The purpose of this study was to clarify the factors related to care burden in the main family caregiver for elderly people with dementia living at home, and to gather basic data aimed at developing measures to deal with behavior disturbances in senile dementia. We distributed questionnaires to 177 caregivers of elderly people with dementia at home. The results were as follows:

1）A factorial analysis found 9 factors on behavioral disturbance.

2）There was a significant correlation between care burden of the caregivers and elderly people’s activities of daily living（ADL）, the severity of dementia, and behavioral disturbance.

3）Care burden was significantly higher in caregivers who were not healthy, who had a bad relationship with elderly people or who had to give care for more than three hours a day than in caregivers who did not. There was a tendency for caregivers who did not have someone to help them to have more care burden than caregivers who did.

4）Results of the multiple regression analysis indicated that behavioral disturbance, ADL, helpers for the caregiver, the nature of the relationship with elderly people and the amount of time given to caregiving each day were significant factors for care burden. Behavioral disturbance was the most significant factor influencing care burden.

As for the Investigation methods, of people who use the services of 5 home care support centers and 4 home nursing stations in Osaka Prefecture during past 1 year, 112 families having elders who need much care burdens were selected as the subjects. As a result, the average period of accepting the home care services has tended to be longer（4.4 year） as well as the average age of the people who are the main cares has tend to be older. In about 60% of cases, elder abuse was recognized.

As for the elder abuse some types of it were overlapping. The common factors in elder abuse（physical abuse, psychological abuse, a kind of neglect）appeared to be the badness of human relations, care burden, and economic problems. When the number of the related services were more than 4, care improvements were identified.

The purpose of this study was, to develop an algorithm of nutritional assessment and management in pressure ulcer management through standardization of judgement and care delivered by nurses in home health care setting. Self-administered questionnaires were sent to 315 active nurses who belong to 32 home visiting nurses stations. The questionnaires included items, which refer the guideline of pressure ulcer treatment by Agency for Health Care Policy and Research of the US department of Health and Human Services.

The response rate was 41.6%. The findings of this study showed that the home health care nurses employed the following items for nutritional assessment and management: 1）items related nutritional condition and factors influencing its improvement and their criteria, 2）ways to assess water balance per day, 3）physical and psychosocial health which may affect orally dietary intake, and 4）ways of dietary and water supplementation, The terms and numerical values by the use of the subjects on each item were defined as standardization or criteria. On the basis of these results, one algorithm was developed.

This algorithm requires further research to examine its reliability and validity.

The purposes of this study are 1）to establish home nursing skills based on the analysis of home nursing practice for elderly and 2）to identify challenges through interview of public health nursing in charge of home visits of all elderly people at home in K town.

The method: To analyze nursing skills based on the home visit records of K town, Gunma Prefecture in 1995 and 1997 and on the interview of public health nurses on individual patients. The interview also covered present status of patients’ care at home,family education on care and various ideas on practical nursing skills.

The survey results: 1. Forty-nine nursing skins in 9 categories were extracted. 2. The challenges for home nursing are prevention of fall and choking at home, establishment of daily routine, quick response to change of disease conditions, improvement of family education on care and treatment, psycological support to care givers and adequate use of institutional care.

We have been done the nursing intervention trial for people with disabilities using videophone system by the Integrated Services Digital Network （ISDN） telephone line（128 kbps）. The videophone allows two-way communication by simultaneously transmitting video and audio,Contents of the nursing intervention trial using videophone are the advise and instruction of physical exercise, advise and instructions regarding activities in daily life, the nutritional advise and instructions and emotional support for the subjects and families. After the nursing intervention for three-month period, we recognize the following effects:（1）Videophone communication is effective mean to get rid of the subjects’ sadness and loneliness. （2）Periodic videophone communication is effective to make the subjects’ attitude and activities in daily life positive. （3）Subjects’ social interaction include conversation is increased by videophone communication.

Home care using video-telecommunication has a possibility of unique nursing technique with new quality.

On home health care, visiting nurses cooperate with other health care workers in taking care of the clients. In order to clarify the role of visiting nurses who work with other specialists in home health care, we analyzed the roles and performances of the nurses and the other health care workers in helping clients keep clean, solve their problems, and cope with emergencies, as those were the typical instances where the above professional people worked in cooperation. In the analysis, we considered the seriousness of the clients’ illnesses and/or disabilities, contents of care services, commitments of the clients’ family members, family support systems, and the background of visiting nurses and other nursing staff. Our survey subjects were visiting nurses and home care helpers who worked at home care stations in K City and its suburbs. We conducted individual face-to-face interviews in ten cases. As a result of the study, we have found out the following : the care provided by visiting nurses was focused on the clients’ physical health, as they worked with other health care workers : their role may be defined as that of a health care coordinator, owing to the fact that they convened meetings for other staff when necessary and they provided the other staff with necessary information and guidance to facilitate their cooperative work.