Oral health care status of homebound elderly in Japan.

We examined the present conditions of oral health care in order to contribute towards an effective system to provide oral health care for homebound elderly in Japan. A questionnaire was mailed to homebound elderly subjects (n=908) and returned by mail. A 73.6% response was achieved. The questionnaire was designed to elicit information with respect to the general condition of the subjects and independence of oral health care. About 70% of the subjects were chair- or bed-bound. Among all subjects, 37.6% required partial or full assistance on toothbrushing, 55.6% on cleaning dentures and 46.7% on eating. The degree of oral health care tended to be poor for chair- or bed-bound elderly compared with independent or house-bound elderly. Homebound elderly with lower Activities of Daily Living Scale (ADL) required more support for oral health care compared with elderly with higher ADL.

New strategy for better geriatric oral health in Japan: 80/20 movement and Healthy Japan 21.

A review of strategies for better geriatric oral health in Japan is presented. The rapid growth of the aged population in Japan has been associated with the decreasing ability of family caregivers to provide home care due primarily to immature social support systems. As rural ageing has a stronger likelihood of this trend, there is a difference in the oral health of older adults in urban and rural areas. A national survey demonstrated that only 29.8% of the adult population in rural areas had at least one dental visit in the preceding year versus 34.0% in urban areas. Another national survey showed that the proportions of the elderly with untreated teeth that have decay and those without any treated teeth in metropolitan areas, urban areas, and rural areas were 6%, 7% and 12%, respectively. Maintaining good oral health is crucial for maintaining quality of life in later years. A survey in a rural area in Japan demonstrated that, among elderly with nine or fewer natural teeth who wore no dentures, 45% were bed-bound or house-bound. However, among those with 10 or more natural teeth, 80% were active and able to go out alone. Another survey suggested very few house-bound elderly requested dental care, although most of them had oral health problems and mastication dysfunction. A new strategy, 'Healthy Japan 21' suggests positive actions to keep 20 or more teeth by the age of 80, and encourages collaboration between local health authorities and dental associations to encourage positive oral care for the frail elderly including domiciliary dental services within communities.

[Analysis on the relationship between use of health check ups and medical care by elderly patients. A study on urban cities with high health check-up rates].

The aim of this study was to evaluate the influence of health examination provided by municipalities in Japan on the use of medical care by elderly patients aged 70 and above. The study was carried out to compare health indicators of cities with high and low usage rates for health check ups over 14 years. The indicators of health service utilization included mean bed days, mean inpatient fees, and mean outpatient fees in 1983, 1988, 1993 and 1996. The data for these indicators were collected from all 12 Japanese cities, where more than 50% of the target population had annual health check-ups in 1983, 1986, 1989 and 1992, as the subjects of high rate cities. All other 134 cities belonging to the same prefectures with the 12 cities were included as the control low rate cities. The correlation coefficients for all the 146 cities showed that usage rates of health check ups had an inverse relationship with mean bed days and mean inpatient fees for the elderly population in all the fiscal years 1983, 1988, 1993 and 1996. In nine out of the ten prefectures, mean bed days and mean inpatient fees were lower in the high rate cities as compared to the low rate cities for all the fiscal years compared. The bed days in the 12 high rate cities were 72% of those in 134 low rate cities in 1983, and the percentages were 66%, 72%, and 78% in 1988, 1993 and 1996 respectively. No remarkable differences in mean outpatient fees were observed between the high and low rate cities. The differences in use of medical care by inpatients suggest that providing preventive health services would decrease the demand by the elderly and result in a more efficient use of health resources.

Associations between self-assessed masticatory disability and health of community-residing elderly people.

OBJECTIVE: To examine the relationship between the self-assessed masticatory disability and the health of community-residing older people. METHODS: Of 1473 randomly selected people aged 65 years and older living in Settsu, Osaka Prefecture, in October 1992, data on general health status, history of health management, psychosocial conditions, and dental conditions were obtained from 1405 people by interviews made during home visits. Follow-up for 54 months was completed for 1306 subjects (93.0%; 1072 living, 234 deceased). RESULTS: Being over 75 years of age, having poor general health and poor dental status, not using dental health checks, not using general health checks, not participating in social activities, not feeling that life is worth living (no "ikigai"), and feeling anxious about the future were univariately and significantly associated with self-assessed masticatory disability. Logistic regression analyses indicated that being older than 75 years, having poor general health and poor dental status, not using dental health checks, and not participating in social activities were independently associated with self-assessed masticatory disability. The Cox proportional hazards model showed that being male, over 75 years of age, and in poor general health, as well as not using general health checks, and not participating in social activities were independently associated with mortality. Self-assessed masticatory disability was univariately and significantly related to mortality, but by itself was not a significant risk factor for mortality, because of the potential influence of other variables. CONCLUSIONS: Certain health and psychosocial factors are closely associated with self-assessed masticatory disability among older people. Further investigations are needed to determine whether masticatory disability is a significant risk factor for mortality.

