A case-control study on factors relating to discontinuation of domiciliary care for the bedridden elderly in a metropolitan area]

A case-control study was conducted to examine factors relating to discontinuation of domiciliary care for the bedridden elderly in Shinagawa-ku, Tokyo. Cases were bedridden residents aged 65 years and over who had abandoned home care and applied for admission to live in a special nursing home for the aged between April and September in 1990 after being recipients of welfare allowances for disabled elderly. Controls were bedridden residents who continued to be given home care and matched to cases by sex, age and beginning month of the receiving of allowances. Among 50 cases and 94 controls interviewed, we obtained responses from 31 cases (62%) and 60 controls (64%). The main results were as follows: 1. During the home-care period, ADL (activities of daily living) of cases, especially walking ability, deteriorated more severely than in controls. Night delirium also appeared more frequently in cases. 2. The primary caregivers of cases were older than those of controls. Remarkable differences between cases and controls were observed in the family structure, the number of family members and the number of sub-caregivers. Cases tended to live alone or live with a spouse only, and with smaller number of family members and caregivers. 3. Case lived more frequently in houses with small numbers of rooms and without rooms of their own. 4. As regards utilization of domiciliary care services, cases used dispatch of home helpers more frequently and used day services less frequently.     

Epidemiological factors affecting place of terminal care and of death in the elderly

To clarify the factors associated with the location where terminal care and death occurs in the elderly, we conducted interviews of family members who had cared for elderly persons who died from cerebral infarction in Fukui City, Sabae City, and Oono City in 1985. Subjects selected had conscious levels that were clear or Level 1 on the Japan Coma Scale at the onset of disease and whose debilitation had exceeded six months. We evaluated the characteristics of three groups, Group 1 comprising 21 subjects who had died in a hospital after both institutional and home care, Group 2 being 30 people who had died at home after a similar course of treatment as Group 1, and Group 3 being 18 subjects who had died at home after non-institutional care. In Group 1, elderly spouses of the subjects performed a larger part of the care than in the other groups. Caregivers who were members of the same household as the subjects had higher rates of having jobs other than housekeeping and of receiving medical treatment for some disease in Group 1 than in the other groups. Subjects in Group 2 received relatively more care in their own households and obtained greater amount of medical service assistance. Subjects in Group 3 experienced the least amount of disturbance in daily living activities, the shortest period of debilitation, and had the most household members able to take care of them.(ABSTRACT TRUNCATED AT 250 WORDS)     

Health policy in transition: terminal care and site of death in Japan

OBJECTIVES: In Japan, hospitals have replaced homes as the predominant site of death, especially for the elderly. Site of death is a reliable indicator of where older people receive care before they die. We conducted a population-based study to identify the factors that determine site of death in a typical rural area in Japan. METHODS: Study subjects were residents of Kawakami town, aged 70 years or older, who died during 1981 and 1990. Death certificates provided information on age, gender, cause of death, duration of illness before death, family members, family occupation, and site of death. RESULTS: Among 455 subjects, 52.7% died at home, while 47.3% died in hospital. Multiple logistic regression analyses indicated that subjects with cancer were 6.1 times more likely to die in hospitals than those with other diseases. Subjects who died in their seventies were 2.3 times more likely to die in hospital than older subjects. Members of non-farming families were 1.7 times more likely to die in hospital than members of farming families. Gender, duration of illness, and the presence of spouse or children in the household were not significantly related to site of death according to multivariate analyses, although trends did exist. CONCLUSION: This case study illustrates the importance of developing geriatric care systems in Japan, utilizing alternatives to hospitals, such as nursing homes and formal home care. This is particularly true for patients with cancer. As the older population rapidly increases in Japan, the need for alternatives in geriatric care grows more critical.     

