Objects: Objects of this study are: (1) to determine the arm muscle circumference ratio compared with standard score (i. e., ％AMC) of elderly clients utilizing home care support centers and to evaluate their nutrition conditions; (2) to clarify their feeding behavior / attitudes in connection with ％AMC.

Subjects and Methods: Subjects were 59 frail elderly staying at home who utilized home care support center in Tokyo in a given period (i. e., from January through June in 1998).

The methods were: (1) to measure am muscle circumference and triceps skinfold thickness of the clients; (2) to interview clients to ask their feeding behavior / attitude using a questionnaire when interviews visited their homes in July through August in 1998.

Results: (1) %AMC of 32.2% of all the subjects was less than 90% of standard scores. (2) %AMC was lower for male compared with female, and the older the client was, the lower the %AMC was inclined to be. (3) Male clients with higher ％AMC associate with others and exchange information on health and nutrition more frequently through exchanging various kinds of foods compared with those with lower %AMC. (4) Female clients with higher %AMC show such tendencies as enunciating their own opinion requests concerning meals, cooking themselves, and inviting others to meals. (5) Clients with higher %AMC have a lot to keep in mind when eating: in other words, they are aware of the importance of eating.

Conclusion: Results above suggested that when we support elderly clients with regard to their dietary life, it is important to give careful consideration to human relationship between clients and caregivers. We also need to know whether the client can feel comfortable to make a request on meals, which helps to seek their independence concerning dietary life. It is also necessary to encourage them to eat together with family or other companions.

The objective of this study is to examine the differences in self-efficacy to the knowledge and skills related to care management for the elderly among registered nurses and care workers in home-based care centers. The study is based on a cross-sectional survey. The sample was a probability sample drawn from member’s list of home-based care centers. All respondents work in each home-based care center. The response rate was approximately 74%.

As a result, care workers had better understandings about the daily life of the elderly in a community than registered nurses. In addition care workers had better interpersonal and service coordination skills than nurses. On the other hand nurses had more general knowledge about health and mental health of the elderly than the care workers. The results indicated that registered nurses in home-based care centers had weakness in knowledge and skills related to home-based care in a sense of care management and they should recognize and overcome the weakness in order to improve the care management skills.

As consideration registered nurses in home-based care centers should recognize their own weakness in knowledge and skills related to care management and make effort in reducing the differences in order to enhance the cooperation among workers in home-based care centers.

The purpose of this study was to make clear the recognition of stroke patients and their families for walking ability, and factors that contributed the recognition of walking ability. We investigated the registrants of stroke patients aged 50 and over in Toyama prefecture. The subjects of this study were 300 patients randomly sampled out of all 589 registrants they were judged that walking ability were good on discharge by doctors and were alive at March 1995. The questionnaire was send and 210 (70%) were withdrawn.

The results were as follow.

1) Of all subjects, walking ability of 101 (52.3%) patients were recognized as “need care” by the patients and their families on discharge.

2) According to the results analyzed about the factors that contributed the difference of recognition of walking ability between doctors, and their families using a multiple logistic method, “need care on eating” and “need care on taking bath” were significantly related with the difference.

From this study, as for effective rehabilitation and care at home, medical worker should make more consideration about communication with patients and their families.

The purpose of this study is to identify a relationship between implementation of care plan and needs-resolution, and to clarify influential factors on implementation of care plan for effective care management. Subjects were 58 clients who received home care services for the first time and their care managers. Care managers followed up their clients for three months after making the care plan, and monitored changes of the care plans and client’s needs. As a result, 54 (93.1%) clients changed their care plans. Of 570 care plans in total for 58 clients, 491 (86.1%) were implemented. Of 491, 111 (19.5%) care plans were implemented with some revision. The needs-resolution / improvement rate due to the implementation of the care plan was 69.5% (341). Change of the client needs influenced the care plan revision. Effective care management can be achieved by monitoring needs-change, earlier revision of care plan, and a higher implementation rate of care plan.

This paper reports a retrospective study of care needs for discharged patients and their families. We clarified the structural factors of care needs to discharge for the patients with cerebral vascular disease and their families in hospitalization, and discussed with the relation of care needs and caregiver-burden of their families. At first, we interviewed directly with the family of the patients in order to make categories of care needs to discharge, mailed the questionnaire to other subjects (n=87) to obtain their thinking about care needs, and then analyzed the factors of care needs and the relationship, respondent rate 60.4% of care needs and caregiver-burden through non-parametric Kruskal Wallis test.

