Research on the policy system of integrated elderly care and medical services / 沈阳医学院学报

In order to cope with the challenges of an aging society,the construction and implementation of a policy system about integrated elderly care and medical services is an important measure to protect the health rights and interests of the elderly.By integrating medical care with elderly care services,the policy aims to provide comprehensive and continuous support for elderly care and health,and meet the diversified needs of the elderly in terms of medical treatment,rehabilitation,nursing,and life care.The construction and implementation of this policy system will not only help to improve the quality of life of the elderly,but also help to improve the service efficiency of the medical and health system and promote sustainable social and economic development.This paper reviews the policy of integrated elderly care and medical services from multiple perspectives such as its development history,policy level,classification and characteristics.

Advantages, development opportunities, and practice paths of traditional Chinese medicine in prevention and treatment of elderly comorbidities / 中国中药杂志

This article focused on the significant public health issue of comorbidities in the elderly population and highlighted the important role of traditional Chinese medicine(TCM) in the prevention and treatment of comorbidities in the elderly. It suggested that TCM should fully utilize its advantages in holistic perspective, syndrome differentiation and treatment, and preventive medicine in the process of preventing and treating comorbidities in the elderly. At the same time, in response to the significant shift in the disease spectrum of the elderly, the increasingly innovative concepts in diagnosis and treatment, the growing demand for proactive health by the el-derly population, and the current emphasis on patient-centered evaluation standards, it is necessary to further conduct basic theoretical and experimental research on comorbidities in the elderly using TCM, emphasize clinical research on comorbidities in the elderly, explore appropriate efficacy evaluation systems, improve TCM prevention and treatment strategies and comprehensive intervention programs for comorbidities in the elderly, and leverage the unique role of TCM in the rehabilitation of elderly comorbidity patients. By analyzing the potential of TCM in the field of comorbidities in the elderly, this article is expected to provide new insights for future clinical practice and scientific research.

Exploring age-related visual dysfunctions and strategies for visual function restoration / 中华实验眼科杂志

According to the international definition on the aging society, China has entered an aging population period.The research and strategies addressed on age-related health problems have become one of the key parts of the national strategy of Active Health.Age-related visual function decline and ocular diseases include presbyopia, cataract, age-related macular degeneration, glaucoma, diabetic retinopathy, etc.It is significant to engage the role of Active Eye Health Project in the research on related areas and in introducing appropriate scientific strategies to early intervene their occurrence and development.On the basis of prior research and practices conducted by other teams, this article analyzed age-related eye health problems as well as their serious impacts, and put forward the concept and specific strategies related to visual function decline and restoration.Additionally, combined with the preliminary practice of our team, the feasibility and the clinical significance of early intervention were investigated.

Readiness of healthcare providers to face the aging society in Indonesia

@#The demographic transition occurs all over the world, including Indonesia. The Indonesian Ministry of Health announced that Indonesia has been dominated by an aging society since 2017. The proportion of elderly has reached 9.03%. This commentary study aimed to see the general conditions of healthcare providers (primary healthcare centers and hospitals) in facing the aging society. Results showed that the primary healthcare centers and public hospitals are not ready yet to face the aging society. In fact, primary health care is not friendly to the elderly in terms of the facilities and the limited services of home visits. This study recommended the government and stakeholders to provide the optimal quality and quantity of health care services to the elderly who have dominated the population.

Associations of frailty, physical activity, and physical fitness with incident long-term care and support needs in community-dwelling older Japanese adults / 体力科学

Prevention of functional disabilities leading to long-term care and support needs in older population is one of the most urgent social issues facing Japan today. Frailty has been recognized as a pre-stage of functional disabilities leading to long-term care and support needs, and so, it is often treated as a target in their preventive interventions. Furthermore, because reductions of daily physical activities and physical fitness are considered as part of the major causes of physical frailty, their improvements have been also explored in community-based measures to prevent long-term care and support needs. This review paper aimed to summarize present findings regarding associations of frailty, physical activity, and physical fitness with incident long-term care and support needs in community-dwelling older Japanese adults. Through the review of literature, most of the previous prospective cohort studies showed that community-dwelling older Japanese adults who are free from frailty or maintain good physical activities and physical fitness have a reduced risk for the incidence of long-term care and support needs. These findings support an expectation that prevention of frailty and/or improvements of daily physical activities and physical fitness can be effective strategies to prevent older people from undergoing long-term care and support needs. It should be, however, understood that the associations found in the previous studies are not causal. Future prospective cohort studies defining exposure variables based on multipoint observations, as well as well-designed interventional studies are needed to validate the expectation.