慢性病老年人养老方式选择的影响因素研究

目的 了解慢性病老年人养老方式选择的影响因素,为其提供合适的养老方式。方法 通过多阶段分层抽样调查厦门市60岁及以上常住老年人的人口学资料、养老方式选择及慢性病患病情况等,采用χ2检验和多分类Logistic回归分析慢性病老年人养老方式选择的影响因素。结果 1 276名老年人中慢性病患病率为61.4%,慢性病老年人（相比未患慢性病老年人）选择社区居家养老和机构养老的比例均较高。以家庭养老为参照,慢性病老年人选择社区居家养老与机构养老的影响因素分别是与子女关系、居住地、文化程度、婚姻、孤独感,独居、与子女关系、文化程度、年龄、居住地。结论 慢性病老年人养老方式选择仍以家庭养老为主,但较未患慢性病老年人低。独居、年龄、婚姻、居住地、孤独感是慢性病老年人养老方式选择特有的影响因素。     

Characteristics of "Tojikomori" and "Tojikomerare" among home disabled elderly: daily life of housebound elderly

BACKGROUND AND PURPOSE: A Japanese word Tojikomori means shutting oneself in a room or house, or generally withdrawing. It has been pointed out that Tojikomori results in a decline in mobility among disabled elderly living at home. As a result of the qualitative study, we have attempted to define two types of Tojikomori. The first type, or the narrowly defined Tojikomori, is the elderly who are housebound-inactive but have a high mobility level. The second type, Tojikomerare (the passive of Tojikomori), is the elderly who are housebound-inactive because of their low mobility. The purpose of this study is to describe characteristics of Tojikomori and Tojikomerare. METHODS: 321 disabled elderly (male: 122, female: 199, mean age 78.8) were interviewed at home by nurses in Wajima City, Japan, in 1998. The subjects were selected from the list of used in a screening survey, the Whole Wajima Elderly Survey. Mobility, life space, activity, physical function, psychosocial factors, caregiver's burden and caregiver's care to elderly were measured. The Tojikomerare subjects were operationally defined as the housebound-inactive elderly who were unable to walk. The Tojikomori were identified as the housebound-inactive elderly who were able to walk 5 yards but were unable to take a bus. RESULTS: Results obtained were as follows: 1. Housebound were not found among elders able to go out bus. There were 16 Tojikomori (10.1%) in subjects who were able to walk 5 yards (n = 153). Among the subjects who were unable to walk (n = 72), 49 people (68.1%) were classified as Tojikomerare. 2. The physical function, autonomy and social network of the Tojikomerare subjects were lowest among subjects unable to walk. They used day care least and received least care from their caregivers. In addition, their caregivers' burdens were modest. 3. Among the elderly who were able to walk 5 yards, autonomy and social network of the Tojikomori ranked lowest, although physical function was not low. CONCLUSION: Tojikomerare had lowest physical and psychosocial function, but they were cared for the least by caregivers. Tojikomori had the lowest psychosocial function among elderly who can walk 5 yards. The results suggest that it is important to evaluate the mobility, life space, and activity of the housebound elderly when providing community-based services.     

Mortality of frail elderly people living at home in relation to housing conditions.

STUDY OBJECTIVE--The study was undertaken to identify any relationship between the mortality of frail elderly people living at home and their housing conditions. DESIGN AND SETTING--A cohort of frail elderly people living in Yao City, Osaka Prefecture, Japan was followed for six years. Data on demographic variables, activities of daily living, the disease that was the main cause of the disability, medical treatment, the feasibility of continuing family care, and some housing conditions were collected in December 1983 by interview during home visits. Deaths were checked for each year for five years. SUBJECTS--Altogether 423 people aged 65 years or more living at home in Yao City who were disabled and housebound for at least three months were studied. MEASUREMENTS AND MAIN RESULTS--Life table analysis and multivariate logistic regression analysis were done. The cumulative survival rates of old people with good housing conditions were higher than those with poor housing conditions in each group stratified by age, sex, or the activities of daily living level. The odds ratio for poor housing conditions compared with good housing conditions for five year mortality remained highly significant after adjustment for potential confounding factors including age, sex, and the activities of daily living level by logistic regression analysis. CONCLUSIONS--The mortality of frail elderly people living at home is affected by housing conditions. Programmes to improve housing conditions of the disabled are important for home care of the elderly.     

