RESUMO
We conducted a questionnaire survey of ≥4,000 elderly individuals living in mountainous and hilly areas about everyday situations and analyzed their responses to reveal the role of field work. The analysis revealed that field work greatly influenced activities of daily living (ADL) and the Geriatric Depression Scale (GDS) score in these elderly individuals. We summarized the major results as follows: ・A group of elderly individuals who were care in the fields had many opportunities to go out, play active social roles, and participate in local activities. ・In the same group, improvement was observed in overall ADL scores, but particularly in instrumental ADL. ・Depressive tendency was less likely to be observed in elderly individuals who were cared than in those who were not cared. Such intergroup difference intensified among older age groups.
RESUMO
As part of the special study project of the Japanese Association of Rural Medicine (JARM), a questionnaire survey was conducted to probe into the attitude of rural people toward their eating habits and health. Most of the people surveyed had received health checkups carried out by medical facilities affiliated with the JARM. Questionnaires were distributed to a total of 5,397 people (2,588 men; 2,809 women) living in and around provincial cities. Mean age was 53.4 for men and 53.8 for women. More than half of those questioned were farmers or had experienced in farming. The people aged 80 and older accounted for 3.2% of the total. Eighty percent of the total said they felt happy, and those who felt short of exercise also represented 80%, but with advancing age, the ratio decreased. Those over the age of 70 who said they had a habit of taking exercise made up as high as 60%. Many said they were satisfied with food in terms of quantity, but not a few people expressed uneasiness about food safety, dietary life and supply of food. Regarding favorite foodstuffs, many gave rice, vegetables and dairy products. There was a tendency for older people to eat meat less. It was found that, with increasing age, people took to eat dairy products, soybeans, vegetables, fruits and fish were ranked among the most popular foodstuffs. A study of factors related to local production for local consumption and commitment to agriculture found that a significantly large number of people were interested in social participation, eating breakfast, securing food supply and purchasing foodstuffs at outlet stores run by local agricultural cooperatives. From these findings, it was suggested that many residents in and around provincial cities oriented themselves to healthy eating habits and lifestyle, and were very interested in social participation, local economy, agricultural production and consumption of local farm produce.
RESUMO
We have embarked on a project to help old people finding something to live for. The project was worked out as we found that more than half of the elderly we queried said that they preferred to stay at home rather than go out because there was nothing to do. Years ago, an ad hoc committee, comprised of hospital employees, was organized to think up how to use facilities in our hospital effectively for the benefit of the health of the stay- at-home elderly. Based on the ideas proposed by the committee, a total of eight health classes came into existence. They included the exercise class with an aim to prevent locomotive syndrome, the brain training course for maintaining or improving cognitive abilities, the beauty salon dealing with cosmetic treatments and the karaoke club. Each club had a membership of 10 to 30 persons. More than 80% were women. The average age was around 75 years. The club dues range from \0 to \500. Later on, some clubs raised fees, but the number of participants remained almost the same. Many participants in the one-year brain training course had their cognitive abilities improved significantly. It has been found that there are many people living far from the hospital wish to join these clubs but their wish remains unfulfilled. This is one of the tasks we have to tackle with together with the problem that there are too few male participants. In any way, as part of our efforts to revitalize regional communities, we think that it is important to expand our project from now on to have activities built into the daily lives of the elderly.
RESUMO
The subjects of this study were people 65 and older, who live in a mountainous region in the Province of Mikawa, Aichi Prefecture. To determine the factors pertaining to their ability to perform the basic activities of daily living, we used the TMIG index of competence for rating functional capacity and the geriatric depression scale for assessing mental health status, and carried out a logistic regression analysis to examine how the 37 items in the questionnaire survey on senile dementia were related to the functional capacity in the old people. To the index of competence, (To the ability to perform daily activities,?) answers to these questions -“Is there anything you have to do every day,” “Do you have farm work to do,” “Do you have any hobbies,%rdquo; “Are you willing to work hand in hand with others as a volunteer,” and “Do you have someone to talk to” - were closely related, with the odds ratio calculated at 2.0 or above (p‹0.001). Also in mental health status, the odds ratio came to 2.0 or over (p‹0.001) in similar items. These findings suggested that a sense of purpose, a role to play and involvement in community affairs could be the essentials of life for the senior citizens. In the not- too-distant future, it will become necessary to build a system based on the idea that healthy old people are supposed to take care of, and support, their contemporaries who are frail mentally and physically.