Mortality in relation to urinary and faecal incontinence in elderly people living at home.

OBJECTIVE: To examine the relationship between incontinence and mortality in elderly people living at home. DESIGN: Of the randomly selected people aged 65 years and older living in Settsu city, Osaka in October 1992, 1405 were contacted and constituted the study cohort. Follow-up for 42 months was completed for 1318 (93.8%; 1129 alive, 189 dead). MEASURES: Data on general health status, history of health management, psychosocial conditions and urinary and faecal incontinence were collected by interview during home visits at the time of enrolment. RESULTS: From the Kaplan-Meier analysis, the estimated survival rates decreased with a decline in continence in both the 65-74 and 75 years and older age groups. From the Cox proportional hazards model, unadjusted hazard ratios of minor, moderate and severe incontinence for mortality, compared with continence, were 2.27, 2.96 and 5.94, respectively. Multivariate analysis yielded adjusted hazard ratios of minor, moderate and severe incontinence of 0.99, 1.17 and 1.91, respectively, leaving severe incontinence as the significant factor, when other indicators are controlled. CONCLUSIONS: Incontinence is related to mortality and severe incontinence represents an increased risk factor for mortality in elderly people living at home.

Prevalence of intellectual dysfunctioning and its correlates in a community-residing elderly population.

To examine the prevalence of intellectual dysfunctioning and its correlates in community-residing elderly people, a randomly selected sample of 1,405 people aged 65 and over living in Settsu, Osaka, were investigated in October 1992. Data for assessing intellectual dysfunctioning were obtained from 1,364 people (97.1%), excluding 21 clinically demented people (1.5%); 17.6/100, 5.6/100, and 3.3/100 of the population showed minor, moderate, and appreciable intellectual dysfunctioning, respectively, and the prevalence of intellectual dysfunctioning increased with age. By multivariate analyses using logistic regression, age over 75, poor general health, including current medical treatment, and psychosocial conditions such as no participation in social activities, no life worth living (no Ikigai), and anxiety about the future were independent risk factors for intellectual dysfunctioning. We conclude that intellectual dysfunctioning is closely associated with health and psychosocial conditions.

Mortality in relation to the type of household among elderly people living in a community.

The objective of this study was to determine whether there is an association of mortality with the type of household in elderly people. A cohort of 1,352 elderly people aged 65 years and over at baseline in October 1992 was followed for 42 months. Follow-up was completed for 1,266 (93.6%) (172 deceased and 1,094 alive). From the analysis using the Kaplan-Meier method and the log-rank test, male sex, older age group (75 years and over), no satisfaction with present dwelling, disability, no use of health checks, no practices of daily preventive health promotion, no participation in social activities, and no finding life worth living (no Ikigai) were univariately statistically significantly related to mortality. Furthermore, elderly people living with their spouse only or living alone had higher survival rates than those living with their spouse and children or living with their children, and the curves among the four subclasses of household were significantly different. From the Cox proportional hazards model, living with a spouse only remained as an independent predictor for survival, and living alone was not an increased risk factor for mortality, controlling for sex, age, housing conditions, disability, use of health management, and psychosocial conditions.

Does prompt treatment of hypertension after blood pressure check-ups reduce morbidity of cerebrovascular diseases?

