[Current issues in access to care services for the elderly in Japan focusing on special permanent residents and foreign-born Japanese: A report by the Monitoring Report Committee of the Japanese Society of Public Health].

　Japan is currently one of the countries with a long life expectancy, in which a great number of older people need care for their daily living. Japan has become increasingly internationalized due to an increase in foreigners and international marriages. As the number of elderly foreigners and foreign-born Japanese increase, older adults who do not use Japanese as their first language will need more opportunities to receive care.　We examined characteristics such as country of origin, language spoken, lifestyle, living environment, and cultural background of elderly people who were either foreign permanent residents living in Japan or foreign-born Japanese (hereinafter referred to as elderly with an international background, in short, EIB) receiving care support. Ichushi-web, a medical literature database, was used [last search date: June 2, 2018]. These searches extracted 205 papers. After the first and second extraction procedures, only two papers matched this theme. These two reports were for Korean residents in Japan, so-called special permanent residents, and repatriates from China and their spouses, many of whom were aged 75 years old and above.　The number of permanent residents in Japan who speak a foreign language as their first language is increasing. Inhibition of communication between EIB and healthcare welfare service providers is expected to be an obstacle while accessing care support services. For this reason, we must provide them with information related to Japanese healthcare services. Medical interpretation efforts are scattered and the response to EIB in the event of disasters has been discussed. From the perspective of multicultural coexistence, it is necessary to provide long-term care insurance services and medical services to EIB. Such efforts may include development and sharing of tools and the placement of staff who can communicate with non-Japanese speakers. Staff must also understand various illness- and health awareness-related issues.　In the future, considering the increasing number of EIB who may require care services, we must consider cultural backgrounds and language diversification for EIB. These issues require clarification and development of acceptable solutions.

[Methods of coping with musculoskeletal pain among community-dwelling elderly individuals].

Objectives　Musculoskeletal pain impairs vital function and results in a requirement for long-term care. According to studies in other countries, a program that aims at reducing pain through instructions for pain-coping should be implemented. In Japan, a study on pain-coping has recently been initiated; however, the methods of coping with pain that are implemented by community-dwelling elderly individuals have not been evaluated. This study aimed to clarify the methods currently used for coping with musculoskeletal pain and to examine their association with the state of pain among community-dwelling elderly individuals.Methods　A survey was performed by sending questionnaires by mail to 2,281 community-dwelling elderly individuals. Responses were obtained from 1,835 people. The survey items consisted of questions about basic attributes and pain. A total of 16 questionnaire items regarding the methods of coping with pain were used for measuring pain-coping that community-dwelling elderly individuals use. The methods of coping with pain were classified into various types by factor analysis. The scores were calculated by type and their association with the state of pain was analyzed using one-way analysis of variance.Results　As a result of the factor analysis, methods of coping with pain were classified into five categories: "treatment in hospitals," "daily active coping," "restriction of daily behavior," "self-therapy," and "rest." From one-way analysis of variance for the site of pain, there was a significant difference between the "treatment in hospitals" and "restriction of daily behavior" categories. Among both scores, a higher score was observed in subjects with pain in both the lower back and the knee, compared to those with only pain in the lower back or the knee. Among the number of the sites, there was a significant difference between the "treatment in hospitals," "restriction of daily behavior," and "self-therapy" categories; subjects exhibiting two or more sites of pain showed a higher score than those exhibiting one site of pain. For pain duration, there was a significant difference between the "treatment in hospitals," "restriction of daily behavior," and "self-therapy" categories; subjects who had experienced pain for 5 years or longer had a higher score than those who had experienced pain for less than 6 months.Conclusion　We found that five types of methods of coping with pain ("treatment in hospitals," "daily active coping," "restriction of daily behavior," "self-therapy," and "rest") were used by community-dwelling elderly individuals and that "treatment in hospitals" and "restriction of daily behavior" were the most common strategies among elderly individuals with pain.

Risk factors of functional disability among community-dwelling elderly people by household in Japan: a prospective cohort study.