RESUMO
Mountainous areas facing such demographic problems as depopulation and aging, have yet to get over difficulties in securing a means of transportation for people to visit medical facilities. Asuke Hospital, located in a mountainous district of Mikawa, Aichi Prefecture, has worked on the project to improve living conditions for years with a view to laying the foundations for the inhabitants to continue to lead a healthy life. As part of the project, we started shuttle services on a trial basis in 2010 and 2011. As a result, we reaffirmed that there was a pressing need of door-to-door services on the part of patients and members of their families. It was also made clear that, if transportation services are to be an economically feasible project, there must be more users and that users would have to pay a certain amount of money as a fare on the user-pays principle.
RESUMO
The aim of this study was to examine topophilia in the elderly living in mountainous areas. Topophilia, which is the geographical concept invented by Yi-Fu Tuan in 1999, is defined as the affective bond between people and place or environmental setting. A total of 120 elderly subjects living in a mountainous area responded to a standardized, validated 9-item Life Satisfaction Index K (subjective well-being) developed by Wataru Koyano and a new structured 6-item questionnaire on topophilia. Factor analyses revealed two domains of topophilia (public emotion and private emotion toward the living place). Public emotion was the emotion of being hard to leave the living place. Private emotion was the emotion of not loving the living place. There were areas where the elderly had a lesser degree of attachment toward the present state of the elderly could hardly have a sense of well-being and attachments to the current domicile. It is considered that not only physical but also mental approach is necessary to support the daily life of the elderly living in the mountainous area. Also, we examined the influences of aging and the living place on a subjective well-being and topophilia. There was no significant correlation between age and subjective well-being, but there was significant positive correlation between age and the degree of topophilia (r＝0.234, p‹0.01). On the other hand, the degree of subjective well-being by the place of residence was significantly different (p‹0.001; ANOVA), and the degree of topophilia by the place of residence was not significantly different. These findings suggest that subjective well-being is not influenced by age but influenced by the place of residence, and topophillia is not influenced by the place of residence but influenced by age.
RESUMO
A soundcell is defined as a musical unit of meaning with short period of phrase. The soundcell method (SCM) is a musical procedure that decomposes a musical piece into several soundcells and subsequently recomposes the original music with the soundcells arbitrarily scattered. The present investigation aimed to assess cognitive function in the elderly using the SCM. An electronic system realizing the concept and methodology of the SCM was developed, and SCM examination with the school song “Furusato” as the musical piece was performed on18aged females. Four clinical tests were also carried out before or after the SCM examination to screen cognitive function: Mini-Mental State Examination (MMSE), Kana Pick-out Test, and Trail Making Tests A and B. The performance in the SCM examination was compared with the score in the clinical tests. The scores in all four clinical tests were significantly different between subjects who passed and failed the SCM examination. The individuals who passed the SCM examination were not suspected of dementia on the basis of the MMSE and seemed to execute successfully the Kana Pick-out Test. The number of acts and mean act time in the SCM examination were strongly correlated not only with the total score in the MMSE but also with the scores of the two sub-items: attention/calculation and memory recall. The results suggest that the SCM reflects a subject's short-term and recent memory and provides useful supplementary information for early diagnosis of mild cognitive impairment and Alzheimer’s disease since impairment of memory is frequently observed in the early stage of the diseases. In addition, most subjects enjoyed the SCM examination incorporating the element of musical amusement. The SCM is thus expected to allow repetitive and participatory assessment of cognitive function without imposing a large psychological burden on the subject.
RESUMO
We examined how difficult it would be for the elderly living in mountainous areas to go to the nearest hospital using a Voronoi tessellation representing the mathematical concept of neighborhood. We defined the index of the nursing-care capacity for the elderly as the ratio of the number of caregivers to the number of the elderly receiving nursing-care.<br> The mean age of those who drive to the hospital by themselves worked out at 70±9.8 years. Meanwhile, that of those who go to the hospital by bus or taken to hospital in a car driven by a family member came to 80±7.0years. The latter was significantly older than the former.<br> The areas of the Voronoi tessellation generated by patients' places of residence were divided into three groups according to the size. The plots of these three groups of the the places of residence on the map had a three-layer and doughnut-like structure, i. e., inner-, middle-, and outer-layer.<br> The index of the nursing-care capacity in 2008 was less than 1.0 for the patients under 80 years of age. This means that when those who were at the age of 50 in 2008 become old and need nursing-care, access to the hospital will become harder to them than at present. For those who are over 80 years of age and live in the outer layer that is far away from arterial road, it will be almost impossible.<br> These findings suggest that outpatient care with transportation assistance by a family member at present should be reconsidered because of the future lack of care personnel. It would also be necessary to consider the welfare of older people from the geographical point of view in order to manage the problems concerning the various physical and sociological difficulties of the elderly.
