The aim of the present paper is to make clear the concept and problem of geriatric medicine in Japan. Comprehensive geriatric medicine (CGM) is characteristic in medicine for the elderly. It means holistic and general practice for the elderly patients. Two major factors of CGM are geriatric assessment and team approaches.
Comprehensive geriatric assessment (CGA) is taking medical history and checking ADL. IADL cognitive dysfunction, depression and social factors. In Chubu National Hospital, Geriatric assessment unit (CGU) has started in July 1998. Our three major purpose are support for home care after discharge, treatment and care for patients suffered from dementia and rehabilitation for aged patients. Over 1000 patients entered this CGU. It was succeeded in assessment and team approaches.
Acute medicine is necessary in geriatric medicine, but chronic medicine is also important. Geriatricians are also taking care of comovities, or disabilities, and elderly patients have multi-organ damage. So rehabilitation, nutritional evaluation, and care services are very important in geriatric medicine through team approaches. Geriatrician should be active as a team leader. These activities are expected for the solution of the future problems in the super-aged society. Final our destination is to support longevity by highly sophisticated medicine and technology.

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The population in all over the world, also in Japan, is aging rapidly and nearly all countries will experience substantial growth in the size of the population over age 65 till the year 2050. Recent improvements in medicine and public health are now producing more rapid growth in the number of aged individuals. Growth of the aged population inevitably results in an increase in the number of cognitive disorders. Demented people will be more frequent in aged populations. But dementia is one of the disease, and differs from aging process.
Doctors, who diagnose and treat the demented people, need the knowledge of the disease, educate care-givers and cooperate with welfare work stuff. Adequate education and support for care-givers are quite important to lessen their burden. A primary care by the team approach can enhance the QOL for the patients and their families. So differential diagnosis and evaluation of each feature and daily life are quite important.
To conduct the medical service for the dementia, worthy of the national center, it is essential to form the functional group without regard to departments and occupations.

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The bone strength and load decide the occurrence of a fracture. Although it is difficult to obtain the bone strength strictly, bone mineral density that correlates highly with it can substitute it well. A main source of load for the elderly people is a fall that gives the load exceeding the bone strength of them. It is the basics of an intense rise of the fracture incidence in the advanced age period. Thus a method to control the bone strength is important to the prevention. The drugs that have not only positive effects on bone mineral density, but also the evidence for fracture prevention are increasing recently, while these will steadily decrease a fracture occurrence, there is still doubt whether a similar effect can be provided to the elderly people more than 80 years old. Furthermore, as the preventive method by control of load, there are fall prevention or a hip protector. A trial to prevent a fall by adjustment of the environmental condition and physical factors is very important. In addition, hip protectors are recognized as the means that can attenuate the load of a fall with the evidence for fracture prevention from the randomized controlled trials.

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Recently, there has been a resurgence of interest in the interactions between oral conditions and a number of prevalent systemic diseases. Aspiration pneumonia is common and costly especially independent elderly. The mortality that results from aspiration pneumonia is recognized as a major geriatric health problem. It was reported that professional oral care carried out by dentists and oral hygienists lowered the risk of pneumonia in the institutionalized elderly. However, professional oral care cannot always be carried out for the dependent elderly living in the community or for institutional elderly. The elderly person's ability to perform oral self-care decreases over time, and the role of the caregiver becomes increasingly important. Caregivers have a critical role in providing effective oral care. There is a lack of research on how to promote oral care for dependent elderly. The oral care provided by caregivers is not optimal because factors such as time constraints, difficulty involved in brushing another individual's teeth, uncooperative elderly, and the lack of perceived need have been identified. In addition, oral care has been carried out by the caregivers with inadequate vision and in an uncomfortable position. Therefore, the development of a simple and effective protocol for providing oral care (systematic oral care) for persons unable to adequately care for themselves is of importance. Few systematic oral care programs have been published in the literature, so caregivers often do not have adequate guidelines. Therefore, we have developed a systematic oral care program and a new oral care support instrument for elderly.

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One of the salient methodological issues attached to burden research is to objectively measure the degree of psychological burden of caregivers. Dr. Steve Zarit developed the Zarit caregiver burden interview in 1980, which has been widely used in North America. The lack of objective burden scales in Japanese led Dr. Yumiko Arai to devise the Japanese version of the Zarit caregiver burden interview. Currently, we have been conduction longitudinal studies in relation to caregiver burden in several communities located in different regions in Japan. So far, behavioral disturbances was identified as the most significant risk factor for worsening caregiver burden. Prior to the implementation of the long term care (LTC) insurance in April, 2000, it was shown that caregiver burden decreased over a year, indicating that the adaptation model can be applied in case of Japanese caregivers. However, the burden did not change between 1999-2000 despite the fact that there was a significant increase in the number of various services used. The following two reasons for this seeming paradox. First, the increase in the number of different services used may have created another mountain of tedious paperwork for some caregivers, if not adding to their burden, certainly not diminishing it. Second, the LTC insurance scheme recently requires a monthly premium as well as 10% co-payment (user charge) by each insured elderly person.This may well have translated into a greater economic burden for family caregivers.

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As an aged society, the development of assistive devices is urgently necessary. In this paper we present newly developed assistive devices in our department. As self-support devices, non-constrain monitoring in the home has been developed for the self-support device in the elderly. Portable accelerometer was developed for monitoring the physical activity and fall. Furthermore power-assist walker was evaluated for rehabilitation training. In the severe dementia patients doll and toy therapies are applied to heal the patient. Finally, we are planning to establish the division for evaluation of assistive devices for practical use.

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In August 2001, the committee to frame a ground plan of Longevity Sciences in Japan was established.
In order to survey systems of Longevity Sciences in Japan and another countries, and discuss what is an ideal system of Longevity Sciences and Medicine in Japanese future, the committee sent a study group to the United States.
The results of a study had good effects on the report of the committee, and it will play a important role for “National Center for Longevity Sciences”.

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This symposium was held to clarify the present status and the problems to be solved in future, in order to build up and complete the Net-Work system, working together with each member of the Respiratory Disease group at the present time.
The conclusions were:
1. We have to realize the electrical medical cards to be used in all Japan, using ICD 10 hereafter.
2. We have already set up the good co-operation system to collect the treatment results in the fields of tuberculosis and lung cancer. It was requested to set up the working system (net-work of the members to perform clinical studies), collecting many informations available to us.
3. It's eargent to set up the home-page in each institution, for example, offering Q and A (advice) services and showing how to consult doctors by information technology (including telephone service).
4. We have to make protocols of the standard therapy for each field of respiratory diseases in Japan.

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