Nonaka Kumiko, Nishi Mariko, Kobayashi Erika, Fukaya Tarou, Murayama You, Shinkai Shouji, Fujiwara Yoshinori
Research Teams for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology.
Nihon Koshu Eisei Zasshi. 2013 Oct;60(10):651-8.
Area Comprehensive Support Centers play critical roles in identifying those elderly not currently using medical or long-term health care services, offering preventative measures against further health crises and possible isolated death. The purpose of this study was to develop an "At-Risk Elderly Checklist." This checklist can help in identifying those at-risk elderly, allowing people in communities to provide the Area Comprehensive Support Center with information about at-risk elderly.
As a preliminary step, interviews were conducted with 29 professionals who work for 17 different Area Comprehensive Support Centers located in 4 municipalities around the Tokyo Metropolitan Area. We constructed 23 items based on the findings of this preliminary research and existing tools used in different areas. These items represented distinctive characteristics of elderly who need support from Area Comprehensive Support Centers in order to receive necessary medical and long-term care services. A self-report survey was conducted on 109 professionals of 20 Area Comprehensive Support Centers of Ota-ku, Tokyo in order to examine the content validity of the items.
Using factor analysis, we identified 5 factors consisting of 19 items. The first factor consisted of 5 items helping people to identify a serious health crisis from the appearance and condition of the elderly individual's home. The health crisis indicated by these items might require immediate hospitalization. The second factor consisted of 5 items that can help people notice symptoms of dementia through their communication with elderly. The third factor consisted of 4 items useful for assessing health deterioration of the elderly by observing various behaviors. The fourth factor consisted of 3 items that people can use to measure the progress of dementia, including issues with how the elderly dressed themselves. The fifth factor consisted of 2 items that can be used to understand signs of declining health or the progress of dementia by paying attention to the elderly individuals' body odor and personal appearance. From the original 19 items, 14 that were considered the most useful in detecting at-risk elderly were selected based on a frequency distribution. The content validity of 14 items was confirmed by 20 professionals from Area Comprehensive Support Centers in Outa-ku.
This checklist may be effective in the early detection of elderly at risk of serious health crises and isolated death due to not using necessary medical and long-term care services.
地区综合支援中心在识别那些目前未使用医疗或长期保健服务的老年人、提供预防进一步健康危机及可能的孤独死亡的措施方面发挥着关键作用。本研究的目的是制定一份“高危老年人检查表”。该检查表有助于识别那些高危老年人，使社区居民能够向地区综合支援中心提供有关高危老年人的信息。
作为初步步骤，我们对在东京都市区4个市的17个不同地区综合支援中心工作的29名专业人员进行了访谈。我们根据这项初步研究的结果和不同地区使用的现有工具构建了23个项目。这些项目代表了需要地区综合支援中心提供支持以获得必要医疗和长期护理服务的老年人的独特特征。为了检验这些项目的内容效度，我们对东京大田区20个地区综合支援中心的109名专业人员进行了一项自填式调查。
通过因子分析，我们确定了由19个项目组成的5个因子。第一个因子由5个项目组成，帮助人们从老年人住所的外观和状况识别严重的健康危机。这些项目所表明的健康危机可能需要立即住院治疗。第二个因子由5个项目组成，可帮助人们通过与老年人的交流注意到痴呆症的症状。第三个因子由4个项目组成，通过观察各种行为有助于评估老年人的健康恶化情况。第四个因子由3个项目组成，人们可用于衡量痴呆症的进展情况，包括老年人的穿着问题。第五个因子由2个项目组成，通过关注老年人的体味和个人外表可用于了解健康下降的迹象或痴呆症的进展情况。根据频率分布，从最初的19个项目中选出了14个被认为在检测高危老年人方面最有用的项目。大田区地区综合支援中心的20名专业人员确认了这14个项目的内容效度。
这份检查表可能有助于早期发现因未使用必要的医疗和长期护理服务而面临严重健康危机和孤独死亡风险的老年人。
