The Participants were 175 persons requiring assistance who were using a day-care rehabilitation facility in the city of A (Figure 1). Exclusion criteria were those who discontinued day-care center rehabilitation and were hospitalized, and 168 subjects (31 males and 137 females, mean age 82.2 years) were included in the analysis, excluding 7 subjects who met these criteria. This day-care service is for persons requiring support 1 and 2. Informed consent was obtained from the subjects after explaining orally that participation in the survey was not mandatory, that the data obtained from the survey would not be used for any purpose other than research, and that the data would be anonymized for use (Table 1). The study was approved by the Ethical Review Committee of Kurume Rehabilitation Hospital (approval number: 21-001).

Figure 1.Flow chart of survey Participant.

Table 1.General information of rehabilitation users (n = 168).

Number (%).

1. general information

General information (age, gender, level of care, educational history: number of years attended elementary school, junior high school, high school, and university) was obtained from the staff of the A-city day-care center project.

2. physical function

The grip strength was measured using a digital grip strength meter (OG Giken Co., Ltd.), and the grip width was adjusted so that the PIP joint of the second finger was almost at a right angle. The maximum grip strength was measured twice alternately on the left and right sides, without swinging the grip strength meter, and the maximum value was set as the representative value.

For the CS-30, a 40-cm-high chair without armrests was used. The examiner eliminated any risk of falling. At the beginning of the test, the participants were seated with their backs to the chair and their arms crossed in front of their chests in a uniform posture. After several practice sessions, the participants were asked, on cue, to move from a sitting position to a standing position, extending their hip and knee joints fully, and then back to a seated position; the number of standing–sitting cycles during a 30-second period was counted [9].

In the Timed Up & Go Test (TUG) measurements were taken by measuring the time taken to rise from a chair-sitting posture, walk to a target 3 m away, change direction, return to the chair, and sit down. The measurement started immediately after the participants rose from the chair and stopped immediately after they sat back down. Measurements were taken twice, with the fastest value (in seconds) being representative [10].

For the open-eyed one legged stand, the time to hold the posture was measured with a digital stopwatch. The measurement limb position was the standing posture. The subject stands upright with their arms at their sides. The examiner instructs the subject to close their eyes and lift their left foot slightly off the floor.

The examiner then measures the duration of the one-leg stand. The measurement was stopped until the contralateral foot touched the floor. The higher of the two was taken as the measurement value.

3. mental functions

The MMSE (Mini Mental State Examination) was used to assess mental function.

The MMSE includes writing, document composition, and figure copying tasks, and the score ranges from 0 to 30 points.

MMSE scores below 23 are suspicious for dementia (sensitivity 81%, specificity 89%); scores below 27 are suspicious for mild cognitive impairment (MCI) (sensitivity 45% - 60%, specificity 6590%) [11].

The QOL was assessed using the WHOQOL26 which is widely used globally and has excellent reliability and validity [12][13]. The WHOQOL26 comprises 24 items in four domains and 2 items regarding overall QOL as follows: Physical QOL (7 items: ADL, medical supplies and dependence on medical care, vitality and fatigue, mobility, pain and discomfort, sleep and rest, and work capacity); Psychological QOL (6 items: body image, negative effect, positive effect, self-evaluation, spirituality, religion, beliefs, thinking, learning, memory, and concentration); Social QOL (3 items: relationships, social support, and sexual activity); Environmental QOL (8 items: financial relationships, freedom and safety and security, accessibility and quality of health and social care, dwelling environment, opportunities to acquire new information and skills, participation and opportunities for leisure activities, living environment, and transportation.); and overall QOL (2 items: subjective QOL and sense of wellbeing). Up to 5 points were assigned for each item of the four domains, and up to 10 points were assigned for the two items of overall QOL. The QOL survey involved a self-evaluation questionnaire. Respondents were required to indicate “how they felt during the past two weeks”, “how satisfied they were during the past two weeks”, and “how often they experienced this during the past two weeks”, by choosing either “not at all (not good, not satisfied)”, “a little (bad, not satisfied)”, “somewhat (fair, neither good nor bad)”, “a lot (good, satisfied, not satisfied)”, and “a little (good, satisfied, not satisfied)”.

In this study, we used the total score.

4. functional capacity

Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG IC) consists of 13 items and is classified into 3 categories: IADL (5 items), intellectual activity (4 items), and social role (4 items) [14]. The TMIG-IC is answered on a “yes” or “no” scale, with higher TMIG-IC scores indicating a greater ability to perform the activity. IADL refers to the basic skills needed to live independently in the community, such as managing transportation, shopping for daily necessities, cooking, and money management. Intellectual activity refers to the ability to engage in activities such as leisure, learning, and creativity, while social role refers to the ability to interact closely with people and society.

The daily life function was assessed by TMIG IC [8] The distribution of scores was 0 to 13, since indexes were designed to be answered using a two-tailed scale (0 and 1).

Questionnaires, higher scores indicate higher activity ability.

MMSE total score was divided into two groups: “A higher group” of 28 or more score and “A lower group” of 27 or less score. Basic attributes (age, gender, level of care, educational history), physical function, functional capacity, and mental function were compared using chi-square or Mann Whitney’s U test (Tables1-2). Age was divided into two groups: early elderly (65 - 74 years old) and late elderly (75 years old or older), and educational history was divided into two groups: high school up to 9 years or less, and vocational school, junior college, or university up to 10 years or more, respectively.

Pair analyses were carried out using Mann Whitney’s U test (Table3). After all, Binary logistic Analysis for predicting dependent variable (Table 4).

SPSS 26.0 for Windows was used for statistical analysis, and the statistical significance level was set at 5%.