A study of family support, health state and medical care among functionally dependent elderly in Shanghai, China]

The effect of family caregiver's attitudes to elderly on health conditions of functionally dependent elderly, relationships between family support and perceived burden among family caregivers, and factors related to family support were analyzed. Support in this study was defined as help directed at helping functionally dependent elderly achieve independence or self-care. In 1989, a survey was conducted of family caregivers in Shanghai. Functionally dependent elderly were collected by screening of people aged 65 years old and over, and family caregivers who were able to provide support as defined above were included as subjects (n = 468). The following results were obtained: 1. Caregivers with positive attitudes for support had a higher proportion having the ability to obtain physician care compared to those with low family support. The proportion of persons with bedfast condition, cognitive impairment, and abnormal behaviors did not appear to have a relationships to level of family support. 2. There was only a weak relation between family support and perceived burden scale of caregivers. 3. Among all factors, the strongest relationship to family support was with educational background. The health of caregivers and the family relationship between caregivers and functionally dependent elderly were also related to level of family support.     

空巢老年人养老方式选择及影响因素研究——以徐州市为例

目的 探索空巢老年人养老意愿及其影响因素。方法 采用分层整群随机抽样的方法,采用自行设计的问卷对徐州市城乡社区60岁及以上的空巢老年人进行入户调查;采用χ2检验与多分类Logistic回归分析老年人养老方式选择的影响因素。结果 调查的1 176位老年人中,选择家庭自我养老、机构养老、社区居家养老的老年人分别占73.5%、11.9%、14.6%;居住在城市、有离退休待遇、配偶健在的倾向于选择家庭自我养老;高学历、独居、身患多种慢性疾病的倾向于选择机构养老;对子女尽孝评价较低的倾向于选择社区居家养老。结论 空巢老年人养老方式选择还是以家庭自我养老为主,应保护和提高空巢老年人自我养老能力,同时根据老年人特征与需求,加强养老机构的分类服务建设,积极寻找社区居家养老存在的问题并加以改进。     

Four-year follow-up study of self-rated health and life satisfaction among caregivers]

Changes in self-rated health and life satisfaction among caregivers of elderly and factors associated with the changes during a four year were investigated. The sample in the baseline survey consisted of persons randomly selected from recipients of welfare allowances for disabled elderly in two communities in Tokyo. A total of 152 persons were identified as living at home at the time of the first survey and 94 persons were surveyed. In a follow-up survey after a 4-year interval, 73 persons were followed. The main results were as follows: 1. Of the 73 original caregivers, 28 persons continued to give care, and 45 stopped caregiving activities. 2. Among those persons who had been cared for by the 45 caregivers who reported stopping care giving activities, 41 had died and 4 were placed in nursing homes or hospitals. Of the elderly who had died, 60% had been admitted to hospitals, with deterioration of the elderly persons' health being the biggest reason for hospitalization. 3. No significant changes in either self-rated health or life satisfaction were seen after the 4-year interval in those caregivers who continued giving care. Persons who terminated caregiving had an increase in self-rated health in comparison with the original survey. 4. Where self-rated health declined among those continuing giving care, the decrease was related to decrease of cognitive ability of the elderly. A decrease of cognitive ability of the elderly, and also low social support and negative perception regarding caring for the elderly at the baseline survey, was associated with reduction in life satisfaction. 5. Among 45 subjects who terminated caregiving, persons who had low economic backgrounds at baseline, had low improvement of life satisfaction. Persons who did not have jobs had increase in self-rated health.     