The importance of the rate of pure "attended deaths at home" for objective outcome indicator for assessing the prevalence of home care in Japan

BACKGROUND@#No study has yet been performed on the importance of the rate of pure "attended deaths at home," excluding examined deaths subjected to a postmortem examination. Therefore, in the present study, we investigated actual state of pure "attended deaths at home," in order to provide reference data for the future development of end-of-life care at home.@*METHODS@#We performed a detailed survey in Yokohama City according to the type of death, age, and underlying cause of death in cases of home deaths, based on the detailed version of the Vital Statistics Survey Death Forms. Then, we divided deaths occurring in each municipality in Kanagawa Prefecture into two categories: "examined deaths" or "attended deaths," which were also stratified by the place of death, based on the Vital Statistics, and data on number of death cases subjected to postmortem examination from the Kanagawa Prefectural Police Headquarters.@*RESULTS@#In 2013, the survey in Yokohama City showed large differences in age distribution and cause of death between examined and attended deaths. In 2014, home deaths accounted for 15.7% of all deaths in the prefecture, whereas the overall proportion of attended deaths at home was 6.9%.@*CONCLUSIONS@#We should utilize the rate of pure "attended deaths at home" for objective outcome indicator.

A Survey on the Current Status of Supporting Home Medication Use by Caregivers and of the Cooperation with Pharmacists / 社会薬学

The questionnaire was distributed to caregivers regarding their management for home medication therapy. The purpose of this questionnaire was to clarify the role of community pharmacists in city “Z”, Hiroshima in supporting this activity. The results were compared among seven administrative zones. The percentage of caregivers who had routinely administered medications to dependent patients was 81%. Of these, the percentage of caregivers who had encountered difficulty in medication administration to dependent patients was 66%. Only 13% of these caregivers had sought assistance from pharmacists in dealing with issues they faced in the administration of medications. The percentage of caregivers who had easy access to pharmacists was 44%. The percentage of caregivers who received pharmacist-initiated information about patients was 23%. Among the 7 administrative zones in city “Z”, the 2 zones (H-zones) with the highest percentage of elderly citizens, 38.7%, were compared with the other 2 zones (L-zones) with the lowest percentage of elderly citizens, 25.7%, regarding medication management by caregivers. It was observed that the frequency of missing side effects or crushing medicines by caregivers was higher in H-zones as compared to L-zones. The results of this research suggest that close cooperation between pharmacists and caregivers improves the quality of medication therapy management. In an aging society, pharmacist intervention could be very beneficial to providing support and information that would improve the quality of patients’ medication therapy.

A Survey on the Current Status of Supporting Home Medication Use by Caregivers and of the Cooperation with Pharmacists / 社会薬学

The questionnaire was distributed to caregivers regarding their management for home medication therapy. The purpose of this questionnaire was to clarify the role of community pharmacists in city “Z”, Hiroshima in supporting this activity. The results were compared among seven administrative zones. The percentage of caregivers who had routinely administered medications to dependent patients was 81%. Of these, the percentage of caregivers who had encountered difficulty in medication administration to dependent patients was 66%. Only 13% of these caregivers had sought assistance from pharmacists in dealing with issues they faced in the administration of medications. The percentage of caregivers who had easy access to pharmacists was 44%. The percentage of caregivers who received pharmacist-initiated information about patients was 23%. Among the 7 administrative zones in city “Z”, the 2 zones (H-zones) with the highest percentage of elderly citizens, 38.7%, were compared with the other 2 zones (L-zones) with the lowest percentage of elderly citizens, 25.7%, regarding medication management by caregivers. It was observed that the frequency of missing side effects or crushing medicines by caregivers was higher in H-zones as compared to L-zones. The results of this research suggest that close cooperation between pharmacists and caregivers improves the quality of medication therapy management. In an aging society, pharmacist intervention could be very beneficial to providing support and information that would improve the quality of patients’ medication therapy.

