Aim: On observing present Japanese society, we can find deep gaps between the present system and its probable future. One of the gaps may be due to the misconception that future societal make up is not definite. The aim of the current study was to investigate a future societal structure and to develop methods of adding a timed dimension policy to the societal structure. This is named "A theory of structuralism economics".
Methods: We developed 3 societal structure projection engines and applied a system of dynamics language to estimate the future total population of Japan.
Results: The Japan total population reached a maximum in 2005, and thereafter depopulation begun. The populations in the younger working age group (from 25 to 54 years old) and those in the elderly working age group (from 55 to 84 years old) became almost equal in 2010. As economic growth rate depends upon an increase in the working population, the increase in national income rate of Japan approached over 10% per year between 1950 to 1970. The increased working age population of the same period exceeded 2.5% annually. However, after 2005 depopulation began in Japan. In future, national income will decrease proportional to the working age population, but personal national income will hold almost unchanged.
Conclusion: We propose a new strategy for future society structure. The working age should be extended by 10 years. Labor power will come to exceed 60% of the population and will thereafter become stable.

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Aim: With the purpose of gathering basic data in order to prompte various research toward the realization of a vibrant aging society, we performed a nationwide 'Survey on life' intended for citizens over 60 years old who engage in independent living, preserving their state of health even after retirement.
Methods: We created a survey form consisting of 14 question items. Processing 4,000 persons surveyed from 100 locations chosen nationwide, we obtained a total of 2,370 answers from both male and female subjects, with an effective recovery rate of 59.3%. We divided the respondents according to their age into four groups (group 1: 60-64 years; group 2: 65-69 years; group 3: 70-74 years; group 4: over 75 years), examined and analyzed them using multivariate statistical analysis followed by a summary of each response item.
Results: In the main aggregate results, the percentage living with a spouse indicated a double decrease in the 4th group of female respondents in comparison with male respondents, and together with that an increase of the living alone percentage identical with the one above could be seen. The subjective sense of health has gradually declined after peaking in group 1, while the number of persons complaining of poor health doubled as we moved to group 3 and group 4. Analysis of the factors that contribute to discrimination in each age category showed that health and economic items together with social participation items were extracted as the main determining factors. Economic anxiety is strong in group 1 and group 2, in particular, anxiety about the future life showed a tendency about two times higher in the female group rather than the male group of the same age category. The eagerness to contribute to society indicated a high tendency within the female group 1 and group 2. In the canonical correlation analysis of all age categories, the weight coefficient of physical anxiety and health anxiety within the male groups showed 1.95, respectively 2.52. On the other hand, economic anxiety and anxiety about future life indicated -1.97, respectively -1.70, showing large fluctuations on these four items. The female groups presented the same tendency. Items showing a high correlation with individual respondents, showed an increase of the wieght coefficients, starting with younger age, in the following order: 'state of health', 'mental and physical energy', 'desire to contribute to society', 'state of sleep', 'leasure activity', 'living with family', 'health anxiety', 'physical anxiety'. There was no distinction between male and female. Observing the aspects of the relative changes represented in the graphic in the order of the age category, searching for the avarage value of the weight coefficient of all individual respondents considering the four items that registered high fluctuations, within group 1 and group 2 under 70 years, the economic anxiety and anxiety about future life are strong, so that as we move to groups over 70 years, health and physical anxieties tend to emerge slowly.
Conclusions: The result of this survey suggested that for senior citizens, through all age categories, economic and health anxieties existing at various levels and under different aspects, will soon bring a large strain upon the mind of the elderly, turning into the main negative background factor which leads to a general decline of the mental health and the body, and what is more, the willingness to be active.

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[in Japanese]

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I examined the effects and problems of preventive care (the New Preventive Benefit) that was introduced to Japan's public long-term care insurance system in 2006, reviewing official publications of the Ministry of Health, Labor and Welfare and Japanese government as well as Japanese and English empirical studies on preventive care, using five pillars as follows. Firstly, I briefly introduced my previous literature review of preventive care in 2006. Secondly, I show five important points and pitfalls concerning economic evaluation of health services. Thirdly, I reviewed Japanese articles and publications that analyzed economic effect of preventive care. Fourthly, I reviewed English review articles on the effect of fall-prevention programs that are most widely analyzed among several preventive care. Finally, I showed that the Ministry of Health, Labor and Wealth "deflated" the estimation of cost that can be incurred by preventive care in 5 years (from 2006 to 2011). Based on these analyses, there is not yet solid evidence that preventive care can decrease the total cost of long-term care.

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[in Japanese]

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[in Japanese]

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Aim: The present study aimed to (1) examine the mental health well-being of urban community-dwelling elderly individuals; and (2) examine factors related to mental health well-being of those with long-term care insurance certification (LTCI+) and those without LTCI certification (LTCI-).
Methods: We conducted a community-based, cross-sectional study that included 3,905 subjects aged 65 years or older living in Tokyo, Japan. A self-administered questionnaire was mailed to each participant. Mental health well-being was assessed using the Japanese version of the World Health Organization Mental Health Wellbeing Index - five items (WHO-5).
Results: Of the 2,431 respondents (response rate, 63.5%), 1,954 who completed WHO-5 were analyzed (241 LTCI+; 1,713 LTCI-). The total score of WHO-5 was 15.61±6.08 among all subjects; when a cut-off criterion of 12/13 was used, the frequency of low mental health well-being was 29.5% among all subjects. In a stratified analysis according to LTCI certification using multivariate logistic regression analysis, small social support network, heart disease, and daytime sleepiness were independently associated with low mental health well-being for the LTCI+ group; low education level, small social support network, low subjective health, daytime sleepiness, and worries about forgetfulness were independently associated with low mental health well-being for the LTCI- group.
Conclusion: To improve mental health well-being of community-dwelling elderly individuals with LTCI certification, attention should be focused on those with small social network or daytime sleepiness. To improve mental health well-being of community-dwelling elderly individuals without LTCI certification, attention should be focused on those with small social network, low subjective health, or worries about forgetfulness.

