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

摘要本研究旨在了解日本长期照护保险资格决定过程中被分类为体弱的社区居住老年人的运动习惯、自评功能适能、日常生活活动（ADL）和对跌倒的恐惧。受试者年龄在75岁及以上，分为体弱老年人组（n=126，男=29，女=97）和健康老年人组（n=262，男=114，女=148）。我们采用问卷调查的方式对运动习惯、自评功能适能、ADL、害怕跌倒和减少活动进行了访谈调查。该调查是在2000年11月至12月期间以挨家挨户的方式进行的。回答没有锻炼的人在虚弱组中高于健康组。在自评功能健身项目中，体弱组耐力、肌力和柔韧性较低。基本ADL依赖率在沐浴（男=65.5%，女=84.5%）和步行（男=72.4%，女=79.4%）两项中均较高。此外，虚弱组的辅助ADL依赖率远高于健康组。体弱多病的老年人中有跌倒恐惧的男性占93.1%，女性占93.8%。在害怕外出的人士中，66.7%的男性及60.4%的女性曾因害怕外出而减少外出。我们的研究结果表明，需要一个干预方案来提高老年人的洗澡和行走能力以及社会支持。在体弱多病的老年人中，自我评估的跌倒恐惧与减少活动显著相关。

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.