Stop Discussing New Medical Specialty Boards

The Korean society is rapidly aging and the health care needs for aged people are increasing. In this context, some physicians claim to establish new medical specialty board (MSB) for geriatric medical experts but also MSB for primary medical care specialists, clinical pharmacologists, and public health experts. In Korea, basic concept for the specialty board system is still under debates and the legal support for the system is poor. At present, doctors with MSBs in private sectors supply 92.4% of primary medical care but the National Health Care System requires more primary care physicians than specialists in Korea. Therefore, the government must invest in the education of doctors more to improve the public health care system. The proposal of the new MSB for geriatric medicine must be gradually developed according to the national long-term health plan, social needs, and national budget for the public benefit. Please stop discussing unprepared new MSBs.

10 Main Pledge of 19th Presidential Election / 보건행정학회지

On May 9th 2017, the 19th presidential election was held. This election was historically significant because of the impeachment of the former president. This election was held in a relatively short period of time, unlike the normal presidential elections. Therefore, there was not enough time to deliberate pledges for candidates and review pledges for the people. South Korea has suffered from many healthcare problems associated with low-birth rate, population aging, and low economic growth rate. In this paper, we compared the ‘10 main pledge’ of the major five candidates of the 19th presidential election and discussed focusing on the healthcare issue. As a result of comparing the 10 main pledge of the major candidates, it was difficult to find healthcare parts whereas there were lots of welfare parts existed. We need enough time to review and discuss pledges in the next election.

Factors Influencing the Dispensing of One-Dose Package Medications to Elderly Outpatients / 社会薬学

<p>Decreased adherence to medications among the elderly has become a problem in recent years. To overcome this problem, the dispensing of one-dose packages of medicines has been suggested. The purpose of this study was to survey elderly outpatients in a regional hospital at the Tokachi Development and Promotion Bureau and to analyze the factors that influence patients’ preference for a one-dose package medicine. The dispensation of one-dose package medication was observed in 20% of elderly outpatients. A correlation between the percentage of dispensed one-dose package medications and the number of agents was observed. Furthermore, dispensing rates of one-dose package medications increased with aging. Within the various departments analyzed, one-dose packaging rate was high in the Departments of Cardiology and Psychiatry. In this study, the correlation between residential municipalities of outpatients and one-dose package medications was examined. In the municipalities with a high rate of aged individuals and high average of household members, one-dose package medication rate was low. Multivariate logistic regression analysis confirmed these factors as significant. That one-dose packaging rates increased with the number of drugs and aging are consistent with the notion that one-dose package medications are designed to increase drug adherence among the elderly. Interestingly, one-dose package dispensing rate was low in areas with advanced aging. Because aging in Japan is expected to advance in the future, it is important to survey one-dose package dispensations.</p>

The long-term care insurance in Japan:Experience and enlightenment / 中国卫生政策研究

Japan’s long-term care insurance takes grassroots governments as its insurer and the elderly and part of the non-elderly as its insured;The costs is shared by government、society和individual, and is, payed through isti-tutions, communities and hothes. Since its establishment, its security level has been increasing, the role of preven-tion has been rising, the status of community-based and home-based has been highlighting, and the cooperation a-mong relevant industry has been strengthening. But at the same time, its costs was soaring during the past decade, and the continued development of the system is facing transformation pressure now. Take this as a warning, the devel-opment of long-term care in China should learn its strong points, but also try to avoid its shortcomings.

