The current study analyzes the relationships between the achievements of care planning and care managers’ characteristics and between the achievements and human relationship factors such as relationships with service users and colleagues. The research design is a cross-sectional survey, and the response rate by mail was 53.4%( N=187). The participants in the study were af filiated with the A Association of Care Managers. Multiple regression analyses were performed in order to examine the relationships. The significant factors were particular professional fields, professional experiences, positive relationships with service users, other human resources, and colleagues. The characteristics of highly achieving care managers were : the professional fields were social work and care work, ample professional experience, and positive relationships with service users, other human resources, and colleagues.

The purpose of the current study is to examine factors related to case advocacy of service coordination in care management by using the structural equation modeling. The research design is a cross-sectional survey by using mailed questionnaire. The participants in the study are 400 care managers in the Kinki District. The care managers’ understandings of service user’s self-reliance, collaborations with other service providers, and support from their colleagues and supervisors were selected through a review of literature, as the related factors in the analysis. The data of 190 care managers was adopted. The results indicate that the model fitted the data and the service users’ self-reliance and collaborations with the other service providers are positively and significantly related to the case advocacy focused service. In addition, the collaborations are related to the service users’ self-reliance. The practical implication of the study is that care managers should assess service users’ conditions and understand the status of the users’ self-reliance in order to improve case advocacy of service coordination activities through the collaboration with other service providers.

In this study, we compared the physical, cognitive, and psychological functions of 146 elderly people with musculoskeletal ambulation disability symptom complex (MADS) (comprised of 14 males and 132 females, with an average age of 78.0±5.6) and 376 elderly people without it (comprised of 90 males and 286 females, with an average age of 71.2±7.0). The study was basic research for providing effective home care to prolong healthy life expectancy. We tested physical functions, such as walking ability (walking speed and the time it takes to walk along a 10-m obstacle course) and muscle strength (grip and quadriceps strength), cognitive functions with the Mini-Mental State Examination (MMSE) and Trail Making Test (TMT), and psychological functions, such as subjective health perception, life satisfaction, and quality of life. The results showed that elderly people with MADS were significantly older and comprised more females. On comparison by using analysis of covariance with adjustment for age and gender, significant differences were detected in walking ability (walking speed and the time it takes to walk along a 10-m obstacle course) and subjective health perception, but not in other categories. From these findings, we clarified that elderly people suffering from musculoskeletal ambulation disability symptom complex (MADS) have characteristic features of a reduced walking ability and a feeling of uncertainty about their health.

The purpose of this study was to clarify how elderly people living in the community perceive and cope with urinary incontinence. Study subjects comprised 10 elderly community residents aged 65 years and over who experienced symptoms of urinary incontinence. Data were collected via semi-structured interviews, which were then analyzed using qualitative and inductive methods. Four categories were identified to judge perception of urinar y incontinence: [no big problem], [hampers normal life], [embarrassing] and [unforeseeable concerns]. Regarding coping with urinar y incontinence, four categories were extracted: [keeping it a secret], [collecting information secretly], [taking precautions] and [accepting the fact that urinary incontinence will not improve]. It was found that elderly people try to cope with their incontinence carefully without seeking professional help. The results of this study suggest the possibility that urinary incontinence requiring precautions and treatment remains a hidden problem. The results also suggest the necessity of: awareness raising and dissemination of accurate information to enable elderly people to manage their incontinence appropriately, individual support for elderly people to enable them to consider with healthcare professionals how to cope with urinary incontinence, and cooperation with local medical institutions, to ensure that elderly people receive appropriate medical treatment when necessary.

The purpose of this study is to clarify how the dwelling style (living either at home or in institutions and not including the hospitalized) of elderly people requiring long-term care support is related to their mortality. The subjects were 2,141 elderly people over 65 years old (excluding those who are hospitalized), who were certified between April 2003 and December 2004 in a city as people requiring long-term care. The information on the subjects was taken from the data made by the Certification Committee of Needed Long- Term Care and the Basic Resident Register. The follow-up research was conducted until August 10, 2009 (the average follow-up research period is 5.7 years). We calculated hazard rates (HRs), using the Cox proportional-hazards model. Although the univariate analysis of the data reveals that the women living in institutions have high relative risk of mortality (1.86, p ＜ 0.001), the multivariate analysis, controlling for age, necessity for care, condition of bedridden subjects, progress of dementia and condition of disease, reveals that there was no difference in the mortality risk between the dwelling styles of living at home and in an institution; the mortality rate was 0.93 for men and 0.99 for women.