In Japan, more than 20 million people utilize blood pressure check-up services in their work places or communities every year. To examine the relationship between prompt treatment of hypertension after these blood pressure check-ups and the severity, age at onset, and type of cerebrovascular diseases in these patients, a study was performed with the cooperation of all 174 independent physicians, 17 hospitals, and 4 welfare homes in the city of N.. All patients aged 50 years or more who visited a physician during the study period in this city were included in the study (n=978). Information on hypertensive control before the onset of cerebrovascular diseases was obtained from 668 patients. The results suggests that for those who had received prompt treatment after early detection of hypertension, the disease was less severe and the onset of the disease was delayed. Among our subjects, 47% of the patients claimed to have received prompt treatment after detection of hypertension. As N. is an ordinary Japanese city in terms of the promotion of health check-up programs, this percentage suggests that blood pressure check-up programs for the early detection of hypertension throughout Japan may have contributed to an overall reduction in severity for almost half of the patients with cerebrovascular diseases.

Effects of preventive health services on survival of the elderly living in a community in Osaka, Japan.

STUDY OBJECTIVE: To examine the relationships between the use of preventive health services--such as health checks, basic health examination/cancer screening, and daily preventive health practices--and survival of elderly people living in the community. DESIGN AND SETTING: A cohort of elderly people aged 65 years and over living in Settsu City, Osaka was followed for 38 months. Data on the history of health management, disability scores, and psychosocial conditions were collected in October 1992 by interview during home visits. SUBJECTS: Of the 1491 people randomly selected from the computerised sex-age register at enrollment, 1473 were contacted and responses were obtained from 1405 (95.4%). They constituted the study cohort. Follow up was completed for 1325 (94.3%) (154 decreased and 1171 alive). MEASUREMENTS AND MAIN RESULTS: From the analysis using the Kaplan-Meier method and the log-rank test, female sex, younger age group (65-74 years), use of health checks, use of basic health examination and/or cancer screening, use of daily preventive health practices, less disability, taking part in social activity, and finding life worth living were univariately statistically significantly related to survival. The estimated survival rates were highest in those with regular health checks or daily preventive health practices before 59 years of age or both basic health examination and cancer screening. From the Cox proportional hazards model, use of health checks and use of daily preventive health practices remained as statistically significant factors associated with survival, controlling for other factors such as sex, age group, medical treatment, disability scores, and psycho-social conditions, and these hazard ratios (not used v starting at 59 years) were 0.41 (95% CI, 0.25, 0.66) and 0.52 (95% CI, 0.30, 0.88), respectively. CONCLUSIONS: Health management efforts such as health checks and daily preventive health practices may increase survival in the elderly.

Oral health habits and the number of teeth present in Japanese aged 50-80 years.

OBJECTIVE: To suggest appropriate oral health habits for daily practice in order to prevent tooth loss. DESIGN: Cross sectional study correlating mean number of teeth and oral health habits. SETTING: All 97 dental clinics in an urban area (population 256,000) in Osaka Prefecture, Japan. SUBJECTS: 1,248 persons aged 50-80 who received dental treatment at any of the dental clinics between 10 January and 7 February, 1992. OUTCOME MEASURES: The number of teeth present was recorded by the dentists in their clinics. The subjects were asked to complete questionnaires on oral health habits, prior dental attendance patterns and the perceived general health status. RESULTS: Mean number of teeth present had a significant relationship with perceived health status. Implementation of particular oral health habits, such as using a toothbrush with nylon tufts and hard tufts, changing the toothbrush within three months, receiving tooth brushing instruction, scaling, and prompt dental treatment were related positively to the number of teeth present. Furthermore, the frequency of dental visits in the past showed an inverse relationship with the mean number of teeth present. This result does not necessarily mean, however, that regular dental visits are undesirable. From multiple regression, the mean number of teeth was calculated to be from 27.9 to 16.9 at 50 years of age and from 12.2 to 3.0 at 80 years of age in relation to oral health habits. CONCLUSIONS: To keep more teeth in the later years, it is evident that prevention of dental disease in earlier life is essential, and that individuals should receive prophylactic treatment, and maintain proper tooth brushing habits throughout life.

[Demand by the elderly for "meals-on-wheels" services].

A survey was performed to assess the demand for "meals-on-wheels" services by elderly persons living alone in N. city (Osaka Prefecture). The purpose of this study was to identify the factors which are related to the demand for such services. Subjects of this study were 1,853 elderly persons of whom responses were received from 1,783 (95.2%). The percentage of the subjects who needed meal delivery services was 64.5%. Physical condition, living conditions, and dietary habits all correlated significantly with the demand. Elderly who were in poor health, were less affluent, or had trouble preparing meals and performing other housework, expressed a need for "meals-on-wheels" services and asked for more services than others. Those who requested meal delivery services had poorer dietary habits than those who did not. Also, there was more demand for these services by elderly male, as well as those elderly with poor dietary habits. The poorer the quality of life of the elderly person correlated with a greater desire for "meals-on-wheels" services. This study showed that there was a great demand among the elderly living alone for "meals-on-wheels" services. While food is one of the basic elements in life, it is often taken for granted, and meal delivery services for the elderly have been largely neglected. The need for urgent improvement and expansion of meal delivery services for this population is indicated by this study.