RESUMO
We looked into the effects of the specified health examination and health guidance, which was enforced in 2008 in place of the fundamental health examination, and found that there were plenty of problems to be addressed. The changes in the standard range of the specified health examination and checkup items seemed to have been received much more unfavorably than anticipated.In the new health scheme as compared with the previous one, the occasion to perform blood tests for anemia and electrocardiography decreased drastically;there was veritably no funduscopy (ophthalmoscopy?); and the chances that the examinees were told to receive medical treatment or to watch yourself carefully were increased by a large margin. Since the objective of the health checkup was changed greatly, emphasis was placed on the detection of metabolic syndrome in the specified health examination. We thought that the hospitals, affiliated with the Aichi Prefectural Federation of Agricultural Coopeatives for Health and Welfare, had to renew their efforts for the maintenance of the health of local residents and the prevention of disease.
RESUMO
After 1985, the decrease in domestic nursing power progressed gradually. The care for the elderly shifted from domestic private nursing to public nursing-care services when the long-term nursing-care insurance law was enacted in 2000. Because many of the elderly receiving nursing care suffer from chronic ailments of hypertension or the consequences of cerebrovascular disease, etc., cooperation between hospitals and nursing homes is necessary and indispensable. We began exchanging information by E-mail on a trial basis with a special elderly nursing home in April 2009. We aimed to integrate medical care and nursing by sharing medical and nursing information. We concluded that the use of E-mail could serve our purpose. The reason why we reached this conclusion is as follows:The mechanism of the information transmission by E-mail, that also relates to semiotics and narratology, is related to the essence of the description. This mechanism functions as a tool for mutual understanding among hospitals, nursing homes, and families. This also functions as a device to make the medical and nursing experience join. As a result, this mechanism enables the elderly to escape death as dying of sickness in the hospital and to die a natural death in the course of nursing. It is an easy method that can be introduced at a low cost for the purpose of establishing cooperation in medical and nursing care among hospitals, clinics, nursing homes, and nursing support centers, etc. especially in medically underserved remote areas.
RESUMO
To assess the effect of pre-germinated brown rice on metabolism of glucose and lipids, blood parameters of glucose and lipids were measured before and after 3 months of intake of test rice, which was mixed with pre-germinated brown rice (PGBR) and white rice in a ratio of 1:1, in patients with diabetes mellitus type 2 (DM). Glycosylated hemoglobin A1c (HbA1c) was significantly decreased from 6.40±0.23% to 6.23±0.19 after 3 months of intake of PGBR. The fasting plasma glucose level was not changed by intake of PGBR, but serum insulin level and HOMA-IR were decreased slightly. As the decrease of LDL-cholesterol (LDL-c) and the increase of HDL-cholesterol (HDL-c) were slightly observed after 3 months of intake of PGBR, the LDL-c/HDL-c ratio was decreased significantly from 2.03±0.13 to 1.83±0.12. These changes were significantly larger in the high PGBR in take group than in the low PGBR in take group. These results suggested that the PGBR intake might have potentialities as one of therapeutic methods for diabetes mellitus type 2 and also be useful in the freatment of hypercholesterolemia.
RESUMO
This paper proposes a method for evaluating and scoring the activities of rehabilitation service users in order to pinpoint the problems with the health service of this kind and set the adequate targets for each user. Sincs the Nursing Care Insurance System was introduced in Japan in 2000, it has been argued that home-visit rehabilitation services should be excluded from home-nursing care services. However, the methods of certifing that nursing care is required are not fully established yet for setting the rehabilitation targets for service users. As things stand, it is recommended that such a method as the Functional Independence Measure (FIM) or the Barthel Index (BI) should be utilized. However, these methods only evaluate “performing activities” (the activities that a user usually performs). In order to set the users' targets, we thought it necessary to establish a method for evaluating “possible activities” (the activities that a user is able to perform at his/her full capacity). We have established a method called Functional Scoring (FS) which evaluates and scores the both performing and possible activities based on the same evaluation items. We conducted experimental evaluations on the home-visit rehabilitation users for one year from October 2005 to September 2006. When the first evaluations in 2005 were compared with the second evaluations in 2006, the total score of the performing activities significantly increased from 44.1±13.7 to 47.8±14.2 (P<0.05). Although the total score of the possible activities did not significantly increase, it demonstrated an upward trend from 49.6±13.2 to 51.6±13.5. The result suggests that our method is useful for distinguishing between the performing and possible activities. The proposed method enables us to adequately recognize the problems each user has, and to set the rehabilitation target for each user, which can be shared between the user, care personnel, and care service provider.