The results are as follows:

1) The care needs for the discharged patients and their families were summarized 41 items which consisted of 35 items of “Common care needs items” (4 factors) and 6 items of “Rehabilitation care needs items” (1 component).

2) The Factor II, Factor III and Component I were introduced to be important factors correlating with the care-burden score.

3) The care-burden score had relevancy to 20 items of “care needs” at the point of discharge and 13 items at the point of the investigation.

This study was conducted to clarify the main factors why elderly people had stopped receiving day service. Among the aged who had been registered receiving day service, two groups were selected: a group of 40 elderly women who stopped receiving day service (discontinued group) and a control group of 60 elderly women who regularly attend day service. A survey was conducted by leaving a questionnaire consisting of 20 items concerning various activities of daily living (ADL), instrumental ADL (IADL) and health states, reasons why they quit the service.

As a results of the study, it was found that ADL, IADL, and health states were significantly lower in the discontinued group than those of the control group. About half of the elderly in the discontinued group were described that “sick or disabilities” as the reasons for stopped receiving day service.

Consequently, it is recommended that care management be provided when they stop day service, because few people know or use about social resources.

Purpose: To clarify the function of nurse’s visits at night through the activity of a pioneer visiting nurse station.

Method: Subjects were all users through December, 1995 to the end of August, 1997 except children of a municipality-funded visiting nurse station which provides nurses’ visits in day and night by three shifts. Content of provided care to the users were collected from the records of care plan as well as home visits and compared to the statistics of the stations in all over Japan. Based on the data collected, care needs, the profession and time zone provided were described.

Results and discussion: 1) Eighty-nine subjects of all users of the station were older than that of the visiting nurse stations of all Japan, Also the rate of bedridden and cancer patients were more than all Japan. It means that this station could support more frai1 elders compared to other stations in Japan. 2) Through the content of care provided in each time zone by nurses and home-helpers enabled the quick change of service use and nurses’ correspond as well as providing medical treatment. 3) Thirteen percent of all users needed for night time visits. It was speculated that when the providing system for night visit was prepared, more than 10% of users needed night time visits. 4) More than sixty percent of users; 21 of 35 died at home.

Conclusion: Around-the-clock in-home nursing care enabled more clients stay at home through care for dying patients at home and quick response when clients get sick as well as providing medical treatment at home.

The purpose of this study was to determine to what extent the nursing staff and the medical staff agreed on the evaluation of the daily life of terminally ill patients who were cared for by nurses and physicians at home. Data was collected by survey methodology. The semistructured questionnaires with the T. Noguchi and I. Shono QOL state tool were sent to the nursing and medical staff who had jointly provided care for those patients. A Total of 12 cases were analyzed.

The findings are as follows: cases about which nurses and physicians agreed to a high degree also marked high on the QOL evaluation. Of the 13 items of the tool, seven maintained QOL till terminal stage; they were sleep, pain, diet, cleanliness, elimination, emotional stability, and right to choose.

What has turned out to be important is this. The nursing and medical staff who collaborated in caring for terminally ill homebound patients should first evaluate the quality of the care they provided separately and then minimize whatever differences between the two staffs in order to maximize the patient’s overall quality of terminal life.

Objectives: This article identified the factors relating length of time for a making a support network for demented elderly managed by district nurses. The examined factors included their abnormal behavior, mental symptoms and his/her caregiving situations.

Methods: Relationships between each abnormal behavior and mental symptom of 77 demented elderly and months required to accomplish a caregiving network were examined using t-tests. And so were examined with their caregiving situations. Seventy-seven demented elderly mainly from Tokyo and Tochigi, and some from other local places, were assessed to be middle level dementia or more serious ones by their nurses using Dementia Scale developed by Karasawa.

Results: Insomnia, delusion, and seclusion were promoting factors for making caregiving network for diet, excretions, communication and money administration. And so were the caregiving situations such as caregivers’ active attitude in applying social resources and being cared by family members who live with. Delaying factors in managing a support network concerning less frequency for a patient to feel uneasy or unpleasant were abnormal behavior such as aggressiveness, rejection of care, abnormal diet, and making mess with excretions, and delusion.