What needed for home health care of the elderly in their residential environment.

日本的人口老龄化正在显著加速。目前正在等待一份适用于日本老年人的有效和高效家庭保健的实用指南。本研究的目的在于界定日本家庭医疗保健系统的理想居住条件和居住环境。我们选择了来自医疗护理、建筑、社会福利领域的研究人员，因为这些领域都是对这个问题进行全面研究所必需的。首先，采用邮件访谈法对8000名城市老年人进行分层随机抽样，探讨影响机构化的环境因素。其次，我们通过访问访谈的方式评估功能（肌力、步行速度、日常生活活动、日常生活工具活动等）和居住环境（住房设备、房间布置、社会支持网络、家庭功能等），进一步进行评估。更重要的是，我们对房改后残疾老年人的身体功能进行了跟踪。最后，我们分析了拥挤的大城市东京的社会指数和健康指数（包括各城市按死因划分的年龄特定死亡率：来源数据由日本统计局批准）。根据每一项研究成果，委员们从健康城市居住环境的角度对存在的问题进行了充分的讨论。综上所述，建议澄清以下4点。1. 帮助开发适合老年人的设备，不仅在家里，而且在公共空间是必要的。2. 对于严重残疾的老年人来说，培养照顾者是必不可少的（住房改革本身对照顾者功能的提高贡献较小）。3. 对于中度残疾的长者来说，适当的运动建议和充足的社会资源，包括房屋改革，是不可或缺的。4. 如果能灵活利用现有的社会资源，社会支持网络就能有效地提供高效率的家庭保健服务。少

The aging of the population in Japan is accelerating markedly. A practical guideline for effective and efficient home health care suitable for Japanese elderly is awaited. The purposes of the present study is to define the desirable housing conditions and environment of residence for Japanese home health care system. We selected research members from medical nursing, architecture, and social welfare fields, because all of these fields are necessary for comprehensive research on this issue. Firstly, we performed a mail interview survey (subjects were 8,000 stratified random sample of urban elderly) to investigate the environmental factors affecting institutionalization. Secondly, we assessed the functions (muscle strength, walking speed, activity of daily living, instrumental activity of daily living, etc.) and environment of residence (housing equipment, arrangement of the rooms, social support networks, family functions, etc.) by visiting interview survey for further evaluation. Third … More ly, we followed up physical function of the disabled elderly after the housing reform. And the lastly, we analyzed social indices and health indices (including age-specific death rate by causes of death by municipalities: source data were approved by Japanese Statistics Bureau) in an overcrowded huge city, Tokyo. Based on each research result , members filly discussed on the problems from the perspective of environment of residence for healthy cities. In conclusion, the following 4 points were clarified as the recommendation. 1. Aid development of suitable equipments for the elderly, not only inside of the house but also in the public space is necessary. 2. For the severely disabled elderly, development of caregivers is essential (housing reform itself less contributed to the improvement of their function). 3. For the moderately disabled elderly, suitable advices for physical exercise and adequate provision for social resources including housing reform are indispensable. 4. Social support network, for efficient home health care works effectively, if the eidsting social resources were utilized flexibly. Less