RESUMO
To clarify the proposed support of home care in elderly-only households in a rural area in Japan, we analyzed the actual supplies of long-term care insurance services in February 2002. The insurance benefit receivers were classified into the following three categories: the aged living alone, elderly-only households and other kinds of household. Participating in this study were 502 users of long-term care insurance services (males; 160, females; 342, average age; 83, range; 54-100) in Asuke town, Shimoyama village, Asahi town and Inabu town in Aichi prefecture.<BR>In the 502 subjects, 79 lived alone, 82 in the elderly-only households, 341 in other kinds of household. Among them, there were no remarkable differences in the degree of necessity of long-term care. However, those who received various types of home services were 37 (46.8%) in the aged living alone, 62 (75.6%) in the elderly-only households, and 262 (75.6%) other kinds of household.<BR>In the aged living alone category, the number of those who received home services decreased rapidly as the conditions requiring nursing care were aggravated. However, in the elderly-only households and other kinds of household, the rate of home care remained almost the same even if the classification of the conditions requiring care was changed.<BR>Comparing the kinds of home services between elderly-only household and other kind of household, the rate of receiving home-visit nursing increased as the severity in the degree of necessity of long-term care became severes. On the other hand, the rate of commuting for day care decreased in other kinds of household but high in the elderlyonly households.<BR>These findings revealed that most of the care receivers in the elderly-only households were provided home care on a long-term basis by receiving home-visit nursing which reduces the anxiety of patients and their families and that commuting for day care that relieves families was popular in these rural communities.
RESUMO
To clarify what are contributing factors associated with the place to die (home or hospital) in a rural area, we investigated several background factors of 107 patients who died at home or in hospital after receiving home care service during the period of four years from July 1995 to June 2000. The subjects were divided into two group those who died at home (39 cases, 36%) and those who died in our hospital (68 cases, 64%). The ratio of deaths at home increased every year, and reached a half of those who died after receiving home care service. The average age in those who died at home were 87.1±9.5 years, that was higher than that of those who died in our hospital (82.2±9.8 years). There was no difference betwe two groups about sex, basic diseases and the time required to get to the hospital by car. Death at home was more preferred by patients, whereas death in the hospital was preferred by patients' families. The level of activities of daily living (ADL) in those who died at home was lower compared with that in those who died in the hospital. Those who died at home significantly had lesser complaints (pain, dyspnea and so on) and had more care-givers in the family, than those who died in the hospital. These results revealed that the major factors in death at home are: 1) low level of ADL, 2) preference to death at home expressed by patients, 3) presence of additional care-givers, and 4) no complaint of symptoms from patients.
RESUMO
To clarify characteristics of home care in rural areas in Japan, we investigated the actual status of home care in a rural area (Asuke town, Asahi town, Inabu town, northern part of Toyota city and Shimoyama village) in Aichi prefecture. The subjects were 149 patients who were under medical care and nursing supervision at home for the last 2 years and a half. Age, sex, ADL, prognosis, principal care-givers of the patients and distance from patients' houses to our hospital were compared with the average data of all the nurse stations in Japan (1996). The percentage of patients over 90 years old was 23.4% in this area as against 13.5% of the national average. Sex and ADL levels were similar to the average. The proportion of females as principal care-givers of patients was 80%, which is about average. However, the proportion ofdaughters-in-law was 51.7%, double of the national average. In 48 cases (32%), the time required to get to the hospital by car was over 31 min. This ratio was 3 times higher than that of the average data, and it took 50 min from farthest patient's house (35km). In prognosis, 66 patients died-44 cases (67%) in hospital and 22 cases (23%) at home.<BR>Our questionnaire survey regarding patients' and care-givers' wishes was responded to by 38 of 47 principal care-givers who utilized our home care and nursing survice program. One half of care-givers were over 60 yearsold and had taken care of a patient for over 5 years. Mental stress, feeding and toileting were major problems most principal care-givers cited. However, they required services at a day-care institution for elderly patients and recovery of used paper diapers. Death at home was wished by 23 (61%) patients and care-givers, if they received enough medial care and welfare services.<BR>These findings revealed that elderly people take care of elderly patients, their houses are far from the hospital and they wish to die at home. More collaboration among all providers of medical care and health and welfare services, and the establishment of an information network are necessary to improve these problems, resulting in safe, acceptable and satisfied home care for patients and care-givers.