In order to clarify the relationship between QOL and dialysis acceptance in elderly dialysis patients, an anonymous questionnaire survey was conducted on 154 elderly dialysis outpatients older than 65 years of age in Fukuoka and Saga prefecture using a dialysis acceptance level assessment scale, and the KDQOL-SFTM. The results showed that dialysis acceptance was significantly correlated with 16 of the 18 items on the KDQOL-SFTM.

Furthermore, multiple regression analysis (adjusted R²) indicated that cognitive function, dialysis acceptance affected daily living, and mental health. These findings suggest that a correlation exists between dialysis acceptance and QOL in elderly dialysis patients and that dialysis acceptance influences their QOL.

Acceptance of dialysis is needed to support QOL (dialysis acceptance affected daily living, cognitive function, and mental health), and this indicates its effect on the overell health of the elderly dialysis patients.

The present study examined the buffering and reducing effect of resources for negative appraisals of family caregivers. The mailed survey was conducted to550 caregivers. The dependent variables are three negative appraisal subscales, and the independent variables are the number of problematic behaviors of the elderly as stressors and positive appraisal variables. perceived health status of caregivers, social activity, assistant caregivers and visiting nurse services as caregiver resources. Correlation analysis and two-way ANOVA were performed in order to achieve the present study objectives. The results showed that (1) perceived health status of caregiver, 'affection toward the caretakers' and social activity reduced 'feelings of restriction of social life', and assistant caregiver and visiting nurse services partially buffered 'feelings of restriction of social life'; (2) perceived health status of caregiver, the three subscales of positive appraisal, and social activity reduced 'anxiety about continuing caregiving', and assistant caregiver partially buffered 'anxiety about continuing caregiving'; and (3) only 'affection toward the caretakers' reduced 'distress of the relationships with others'. In conclusion, the findings from the current study implied that caregivers for the elderly could empower themselves by internal resources such as positive appraisals as well as external resources such as assistant caregivers and visiting nurses.

We investigated mental health issues and related factors affecting care managers in ''Y'' Prefecture using various questionnaires, including the Japanese version of the 12-item General Health Questionnaire (GHQ-12).

The results are as follows:

①The care managers' average mark on the GHQ-12 measured 5.1 points, and the rate of poor mental health was 72.9%.

②By using multiple regression analysis related to mental health and including issues such as background, the number of care managers in an institution, stress factors named by Matsuyama such as 'lack of ability,' 'cooperating with senior staff and colleagues,' and 'working efficiently,' bewilderment factor was 'difficulty of maintaining relationships with clients,' weight of responsibilities, effect of training programs, care managers' sense of subjective health, and methods of coping withs tress in their accepted role using 'positive attitude,' 'resignation,' and 'control of one's action and feelings' approaches.

③Respondents indicated that their mental health would be "good" if there were more care managers in their institution, if they had greater "ability,'' if cooperation between them and their senior staff and colleagues improved, if they were able to work more efficiently, if they had more opportunities for further study in their field, if they had a better sense of subjective health, and if they relied on a 'positive attitude' approach to cope with stress. Mental health would decline if their sense of difficulty in maintaining relationships with clients were to increase, if they were given heavier responsibilities, and if they had to rely on a 'resignation' and 'control of one's action and feelings' approach to cope with stress.

Our results suggested that care managers' mental health could be maintained in a healthy state if they were able to work more efficiently, and by having more opportunities for continued study in their field.

The purpose of this study was to identify the sleep patterns and sleep perceptions of female caregivers who were providing routine night-time care for ventilator-dependent spouses at home. Ten caregivers (mean age =59.6 yr.) and 10 non-caregivers (mean age=59.8 yr.) participated in the study. Their sleep patterns were measured and compared by electroencephalography (EEG) that was recorded during the two successive nights at their home. Their perceived quality of sleep was measured by the Sleep Evaluation Questionnaire.

1) The caregivers were away from their beds more frequently (p<.01) and for longer periods (p<.01) in order to provide care during the night than were the non-caregivers.

2) The percentages of sleep stage 3 and 4 in each sleep cycle of the caregivers decreased drastically from the second sleep cycle to the third sleep cycle. In the third sleep cycle, caregivers had significantly lower percentages of 1-2 Hz EEG waves (p<.05) and significantly higher percentages of 12-13 Hz and 13-14 Hz waves (p<.05) than that of the non-caregivers.

3) The caregivers reported a significantly lower quality of sleep than did the non-caregivers.

