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.