Development and Clinical Use of Assessment Indicators for Improving Medication Adherence of Elderly Residents in Nursing Home

BACKGROUND: South Korea is rapidly being an aging-society and the demand of long-term care insurance services for elderly patients is rising. In addition, because the elderly taking multiple medicines, the adherence is lowered and the adverse events are easily occurred. Therefore, many are interested in introducing the geriatric pharmacy specialist to manage this situation. PURPOSE: By applying a similar program such as the geriatric pharmacy specialist working in nursing home, we conducted this study to evaluate the potential contribution to both the health insurance services and financial savings for the elderly patients. METHODS: We conducted a trial in an elderly nursing home to collaborate between doctor and pharmacist making a checklist for improving medication adherence and establish a consultation system. Also we applied a smart phone application in the pharmaceutical care processes. RESULTS: Thereby completing the drug therapy related checklist apply to nursing facilities in South Korea. And we got a performance that improves medication adherence when used in the clinical practice settings. CONCLUSION: By introducing a training program of pharmacy care managers and geriatric professionals such as the United States and Japan, we revealed the elderly nursing home residents and vulnerable elderly people living alone were improved the medication adherence and it will contributed to the health and quality of life of the patients.

<b>A Case of Recurrent Pneumonia Successfully Treated with Jiinshihoto</b> / 日本東洋医学雑誌

A 56-year-old woman visited our hospital with a persistent fever of 38 °C. Chest radiography and plain computed tomography (CT) showed scattered infiltrative shadows in both lung fields. She was diagnosed as having pneumonia and received antimicrobial therapy. Subsequently, the pneumonia was improved and defervescence was observed. Although pneumonia appeared 1 and 5 months later, antimicrobial therapy again recovered the patient's condition. At that point, we noticed from the patient's medical history that she had developed pneumonia 2—3 times a year over the past 4 years. Therefore, we prescribed low-dose macrolide therapy and an expectorant as prophylactic treatment. However, she developed pneumonia again after 4 months, but recovered with antibiotics.<br>Jiinshihoto was administered, because the pneumonia repeated over short periods. Subsequently, no pneumonia developed during the 1.5 years following Jiinshihoto administration. In Japan's aging society, death due to pneumonia has increased and will increase. In many patients, antimicrobial therapy alone results in recurrent pneumonia despite of temporary improvement. Furthermore, because it is important to prevent the development of pneumonia, this case is considered of value in Japan, as Jiinshihoto proved effective in preventing recurrent pneumonia.

Care Café for healthcare professionals─blending communities

<b>Aim</b>: Many methods aiming to achieve face-to-face, multi-discipline healthcare cooperation have been attempted in Japan in order to optimize the community care system. There are however, many obstacles to the commencement or successful coordination of meetings, seminars, and workshops for health care professionals, particularly longterm cooperation and financial constraints. We have developed methods to solve these problems. <b>Methods</b>: We invented a new method, called Care Café based on the philosophical and sociological ideals utilized by the World Café. Care Café is held on a regular basis to facilitate communication and cooperation between healthcare professionals with the aim of finding solutions to mutual problems. <b>Results</b>: Care Café has been held on a monthly basis in Asahikawa, where it started. There have been 9 Care Café events in Asahikawa so far, with the number of healthcare professionals in attendance totaling approximately 700. The concept of Care Café is earning greater recognition in Japan, and Care Café events have now been held in 16 different Japanese cities, for an aggregate total of 29 events nationwide. We have received Care Café reports from participating cities detailing successful multi-discipline healthcare cooperation in solving medical issues. <b>Conclusions</b>: Care Café started in Asahikawa. It has been spreading among healthcare professionals nationwide. We expect Care Café to establish and develop new face-toface, multi-discipline healthcare cooperation.

The Role of the General Practitioners in Aging Society / 中国医学伦理学

China has entered the aging society , in urban communities and rural grassroots their are still many older people lack of health insurance , elderly patients with chronic diseases become the most difficult people to see a doctor, this needs to train more general practitioners to solve these problems .From a macroscopical view , general practitioners can bring substantial economic benefits and broad social benefits .From a microscopic view , they also can make effective use of family medical resources , bring convenient for old people going to a doctor and carry out an important role of health education .Improving the General Practitioner -Elderlyservice mode , the govern-ment needs to further improve the elderly medical service system and security system , vigorously promote grass -roots community health service institutions of medical conditions , develop specialized general medical personnel ac-cording to the needs of the elderly , implement contractual service relationships between general practitioners and the elderly.

