Purpose : To contribute to health maintenance and improvement in QOL of the elderly, we analyzed influence of various factors on dietary balance of the elderly including the use state of in-home health and welfare services which relate to dietary habits such as meal delivery service. Method : 10,538 of 70 years old or more were analyzed from the data of "At home counseling work supporting the strategy for reducing the bedridden elderly to zero in fiscal 1996" which All Japan Federal of National Health Insurance Organization had executed for "the elderly who might become bedridden" extracted by receipts in 75 municipalities of 10 prefectures. Dietary balance of the elderly was evaluated by the nourishment diagnosis score used by the National Nutrition Survey in 1990 and the each question which constitutes it. As the factors which exerted the influence on dietary balance of the elderly, the use state of home help service, day care, day service, and meal delivery service was taken up, in addition to sex, age class, health status, dementia's presence, family member, and receiving medical care, and the examination was carried out through the multiple logistic regression analysis. Result : The dietary balance in female was better then that in male and it in the elder was also better than that in the younger. Moreover, bedridden, dementia's presence, living alone, and non-receiving medical care were risk factors for good dietary balance. The dietary balance of home help service users was especially worse than that of non-users. Conclusion : Since none of at home services for the elderly which were taken up in this study did not show enough contribution for the dietary habits improvements of the elderly, we thought the necessity of appropriate dietary support to the elderly.

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Correlation between leisure time activities of working people aged over 50 years and general attributes (gender, age, educational background, presence of a spouse, income, self-assessment of health status, and treatment received at medical institutions) were evaluated. The subjects surveyed were a total of 1,110 people aged over 50 years (1,030 men and 80 women) working in six companies, each with more than 500 employees, located in Chiba Prefecture. Questionnaires to be filled out by each of the 1,110 employees were sent to the six companies. Responses were received from 590 (53.2%) of the employees (550 male employees and 40 female employees), and data obtained from these responses were used for analysis. The results of analysis indicated that both the amount and the quality of activities in the daily lives of workers approaching retirement age were insufficient. The results also showed that these activities were correlated with gender, presence of a spouse or self- assessment of health status.

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The purpose of this study was to clarify the relations between the professional skills and experiences as manager. The subjects were 1,036 professionals for health-social servicesrcare workers, home helpers, visiting nurses, physical therapists, occupational therapists and social workers. Professionals were asked to answer a questionnaire on "Evaluation of Professional Skills and Knowledge (EPSK, 79 items)", and expereinces as manager. The results were as follows ; 1) professionals as manager put significantly higher marks on EPSK than the others. 2) Factor analysis indicated the difference between professionals as manager and the others, such as "evaluation" related items. Further research must be done to promote effective education system for health-social professonals.

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The purpose of this study was to identify characteristics of a model district, potential residents' life style and health problems, and challenges on support of city planning and health programs. We conducted four focus - group interviews in 35 subjects including 9 representatives of self-governing committee in the model district, 16 of 18 district welfare commissioners who agreed to participate in the study, 10 "A" Health Center staff. The following results were obtained : 1) It was pointed out that restructure of community, a relation between old and new residents, home-bound and withdrawal may be deteriorated in the elderly along with an environmental change due to rebuilding of the housing complex. Preventative measures and support system such as emergency system and networking among residents are necessary. 2) Representatives of self-governing committee and district welfare commissioners had an ideal image as a supportive and friendly city to the elderly and disabled people. The study found that they took an important role as supporters of the residents' side for those who needed help. 3) Not only representatives of self-governing committee and district welfare commissioners but professionals in health center should support persons with dementia and mental disorders, and families with multiple problems. Challenges are sugested : (1) provision of health and living information to the residents, (2) clarification of consulting department and functions of each division, (3) information feedback among residents, administration and related agencies, (4) preventative support network and review of emergency system, (5) training and support of representatives of residents' side and health care leaders in the district, (6) participation of multidisciplinary and residents in the city planning with a broad vision, (7) systematic cooperation between residents and professionals for the ideal city planning.