Our goal is development of “the urinary catheter management training program for visiting nurses”. Therefore, to clarify in which aspects visiting nurses have difficulty performing catheter management of long-term indwelling urinary catheter users, we carried out a questionnaire survey of 30 managers of home-visit nursing stations, using the placement method. When descriptive contents of the experience of dif ficulty were analyzed by Berelson’s content analysis technique, the following categories in the descending order of frequency were obtained: difficulty in assessment and handling of complications and troubles related to indwelling catheter use; difficulty in education of patients and caregivers; difficulty in the use of catheter-related materials; difficulty in cooperating with physicians; difficulty in catheter insertion and removal procedures; and difficulty related to catheter management by home care staff other than healthcare professionals. In order to provide an adequate training program, careful study of the contents and nature of the experience of difficulty is necessary.

The purpose of this study was to characterize the living environment that causes falls of the elderly, and also their coping toward the living environment at the time of the fall by investigating cases of women with age-related postural changes and the situations in which they had their accidents. We studied five elderly women with age-related postural changes living at home. Factors of the living environment that may have caused falls include dilapidated houses in which movements such as change of direction or standing up are frequently necessary, poor maintenance of the dwelling environment and disturbances of the living environment by complicated traffic lines. In order to compensate for difficulty in movement caused by postural change or illness, the subjects took specific actions to address their needs such as “standing up while touching the floor to support themselves,” or “rocking their bodies back and forth,” and interacted with furniture and small daily articles in the living environment in an active and flexible manner.

On the other hand, the subjects demonstrated coping strategies such as “the same as usual” toward their daily living activities: they avoided extra effort, for example, by standing up without the help of a handrail or using the vacuum cleaner without extending the power cord, and became less active in their living environment. It was shown that the aforementioned contradictor y behavior toward their living environment increased the risk of falls.

The purpose of this research is to study the functioning of elderly Parkinson's disease patients who are living at home by surveying differences in the vital functions under winter and summer climate conditions, and to obtain suggestions how such patients living in snow-covered regions can be best supported in their daily life.

The same survey was conducted in winter and summer among Parkinson's disease patients aged 65 and over, who are under home medical care. The purpose was to study and analyze their vital functions in the two seasons; valid answers for the analysis were obtained from 85 patients.

Statements, which showed a clear seasonal difference, were as follows: “My arms and legs get cold” received many positive responses in winter; and “I sweat a lot” received many positive responses in summer. Such symptoms as bradykinesia, a postural reflex disorder, and muscle rigidity were found in 70 to 80% of patients in both seasons. A seasonal difference was found in a group assessed as Stage 3 on the Hoehn and Yahr scale; there were significantly many positive responses to subjective symptoms concerning the difficulty of body movement in winter, as shown by statements such as “It is hard to turn in a different direction.” Since impediments to physical functioning are more likely to occur in winter, there is a need to offer support to prevent accidents and the decline of vital functions while focusing on the activities of daily living (ADL).

This study aims to identify the factors influencing the choice of place of recuperation at the time of discharge from the hospital and one year after discharge (referred to below as “one year after”). A selfadministered survey regarding living conditions one year after being discharged from the hospital was given to 156 patients discharged from the convalescence rehabilitation ward at A School of Medicine. The patients were more than 40 years of age and covered under long-term care insurance. Completed surveys from 102 respondents were used for analysis. Factors influencing the choice of place of recuperation at the time of hospital discharge and one year after were identified by binomial logistic regression analysis of activities of daily living (ADL), which included age, medical disorder, family structure, and degree of autonomy (mobility, going to the toilet, meals). Similarly, factors influencing the desire to enter a facility one year after were identified in 16 respondents.

Results indicated that the factors influencing hospital discharge were age, ability to go to the toilet unaided, and degree of meal autonomy. Degree of meal autonomy was a factor influencing home care one year after. Solitary life at the time of hospital discharge was the primary factor influencing the desire to enter a facility.

On discharge from the rehabilitation ward, the degree of ADL autonomy and family conditions were factors that influenced continuation of home care.

The purpose of this study is to clarify details regarding preferred discharge destinations and discharge planning services for patients with cerebrovascular diseases and their families in order to help to facilitate hospital discharge planning. In studying 71 cases of patients aged 65 or over who were admitted to the hospital for treatment of cerebrovascular diseases (and their families), we conducted a questionnaire survey of primary nurses regarding discharge planning offered to these patients. Of discharge planning services, more than 90％ of the subjects confirmed that there had been “explanation of prospective medical conditions to patients and their families,” “explanation of treatment policies to patients and their families” and “understanding and confirmation of preferred discharge destinations for patients’ families.”

When “there were differences between patients and their families in terms of preferred discharge destinations,” or “preferred destinations remained unknown,” many support services were provided. These included : “understanding and confirmation of the anxieties felt by patients and their families in relation to hospital discharge,” “explanation of services and systems available for patients and their families” and “searching for hospitals or facilities as discharge destinations, and negotiating and making adjustments with facilities.” In case of any differences between a patient and his/her family with regards to preferred discharge destinations, support should be focused on building consensus and helping the two parties to understand their feelings for each other.