The present study summarizes the features of the central and peripheral vision of elderly pedestrians who are judging when it is safe to cross the road in front of an approaching car. For the pedestrian’s central visual field, we investigated the effect of age on the timing judgment using an actual car. The results for daytime conditions indicate that the elderly pedestrians tended to make later judgments of when they crossed the road from the right side of the driver’s view at high car velocities. At night, for a car with its headlights on high beam, the average car–pedestrian distances of elderly pedestrians on the left side of the driver’s view were significantly longer than those of young pedestrians at velocities of 20 and 40 km/h. Cars with their headlights on highlights could be an effective countermeasure to keep the safety car–pedestrian distances of elderly pedestrians. When we focused on the eyesight of elderly pedestrians, the eyesight did not affect the timing judgment of crossing a road during the day. At night, for a car with its headlights on either high or low beam, the average car–pedestrian distances of elderly pedestrians having good eyesight were longer than those of elderly pedestrians having poor eyesight, for all car velocities. To correct the poor eyesight with glasses could also be an effective countermeasure for elderly pedestrians to keep safety car–pedestrian distances. The car-body color in the elderly pedestrian's peripheral vision affected the pedestrian’s awareness of the car.

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The purpose of this study is to clarify the mechanism of traffic accidents involving cyclists. First, cyclist behavioral characteristics were obtained at an intersection in a city in Tokyo, where cyclists’ collisions had often occurred. The major mechanism of the accidents involving cyclists was due to a combined effect of cyclist behavior, such as the average bicycle velocity of 3.09 m/s at the initial line of an intersection, and the low visibility due to a box-type building （an obstruction） at the corner of the intersection. Second, near-miss situations captured by drive recorders installed in passenger cars were investigated. Since the similarities of the approach patterns between near-miss incidents and real-world fatal cyclist accidents in Japan were confirmed, we analyzed the 229 near-miss incident data via video capturing bicycles crossing in front of forward-moving cars. The average time to collision in the cases where bicycles emerged from behind obstructions was shorter than that in the cases where drivers had unobstructed views of bicycles. When both a cyclist and a car driver have low visibility due to obstructions, they would have a higher potential to meet a car-to-cyclist accident. The present results might become a basis for the countermeasure to prevent traffic accidents involving cyclists.

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Emergency medical care is an important safety net for safe living within a community. However, the provision of medical care needs to be reformed owing to complicated social problems such as super-aged society, changes in household composition, and high mortality rates. The demand for emergency medical services has increased annually, and the number of people aged ≥75 years who require emergency conveyance has also steadily increased. In urban areas, however, most medical institutions that respond to emergency demands are private medical institutions, and over the past few years, the number of institutions that provide emergency medical care has decreased, for various reasons. Thus, elderly people have been forced to be transported to hospitals located far away from their community. Furthermore, they often face difficulty upon discharge home owing to the lack of a caregiver or dementia. It is therefore necessary to build a system wherein medical care is provided smoothly such that the community-dwelling elderly population feels reassured of their safety. A community-based integrated care system is defined as a system that comprehensively secures medical care, nursing care, care prevention, home, and daily life support such that the care provided enables the elderly patient to be independent as much as possible, depending on their abilities in familiar places, based on the situation in each area. If an elderly patient’s condition is not serious or life threatening, a community-based hospital first accepts the patient and preferably provides treatment. Physicians engaging in treatment at home and physicians working for a community-based hospital or the secondary emergency hospital will play a role as a conductor in the cooperation of the team in terms of the daily life of people within the community. After medical care is provided during the acute phase, the physicians working at highly advanced medical institutions will return the patient to medical care, welfare and life in the community. It is necessary for the physician to acquire the ability to provide general medical care and to have a wide perspective that can enable cooperation within and outside the community-based integrated care system. Among collaborative efforts to ensure social functioning that supports everyday life in the community, it is necessary that emergency medical care closely cooperate with various institutions to assist elderly people.

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To clarify pharmacy pharmacists’ responses to the prescription of drugs whose package inserts prohibit driving, we conducted a questionnaire survey involving a total of 497 pharmacists belonging to the Shiga Pharmaceutical Association between December 1, 2014, and January 15, 2015. As a result, 116 pharmacies provided completed questionnaires. The number of patients driving to pharmacies was considered to be “very high” or “high” by 78.5％ of the pharmacies. More than 50％ of the pharmacies always reminded patients about the influences of the following drugs on driving：antianxiety drugs, hypnotics, antiallergic drugs, agents to treat pain, antiepileptics, antidepressants, antiparkinson drugs, and antidiabetic drugs. When prescribing these drugs to patients aged 18 years or older, most pharmacies asked them whether or not they drove；however, 11 （9.5％） pharmacies did not usually do so. Concerning responses made when drugs influencing driving have been prescribed to patients who drive on a daily basis, 61 pharmacies stated that they provided patients with pharmaceutical education to direct them not to drive while on medication（prohibition of driving）, and 53 pharmacies made choices other than the prohibition of driving. The reasons why the latter did not provide pharmaceutical education directing patients not to drive included the：1） importance of strict medication adherence to treat their primary diseases, 2） no manifestation of expected side effects among patients receiving drugs from before, and 3） disruption of patients’ daily and social lives. Our findings suggest that, as the prohibition of driving hinders the daily and social lives of some patients, it is difficult to provide all patients with pharmaceutical education directing them not to drive. Depending on the drug and patient, it may be possible to prohibit them from driving when they begin their medication, and then to allow them to drive with care after confirming their conditions. To facilitate the prescription of drugs influencing driving, it is recommended to design detailed pharmaceutical education manuals that also give consideration to patients’ QOL.

