Toward the realization of a better aged society: Messages from gerontology and geriatrics
Toward the realization of a better aged society: Messages from gerontology and geriatrics
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DOI：
10.1111/j.1447-0594.2011.00776.x
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发表时间：
2012-01-01
影响因子：
3.3
通讯作者：
Kita, Toru
中科院分区：
文献类型：
--
作者：
Arai, Hidenori;Ouchi, Yasuyoshi;Kita, Toru
1. 背景：最近的医疗进步以及卫生和食品供应的改善使日本成为世界上最长的预期寿命。过去50年来，老年人口比例从1960年的5.7%增加到2010年的23.1%，增长了四倍。这一变化的速度是世界上最快的。与过去100年来老年人口比例仅增加两倍的法国相比，日本社会正在以前所未有的速度老龄化。此外，2008年，由体弱者组成的高龄老人（75岁及以上）的比例超过了全国人口的10%。在这种情况下，许多日本老年人希望健康地度过晚年，希望在人生中取得伟大的成就。为此，我们不应将人口老龄化视为一种消极的社会现象，而应创建一个老年人通过社会参与和贡献过上健康富裕生活的社会。通过社会参与和贡献实现健康富裕的生活。阻碍老年人健康生活的因素包括老年时出现的各种心理和社会问题以及高发病率。因此，老年学侧重于老年人的健康促进，涵盖社会福利、心理、环境和社会系统的研究；老年医学以老年人的健康保健为重点，开展促进老年人健康的研究、教育和实践，变得越来越重要。此外，除了需要多学科护理来支持老年医学外，还需要为老年护理专业人员建立全面的教育体系。因此，我们现在应该认识到老年学和老年医学的重要性，并进行医疗服务改革，以应对即将到来的老龄化社会。人口老龄化是一个全球现象。作为世界上老龄化程度最高的社会，日本所采取的行动受到了世界其他国家的密切关注。日本的老龄化社会不仅带来医疗、护理、福利等问题，还带来与经济、产业、文化密切相关的复杂问题。因此，要解决这些问题，需要通过医学、护理学、护理学、社会福利学、社会科学、工程学、心理学、经济学、宗教学、伦理学等跨学科的方式，实现产业、教育机构、行政和社区之间的宏观整合与合作。关于推动老年学，日本科学会议“可持续老龄社会科学共同体构建委员会”也准备了一份提案，并于2011年4月20日公布。2。现状与问题 (1) 促进老年人的社会参与和贡献 在日本，由于低出生率和高预期寿命，预计总体劳动力比率在不久的将来会下降。相比之下，许多老年人，特别是年轻的老年人，有足够的体力履行自己的工作职责，为社会做出贡献。对于这些人来说，应该通过对老年人进行再教育和提供多种工作类型来建立老年人可以工作的社会结构。促进老年人的社会参与和贡献预计将导致劳动力大幅增加。此外，预计这不仅会通过增加总消费来促进国民经济活动的好转，还会减少可能需要护理的老年人数量。因此，为了让老年人能够从事各种社会活动，应制定发展再教育社会结构、各种就业状况和就业机会的策略。然而，由于工作岗位总数是固定的，因此还应该考虑年轻工人。 （二）培养老年医学专家 老年人往往患有多种疾病，出现多种病因的老年综合症。体征和症状因人而异，并且通常不典型；因此，患者需要到不同的医院就诊，同时接受多项筛查检查和处方。为了解决这个问题，需要一个由初级保健医生进行的有效筛查系统，以及医院和诊所之间保护隐私的医疗数据共享。在老年临床环境中，医疗保健专业人员应了解老年人的身体特征，他们不仅经常患上痴呆症，而且还容易出现抑郁、跌倒和尿失禁等老年综合症，因此需要采取综合护理的方法。然而，现有的日本医学教育体系并没有为能够满足上述要求的医疗专业人员做好准备。因此，迫切需要培养能够提供全面护理的医疗专业人员，特别是对高龄老人的护理，例如老年病专家和了解老年护理原理的医疗专业人员。 （3）老年特有疾病诊断和医疗服务改革 日本痴呆症等老年特有疾病诊断体系和医疗服务改革明显滞后。应调查诊断、护理和护理的现状，收集学术数据。为了为提供安全的老年护理和护理积累证据，迫切需要临床研究的推广和高水平医疗服务的老年医疗中心的显着扩大。 （4）推广居家护理和多学科护理为减少急症医院住院时间，减轻急症医院医护人员的身体负担，满足老年人居家养老的需求，需要进一步推广居家护理。此外，为了满足老年人医疗保健和福利方面的各种需求，越来越需要“多学科护理”。医疗、护理和福利领域的医护人员之间共享针对疾病预防、医疗、护理和福利问题的对策，并充分利用医疗保健人员的专业知识进行合作是很重要的。 3.因此，老龄化分委会提出如下建议：1 开发和推广使老年人能够在护理学、护理学、社会福利研究、社会科学、心理学、经济学、宗教伦理学以及医学等各个领域以跨学科的方式参与社会并做出贡献的体系；2 在本科、研究生和终身教育中推广老年学，改革和加强老年医学；3 在每个地区建立老年医学中心领域，积累老年疾病和老年病学的大规模证据； 4 家庭护理和多学科护理的结构发展和推广。通过实施上述措施，日本有望成为世界其他国家的成功典范。老年老年国际 2012； 12：16-22。
1. Background: Recent medical advancements, and improvements in hygiene and food supply have led to Japan having the longest life expectancy in the world. Over the past 50 years, the percentage of the elderly population has increased fourfold from 5.7% in 1960 to 23.1% in 2010. This change has occurred at the fastest rate in the world. Compared with France, where the percentage of the elderly population has increased just twofold in the past 100 years, Japanese society is aging at an unprecedented rate. In addition, the percentage of the very elderly (aged 75 years and over), comprising more frail people, exceeded 10% of the nation's population in 2008. In such a situation, many elderly Japanese wish to spend their later years healthy, and wish to achieve great accomplishments in their lives. To achieve that, rather than considering an aging population as a negative social phenomenon, we should create a society where elderly people can enjoy a healthy, prosperous life through social participation and contribution.healthy, prosperous life through social participation and contribution. Factors that hamper the elderly from leading a healthy life include various psychological and social problems occurring in older age, as well as a high incidence of diseases. Therefore, gerontology, which focuses on health promotion of the elderly by encompassing the study of social welfare, psychology, environment and social systems; and geriatrics, which focuses on health care of elderly people and carried out research, education and practices to promote health in the elderly, are becoming more important. Furthermore, along with a need for multidisciplinary care to support geriatric medicine, the development of a comprehensive education system for aged-care professionals is awaited. Thus, we should now recognize the importance of gerontology and geriatrics, and a reform of medical-care services should be made in order to cope with the coming aged society. Population aging is a global phenomenon. The actions being taken by Japan, the world's most aged society, have been closely watched by the rest of the world. Japan's aged society has been posing not only medical, nursing and welfare problems, but also complex problems closely associated with economy, industry and culture. Therefore, to solve these problems, a macroscopic integration and cooperation among industries, education institutions, administration and community through an interdisciplinary approach including medical science, nursing science, nursing care, study of social welfare, social