Current status of dental geriatric education in Korea / 대한치과보철학회지

PURPOSE: The aim of this study was to evaluate the current status of dental geriatric education in Korea. MATERIALS AND METHODS: One of the faculty members related in geriatric education was selected in each Korean dental school and the questionnaire on geriatric dental education was sent to them by e-mail. The questionnaire consists of the topics about undergraduate geriatric education and administration of the geriatric education. The information obtained from the questionnaire was compared with that of other countries in the aspects of curriculum, teaching methods, subjects, and existence of specific clinics, etc. RESULTS: Seven schools have geriatric dentistry in undergraduate education curriculum. Among those, only two schools had it taught by theoretical lecture as well as clinical lecture. Two dental schools had specific geriatric clinic among seven dental schools. Compared with the USA and western European countries, the geriatric dental education in Korea is at a developing stage and was perfunctory without diverse clinical experience. CONCLUSION: In Korean dental schools, geriatric education was mostly conducted by lectures, and clinical teaching programs were not well organized compared with developed countries. It seems that the status of geriatric dental education in Korea has not been well established academically or administratively yet.

Is free medical care possible?

Free medical care is currently a highly debated issue in Korea. However, from a practical point of view, 'completely free' medical care is impossible. Last year the National Health Insurance Corporation (NHIC) reported a huge deficit of up to 1.3 trillion in Korean won, which is the largest deficit in the past 10 years. NHIC expenditures are skyrocketing for many reasons: drug overuse, very expensive new drugs or devices increasing geriatric population and survivors of cancer or chronic illnesses, expanding insurance coverage for new diagnostic tests, drugs, neonates, rare diseases, disabilities, and cancer, occurrence of new diseases, increasing number of doctors, moral hazard, and wasting of resources due to the duplication and counteraction between modern medicine and Oriental medicine. What, then, should we do to provide partially free medical care? We need to reduce expenditures for drugs and increase health insurance premiums. Korean health insurance premium currently low compared to that of other countries in Organization for Economic Co-operation and Development. It is also necessary to introduce the concept of a health tax, in which healthy individuals with a high income pay higher premiums while sick or low-income individuals pay lower premiums. Expanding public health coverage such as vaccinations, regular health surveillance programs, and education on health promotion should be implemented. Private health care insurance can be introduced carefully with close monitoring. The last and most important recommendation is that society must become more ethical and transparent. Korea is entering a new era as a developed country and as a result a welfare system, including medical care is notoptional but is mandatory in some part. However, even a partially free medical care is going to be possible only if the entire health care system is operated in an ethical and efficient way for maximal utilization of limited resources while avoiding moral hazard and waste.

The Perspectives on Development of Korean Quality Measurement Tools for Geriatric Hospitals

The payment system such as national long term care insurance for the elderly and per diem rate for geriatric hospitals introduced in 2008 has greatly changed the Korean medical system for the elderly. Therefore, today it would be inevitable to discuss quality assessment of healthcare services provided by nursing facilities and geriatric hospitals in order to effectively establish and operate the introduced systems. Under these circumstances, in an effort to provide elderly people with high-quality medical services with limited resources, it is believed that the quality indicators need to include the following: (1) provision and management of medical services for major health problems; (2) assessment of quality of life for residents; (3) assessment of ADL and rehabilitation services so as to maintain and improve functions; (4) assessment of convenience of living facilities; and (5) assessment of rate of potential avoidable hospitalization in acute care hospitals. Moreover, along with an effort to define roles of nursing facilities and geriatric hospitals, it would be necessary to set up the feasible stepwise strategy through discussions with relevant institutions.

The Long-term Care Management for the Elderly in Korea

No abstract available.