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Recently, the proportion of elderly people has been increasing in Japan; with 25.0％ of the population aged 65-years-old or more. Furthermore, the number of solitary households is increasing. According to the data from the Japanese population survey in 2010, solitary households account for 32.4％ and represent the most popular category among the household types. The Japanese government defines solitary death as a “miserable death with no care that remains undiscovered for a long period”. Due to the ambiguity of this description, many surveys have focused on persons who live alone. We consider that living alone is not sufficient when considering solitary death, but rather, less communication with others is the most important factor. In order to quantitate the number of solitary deaths in Japan and determine effective intervention（s） to reduce these deaths, we investigated the postmortem interval to discovery of the death as an indicator of solitary deaths. We administered a survey to 448 elderly people aged 65 years or more in the Osaka Medical Examiner’s Office over three years, from April 2010 through March 2012, and we excluded suicidal deaths. Data were collected regarding gender, age, postmortem interval （PMI）, family structure, situation of discovery of the body, cause of death, and the interval from the last hospital visit to discovery. The elderly who lived alone were generally discovered more shortly after death than the younger deceased. Subjects who were male, unemployed and living alone were at higher risk of longer PMI. We found that regular referral to the hospital reduced the PMI. As the number of solitary households increases, it is essential to reduce the PMI for those persons maintaining a solitary household. We suggest that comprehensive measures are necessary, including waking the elderly people for work, as well as a system of regular hospital care and for frequent calls by caregivers, in order to reduce the PMI.

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Although the population of Japan is rapidly decreasing, the percentage of elderly people is increasing. In 2014, the number of elderly over the age of 65 reached the record of 330 million people or 26％ of the total population and is expected to continue to increase. On the other hand, the number of elderly people involved in bicycle traffic accidents comes in third largest, among those involved in in all conditions of traffic fatalities. In addition, elderly people make up the largest number of deaths in traffic accidents involving bicyclist of all ages. Hence, there is need for the prevention of traffic accident for elderly bicyclists. In this study, a Bicycle Simulator for evaluating the induction factor of traffic accidents was developed. A virtual traffic environment was developed using VR technology. Through simulation of road crossing, we were able to study the induction factor of traffic accident of road crossing while riding a bicycle, especially by elderly people. Using the Bicycle Simulator, we evaluated the actions of road crossing while riding a bicycle by 10 elderly and 10 youths. Elderly people have more accident in near lane, 2.4％ under the condition of 40km/h and 2.3％ under the condition of 60km/h. In addition, from the analysis of rear confirmation time of 3 seconds before road crossing, we found no significant difference between the rear confirmation time of elderly participants that met with accidents （Average 0.81 sec （s.t.d 0.06 sec）） and those not met with accidents （Average 0.66 sec （s.t.d 0.29 sec）） at near lane. However, participants that met with accidents at near lane is found to be facing to the front 1 second before road crossing. This shows the possibility of accidents caused by not carrying out ideal rear confirmation.

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Approximately for one in ten motor vehicle collisions, the cause of collision is due to the driver’s health problems. In some cases, the drivers subsequently die of the diseases. We evaluate the usefulness of Advanced Automatic Collision Notification system with real-world frontal collision cases. Among the forensic autopsies performed at Tochigi Prefecture through April 1998 to March 2014, 48 fatal drivers who had died of disease attack while driving were collected. In each case, driver’s back ground, cause of death, injury severity and information about the collision were surveyed. Most common cause of deaths was heart diseases （75.0％） and mean injury severity score of the drivers was 3.8. In 43 cases, subsequent collisions were occurred without taking avoidance maneuvers of drivers. Drivers in 5 cases could stop the vehicle after the disease attack. Among 43 collision cases, airbag was deployed in 3 cases. For the 37 cases in which airbag was not deployed or not equipped, mean time from collision to emergency call was 5.1 minutes, however, from collision to hospital arrival was 43.3 minutes. Because the airbag was not deployed in most of our series, the drivers may not be obtained the benefits of Advanced Automatic Collision Notification System. To save the drivers suffering disease attack while driving, development of further systems in which sudden changes of health problems of the drivers can be detected and immediately taking emergency notification is required.

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In accordance with aging in Japan, many vehicle drivers suffer from any diseases or symptoms. We investigated the inpatients, emergency room visitors and autopsied vehicle drivers who had suffered from sudden onset of diseases while driving. Because some of them had been involved in subsequent vehicle collisions, preventive measures were required. Our research team examined the prevention of these types of vehicle collisions. The medical staffs have to keep the driver’s health in good condition. The engineers have to consider further technology for avoiding uncontrolled vehicle’s collisions. Furthermore, based on the background of vehicle collisions, the comprehensive preventive measures are prepared. Therefore, our research team brought the proposal to prevent the driver’s health-related vehicle collisions. We hope this proposal might be used for the traffic safety in Japan.

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[in Japanese]

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