A development of overall health promotion program for community-dwelling frail elderly in the Japanese long-term care insurance system

本研究以日本长期照护保险制度中被判定为体弱的社区居家老人为研究对象，以75岁以上的体弱老人为研究对象，探讨其运动习惯、自评功能适能、日常生活活动能力（ADL）及跌倒恐惧感的现况健康老年组262例，男114例，女148例。采用问卷调查的方法，对运动习惯、自评功能体适能、日常生活活动能力、跌倒恐惧、活动减少等进行访谈调查。调查于2000年11月~ 12月采用入户调查的方法进行，结果显示，体弱组回答不锻炼的人数明显高于健康组。在功能体适能自评项目中，耐力、肌力、柔韧性在体弱组中相对较低。基础ADL依赖率以洗澡（男= 65.5%，女=84.5%）和步行（男= 72.4%，女=79.4%）为高。此外，工具性ADL依赖率也明显高于健康组。体弱老年人中有93.1%的男性和93.8%的女性害怕跌倒。在有恐惧心理的老年人中，有66.7%的男性和60.4%的女性因恐惧心理而减少外出。自评跌倒恐惧与体弱老人活动减少显著相关。

The purpose of this study was to clarify the exercise habits, self-rated functional fitness, activities of daily living (ADL) and fear of falling in community-dwelling elderly who are classified as frail by eligibility decision process of the Japanese long-term care insurance system.The subjects who aged were 75 years and older, classified into frail elderly group (n=126; ma1e=29,female=97) and healthy elderly group (n=262; male=114,female=148). We had carried out an interview survey using questionnaire asking about exercise habits, self-rated functional fitness, ADL, fear of falling and activity curtailment. The survey was carried out by door-to-door method and data were collected from November to December 2000.Respondent who answered no practice exercise was higher in the frail group than in the healthy group. Among the self-rated functional fitness items, endurance, muscular strength and flexibility were comparatively low in the frail group. The rate of basic ADL dependence was higher in bathing (male=65.5%, female=84.5%) and walking (male=72.4%, female=79.4%), for both sexes of the frail group. Also, the rate of instrumental ADL dependence was much higher in the frail group than in the healthy group. The 93.1% in male and 93.8% in female among frail elderly had fear of falling. Of those who are afraid, 66.7% in male and 60.4% in female had curtailed from going out due to this fear.Our findings suggest that an intervention programs is needed to improve bathing and walking ability as well as social support for the frail elderly. Self-rated fear of falling was significantly associated with activity curtailment in frail elderly.