Background: Susami is a typical rural town of which about 5,000 with a 40% aging rate, located in the south of Wakayama prefecture. The needs with regard to medical care, nursing care and senior care has been increasing every year. However, there are few staff members involved in such care services. To take better care of our community, we developed the "Susami information sharing system." Methods: The subjects consisted of 2,600 people from Susami who provided their consent for their information to be shared. Using the information sharing system, the medical information, including prescriptions, infusions, imaging and laboratory data is automatically extracted from the electronic medical records at Susami hospital. Home nursing information is uploaded by a handheld unit by nurses at home nursing stations. Senior care information is also shared by care workers as part of the Susami social welfare association. Welfare information, including the results of basic medical examinations, cancer screening and vaccination data are uploaded by staff of the government office. Infrared motion sensors are installed in the homes of subjects living on their own to monitor their life activities. All information is collected by a shared host server through each information disclosure server. All information can be seen in the electronic medical records and PC monitors. Results: The Susami government office administers this system under an annual budget, 3,800,000 yen. Most of the budget is the maintenance cost of the infrared motion sensors. The annual administration expense for the system's servers is 680,000 yen. Conclusions: Because the maintenance cost is relatively low, it is not difficult for small-scale governments like that in Susami to maintain this system. In the near future, we will consider allowing other departments and practitioners to connect to our system. This system has strengthened both mutual understanding and cooperation between patients, health care providers, nurses and caregivers.
Aim: The purpose of this study was to investigate determinants of changes in physical fitness after a fall-prevention exercise program in older females. Methods: The study subjects included 83 community-dwelling females 65 years of age or older (mean age: 70.4±4.0 years) living in Kasama City, rural Japan. All subjects participated in a fall-prevention exercise program called square-stepping exercise (SSE) conducted once a week for 11 weeks. In order to assess the physical fitness benefits of by the exercise program, we measured the results of five physical performance tests: grip strength, one leg stand, sit and reach, timed up and go and the choice-stepping reaction time. In addition, we evaluated comprehensive physical fitness scores based on the standardized total score of the five physical performance tests. The changes in the comprehensive physical fitness score between baseline and after the program was used as the dependent variable, while the baseline values of age, education, clinical history, physical activity, Lubben social network scale, geriatric depression scale, five cognitive function test result, comprehensive physical fitness score and percentage of attendance were treated as independent variables. Results: A stepwise multiple regression analysis revealed that the change in comprehensive physical fitness score correlated significantly with the baseline values of age (β=-0.273), the five cognitive function test result (β=0.293) and comprehensive physical fitness score (β=-0.607). Conclusions: These results suggest that older females with a low level of physical fitness at baseline are more likely to improve their physical fitness with a period of exercise training. However, the improvements in physical fitness are lower in older females with a low level of cognitive function than in those with a high level of cognitive function.
Aim: We examined the relationship between the swallowing function and the health-related QOL (quality of life) among community-dwelling dependent elderly persons. Methods: The subjects included 191 community-dwelling dependent elderly persons. Data were collected via questionnaires, including information regarding age, gender, the level of care required, post-cerebrovascular disease, the health-related QOL and the swallowing function. We used the SF-8 to measure the health-related QOL and the DRACE (Dysphagia Risk Assessment for the Community-dwelling Elderly) to evaluate the swallowing function. Results: The average DRACE score was 4.29±3.81. In addition, the swallowing risk was found to be related to the SF (social functioning) and MH (mental health) subscales of the SF-8. Conclusions: Our results suggest that the swallowing function is significantly related to the health-related QOL among community-dwelling dependent elderly persons.
Aim: This study aimed to classify evaluation criteria for activity care perceived by nurses and caregivers at long-term care insurance facilities to be important. Methods: We distributed questionnaires by mail to chief nurses and caregivers at all special nursing homes and elderly healthcare facilities in five prefectures in the Chugoku region and enrolled 657 subjects in the analysis. Answers were given on a five-point scale indicating the perceived degree of importance of the evaluation criteria. Multidimensional scaling combined with a cluster analysis was used to examine similarities. Results: Clusters were identified in the following categories: 1) comfort, 2) spontaneity, 3) elimination of tension and 4) interactions with others. Mean values were allocated to clusters in order of the highest category: cluster 1 (4.48), cluster 2 (4.23), cluster 3 (3.95) and cluster 4 (3.48). The two-dimensional model exhibited good relevance (RSQ of 0.948). For dimension 1, "complexity," clusters representing simple-to-complex behavior were arranged based on the highest mean values. For dimension 2, "openness," the mean values were high for clusters 1 and 2, which were close to the middle. In contrast, cluster 3, which was at the upper end, and cluster 4, which was below the middle, exhibited low values. Conclusions: A two-dimensional structure and four clusters that could not be understood based on conventional activity care classifications were identified, thereby clarifying future directions for evaluation criteria. The subjective importance of evaluation criteria focused on the complexity of behavior and individual openness. Versatility, comprising visual comprehension and measurability, appeared to be used as a reference.
The Japan Geriatrics Society (JGS) published the JGS Guidelines for Decision-making in the Care of the Elderly Focusing on Indications for Artificial Hydration and Nutrition (AHN) in June 2012. While these guidelines have been implemented in medical practice, they have not pervaded the awareness of the common public, especially in the countryside. Therefore, we developed a set of guidelines and a support tool for the use of AHN in older adults in our community, northern Iwate Prefecture, Japan in accordance with the original guidelines. Our guidelines consist of three sections: "The wishes of the patient and his/her family members,""Evaluation of the patient's general medical condition" and "The selection of a facility for medical treatment." People from various occupations took part in our conference, including patients and their family members, attending doctors and nurses, social workers, speech therapists, nursing home staff and so on. The first and foremost priority is to consider whether the decision to extend a patient's life corresponds with that patient's own narrative. It is burdensome for non-experts to participate in a conference attended by a variety of professionals. Therefore, we created a support tool for introducing AHN in order to alleviate psychological stress among the participants of this conference. The tool consists of 28 items in which the participant is asked to answer all questions, in the expectation that this activity will reduce their mental burden. It is important to conduct such activities, as well as improve the quality of the content of the guidelines and support tool.