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Aim: The oral management of dementia patients is critical to prevent aspiration pneumonia and maintain patients' quality of life. However, the oral health status of these patients has not been adequately elucidated thus far, and it is not well understood how oral care is managed for mild dementia patients. To provide effective oral management for mild dementia patients, we investigated their oral health status and how their oral care was managed.
Methods: We enrolled 10 outpatients aged 66 to 85 years old who regularly visited our neurology clinic. All of the patients had mild dementia. We conducted 2 questionnaire studies regarding oral hygiene and dentures and performed an oral examination to evaluate the changes in oral hygiene status over time. The questionnaire was designed to explore the understanding of oral hygiene methods. Oral care instructions were given to the patients and their caregivers. Three surveys of 2 questionnaires each were performed. The survey was conducted at the initial visit, and 3 months and 6 months later.
Results: Although oral care instructions were given to the patients and their caregivers, neither their plaque index nor gingival index showed major improvement over time. Based on the results of these questionnaires, patient awareness of oral hygiene did not change over time.
Conclusion: It is difficult for patients with mild dementia to perform oral care by themselves. It is important to make oral hygiene habits second nature in middle-aged patients, to introduce oral management to be performed by the caregivers and to promote early dental intervention to improve and maintain oral hygiene status in mild dementia patients.

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Aim: Pain management is vital for both the maintenance and improvement of the quality of life of residents, in Japanese long-term care facilities. However, few studies examining pain assessment in older populations have been published.
The purpose of this study is to investigate the actual conditions related to pain assessment of residents by nurses in Japanese long-term care facilities. Included in this investigation are the actual frequency of pain assessments, the nurses own perceptions of the pain assessment of their residents, whether or not nurses have undertaken any training related to pain assessment, and the need for a pain assessment training period.
Methods: A questionnaire was distributed to 487 nurses in 60 Japanese long-term care facilities.
Results: A total of 443 valid responses were collected. The data revealed that 74.7% of these nurses lack the confidence to suitably assess the residents' pain and 44.2% of these nurses do not conduct pain assessments on a regular basis. Additionally, only 9.9% of the nurses surveyed have participated in seminars concerning pain in older people.
Conclusion: The results indicate that over 70% of nurses lack the confidence to suitably assess their residents' pain. In addition, the number of residents who cannot self-report their pain because of cognitive impairment is increasing. Therefore, it is necessary to develop new approaches which provide nurses with sufficient knowledge and confidence to conduct appropriate pain assessments on their residents.

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Aim: The purpose of this study was to demonstrate the effectiveness of intermittent fluid infusion (intermittent rehydration therapy) to dehydrated elderly patients and the efficacy of Heisei Solution Water (HSW), an oral and enteral rehydration solution developed by our group.
Methods: We enrolled 375 elderly patients with suspected dehydration from among 1,921 patients of our hospital and 13 affiliated hospitals. A total of 36 of 375 patients received intermittent rehydration therapy. These patients were then divided into 3 groups according to the method of administration: (1) oral and enteral administration (n=16), (2) intravenous administration only (n=10) and (3) combined oral, enteral and intravenous administration (n=10). We then compared blood urea nitrogen/creatinine (BUN/Cr) ratios among the 3 groups.
Results: BUN/Cr ratios were improved in all groups, but there was no statistically significant difference in the degree of improvement of BUN/Cr ratios among the 3 groups.
Conclusion: Intermittent rehydration therapy is a highly effective way to manage dehydration. The intermittent oral and enteral administration of HSW demonstrated the same effectiveness as other forms of administration.

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Aim: Chronic cystitis in diaper-dependent elderly patients can be a causative pathology for recurrent urinary tract infections (UTIs) in community hospitals.
Methods: We analyzed hospital infections to determine causative organisms from January 2007 to December 2009 in patients in a long-term care hospital. The reading causes of hospital infections were UTIs (30.4%), aspiration pneumonia (CAP; 26%) and hospital-acquired pneumonia (HAP; 17.2%). Of a total of 3,097 hospital infections over the investigation period, UTIs were the most common (n=940, 30.4%) followed by CAP (n=809, 26%) and HAP (n=533, 17.2%). Of 278 UTIs in 2007, the causative strains were Escherichia coli (n=106, 38%), Enterococcus faecalis (n=44, 16%), Proteus mirabilis (n=31, 11%), α-hemolytic streptococcus (n=22, 8%), and β-hemolytic streptococcus (n=14, 5%). Extended spectrum β-lactamase (n=14, 13%) strains were noted in 106 patients with Escherichia coli. We then retrospectively examined the records of 110 diaper dependent elderly patients, (medical words, n=52, mix-care wards, n=68) for UTIs over the same study period. Of these 16 (14.5%) had no UTIs at any time, 12 (11%) were infected 50% of the time, 17 (15.5%) were infected 51% to 99% of the time and 65 (59%) were infected 100% of the time. The UTI rate was not correlated with bladder function or between the 2 wards. We treated bacterial cystitis with antibiotics for 3-5 days but these were unsuccessful. Antiseptics worked temporarily, but recurrence or re-infection always occurred. It remains unknown if diapers are a potential cause of chronic cystitis in dependent elderly patients. The clinical dilemma of whether recurrent diaper cystitis should be treated and prohibit the growth and spread of drug-resistant strains, remains challenging.

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[in Japanese]

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