BACKGROUND: Although the number of elderly people needing care is increasing rapidly in the home setting in Japan, family size and ability to provide such support are declining. The purpose of this study was to identify the risk factors of functional disability by household composition among community-dwelling elderly people. METHODS: A total of 1347 elderly people aged 70 years and over participated in a baseline geriatric health examination for this prospective cohort study. In the health examination, we conducted an interview survey using a questionnaire in July 2004 and July 2005. Questionnaire items covered the following: age, sex, household, medical history, instrumental activities of daily living, intellectual activity, social role, Motor Fitness Scale, falls experienced during the past year, Dietary Variety Score, frequency of going outdoors, cognitive impairment, and depressive status. We defined the occurrence of functional disability as certification for long-term care needs of the subjects. The certification process started with a home visit for an initial assessment to evaluate nursing care needs using a questionnaire on current physical and mental status. The onset of functional disability was followed from July 2004 to March 2011. Cox proportional hazard regression analysis was used to estimate the risk factors related to the onset of functional disability, adjusted for age and sex. RESULTS: Of the 1084 participants, 433 were male (39.9%), and the average age was 77.8 (standard deviation, 5.4). Up to March 2011, functional disabilities occurred in 226 participants (20.9%). Elderly people living only with their children demonstrated a significantly higher risk for functional disability than the three-generation household group (hazard ratio, 1.61; 95% confidence interval, 1.08-2.40). The risk factors for functional disability varied according to household group. CONCLUSIONS: In Japan, the number of vulnerable households with elderly people in need of care has increased steadily over the years. Appropriately identifying the risks related to functional disability requires a means of assessment that takes the household composition into consideration.

The predictive power of physical function assessed by questionnaire and physical performance measures for subsequent disability.

BACKGROUND AND AIMS: To compare the predictive power of physical function assessed by questionnaire and physical performance measures for subsequent disability in community-dwelling elderly persons. METHODS: Prospective cohort study. Participants were 813 aged 70 years and older, elderly Japanese residing in the community, included in the Tsurugaya Project, who were not disabled at the baseline in 2003. Physical function was assessed by the questionnaire of "Motor Fitness Scale". Physical performance measures consisted of maximum walking velocity, timed up and go test (TUG), leg extension power, and functional reach test. The area under the curve (AUC) of the receiver operating characteristic curve for disability was used to compare screening accuracy between Motor Fitness Scale and physical performance measures. Incident disability, defined as certification for long-term care insurance, was used as the endpoint. RESULTS: We observed 135 cases of incident disability during follow-up. The third or fourth quartile for each measure was associated with a significantly increased risk of disability in comparison with the highest quartile. The AUC was 0.70, 0.72, 0.70, 0.68, 0.69 and 0.74, for Motor Fitness Scale, maxi- mum walking velocity, TUG, leg extension power, functional reach test, and total performance score, respectively. CONCLUSIONS: The predictive power of physical function assessed by the Motor Fitness Scale was equivalent to that assessed by physical performance measures. Since Motor Fitness Scale can evaluate physical function safely and simply in comparison with physical performance tests, it would be a practical tool for screening persons at high risk of disability.

The development of a Tai Chi exercise regimen for the prevention of conditions requiring long-term care in Japan.

This study was to examine an effect of such an exercise program on preventing conditions requiring long-term care in the Japanese frail elderly who participated in a Tai Chi Yuttari-exercise program. The first-intervention group underwent an intervention program by participating in a Tai Chi Yuttari-exercise session once a week for 3 months. Each session lasted 90 min including a break time. Moreover, the subjects received a video recording of the exercise, and instructions to carry out the exercise at home. The same program was administered to the second-intervention group. Physical function improved significantly in the first-intervention group, with single-leg balance (SLB) increasing, and trunk anteflexion increasing after the intervention program. Furthermore, the total score of the Motor Fitness Scale (MFS) improved significantly. On the other hand, mono- and multi-variate analyses showed no significant differences observed in the second-intervention group during the study period. A careful interpretation of the results suggests that Tai Chi Yuttari-exercise improves physical function and ability for frail elderly individuals and could reduce the need for long-term care.

Comparison of characteristics and care-needs certification proportion between participants and non-participants in a geriatric health examination over a 3-year follow-up.

The purpose of this study was to compare the care-needs certification proportion of participants and non-participants in a geriatric health examination targeting community-dwelling seniors aged 70 years and older over 3 years. We implemented a geriatric health examination for 1347 community-dwelling adults aged 70 years and older in a local region of Japan in 2004. We followed the occurrence of new care-needs certification for 3 years in 443 subjects who participated in the health examination and in the 395 non-participants. Among the 838 subjects, there were 94 new certifications (11%) during the observation period. Non-participants had a significantly higher proportion of dependent, required assistance with walking and bathing, a history of stroke, poor self-reported health, tendency for depression and outdoors less than once a week than participants. Non-participants had a significantly lower average score of the motor fitness scale (MFS), their standing time from a long sitting position on the floor and the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG Index of Competence). The proportion of care-needs certification over 3 years was significantly higher for non-participants (63/395, 16%) than for participants (31/443, 7%, p<0.05). Non-participants have a higher risk of care-needs certification. It is necessary to investigate current data gathering methods for seniors who do not undergo these examinations.

