Japanese Attitude Toward Terminal Illness and End-of-Life Care:Analysis of Questionnaire Responses-Part I / 日本農村医学会雑誌

　　This paper deals with an analysis of responses to a questionnaire survey to look at the attitude of Japanese toward the problems involving telling the terminally ill patients the truth, palliative care and other related matters. The survey, designed to understand and treat the terminally ill patients properly, was carried out with the cooperation of 76 out of 114 hospitals affiliated with the National Federation of Agricultural Cooperatives for Health and Welfare.　　Effective responses came from 7,811 people (females/ males＝1.9 and age from 14 to 91). They consisted of high school students, nursing school students, hospital staffs and people with other occupations. Most of them were ready to join this study.　　Of the respondents, it was found, 21.0% of the respondents were religious people, 14.5% had seriously considered their own death, 2.4% wanted to live as long as possible even with a life-limiting disease, 26.0% wanted to be informed of the terminal illness generally, 76.4% wanted to be precisely informed, 34.5% wanted family members being informed on a terminal diagnosis, 27.5% wanted to be informed alone without the knowledge of the family members, 90.1% wanted to be informed by doctors in charge, but not by family doctors, 60.3% wanted the use of a proper dose of opium to alleviate pain, 67.3% wanted to use hospice care, 7.8% wanted to see a man of religion at the terminal stage of life, and 39.6% wanted to die at their own home.　　Significant differences were found in the response to the questions depending on their sex, age and occupations (high school students, nursing school students, medical persons or people with other occupations).　　The findings of 22 other large-scale surveys conducted between 1987 and 2012 showed that the ratio of those who did not like to receive the information on terminal (IT) decreased (from 30-40% to blow 1%), and that the ratio of those who wanted to be informed of their incurable illness increased (from 55-65% to 75-85%), thus indicating that IT seems to have being accepted widely in Japan.

Japanese Attitude Toward Terminal Illness and End-of-Life Care:Analysis of Questionnaire Responses-Part II / 日本農村医学会雑誌

　　Using the results of a questionnaire survey, a study was made to ascertain whether or not the March 11, 2011 Great East Japan Earthquake influenced the attitude of survivors toward terminal illness and end-of-life care. The survey was taken one year after the devastating earthquake with the cooperation of 76 hospitals affiliated with the National Federation of Agricultural Cooperatives for health and Welfare. A total of 7,811 people ranging in age from 14 to 91 (M/F＝1/1.9) responded to the survey. They consisted of high school students, nursing school students, staffs of hospitals, and people with other types of occupation.　　Respondents from the two hardest hit regions (Fukushima and Ibaraki Prefectures: FIP) and three neighboring ones (Akita, Niigata and Nagano Prefectures: ANNP) were devided into the suffered and the non-suffered. The average suffering rate was 11% throughout the areas covered by the survey, which was compared with about 55% in FIP and 14-3.2% in ANNP.　　Analyses of sufferings of the respondents, broken down by age, sex, studentship and occupation, revealed that female sufferers outnumbered male sufferers and were younger in FIP than in ANNP. It was also found that female sufferers included many nursing students and medical staffs. A large number of male medical progessionals also fell victim to the quake.　　Interesting to note are the findings that a large number of male respondents from Fukushima and Ibaraki replied that they had religious faith, would prefer to be told the truth if they were terminally ill, had pondered over death, would like to see a man of religion when they realized their days were numbered, would desire the use of an optimum dose of opium to ease pain, and wished to deepen their knowledge of terminal illness. By contrast, more women than men said that they would choose to stay at home when they realized their days were numbered.　　These findings showed that the Great East Japan Earthquake significantly influenced the attitude toward terminal (care) with striking differences between men and women.

Evaluation of performance status of daily living activities and of the future risk of falls in the non-handicapped, community-dwelling elderly

<p><b>OBJECTIVES</b>There is a growing need to evaluate the performance status of the activities of daily living (ADL) of the elderly in the rapidly aging Japanese society. The purpose of this study was to verify the usefulness of our new scoring sheet for assessing present ADL status and to clarify whether or not the assessed ADL status can predict the future risk of adverse conditions related to falls.</p><p><b>METHODS</b>The validation study was performed using 116 non-handicapped community-dwelling Japanese elderly at least 60 years of age. Of those subjects, 44 were also analyzed for the relationship between baseline ADL status and subsequent risk of adverse conditions related to falls.</p><p><b>RESULTS</b>The daily living performance score sheet had good internal consistency, with a Cronbach's alpha of 0.82 and a sequential hierarchical structure that reflected the difficulty of the activities. The total score was significantly and positively associated with six of eight subscale scores on the Short-Form 36-Item Health Survey (P < 0.01). In the follow-up study, every one-point decrease in total score was significantly associated with a 39% elevated risk of a stumble or fall (P = 0.022) and also borderline significantly associated with higher risks of a fall, anxiety while walking indoors, and anxiety while walking outdoors (P < 0.10).</p><p><b>CONCLUSION</b>Our new scoring sheet can reliably and comprehensively assess present ADL status. The assessed ADL could predict the future risk of adverse conditions related to falls.</p>

Influence of Life-related Factors and Participation in Health Examination on Mortality in a 4.5-year Follow-up of a Rural Cohort

To identify life−related factors causing increased mortality, 2, 769 rural residents aged 29−77 were investigated through a self−administered questionnaire in 1990. Death certificates and migration information were inspected during the 4.5−year follow−up period. Age, obesity, life attitude, job, marital status, drinking and smoking habits, previous or current illness, and frequency of participation in health examinations were checked during the baseline survey. The person−year mortality rate was higher among irregular participants in health examinations than among regular participants both among males and females. From Cox’s multiple regression analysis, factors with a significantly high hazard ratio (HR) for mortality were irregular participation (HR=2.05), increase of age (HR=1.54, for 10 years), previous or current illness (HR=2.44), unemployment (HR=1.95), and living without a spouse (HR=2.61) for males; and for females they were having previous or current illness (HR=15.21) and living without a spouse (HR=2.94). Thus, irregular participation in health examinations, unemployment and aging showed a relationship with a higher mortality only in males. A previous or current illness and living without a spouse were related in both sexes.