science, engineering, psychology, economics, religion and ethics should be made. Regarding the promotion of gerontology, the "Committee for Establishing a Scientific Community for Sustainable Aged Society" of the Science Council of Japan also prepared a proposal and this was announced on 20 April 2011.2. Current situation and problems ( 1) Promotion of social participation and contribution of elderly people In Japan, the overall labor force rate is expected to decrease in the near future as a result of the low birth rate and high life expectancy. In contrast, many elderly people, particularly the young-old, have sufficient physical strength to fulfil their job duties and make a social contribution. For these people, a social structure where elderly people can work should be developed through re-educating the elderly and providing various job types. Promotion of social participation and contribution of the elderly is expected to cause a substantial increase in the labor force. Furthermore, it is also expected to contribute to not only the upturn of national economic activity through an increase in total consumption, but also a decrease in the number of elderly people who are likely to be in need of care. Therefore, in order for elderly people to be engaged in various social activities, strategies for developing a social structure for re-education, various employment statuses and employment opportunities should be prepared. However, as the total number of jobs is fixed, consideration should also be given to young workers. (2) Fostering medical specialists for aging Older people often suffer from many diseases, together with geriatric syndromes with multiple etiologies. Signs and symptoms vary according to each individual, and are often atypical; therefore, the patients visit different hospitals and receive many screening tests and prescriptions at the same time. To solve this problem, an effective screening system carried out by a primary-care doctor, and privacy-preserving medical data sharing among hospitals and clinics are needed. In a geriatric clinical setting, health-care professionals should be aware of the physical traits of older people who often develop not only dementia, but also geriatric syndromes, such as depression, falls and urinary incontinence, so that a holistic approach with consideration of nursing care is required. However, the existing Japanese medical education system is not prepared for medical professionals enabled to respond to the aforementioned requirements. Thus, the fostering of medical professionals who can provide comprehensive care - especially for the oldest-old - such as geriatric specialists and medical professionals who understand the principles of elderly care, is urgently needed. ( 3) Diagnosis of elderly-specific diseases and reform of medical-care services In Japan, the diagnostic system for elderly-specific diseases, including dementia, and reform of medical care services are markedly delayed. The current status concerning diagnosis, care and nursing should be investigated to collect academic data. In order to accumulate evidence for providing safe elderly care and nursing, the promotion of clinical research and a marked expansion of geriatric medical centers with high-level medical services are eagerly awaited. ( 4) Promotion of home-based care and multidisciplinary care To reduce the length of stay in acute hospitals, to reduce the physical burden of healthcare professionals working at acute hospitals and to meet the demand of older people who prefer to remain in their own homes, further promotion of home-based care is needed. In addition, "multidisciplinary care" is increasingly needed to meet various demands in the medical care and welfare of the elderly.It is considered important to share countermeasures against the problems of disease prevention, medicine, care and welfare among healt-care professionals in medicine, care and welfare, and cooperate by making the best use of health-care professionals' specialties.3. Contents of the proposal The subcommittee for aging, thus, provided the following proposal:1 Development and promotion of systems that enable elderly people to participate socially and make a contribution using an interdisciplinary approach among the various areas, including nursing science, nursing care, study of social welfare, social science, psychology, economics, religion and ethics, as well as medical sciences;2 Promotion of gerontology, reform and enhancement of geriatrics in undergraduate, postgraduate and lifelong education;3 Building geriatric medical centers in each area, and accumulating large-scale evidence of geriatric diseases and geriatrics; and4 Structural development and promotion of home-based care and multidisciplinary care. Through implementation of the above measures, Japan is expected to function as a successful example for the rest of the world. Geriatr Gerontol Int 2012; 12: 16-22.