[Relationships between participation in community activities and psychosocial and physical health of community-dwelling elderly].

OBJECTIVE: The aim of this study was to clarify relationships between participation in community activities and psychosocial and physical health of community-dwelling elderly. METHODS: The participants of the present study were 413 people selected on the basis of a random 1/3 extraction of people aged 65 or older and living in a rural community in Miyagi prefecture. The baseline survey was conducted in February 2008. One year later, we conducted a follow-up survey to clarify how participation in community activities influenced the elderly. Finally, we analyzed data for 218 people, focusing on influences on psychosocial and physical health using the logistic regression model. The state of community activity was treated as a dependent variable, and mental and physical health indicators were assessed as the independent variables. RESULTS: Of the elderly sample, 63 persons were found to be frequent participants in community activities, 60 were infrequent participants, and 95 did not participate. The frequently participating individuals displayed significantly better results for declines in depression (OR = 0.34, 95% CI: 0.13-0.89), and social participation (OR = 0.12, 95% CI: 0.05-0.29), as well as the TMIG index of competence (OR = 0.26, 95% CI: 0.08-0.78) as compared with those who did not participate. CONCLUSION: These results suggest that community activities prevent deterioration of mental health, improve social health, and maintain higher-level functional capacity among community-dwelling elderly individuals.

Effect of exercise, aging and functional capacity on acute secretory immunoglobulin A response in elderly people over 75 years of age.

BACKGROUND: Age-associated decline in immune function and regulation, referred to as immunosenescence, brings about an increased incidence of infectious diseases in the aged; however, there are few data on the effect of aging and exercise on mucosal immune function in elderly people. Moreover, there is no evidence on whether the change in functional capacity affects mucosal immunity in elderly people. Therefore, the aim of the present study was to examine the effects of exercise, aging and functional capacity on mucosal immune function in elderly people over 75 years of age. METHODS: The subjects were 92 community-dwelling elderly women aged over 75 years who lived in a rural community in Miyagi Prefecture. The subjects periodically performed approximately 20 min of low intensity exercise. Saliva samples were collected before and after exercise, and saliva flow (SF), secretory immunoglobulin A (SIgA) concentration (SIgA-C) and SIgA secretion rate (SIgA-SR) were determined. The Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) was used to measure functional capacity. RESULTS: In comparison with before exercise, SF, SIgA-C and SIgA-SR were significantly increased after exercise in elderly subjects. In addition, when low and high value groups of resting SIgA levels were compared, acute SIgA responses were observed only in the low value group; however, there was no significant effect of aging and decline in functional capacity on exercise-induced SIgA response. CONCLUSION: These results suggest that resting SIgA levels influence the mucosal immune function response to exercise in elderly people over 75 years of age.

[Relationships between volunteerism and social-physical health and QOL with community-dwelling elderly participating in a long-term care prevention programme].

OBJECTIVE: The aim of this study was to clarify the influence of volunteerism as part of a long-term care prevention program on social and physical health indicators and QOL, as compared with non-participation among elderly people. METHODS: The baseline survey was conducted in 2003 among elderly people (age, 70-84 years) living in a rural community in Miyagi Prefecture. We recruited elderly volunteer leaders for long-term care prevention from among the 1,503 elderly people participating in the baseline survey. Of these, 77 individuals were registered as volunteer leaders. One year later, we conducted a follow-up survey to clarify the influence of volunteerism. Finally, we analyzed data for 69 volunteer leaders and 1,207 non-leaders, focusing on influences of volunteerism on social and physical health and QOL using a logistic regression model. State of volunteer activity was treated as a dependent variable, and social and physical health indicators and QOL indices as independent variables. RESULTS: Non-participating individuals had significant declines in Intellectual Activity (OR: 4.51, 95% CI: 1.60-12.74), Social Role (OR: 2.85, 95%CI: 1.11-7.21), Self-efficacy for ADL (OR: 4.58, 95%CI: 1.11-18.88), Satisfaction with Economic State (OR: 2.83, 95%CI: 1.11-7.21), and Contact with Neighbors (OR: 3.62, 95%CI: 1.29-10.16), as compared with volunteers. CONCLUSION: These results suggest that volunteerism prevents lowering of higher-level functional capacity and social networking among community-dwelling elderly individuals.

