Brief Report| Volume 19, ISSUE 9, P797-800.e2, September 2018

Are the Kihon Checklist and the Kaigo-Yobo Checklist Compatible With the Frailty Index?



      To explore comparability of Kihon Checklist (KCL) and Kaigo-Yobo Checklist (KYCL) to Frailty Index (FI) in predicting risks of long-term care insurance (LTCI) certification and/or mortality over 3 years.


      Prospective cohort study.

      Setting and Participants

      1023 Japanese community-dwelling older adults from the Kusatsu Longitudinal Study of Aging and Health.


      Frailty status was quantified at baseline using KCL, KYCL, and 32-deficit and 68-deficit FI. Relationships of the measures were examined using Spearman rank correlation coefficients. Cox regression models examined the risk of new certification of LTCI or mortality according to KCL, KYCL, and FI. Predictive abilities of KCL and KYCL were compared with FI using area under the receiver operating characteristic curve (AUC), C statistics, net reclassification improvement (NRI), and integrated discrimination improvement (IDI).


      Mean age was 74.7 years and 57.6% were women. KCL and KYCL were significantly correlated to 32-FI (r = 0.60 and 0.36, respectively) and to 68-FI (r = 0.88 and 0.61, respectively). During the follow-up period, 92 participants (9%) were newly certified for LTCI or died. Fully adjusted Cox models showed that higher KCL, KYCL, 32-FI, and 68-FI were all significantly associated with elevated risks [hazard ratio (HR) = 1.03, 95% CI = 1.01-1.04, P < .001; HR = 1.04, 95% CI = 1.02-1.05, P < .001; HR = 1.03, 95% CI = 1.01-1.05, P = .001; HR = 1.04, 95% CI = 1.02-1.06, P < .001, respectively, per 1/100 increase of max score]. AUC and C-statistics of KCL and KYCL were not different statistically from those of 32-FI and 68-FI. Predictive abilities of KCL were superior to 32-FI in NRI and IDI but inferior to 68-FI in category-free NRI, and those of KYCL were superior to 32-FI in IDI but inferior to 68-FI in NRI.