Main trends in hospital use in different cities in Japan.

In this study, trends in hospital use were identified in Japanese cities. Data for all inpatient care in May 1985 (9,555 patients) and in May 1988 (11,205 patients) paid for by National Health Insurance in 12 cities in Osaka Prefecture were analyzed. The main factor affecting differences in inpatient days per insured person of all ages (hospital use) among the cities were differences in hospital use by long-stay patients aged 70 years or older, which depended not on inpatient days per patient but on the rate of hospital admission. The main factor affecting change in mean hospital use from May 1985 to May 1988 seemed to be an increase in hospital use by long-stay patients 70 years of age or older, which did not depend on increases in the rate of hospital admission, but did depend on the number of insured persons 70 years of age or older. Calculation showed that an increase of 13 long-stay patients 70 years of age or older for 10,000 insured persons 70 years of age or older per year was to have accounted for about 40% of the increase in hospital use by all patients. If the trend for increasing hospital use in Japan is to be altered, the first step might be the careful planning for this comparatively small increase in long-stay elderly patients by promotion of a non-hospital-based care system.

[Factors influencing prolonged hospital stays by elderly patients: problems in medical management including use of urethral catheters].

Fifty-nine elderly patients who had been hospitalized more than six months in five hospitals in the city of Mino in Osaka Prefecture, were studied to clarify the factors influencing prolonged hospital stays by the elderly. Their mean age was 82.2 years, and women accounted for 86% of the patients. One-third had suffered a stroke. As for ADL, 44% were completely dependent when walking, eating, bathing and dressing. Moreover, 36% had severe dementia, 19% suffered from decubitus ulcers, 66% were undergoing rehabilitation, 58% were receiving venous infusion therapy, 36% used a urethral catheter, and 10% were receiving tube feeding. The subjects were divided into two groups according to the likelihood of discharge assessed by the doctors in charge: one group consisted of 27 patients who might be discharged and the other of 32 patients with an ongoing need for inpatient care. Multivariate analyses using Hayashi's quantification method II indicated that use of a urethral catheter and not undergoing rehabilitation were the main factors associated with the need for inpatient care, while being a woman, being of advanced age and not having one's own room at home were the non-medical factors which made it difficult for the patients to be discharged from the hospital. As use of a urethral catheter was the factor most strongly related to prolonged hospital stay, multivariate analyses were applied to the 45 patients with urinary incontinence, who were divided into one group of 21 patients with, and one of 24 without a urethral catheter. The factors associated with use of a urethral catheter were then investigated.(ABSTRACT TRUNCATED AT 250 WORDS)

Factors related to long-term stay in hospital by elderly people in a Japanese city.

The characteristics and social backgrounds of 61 elderly patients with long hospital stays and those of 179 incapacitated elderly people living at home in a Japanese city were compared. Discriminant function analysis was performed to clarify the factors associated with long-term use of hospital beds by elderly people. In addition to this analysis, the elderly patients with long hospital stays were divided into two subgroups according to the likelihood of discharge, and these subgroups were compared in the same way. The elderly patients with long hospital stays were more likely to be women, persons with low ADL, living alone and not living with a spouse or a second generation, compared with incapacitated elderly people living at home. Analysis of the subgroups of the elderly subjects with long hospital stays showed that use of a urethral catheter and not undergoing rehabilitation were the medical factors related to difficulty of discharge, while being women, of advanced age and not having their own room at home were the non-medical factors associated with long-term occupation of hospital beds.

Effect of physical exercise on mortality in patients with Parkinson's disease.

