Objectives: To explore the risk factors to locomotive syndrome among community-dwelling middle-aged people in an urban area and to suggest health promotion activities for the middle-aged.

Method: This cross-sectional study involved general citizens aged from 40 to 64 years in Yokohama City, with a self-administered questionnaire by mail and physical performance tests. Data were collected on presence of locomotive syndrome stage 1（LS）by index of stand-up test as dependent variables, demographics, physical characteristics（blood pressure, grip strength, body mass index（BMI）, perceived ill-health）, and social characteristics（scale of social activities, awareness of social resource）as independent variables. The logistic regression analysis was conducted to explore risk factors to locomotive syndrome.

Results: A total of 160 people participated in both primary and secondary surveys. The mean±SD age was 55.5±7.3 years, and 53（33.1%）were male. The prevalence of LS was 28.1%. The logistic regression analysis indicated that BMI（OR=3.75, 95%CI: 1.44-9.73）, perceived ill-health（OR=0.75, 95%CI: 0.57-0.99）, social activities,（OR=0.83, 95%CI: 0.70-0.97）, awareness of social resource（OR=3.76 95%CI: 1.69-8.37）were risk factors to LS.

Discussion: The present study demonstrated that 30% of middle-aged people are faced with the risk of locomotive syndrome. It is suggested that health practitioners should develop the interventions to modify or maintain lifestyle, and to create social activities for middle-aged people.

Aim: To investigate social activity and related factors among community-dwelling frail elders, leading to healthy longevity.

Method: A cross-sectional study via mail was performed in A City in Japan among community-dwelling frail elders. Data were collected on demographic characteristics, individual factors including sex, age, subjective well-being, household, medical history, and functioning, and environmental factors including the comprehensive environmental questionnaire, social resources of health information, as independent variables, and social activities as the dependent variable.

Results: The response number（rate）was 165（55.0%）, of whom 64.3% were female and mean age ±SD was 75.9±6.2 years old. The mean scores of social activities were 12.3±3.8（range: 6.0-18.0）. The multiple logistic regression analysis showed that the score of social activities significantly correlated with life management（β=0.547, p<0.05）, information and communication technology（β=0.398, p<0.05）and social information ability（β=0.697, p<0.05）.

Conclusions:To promote social activities among community-dwelling frail elders, community health care system including individual support and community development is needed in the future.

Objective: This study aims to elucidate the process of actual practice of visiting care before chronic-phase home care patients become aware of their potential needs.

Method: We analyzed semi-structured interview data from 11 visiting nurses, based on the Modified Grounded Theory Approach（M-GTA）.

Results and Discussion: From the results obtained, 24 concepts, 4 subcategories, and 4 categories were generated. While the visiting nurses made efforts to “satisfy patients’ basic needs by making full use of their expertise”, they also endeavored to “create time and space for ‘discourse’” within a limited timeframe. Focusing on “provision of visiting care practice that supports the ‘strength for living’ of home care patients”, such as involvement in which “nurses attend to home treatment patients by attaching importance to their wishes” and the promotion of “actual nursing practice to help raise the ‘strength for living’” of home care patients, the nurses made efforts to “encourage patients to be aware of their potential needs” in such ways as “making a plan for their future prospects” and “encourage their back gently”. In addition, nurses were found to have engaged continuously in “reflection on their visiting care practice” to confirm that their visiting care practice was not inflexible or patronizing.

Objectives: This study aimed to investigate the efforts of outpatient nurses to perceive the needs of home care support for patients in hospitals with 100 beds and over for general wards, and associations with the characteristics of the hospitals.

Method: We conducted a self-administered questionnaire survey by mail with 2,541 hospitals which had 100 beds and over for general patients.

Results: Data of 657 Hospitals were analyzed, and in347 hospitals that were “making efforts” to perceive needs. The characteristics of these hospitals were as follows; “They have stipulated medical fees for outpatient nursing”, “They have a system set up for patients to consult a nurse”, “They have a clear policy and philosophy regarding nursing in their outpatient departments”, and “Nurses are attending study sessions and making an effort to share their knowledge with each other”.

Conclusion: More than half of the hospitals made some kind of an effort to perceive needs. Those hospitals making an effort to perceive needs for home care support had a culture in which outpatient nurses were pro-actively working. The results showed that a hospital’s culture, such as creating policies and philosophies as an organization, and promoting the development of knowledge and motivation through study sessions, might facilitate the adoption of efforts to perceive need for home care support.

Purpose: The purpose of this study was to identify factors related to engagement in social activities among ADL-independent community-dwelling old-old elderly（75 or older）.

Method: The subjects were 998 ADL-independent old-old persons living in city A. An anonymous self-administrative questionnaire was distributed to the subjects by welfare workers, and collected by post. Valid response rate was 56.8%（567 persons）. Besides personal attribute items（sex, age, etc.）and 21 social activity index items, the questionnaire comprised 1 item on predisposing factors, 5 items on reinforcing factors, and 3 items on enabling factors based on Precede-Proceed model. The subjects were divided into high and low activity groups according to their social activity index scores, and logistic regression analysis was conducted with adjustment for personal attributes.

