Collaboration of rehabilitation and welfare for a higher quality of life of aged people with disabilities and their families.

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The purpose of this study is analysis of quality of life (QOL) in aged people with disabilities and their spouses in order to find out an effective program for its improvement.The subjects were a large number of patients with post-strokehemiplegia who were hospitalized for intensive rehabilitation, discharged home and have been on outpatient rehabilitation program and their spouses.They were given a series of semi-structured interviews using the "Comprehensive QOL Evaluation" that had been standardized by us and evaluates three levels of objective QOL (Biological, Personal and Social levels) and a subjective QOL (Psychological or Existential level) in sequence of four time-points (Before the Onset, Worst after the Onset, Present and Future Outlook).The results were as follows :1. There were age and gender differences both in the patients themselves and in the spouses. For example, the aged people (those aged 65 years and older) had slightly lower general QOL than the non-aged (below 65 years) at 'Before the Onset'. However, their downfall in QOL due to stroke was slightly less marked than the non-aged so that the QOL at 'Worst after the Onset' was almost the same in the two groups. The recovery was again slightly less in the aged. This age-related difference was observed both in patients themselves and the spouses although the degree was less pronounced in the spouses.2. A kind of "Vicious Circle" of QOL lowering was found to develop between the patents themselves and the spouses. It occurred in all the levels of QOL.3. Subjective QOL was improved both by improvements of objective QOL and "Acceptance of Disability which is an important psychological-existential phenomenon characterized by an essential change of the value system related to the disability.4. "The Goal-Oriented Rehabilitation Program" was confirmed to be much more effective in improving QOL both in the patients and the spouses as well as in preventing the "Vicious Circle".