In Japan, the number of people aged 85 and over̶of whom about 60% are expected to require long-term care̶ is projected to increase rapidly, reaching 10 million by 2040. Addressing these challenges cannot be achieved through policies that are merely extensions of existing measures. Instead, the development of a population-based approach to frailty prevention is essential as an early-stage strategy within preventive care.
 This paper focuses on the activities of the Frailty Prevention Promotion Council, which exemplify the latest developments in population-based approaches to frailty prevention. It aims to provide a systematic overview of the current status of these approaches, including their background and recent progress.
 The concept of frailty was defined in a statement issued by the Japan Geriatrics Society in May 2014. Frailty is a state between normal health and the need for long-term care. It is characterized by “multidimensionality,” which refers to the progression due to various factors such as physical, mental, psychological, and social factors, and “reversibility,” which refers to the significantly higher possibility than a state of needing care to be able to recover to normal health.
 Based on this statement, in December 2022, the Expert Committee on Frailty Prevention Awareness (chaired by Masafumi Kuzuya, Professor Emeritus of Nagoya University) issued a report entitled “Recommendations on a Population-Based Approach to Frailty Prevention”. The recommendations clearly present the “Three Pillars of Frailty Prevention” as guidelines for community residents based on the latest academic evidence. They systematically outline an appropriate approach to frailty prevention that considers the characteristics of frailty and propose the establishment of a Frailty Prevention Promotion Council to advance these efforts.
 In July 2024, the Frailty Prevention Promotion Council (Chair: Yuji Kuroiwa, Governor of Kanagawa Prefecture; Secretariat: Association for Health Economics Research and Social Insurance and Welfare) was officially established. The Council comprises four prefectures including Kanagawa, 35 municipalities, and 10 companies including Aeon Co., Ltd. In November of the same year, the Council decided to adopt a Frailty Prevention Declaration and disseminate it nationwide. It also established the Council’s organizational structure and tasked its members with initiating the latest population-based approaches to frailty prevention, with the aim of expanding these efforts across the country.
 The key points of the above initiatives are as follows: 1) Frailty is not primarily a disease but a natural aging process that affects everyone. 2) Taking account of its characteristics and extensive academic evidence, local residents are encouraged to monitor their own frailty status, internalize frailty prevention as a personal responsibility, and recognize the importance of delaying frailty through daily lifestyle adjustments. Supported by community-based mutual aid, they collaborate to develop frailty prevention initiatives at the community level. This approach is grounded in the principles of self-help and mutual assistance. 3) Data obtained from frailty assessments are systematically organized and analyzed. By combining primary prevention with primordial prevention methods, a comprehensive population-based approach to frailty prevention is developed in alignment with national policies.
 With 2040 approaching as a critical juncture, it is imperative that industry, government, academia, and the public sector collaborate boldly and decisively to implement these initiatives.

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Background
In this study, we analyzed the association between the score on the risk assessment scale for incident functional disability (risk score) and the cumulative medical and long-term care costs over the following three years, using the risk assessment scale for incident functional disability, which is used to predict the occurrence of requiring long-term care certification and to estimate long-term care costs in Social Impact Bond (SIB) projects and other initiatives.
Subjects and Methods
We used a comprehensive survey of people aged 65 and over who had not received a certification of longterm care need, conducted by the Japan Gerontological Evaluation Study (JAGES) in Taketoyo Town, Aichi Prefecture, in October 2016. Based on the KDB system and long-term care insurance benefit information held by the local government, we ascertained the use of medical insurance services and long-term care insurance services over a three-year period from 1 April 2017 to 31 March 2020. A total of 5,213 people (2,450 men and 2,763 women) were included. The dependent variables were the cumulative medical costs, cumulative nursing care costs, and cumulative medical and nursing care costs over the three-year period. The explanatory variables were the scores on the risk assessment scale for incident functional disability, which is scored on a scale of 0 to 48 based on 10 questions and sex and age, and the square of this score, with the higher the score, the higher the risk. The adjusted variables were the level of education, the stage of the long-term care insurance premium levy as a proxy variable for income, marital status, whether or not the person had a disease that was being treated, whether or not the person had dementia, and the follow-up days. The estimation was carried out using the ordinary least squares (OLS) method.
Results
In the analysis using a linear model, in addition to replicating the results of previous studies that showed that the cumulative nursing care costs were 9,600 yen higher for each point increase in the risk score, the cumulative medical costs were 47,300 yen higher and the cumulative medical and nursing care costs were 56,900 yen higher for each point increase in the risk score. In the analysis using a nonlinear model, a quadratic relationship was observed between the risk score and cumulative medical costs, with a peak at 44.0 points and a peak at 8.6 points. On the other hand, the relationship between the risk score and cumulative medical and nursing care costs was more appropriately linear than nonlinear.
Conclusion
The higher the risk score, the higher the cumulative medical and nursing care costs per person over the following three years, by approximately 57,000 yen. In the future, it is hoped that the risk score will be used as one of the evaluation indicators for the financial effects of medical and nursing care costs in SIB projects, etc., in addition to nursing care costs.

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