Results: The items significantly correlating with high social activities were social activity experience during the young-old period（OR=9.16, 95％ CI: 4.01-20.91）, expanding of relations with others within social activities（OR=4.14, 95％ CI: 1.52-11.31）, cognition of information about neighborhood activities（OR=5.92, 95％ CI: 2.35-14.91）, cognition of information about activities in the city（OR=2.23, 95％ CI: 1.11-4.48）, social network（OR=2.60, 95％ CI: 1.55-4.38）.

Discussion: Engagement in social activities among ADL-independent old-old elderly was found strongly correlated with their social activity experience during the young-old period, their cognition of information, and other factors. These results indicate the necessity of providing support for the old-old elderly in their social activities.

Objective: Family caregivers of persons with early onset dementia（EOD）experience a dilemma between the dedication to care for their spouse and their own changing future perspectives. The aim of this study is to examine how family caregivers of persons with EOD make decisions about patient discharge from a psychiatric facility.

Method: Participants included seven family caregivers of persons with EOD. We used an interview guide and conducted several semi-structured interviews. The interviews focused on exploring how family life changed after a person with EOD was admitted to a psychiatric facility, worries of the family caregivers related to discharge, and the decisive factor about the discharge for the family caregivers. It was a qualitative descriptive study.

Result: The results identified four categories, “liberated from the limitations by admission to psychiatric facility,” and “I have no choice but to undertake the responsibility of the person with EOD,” was a precondition, and, “realistic judgment of whether home care is appropriate,” “family caregiver’s life and facing the person with EOD”, integrated during admission and return, and decision-making about discharge place. In addition, “awareness of the surrounding environment to encourage the decision” was influenced.

Discussion: Families assessed their own meanings and orientation about older age on being separated from persons with EOD, when they were admitted to a psychiatric facility. Consequently, the families made the decision to get them discharged. Moreover, by recognizing the surrounding environment that encouraged the decisions, it helped in relaxing the heavy responsibility associated with decision-making.

Purpose: The aims of this study are to categorize the characteristics of, and evaluate the support requirements of cases requiring family support from visiting nurses.

Method: An anonymous, self-reported questionnaire was conducted among all nurses working in 68 visiting nursing stations in Prefecture A. Questions included client and caregiver characteristics, visiting time and frequency, telephone consultation frequency, duration and contents of family support, and visiting nurses’ perceptions of the efficacy of their support. Responses are for a client family requiring the most support time over a period of one month.

Results: A total of 178 responses were obtained from 223 questionnaires（response rate 79.8%）distributed to the 40 stations which cooperated with this study. Responses indicated that 18.8% of clients had cerebrovascular disorders, 21.8% were in three-generation families, and 59.9% were in a stable home health care environment. In terms of family caregivers, 64.9% had health problems and 82.6% were highly devoted to caring for their family member. Family support comprised 20.4% of home visit time. Despite recognizing a need, approximately 50% of nurses could not provide families with support for finances, interpersonal relationship advice, and end-of-life care. 15.2% of caregivers thought family support could be improved. Related factors were telephone consultation frequency, family caregiver motivation and care type.

Discussion: The health problems and family backgrounds were different in cases that required family support from a visiting nurse. Family support was estimated to comprise approximately 20% of home visit time. Inability to provide much required support suggests the need for better training and systems for family support.

Purpose: The objective of this study was to shed light on the experiences of spouses who were able to provide satisfactory home-based end-of-life care to their husband/wife with terminal cancer.

Method: We conducted an analysis using the modified grounded theory approach. The study participants were eight spouses who were satisfied with home-based end-of-life care that they provided in accordance with their husband/wife’s wishes.

Results: The caregiving experiences of spouses who provided satisfactory home-based end-of-life care consisted of three processes and eight categories. At the stage of ‘home-based end-of-life care selection and decision-making,’ spouses were “building a marital relationship that respects the patient’s desired way of living”, and “making tough decisions leading to home-based care”, which are mutually related. Next, at the stage of ‘independent caregiving for home-based end-of-life care for a terminal cancer patient,’ spouses “spontaneously acted to take on home-based end-of-life care as a spouse” and “expanded the limits of their sense of burden in order to provide home-based end-of-life care.” They did this by “obtaining support from visiting nurses” and “obtaining support from their primary care physician.” In doing this, spouses took action to “fulfill the wishes of the patient within the time they had left.” At the stage of ‘growth after end-of-life care,’ spouses “embarked on a new way of living as a bereaved person.”

Discussion: The caregiving experiences of spouses who provided satisfactory home-based end-of-life care had the stages of ‘home-based care selection and decision-making’ and ‘independent caregiving for end-of-life care for a terminal cancer patient.’ By analyzing the experiences of spouses who provided satisfactory home-based end-of-life care, we discovered an independent caregiving process. The results of this study could serve as reference for the promotion of home-based care for patients who are heavily dependent on medical care.