Comparison of Predictive Ability of Clinical Frailty Scale, Kihon Checklist, and DASC-8 for New Certification of Long-Term Care Needs: A Longitudinal Study

AIM: This study aimed to compare the predictive abilities of three frailty assessment tools-the Clinical Frailty Scale (CFS), Kihon Checklist (KCL), and Dementia Assessment Sheet for Community-based Integrated Care System 8-items (DASC-8)-for new long-term care certification among older adults with cardiometabolic disease. METHODS: Participants aged ≥ 65 years who visited a frailty clinic between July 2015 and December 2024 were included. The primary outcome was new certification of long-term care needs within 5 years. Predictive performance was assessed using the area under the curve (AUC) from receiver operating characteristic analysis and Harrell's C-index from multivariable Cox models adjusted for age, sex, baseline support level certification, and comorbidities. RESULTS: Among 482 participants (mean age 78.9 years; 62.7% female), 86 (17.8%) were newly certified during a median follow-up of 1253 days. AUCs were 0.68 (95% confidence interval [CI]: 0.62-0.73) for the CFS, 0.68 (95% CI: 0.62-0.74) for the KCL, and 0.66 (95% CI: 0.59-0.73) for the DASC-8. Multivariable Cox regression analyses showed that CFS ≥ 4 (hazard ratio [HR]: 2.64, 95% CI: 1.64-4.26), KCL ≥ 8 (HR: 1.68, 95% CI: 1.04-2.71), and DASC-8 Category II or III (HR: 1.74, 95% CI: 1.05-2.88) were independently associated with new certification of care needs. Harrell's C-indices were 0.76 (95% CI: 0.71-0.81) for the CFS, 0.72 (95% CI: 0.67-0.78) for the KCL, and 0.73 (95% CI: 0.67-0.78) for the DASC-8. CONCLUSIONS: The CFS, KCL, and DASC-8 all demonstrated useful and comparable predictive ability for new long-term care certification in older adults with cardiometabolic disease.