Care-needs Certification in the National Long-Term Care Insurance is Useful for Assessment of Premorbid Function in Older Japanese Patients with Stroke

Objective: To investigate the effects of premorbid long-term care insurance (LTCI) care-need certification on functional improvement during acute hospitalization in older patients with stroke. Methods: In this single-center prospective cohort study, we assessed LTCI care-needs certification and the modified Rankin Scale (mRS) at the premorbid stage, on admission, and at hospital discharge in older patients with stroke. We also assessed adverse events during hospitalization. The main outcome was the presence of functional improvement during hospitalization (mRS on admission < mRS at discharge). Multivariate analysis was performed to investigate the relationship between functional improvement and premorbid LTCI care-need certification. Results: In total, 246 older patients with stroke were enrolled in this study. There was a significant independent association between premorbid LTCI care-needs certification (care level 1 = odds ratio [OR]: 0.26, 95% CI: 0.10-0.72, p = 0.01; Care level 2 = OR: 0.27, 95% CI: 0.10-0.73, p = 0.01; care level 3-5 = OR: 0.21, 95% CI: 0.08-0.56, p = 0.002; Not applicable = reference) and functional improvement. Conclusions: Premorbid LTCI care-need certification is associated with short-term functional improvement in older patients with stroke. Assessment of premorbid LTCI care-needs certification is valid for predicting functional improvement in older patients with stroke.