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"Aiikuhan" is a voluntary organization in community which has established in 1936 and supervised by Imperial Gift Foundation Boshiaiikukai (Association for Maternal & Child Health and Welfare). Before the war, the main object of Aiikuhan was to decrease the maternal and infant mortality rate in rural villages, and the main activity was health education. But recently, urbarization and "too low birth rate problems" have covered all over Japan. Aiikuhan activities have to face on change of strategy. The history and recent activities of Aiikuhan are analyzed and importance of voluntary activities in community and also the way to improve the ability for child care in community are discussed. The main activities of Aiikuhan are classified four categories as follows. (1) Transmission of information on health services and knowledge to inhabitants : This activity has been found since establishment of Aiikuhan. Health professionals teach Hanin (members of Aiikuhan, usually hausewives who have experience of child care), and Hanin transmit the knowledge to inhabitants. (2) Self-help activities in community on health promotion : Activities to appeal the health promotion in the community are carried out by Hanin. Detection, recognition and solution of health problems in community such as prevention of diseases due to life stile are important self - help activities in community. (3) Mediation between inhabitants and professionals : Informations of persons who need support by health/social services or informations of problems on safety and wellbeing are reported to professionals ( mainly public health nurse) by hanin. Through this way, health professionals and local government can recognize the problems in community and make efforts to solve them. This type of activities has been increasing after 1970. (4) "Making friends" activities in community : In several communities, Hanin are making efforts to mediate between mothers who are feeling uneasiness on child care, and to organize mother's group. In other cases, "three generations exchange meetings" are organized by Hanin. As even in rural villages, exchanges between inhabitans each other are diluted by spreading urbanization, this type of voluntary activity is increasing importance.

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Town A loans or provides wheelchairs to 45 elderly residents requiring care in the home. An interview survey was conducted of these elderly regarding the use of wheelchairs and accompanying problems, after which the authors considered ways to support the use of wheelchairs from the standpoint of the respective characteristics of care-requiring elderly and family caregivers. 1) It was found that 36 elderly (80.0%) used the wheelchairs, and 9 (20.0%) did not. 2) Of those using a wheelchair, 27 (75.0%) used a common type and 9 (25.0%) used a special assistance type. No difference was seen for the operator, so it was considered that a wheelchair suited to the operator should be selected. 3) The wheelchairs were used outdoors by 25 people (69.9%), but the number of outings was significantly greater among the elderly requiring care who could operate the wheelchairs themselves than those who needed another person to maneuver it (p<0.05). The wheelchairs were used daily only by those elderly requiring care who could maneuver the chairs themselves. 4) The problems expressed by subjects regarding use of the wheelchairs included risk (15 people ; 33.3%), burden on the caregiver (19 people ; 42.2%) , environment problems (14 people ; 31.1%) , and other problems (11 people ; 24.4%) (multiple answers allowed) .These problems are thought to be related to a lack of ability or understanding of how to maintain a proper posture in the wheelchair, insufficient ability on the part of elderly or female caregivers, lack of proper facilities and environment for use, and poor understanding of how to use the wheelchair. 5) The period of wheelchair use is significantly longer among those who have experienced danger (p<0.05) and those who feel it is a burden on the family caregiver (p<0.05), indicating that a continuous evaluation of wheelchair use is required. 6) Most people made no attempt to deal with the problems encountered during wheelchair use. Among those who took steps were some who tied their body in some way so as to maintain posture. It is necessary to investigate methods of dealing with these problems to assure the quality of life among elderly requiring care.

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The purpose of this study was to clarify the factors related promoting carereceiver's self decision-making. The subjects were all the residents of 20 years of age and older in an agricultural village near a large urban center in the main island of Japan (n=3,539). Mail survey was done to get opinions on self decision-making by carereceivers and related factors. The results were as follows : 1) "Older people" were high risk for promoting carereceiver's self decision-making, 2) Those who thought the "family should take care of frail person" tended to think that the "frail person should obey the family's opinions", and the" frail person should endure", 3) Those who believed the "if family do not take care of the frail person, social stigma is extremely uncomfortable" tended to refuse self decision-making by care receiver, 4) Those who thought the "providing of help for frail person is a severe burden for the family" and tended to think that the "frail person should endure", and the "frail person should not express their opinions". 5) By logistic regression analysis, the risk for promoting self decision-making by carereceiver was higher among the people who thought the "family should take care of the frail person", "providing care is a severe burden for the family", and "if family do not take care of the frail person, social stigma is extremely uncomfortable".

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The purpose of this study is to obtain suggestions for planning social supports for the elderly people living alone. The survey was conducted in I-city, suburb of Tokyo. The sample size was 150 elderly people living alone, and the available data was collected from 102 samples by interviewing. The main contents of survey were the conditions of daily life, independent life, the conditions of physical levels, the receiving of social support (instrumental and emotional support) , and the condition of mental well-being. The functional conditions of physical levels were measured by the TMIG (Tokyo Metropolitan Institute of Gerontology) Index. The condition of mental well-being was measured by the GDS (Geriatric Depression Scale) Short Version for Japanese elderly people, and PGC Moral Scale. The results were as follows ; (1) The condition of mental well-being was related to 5 factors ; [Ownership of house], [TMIG Index score], [Convenience in daily life], [Social support], [Age]. It wasn't related to [the Conditions of physical levels], and [Existence of child]. (2) Therefore, it was suggested that the maintaining of functional conditions of one's independent life and the receiving of social support (instrumental and emotional support) were significant for mental well-being of the elderly people living alone.

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