What this means
Higher-level functional capacity (HLFC) may capture functional vulnerability beyond basic activities of daily living in older adults. However, the association of baseline HLFC with subsequent incident long-term care insurance (LTCI) certification remains unclear when death is considered a competing event.
A plain-English summary is on its way. Until then, this is the start of the authors' own summary.
- Who it was tested in
- People
- Kind of research
- A study
The science
- Original title
- Higher-level functional capacity and incident long-term care insurance certification: a competing risks analysis.
- Authors
- Qian M, Zhang J, Li S et al.
- Journal
- Frontiers in public health
- Published
- Oct 22, 2026
- Study type
- Study · in humans
- PMID
- 42903110 ↗
Abstract
Background
Higher-level functional capacity (HLFC) may capture functional vulnerability beyond basic activities of daily living in older adults. However, the association of baseline HLFC with subsequent incident long-term care insurance (LTCI) certification remains unclear when death is considered a competing event.
What they did
This prospective cohort study included 688 community-dwelling Japanese adults aged 65 years or older who participated in the 2017 wave of the Community Empowerment and Care for Well-being and Healthy Longevity Study. HLFC was assessed once at baseline using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC), including the total score and the formal subdomain scores for Instrumental Self-Maintenance, Intellectual Activity, and Social Role. Participants were followed for 8 years. Incident LTCI certification at Support Level 1 or higher was analyzed using Fine-Gray competing-risk regression, with death before certification treated as a competing event. The fully adjusted Fine-Gray model included age group, sex, living arrangement, physical activity, smoking status, alcohol consumption, and disease status.
What they found
Among 688 complete-case participants, 145 developed incident LTCI certification and 79 died before certification. In the fully adjusted model, higher HLFC total score was associated with a lower cumulative incidence of incident LTCI certification (sHR per 1-point increase, 0.941; 95% CI, 0.891-0.994; p = 0.029). Higher Social Role score was also associated with a lower cumulative incidence (sHR, 0.803; 95% CI, 0.702-0.918; p = 0.001), whereas the continuous per-point Instrumental Self-Maintenance and Intellectual Activity estimates included the null after full adjustment. Multiple-imputation and lagged-event analyses generally retained the direction and broad magnitude of the complete-case estimates. Exposure-by-log(time) diagnostics indicated that the Fine-Gray associations varied over follow-up. Estimates also varied under alternative age specifications, with particularly marked attenuation of the total-score association. Higher baseline HLFC total and Social Role scores were associated with a lower subsequent cumulative incidence of incident LTCI certification in the prespecified age-group-adjusted analysis. The total-score association was substantially attenuated under alternative age adjustments, while the magnitude of the Social Role association also varied.
The authors' abstract, grouped under plain headings from its own section labels.
Qian M, Zhang J, Li S et al. Higher-level functional capacity and incident long-term care insurance certification: a competing risks analysis. Frontiers in public health. 2026. doi:10.3389/fpubh.2026.1950765. PMID: 42903110. https://pubmed.ncbi.nlm.nih.gov/42903110/
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