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

本研究以大量脑卒中后偏瘫住院强化康复患者为研究对象，分析老年残疾人及其配偶的生活质量，探讨提高老年残疾人及其配偶生活质量的有效方案。出院回家，并已在门诊康复计划和他们的配偶。他们进行了一系列的半结构化访谈，使用“本研究采用经我们标准化的“综合生活质量评价法”，按发病前、发病后最差、现在和未来四个时间点依次评价三个客观生活质量水平（生物水平、个人水平和社会水平）和一个主观生活质量水平（心理水平或潜在水平）。患者自身和配偶之间存在年龄和性别差异。例如，老年人（65岁及以上）在“发病前”的总体生活质量略低于非老年人（65岁以下）。然而，他们的生活质量下降，由于中风是稍微低于显着的非老年人，使生活质量在“最坏的发病后”是几乎相同的两组。老年人的恢复率也略低。这种与年龄相关的差异在患者本人和配偶中均存在，但在配偶中的程度不太明显.患者自身与配偶之间形成了一种生活质量下降的恶性循环。在生活质量的各个水平上均有发生。主观生活质量的提高是通过客观生活质量的提高和“接纳残疾”来实现的，接纳残疾是一种重要的心理存在现象，其特征是与残疾相关的价值体系发生了本质性的变化.证实“目标导向康复方案”在提高患者及配偶生活质量、防止恶性循环方面更有效。

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".