These findings suggested that caregivers' sleep patterns (a decreased percentage of stage 3 and 4, or deep sleep, from the second to the third sleep cycle) were probably affected by frequent sleep interruptions due to providing care for their ventilator-dependent spouses. Such caregivers' sleep patterns were associated with a lower perceived quality of sleep and less satisfactory sleep.

The purpose of this study is to clarify the factors that relate to the health practices, mental health, and care burden of the primary caregivers in home-care.

As the result, the following was clarified.

Primary caregiver's mental health tended to be defective conditions compared with the person who had no one to care for.

In the following health practices, primary caregiver's mental health tended to be defective: irregular mealtime, midway awakening and insomnia, and little free time.

The state of depression was often found in the caregiver who was consulting a physician.

In the case in which the ADL independence level of the recipient was low and the recipient had symptoms of dementia, the primary caregiver's care burden was high and mental health tended to be defective.

The following points were suggested: it is necessary to secure the good mental health of the primary caregiver by preventing the worsening of conditions of the recipient. Support for the independence of the elderly care recipient and the securing of free time for the primary caregiver, are the necessary "elements" to improve the health practices of the caregiver.

The objective of this study was to investigate whether the daily-life behavior, support needs, and health-related QOL of the elderly living in a mountain area with heavy snowfall change depending on the season. We used a questionnaire to interview 136 subjects (age: 65 years or older) living alone or with other elderly family members and who did not receive Long-term Care Insurance Grade II or above services. The results indicated that seasonal changes were observed only in traveling alone by bus and natural disaster preparedness among the daily-life behavior evaluation items. Among the health-related QOL items, high scores were seen in energy and physical well-being in winter and in mental well-being in summer. In order to maintain both physical and mental well-being, it is necessary to provide support to resolve problems related to snow, to retain social contact in winter, and to help with health management and handle a variety of pains in summer

The purpose of this study was to examine the relation between consumer satisfaction on home help service and the effectiveness. Subjects were 124 users of home help service (41 men, 83 women, and average age was 79.0士9.6 years old). The factor analysis showed that consumer satisfaction with home help service was constructed of 4 factors. The logistic regression analysis was conducted by use of the 4 factors of consumer satisfaction, age, sex, level of care needed, number of home help service uses, and housing in order to find the factors that correlate with the effectiveness of home help service. Results showed that the 1st factor named "the polite attitude of helper and changes after service" and 4th factor named "the improvement of state by home help service" were significantly correlated to effectiveness. It suggested that users evaluate the home help service as an effective service when they were satisfied with good change in life, physical, or psychological status.

The purpose of this study is to clarify required home care during two months after discharge, by which elderly can most effectively recover, by clarifying the physical function and health status at two months after discharge to own home and home care provided for them during two months after discharge. Subjects are 68 elderly, aged sixty-five and over, treated at two hospitals in northern Japan and discharged to own home between November 2001 and August 2002. The data of the 52 included in this study were retrospectively obtained from medical records and structured interviews with them. In order to provide care adapted to the degree of independence, we analyzed the change of ambulatory ability during two months after discharge. Twenty-seven patients could walk without aids at prefracture. But only two could regain premorbid ambulation at two months after discharge. Five accessed home care services. In the meantime, seven have not walked since prefracture. At two months after discharge, they were in need of general assistance to live, that is to say, they became almost bedridden. Nevertheless they used only Day Service to take a bath and have lunch. These results suggest that it is essential for elderly with hip fracture to assess and make individual discharge plan for recuperating at home immediately after hospitalization, in order to promote their independence.

The purpose of this study being to conduct research on overseas literature concerning home visits provided by public health nurses in foreign countries, we collected overseas literature concerning home visits. Using the medical literature database of the U.S. National Library of Medicine, PubMed-MEDLINE, and searching literature with five key words, "health visitor," "public health nurse," "home visit," "home visiting," and "public health nursing," 157 items were retrieved. We extracted 66 literatures among them, excluding Japanese literatures and those without an abstract.

As a result, we obtained the following three results: ① More than half of the targeted literatures were American. ② Literatures that focus on the effect, evaluation, and model construction of home visits after the 1990's were found here and there. ③ As for the flow of the study on home visits in the United States as well as in other foreign countries, we were able to grasp the outline; that is, the study developed into the formation of an outcome index that indicates the effect of the visit. These results suggested that it is necessary to develop research on home visits further, as well as to try to more deeply understand their significance, although it seems that the number of home visit activities provided by public health nurses in Japan is declining.