      Although KCL and KYCL include smaller numbers of items than standard FI, both tools were shown to be highly correlated with FI, significant predictors of LTCI certification and/or mortality, and compatible to FI in the risk prediction.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Clegg A.
        • Young J.
        • Iliffe S.
        • et al.
        Frailty in elderly people.
        Lancet. 2013; 381: 752-762
        • Sewo Sampaio P.Y.
        • Sampaio R.A.
        • Yamada M.
        • Arai H.
        Systematic review of the Kihon Checklist: Is it a reliable assessment of frailty?.
        Geriatr Gerontol Int. 2016; 16: 893-902
        • Satake S.
        • Senda K.
        • Hong Y.J.
        • et al.
        Validity of the Kihon Checklist for assessing frailty status.
        Geriatr Gerontol Int. 2016; 16: 709-715
        • Shinkai S.
        • Watanabe N.
        • Yoshida H.
        • et al.
        Validity of the “Kaigo-Yobo check-list” as a frailty index.
        Nihon Koshu Eisei Zasshi. 2013; 60 ([in Japanese]): 262-274
        • Satake S.
        • Shimokata H.
        • Senda K.
        • et al.
        Validity of total Kihon Checklist Score for predicting the incidence of 3-year dependency and mortality in a community-dwelling older population.
        J Am Med Dir Assoc. 2017; 18: 552.e1-552.e6
        • Shinkai S.
        • Watanabe N.
        • Yoshida H.
        • et al.
        Research on screening for frailty: Development of “the Kaigo-Yobo checklist”.
        Nihon Koshu Eisei Zasshi. 2010; 57 ([in Japanese]): 345-354
        • Ogawa K.
        • Fujiwara Y.
        • Yoshida H.
        • et al.
        The validity of the “Kihon Check-list” as an index of frailty and its biomarkers and inflammatory markers in elderly people.
        Nihon Ronen Igakkai Zasshi. 2011; 48 ([in Japanese]): 545-552
        • Kim Y.P.
        • Kim S.
        • Joh J.Y.
        • Hwang H.S.
        Effect of interaction between dynapenic component of the European working group on sarcopenia in older people sarcopenia criteria and obesity on activities of daily living in the elderly.
        J Am Med Dir Assoc. 2014; 15: 371.e1-371.e5
        • Sewo Sampaio P.Y.
        • Sampaio R.A.
        • Coelho Junior H.J.
        • et al.
        Differences in lifestyle, physical performance and quality of life between frail and robust Brazilian community-dwelling elderly women.
        Geriatr Gerontol Int. 2016; 16: 829-835
        • Maseda A.
        • Lorenzo-Lopez L.
        • Lopez-Lopez R.
        • et al.
        Spanish translation of the Kihon Checklist (frailty index).
        Geriatr Gerontol Int. 2017; 17: 515-517
        • Jang I.Y.
        • Jung H.W.
        • Lee C.K.
        • et al.
        Korean version of the fatigue, resistance, ambulation, illnesses and loss of weight questionnaire versus the modified Kihon Checklist for frailty screening in community-dwelling older adults: The aging study of PyeongChang rural area.
        Geriatr Gerontol Int. 2017; 17: 2046-2052
        • Sewo Sampaio P.Y.
        • Sampaio R.A.
        • Yamada M.
        • et al.
        Validation and translation of the Kihon checklist (frailty index) into Brazilian Portuguese.
        Geriatr Gerontol Int. 2014; 14: 561-569
        • Hwang H.S.
        • Yoon J.L.
        • Park B.J.
        • et al.
        The validity and reliability of the Kaigo-Yobo checklist in Korean elderly.
        J Korean Geriatr Soc. 2012; 16: 121-132
        • Fried L.P.
        • Tangen C.M.
        • Walston J.
        • et al.
        Frailty in older adults: Evidence for a phenotype.
        J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156
        • Bouillon K.
        • Kivimaki M.
        • Hamer M.
        • et al.
        Measures of frailty in population-based studies: An overview.
        BMC Geriatr. 2013; 13: 64
        • Mitnitski A.B.
        • Mogilner A.J.
        • Rockwood K.
        Accumulation of deficits as a proxy measure of aging.
        ScientificWorldJournal. 2001; 1: 323-336
        • Dent E.
        • Kowal P.
        • Hoogendijk E.O.
        Frailty measurement in research and clinical practice: A review.
        Eur J Intern Med. 2016; 31: 3-10
        • Kojima G.
        • Iliffe S.
        • Taniguchi Y.
        • et al.
        Prevalence of frailty in Japan: A systematic review and meta-analysis.
        J Epidemiol. 2017; 27: 347-353
        • Shinkai S.
        • Yoshida H.
        • Taniguchi Y.
        • et al.
        Public health approach to preventing frailty in the community and its effect on healthy aging in Japan.
        Geriatr Gerontol Int. 2016; 16: 87-97
        • Taniguchi Y.
        • Yoshida H.
        • Fujiwara Y.
        • et al.
        A prospective study of gait performance and subsequent cognitive decline in a general population of older Japanese.
        J Gerontol A Biol Sci Med Sci. 2012; 67: 796-803
        • Murayama H.
        • Shinkai S.
        • Nishi M.
        • et al.
        Albumin, hemoglobin, and the trajectory of cognitive function in community-dwelling older Japanese: A 13-year longitudinal study.
        J Prev Alzheimers Dis. 2017; 4: 93-99
        • Arai H.
        • Satake S.
        English translation of the Kihon checklist.
        Geriatr Gerontol Int. 2015; 15: 518-519
        • Searle S.D.
        • Mitnitski A.
        • Gahbauer E.A.
        • et al.
        A standard procedure for creating a frailty index.
        BMC Geriatr. 2008; 8: 24
        • Ikegami N.
        Public long-term care insurance in Japan.
        JAMA. 1997; 278: 1310-1314
        • Tsutsui T.
        • Muramatsu N.
        Care-needs certification in the long-term care insurance system of Japan.
        J Am Geriatr Soc. 2005; 53: 522-527
        • Moriyama Y.
        • Tamiya N.
        • Kamimura A.
        • et al.
        Doctors' opinion papers in long-term care need certification in Japan: Comparison between clinic and advanced treatment hospital settings.
        Public Policy Admin Res. 2014; 4: 31-37
        • Pencina M.J.
        • D'Agostino R.B.
        • Pencina K.M.
        • et al.
        Interpreting incremental value of markers added to risk prediction models.
        Am J Epidemiol. 2012; 176: 473-481
        • Fukutomi E.
        • Okumiya K.
        • Wada T.
        • et al.
        Importance of cognitive assessment as part of the “Kihon Checklist” developed by the Japanese Ministry of Health, Labor and Welfare for prediction of frailty at a 2-year follow up.
        Geriatr Gerontol Int. 2013; 13: 654-662
        • Suzuki N.
        • Makigami K.
        • Goto A.
        • et al.
        Comparison of ability-based and performance-based IADL evaluation of community-dwelling elderly using the Kihon Checklist and TMIG Index of Competence.
        Nihon Ronen Igakkai Zasshi. 2007; 44 ([in Japanese]): 619-626
        • Kato C.
        • Fujita R.
        • Ida K.
        Participant characteristics and intervention effects of a program to improve the physical function in community-dwelling frail elderly subjects.
        Nihon Ronen Igakkai Zasshi. 2013; 50 ([in Japanese]): 804-811

      CHORUS Manuscript

      View Open Manuscript