Board and Care Castaways

Board and care homes for the elderly offer a protective housing option. However limited resources and an increasingly disabled population have put severe stress on these facilities. This study looks at the boundaries of board and care in a California sample by comparing case examples of problem residents who were asked to leave. Results from a discriminate low analysis show those expelled have more personal care needs, fewer social skills, less family support and that the home has fewer resources to deal with the particular resident. Both groups have similar number of health and behavioral problems. Findings suggest additional resources for non-medical, maintenance care are needed to extend stay and prevent nursing home admission.     

Health conditions of caregivers of elderly living at home and the influence of factors present in the home care environment]

Health conditions of primary caregivers for elderly aged 65 and over living at home were surveyed. Subjects were 167 caregivers in Osaka prefecture. Results obtained were as follows. 1) The primary caregivers were largely associated with and varied with the sex of the cared elderly. The caregivers for the female elderly were almost daughters-in-law or daughters. The caregivers for the male elderly were mostly their elderly wives. 2) Seventy-five percent of the caregivers had health complaints, such as anxiety for health, physical fatigue, lower back pain, sleeplessness, or emotional fatigue. 3) Logistic regression analysis was used to statistically analyze factors in the home care environment. Health conditions of the caregivers showed significant correlation with age of caregivers, sex of the elderly, degree of dementia, and number of family members.     

Physicians' outcome predictions for elderly patients. Survival, hospital discharge, and length of stay in a department of internal medicine

In order to study physicians' ability to predict survival, site of living after discharge, and length of stay in a hospital department of internal medicine, five physicians rated a total of 156 patients 65 years of age and older, who had been admitted due to acute illness. Predicted and observed outcome were compared. The results showed no relation except with regard to predicted and observed discharge to own home. Inter-rater reliability was found to be low except with regard to discharge to own home. This study shows that the physicians had difficulties in predicting survival or death in the ward, site of living after discharge, other than to own home, and length of stay in the ward. In order to increase the knowledge about elderly with acute illness and improve planning of individual care, it is desirable to develop reliable and valid instruments for clinical prediction of outcome for elderly persons in short-term hospital care.     

Current status of and factors associated with social isolation in the elderly living in a rapidly aging housing estate community

Objectives

The aim of this study was to examine social isolation development among elderly persons living in a rapidly aging housing estate community in terms of the frequency of activities of daily living outside the home and social contact with neighbors and to identify associated factors.

Methods

A self-administered questionnaire survey was conducted in 2007 (102 subjects) and 2010 (104 subjects) involving elderly residents living on a suburban housing estate. The data collected on the 87 subjects who responded to both surveys were analyzed. The survey investigated physical, psychological, and social factors regarded as being associated with social isolation. The subjects were divided into four social types according to the frequency of activities of daily living outside the home and social contact with neighbors. Multiple logistic regression analysis involved would-be-isolated and non-isolated groups as dependent variables and each factor as an independent variable.

Results

Isolated group subjects increased from 2.3 to 7.0 % during the study period, with the would-be-isolated group accounting for 33.7 % of the study population in both years. Factors strongly associated with the would-be-isolated group were a low subjective sense of well-being and socioeconomic status were identified in 2007, and an older age, low subjective sense of socioeconomic status, and no provision of emotional support in 2010.

Conclusions

The health condition and social well-being of the elderly on a rapidly aging housing estate community tended to decline, revealing that the number of isolated and would-be-isolated subjects is increasing. Taking preventive action against social isolation among the elderly population is essential, suggesting the need to combine community health promotion and social communication interventions and to develop programs aimed at providing opportunities for elderly persons to be emotional support providers.     

