among participants without any choking signs was.76 and.72, respectively, in the area under the ROC curve. Diagnostic sensitivity and specificity to discriminate dysphagia from normal swallowing ability were 65% and 74% when the cut‐off was >10 s based on maximisation of the Youden Index. The 100‐mL WST performed best when the indices of choking signs and swallowing time were combined, with a sensitivity and specificity of 72% and 68%, respectively. Conclusions: The 100‐mL WST would be an adequate screening tool when compared to the EAT‐10. [ABSTRACT FROM AUTHOR]