[Production of a fall prevention exercise programme considering suggestions from community-dwelling elderly].

OBJECTIVES: A fall prevention exercise programme, which elderly persons could undertake in their home alone to maintain and improve leg muscle strength, body balance ability and flexibility, was developed. The programme consisted of number of movements from which the best were selected on the basis of participant evaluation. The purpose of this report is to document the actual contents and an examination of the effects of this exercise programme in elderly people. METHODS: A total of 551 elderly persons, aged 75 years and over, not needing the support of elderly care insurance in S town, Miyagi Japan, were the subjects of this study. An intervention area and a non-intervention area were set in the study region. In the intervention area, 85 elderly people of high-risk for falls were selected to perform a longitudinal intervention study for one year. The selection criteria were as follows: 1) Maximum walking speed slower than median value, 2) Falls had been experienced in the past year. Forty elderly persons (15 men and 25 women) participated in the class. Thirty movements designed to improve flexibility, leg muscle strength, and body balance, and to prevent tripping were executed and evaluated. Effects of this intervention on participants in the fall prevention class were examined using a follow-up survey one year after the baseline survey. The outcome of the fall prevention exercise programme was measured in terms of incidence of falls. RESULTS: A final fall prevention exercise programme consisting of ten movements was produced by the intervention. In addition, seven movements using a chair were part of the exercise programme. METS of the exercise programme for students, leaders, and elderly persons were 3.41 +/- 0.37, 3.16 +/- 0.47, and 3.08 +/- 0.4, respectively. The incidence of falls over one year of the participants in the class significantly decreased from 48.4% at baseline survey to 25.8% at follow-up survey, but that of non-participants did not change. One-leg standing times with eyes open of the female participants significantly extended from the baseline survey to the follow-up survey, but not that of non-participants. CONCLUSIONS: This result of intervention suggested that incidence of falls was decreased by the execution of the exercise programme in twelve sessions of fall prevention class and at home.

[Characteristics of elderly leaders volunteering to participate in a fall prevention programme].

OBJECTIVES: This study was conducted to assess characteristics of elderly leaders volunteering to participate in a fall prevention programme. METHODS: We surveyed 1,503 individuals (75 elderly leaders volunteering to participate in a fall prevention programme and 1,428 non-leader elderly) among the elderly population living in a rural community, Miyagi Prefecture. Subjects were aged 70-84 years. The questionnaire covered socio-demographic factors, as well as physical, psychology and social variables. To analyze the characteristics of the elderly leaders volunteering to participate in this programme, the relationships of socio-demographic, physical, psychology and social factors to whether the elderly were leaders in the programme were analyzed using logistic regression. RESULT: As a result of multiple logistic regression analysis, the characteristics of elderly leaders volunteering to participate in the fall prevention programme were as follows; 1) being male (OR = 0.25, 95%CI 0.14-0.44); 2) young age (OR=0.43, 95%CI 0.25-0.73); 3) having a high intellectual activity (OR = 2.72, 95%CI 1.65-4.48); 4) being well satisfied with their health (OR = 1.45, 95%CI 1.02-2.07), and 5) having a high IKIGAI (OR = 1.06, 95%CI 1.01-1.13). CONCLUSION: Only elderly individuals capable of high-level intellectual activities can fill the roles of elderly volunteer group leaders discussed in this study.

[Effect of elapsed time after standing up on orthostatic blood pressure change in the elderly].

The effect of time elapsed after standing on the orthostatic change in blood pressure was investigated. The study subjects were recruited from 237 community-dwelling elderly residents free from any history of cardiovascular disease and not on medication. Basal blood pressure was determined by averaging two determinations of supine blood pressure measured with an automatic oscillometric blood pressure recorder after resting for more than 10 minutes. Orthostatic change in systolic blood pressure (SBP) was determined as more than a 10% increase or decrease in SBP after standing. In the total population, maximum change in SBP was observed at 1 minute after standing-up. However, 8.4% and 7.2% of subjects showed abnormal increase or decrease in SBP only after 3 minutes. These results suggests that orthostatic dysregulation of blood pressure could be evaluated by measuring at 1 minute after standing up. However, if abnormal variation of blood pressure was not observed at 1 minute after standing up, repeated measurement at 3 minutes would be necessary.