Lifestyle differences between conjugal bereaved women and non-bereaved women in later life

PURPOSES: In Japan, there has been limited research regarding lifestyle of elderly bereaved. The present study was conducted to clarify lifestyle characteristics in conjugal bereaved women compared to non-bereaved women. METHODS: Subjects consisted of 872 bereaved and 643 non-bereaved elderly women aged 65 or over in T prefecture. Bereaved subjects experienced the death of a spouse in 1994 and their family structure remained unchanged after the bereavement. Non-bereaved subjects were randomly selected from community registration lists in 1995 and matched for age and area of residence. Lifestyle characteristics were obtained by home visit and interview. For the analysis, we divided the subjects into 4 groups by age and family structure. Multiple logistic regression analysis was performed to identify lifestyle characteristics of bereaved elderly women, after adjustment for physical ability and disease, as confounding factors. RESULTS: Bereaved elderly women were significantly associated with no roles at home, no hobbies, lack of contact with friends, physical inactivity, sleeplessness and irregular meal patterns compared to the non-bereaved. Analysis of the 4 groups revealed bereaved women living with family members have more unfavorable lifestyle characteristics than bereaved women living alone. Bereaved women living with family members had no roll at home and sleeplessness. CONCLUSION: Bereaved women have unfavorable lifestyle characteristics. Those living with family members had more unfavorable lifestyle than bereaved women living alone. From the preventive point of view, interventions for bereaved women are needed. This is particularly the case for bereaved women living with family members. Not only health services but also social welfare services are needed to reconstruct favorable lifestyles and maintain health and well-being.     

Factors in continuation of home health care for patients with intractable neurological diseases

OBJECTIVE: This study was carried out to elucidate factors related to difficulty in continuing home health care and to investigate problems of the corresponding support system for patients with intractable neurological diseases. SUBJECTS AND METHODS: Subjects were 139 cases of amyotrophic lateral sclerosis (ALS), 376 cases of spino-cerebellar degeneration (SCD) and 1,048 cases of Parkinson's disease (PD) who were collected from the nationwide survey of health and social service needs of the patients with intractable diseases in 1995. Factors and problems related to limited activity due to diseases and necessity for medical care were analysed. The need for facilities of long-term care was also studied. RESULTS: The characteristic conditions of patients with ALS were shorter duration of the illness, higher percentage of conditions requiring medical care and disorders of swallowing or respiration and full nursing care in daily life compared with the other two diseases. The characteristics of PD were higher percentage of female and older age in both patients and their family caregivers. The proportion of cases for whom health care was judged to be prone to difficulty was 23.0% in ALS, 10.9% in PD and 7.2% in SCD, respectively. Regarding the factors related to difficulty in continuing home health care, conditions requiring medical care, the need for full nursing care in daily life, and the duration of the illness were recognized in ALS. In SCD, 5 factors, including conditions requiring medical care, the need for full nursing care in daily life, patients age greater than 65 years, the duration of the illness, and patients being nursed by their sons or daughters were detected. In PD, 4 factors, such as conditions requiring medical care, the need for full nursing care in daily life, the patients being nursed by persons other than the spouse, and the need of nursing care were found. CONCLUSION: These results suggest the necessity of social functions of medical care, nursing and family support that can be supplied at home effectively according to symptoms in progress, and the need for facilities of long-term care of patients for whom continuation of home health care may become difficult, which will work as a support system for long-term care of patients with intractable neurological diseases.     

Expenditures for long-term care services by community elders.

Costs of care are presented for elderly persons in five community-based settings. These settings include elderly persons living in their own homes or in group housing and who do or do not receive case-managed home care. Expenditures for care ranged from a low of about $1,100 per year to a high of $4,025. The level of expenditure was directly related to risk of institutionalization and was higher for those receiving case-managed home care. As a majority of the elderly use a substantial amount of care even without case management, the potential for community care demonstration programs to yield significant cost savings appears quite limited.     

Factors explaining the referral of the elderly to home nursing or home help.