Public health nurses visited and followed up for more than one year 438 patients with Parkinson's disease living in Osaka. The follow-up period averaged 4.1 years, during which 71 deaths were observed. The patients were classified according to the degree of physical exercise they performed, and the ratios of observed to expected deaths were calculated. The exercising group showed the lowest ratio of 1.68 (1.45 for patients able to walk independently, and 1.89 for those could not) while all patients exhibited a ratio of 2.47. Multivariate analysis using Cox's proportional hazard model, adjusted for age, sex, walking ability and duration of disease at study entry, showed that, compared with the exercising group, the non-exercising patients had a hazard ratio of 1.83.

[A comparative study of the characteristics and social backgrounds of frail and elderly persons at home, long-stay elderly hospital patients, and residents of welfare homes for the frail elderly].

Three studies were carried out in Mino City, Osaka Prefecture, on 188 frail and elderly persons living at home (the home group), 61 elderly patients who had been hospitalized more than six months (the inpatient group), and 72 residents of welfare homes for the frail elderly (the resident group). The characteristics and social backgrounds of the three groups were compared. About 30% of each group had suffered a stroke. As for ADL score, moderate disability was dominant in the home group, severe disability in the inpatient group, and slight disability in the resident group. The proportions of those who had been living alone and those who had no spouse were significantly higher in the inpatient group and in the resident group than in the home group. Significantly fewer subjects in the resident group had been living with their offspring than in the home group or in the inpatient group. The percentage of those who did not have their own home was the highest for the resident group. Multivariate analyses using Hayashi's quantification method II were conducted for a comparison between cases belonging to the home group and the inpatient group, and between the home group and the resident group. The analysis of the home group and the inpatient group revealed a relationship of the inpatient group to severe disability in ADL, and living alone. Differences between these two groups were related to such variables as ADL, sex, living or not living alone, living or not living with offspring, and having or not having a spouse.(ABSTRACT TRUNCATED AT 250 WORDS)

Relation between use of health check ups starting in middle age and demand for inpatient care by elderly people in Japan.

OBJECTIVE: To find out whether there is any correlation between the use of general health check ups (provided for by the Health Services for the Elderly Act 1982) by insured Japanese residents aged 40 or older and demand by the elderly for inpatient care. DESIGN: A questionnaire was posted in 1988 to municipal offices of Japanese cities. All questionnaires were returned with data for 1983 and 1986. SETTING: All 509 Japanese cities with a population of 30,000-199,999. SUBJECTS: All people aged 40 or older who hold a resident card and are not offered health examinations at work are eligible for general health check ups. The questionnaire also inquired about use of inpatient care by elderly residents (aged 70 or older) who were covered by national health insurance. MAIN OUTCOME MEASURES: Correlation coefficients between the rates of use of general health check ups and mean annual bed days for the elderly. Comparison of relative changes by analysis of correlation between improvement indices in mean bed days and mean inpatient fee. RESULTS: In cities with relatively high rates of use of health check ups both the mean annual bed days and the mean inpatient fee for the elderly tended to be low. Correlation coefficients between the logarithmic rates of use of check ups and mean bed days by sizes of cities and number of beds were all negative values. There tended to be more correlation between improvement indices for rate of use of check ups and both mean bed days and mean inpatient fee with higher rates of use in 1983, and the correlation was significant for rates of 60% or more. CONCLUSIONS: Strong health service programmes that start in middle age decrease the demand for inpatient care of the elderly. It was estimated that in a single year from 1985 to 1986, when there was an increase in the rate of use of check ups from 25.5% to 27.6%, the reduction in the number of bed days for the total of 8.5 million elderly insured people was 2.21 million bed days.

[The effect of professional dental health care in the prevention of periodontal diseases in adults].

Dental health conditions of participants in adult general health examinations provided as a health service by a local government from 1983 to 1987, were analyzed to evaluate the effect of individual dental health instructions with prophylactic treatment (individual instructions) for preventing periodontal diseases. For this purpose, Periodontal Index (Russel) and Debris Index (Greene & Vermillion) of 557 dentate adults aged 40-59 were examined. In the group that received individual instructions, average PI showed a significantly greater decrease during the period from the first inspection in 1983-1986 to the last one in 1987, compared to the group that received no individual instructions. For those with PImax greater than or equal to 6 at the first examination in 1983-1986, the figures of average PI showed a significantly greater decrease in those receiving instruction than the group that received no individual instructions. Between 1983-1987, the proportion of persons with PImax greater than or equal to 6 decreased from 74.2% to 27.3% as a result of the individual instructions. The figures for average DI showed significant changes but, no significant difference was observed between the two groups.