ORIGINAL ARTICLE EPIDEMIOLOGY, CLINICAL PRACTICE AND HEALTH Factors associated with changes of care needs level in disabled older adults receiving home medical care: Prospective observational study by Osaka Home Care Registry (OHCARE) Mariko Yamamoto, 1 Mai Kabayama, 1 Eriko Koujiya, 1 Ya Huang, 1 Masako Akiyama, 1 Yoko Higami, 1 Kana Kodama, 1 Toshinori Nakamura, 2 Atsushi Hirotani, 3 Toshio Fukuda, 4 Michio Tamatani, 5 Yoshinari Okuda, 6 Masashi Ikushima, 7 Yoshichika Baba, 8 Masahiro Nagano, 9 Hiromi Rakugi 10 and Kei Kamide 1,10 1 Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan 2 Nakamura Clinic, Osaka, Japan 3 Hirotani Clinic, Osaka, Japan 4 Fukuda Clinic, Osaka, Japan 5 Tamatani Clinic, Osaka, Japan 6 Okuda Clinic, Osaka, Japan 7 Ikushima Clinic, Hyogo, Japan 8 Baba Clinic, Osaka, Japan 9 Nagano Clinic, Osaka, Japan 10 Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan Correspondence Professor Kei Kamide MD PhD, Division of Health Sciences, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka 565-0871, Japan. Email: kamide@sahs.med.osaka- u.ac.jp Revised: 8 August 2019 Accepted: 12 September 2019 Aim: To clarify factors associated with changes in care needs level and mortality among dis- abled older people receiving home medical care over a period of 2.5 years. Methods: The study included 179 participants, aged ≥65 years, receiving home medical care, who consented to join the Osaka Home Care Registry study. The main outcome was changes in the care needs level of participants eligible for the long-term care insurance sys- tem. We investigated the association of changes in care needs level with basic characteristics and care-receiving status. Results: At the 2.5-year follow up, 20.0% of participants showed deteriorated levels, and 41.8% of participants died. In multiple logistic regression, age (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.00–1.21; P = 0.051) and bone joint diseases (OR 0.34, CI 0.09–1.22; P = 0.098) were possible risks associated with deterioration of the care needs level. Male sex (OR 3.28, CI 0.91–11.74; P = 0.068) was a possible risk factor for mortality, and lower serum albumin (OR 0.22, CI 0.07–0.73) was a significant risk factor for mortality. Conclusions: We clarified the different factors associated with deterioration of the care needs level and mortality among disabled older people. Old age and bone joint diseases might be predictive factors for the further deterioration of independence of physical activity, and a low serum albumin level is considered to be strongly associated with increased mortality. Geriatr Gerontol Int 2019; ••: ••–••. Keywords: care needs level, deteriorated, home medical care, mortality, older people. Introduction In Japan, the older population is rapidly increasing. As a result of aging populations, the number of disabled older adults has become a major issue in most countries. To address this issue, the Japanese government introduced the long-term care insurance (LTCI) sys- tem from 2000. 1–3 There are 6.40 million people in Japan certified as eligible for the LTCI system. 4 Most people with LTCI have mul- tiple chronic diseases, such as stroke, chronic heart failure and cancer; lifestyle-related diseases, such as diabetes; and/or geriatric syndromes, such as dementia, bone-joint diseases and frailty. 5 The numbers of people receiving LTCI and home medical care are increasing, and most of them are older people aged >75 years. 4,6 Expenses for LTCI are rapidly growing. As the Japanese government is planning to stop this increase in expenses for LTCI, preventive care has become very important. In Japan, the main diseases leading to care requirements include bone joint diseases, cerebrovascular diseases and dementia. 4,5 Vari- ous factors related to deterioration of the physical function of older people were clarified in previous reports. 7–10 Also, it was reported that the number of comorbidities and an advanced age might be important risks associated with LCTI certification. 4,5 As for diseases causing a decline in physical functions of older people, cardiovascu- lar diseases, osteoarthritis and stroke have been reported, but research on the factors associated with changes in care needs level have been insufficient. 11,12 The factors of male sex, advanced age and impaired physical function have been reported to lower the survival rate of older people. 13,14 Also, some studies in Japan have used the care needs level as the main outcome, but those studies 1 | © 2019 Japan Geriatrics Society DOI: 10.1111/ggi.13790