Factors explaining the referral of the elderly to home nursing or home help or both were studied in a population (n = 1358) aged 60 years or over and living in the commune of Aht?ri, a semi-industrialized community in middle-western Finland, using social and health care registers and questionnaires in collecting data. The clients of home nursing and of combined home nursing and home help were predominantly women, whereas men were in the majority among those referred to home help. A stepwise regression analysis showed old age, living alone, low self-perceived health, low education and few visiting contacts to explain home nursing or home help among men. Among women, the most important variables explaining home nursing or home help in the regression model were old age, low self-perceived health, low standard of housing, high amount of symptoms and lowered functional capacity. The poor availability of social support is more important a factor explaining the referral to home care among elderly men than among women. On the other hand, low health status and poor functional capacity, as well as poor availability of physical support are more important factors among women than men.     

新疆牧业地区失能老年人居家非正式照护质量的影响因素分析

目的 分析新疆牧业地区失能老年人居家非正式照护质量的影响因素。方法 运用家庭照护质量量表（FCCI）对335例新疆牧业地区哈萨克族失能老年人居家非正式照护者进行现场调研,采用多重线性回归法对照护质量的影响因素进行分析。 结果 居家非正式照护质量平均得分为44分;被照护老年人的失能程度、与照护者关系、被照护时间、照护者就业情况、年龄及社会支持是影响居家照护质量的主要因素,上述6个变量解释失能老年人居家照护质量总变异量的32.3%。其中,被照护老人的失能程度重（Beta = - 0.475）、配偶照护者(Beta = - 0.171)、被照护时间长(Beta = - 0.180)、照护者就业状况差(Beta = - 0.134)、照护者年龄大(Beta = - 0.116)为其危险因素,高社会支持(Beta = 0.110)为保护因素。结论 新疆政府相关部门在解决失能老年人的长期照护问题中,应优先考虑牧业地区失能程度重、照护时间长及年龄较大的照护者,减轻其照护负担,提高居家非正式照护质量。     

Predictors of dietary intake in a functionally dependent elderly population in the community.

OBJECTIVES. The aim of this study was to describe dietary intake and identify predictors of energy and protein intake in a group of high-risk elderly people. METHODS. All elderly persons receiving publicly financed home care services in the area of Sherbrooke, Quebec, Canada, were eligible. Subjects (n = 145) 60 to 94 years of age from three home care programs were interviewed to measure sociodemographic, health, and food-related behavior variables. Three nonconsecutive 24-hour recalls were used to describe usual dietary intake. Independent predictors of energy and protein intake were derived from multiple regression analyses. RESULTS. Very low mean energy intakes were observed in this functionally dependent population. More than 50% of the study subjects did not meet the recommended levels of daily protein intake (0.8 g/kg body weight). Significant independent determinants of intake were burden of disease, stress, poor appetite, and vision. CONCLUSIONS. Results suggest that community-living elderly people with loss of autonomy may have more nutritional problems than healthy elderly individuals. Surveillance of predictors of dietary intake may enable early detection and prevention of nutritional deficits.     

Attitudes to cuts in expenditure and increased fees in health care

The aim of this postal questionnaire study was to measure attitudes to cuts and increased fees in health care in various Finnish population groups. Four groups were identified: a population sample of 2000 subjects, aged 18–70 y; a random sample of 1500 medical doctors of working age; a random sample of 1000 nurses of working age; and a sample of 2200 politicians involved in health and social care administration, mostly at the municipal level (altogether 6700 subjects). The main questionnaire included, among other things, the following questions: (1) Which of 18 specified medical activities at the primary health care level could be cut without causing severe harm to the population? (2) For which of 13 specified medical activities should clients pay at least 50% of the real cost? All the groups indicated the greatest willingness to cut expenditure on health education, occupational health sevices, hygienee inspection, substance abuse care, rehabilitation services for war veterans, and family planning. All the groups were least willing to make cuts in home care for disabled and elderly people, maternity services and clinics for under-fives. Most respondents in all groups felt that the activities for which clients should pay at least 50% of the cost were visits to physicians, occupational health services and dental services, whereas clinics for under-fives and home care for disabled and elderly persons should be kept free of charge. As a conclusion, primary health care and prevention of diseases for small children, mothers, the elderly and disabled persons, were prioritised by all the groups.