MF Researcher Database

Researchers Database

Advance

Ishizaki Tatsuro

    -　Director
Last Updated :2025/04/26

Researcher Information

J-Global ID

Research Interests

  • Long-term Care   Epidemiology of Chronic Disease   Care Coordination   Home Care   高齢者の医療経済学   高齢者の健康増進   加齢の疫学   社会老年学   health economics in older population   Epidemiology in aging   Social gerontology   

Research Areas

  • Life sciences / Healthcare management, medical sociology
  • Life sciences / Hygiene and public health (non-laboratory)
  • Life sciences / Hygiene and public health (laboratory)

Academic & Professional Experience

  • 2011 - Today  Tokyo Metropolitan Institute of GerontologyHuman Care Research TeamResearch Team Leader
  • 2009 - 2011  Kyoto University School of Public HealthDepartment of Health InformaticsAssociate Professor
  • 2000 - 2008  Kyoto University School of Public HealthDepartment of Healthcare Economics and Quality ManagementAssociate Professor
  • 1996 - 2000  Tokyo Metropolitan Institute of GerontologyDepartment of EpidemiologyResearcher
  • 1992 - 1995  Teikyo University School of MedicineDepartment of Public HealthAssistant Professor

Association Memberships

  • SOCIETY FOR APPLIED GERONTOLOGY-JAPAN   JAPAN EPIDEMIOLOGICAL ASSOCIATION   JAPAN SOCIO-GERONTOLOGICAL SOCIETY   THE JAPAN GERIATRICS SOCIETY   JAPANESE SOCIETY OF PUBLIC HEALTH   

Published Papers

MISC

Research Grants & Projects

  • A study of the structure of the beliefs about aging and its' influence.
    Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (A)
    Date (from‐to) : 2022/04 -2027/03 
    Author : 権藤 恭之; 石崎 達郎; 石松 一真; 石岡 良子; 西田 裕紀子; 神出 計; 片桐 恵子
  • 生活困窮者の健康・自立支援のためのビッグデータ基盤整備：健康格差是正をめざして
    日本学術振興会：科学研究費助成事業 基盤研究(B)
    Date (from‐to) : 2020/04 -2024/03 
    Author : 高橋 由光; 光武 誠吾; 石崎 達郎; 後藤 禎人; 加藤 源太; 中山 健夫
  • 高齢者における多剤処方の健康影響評価と服薬指導プログラムの研究開発
    日本学術振興会：科学研究費助成事業 基盤研究(B)
    Date (from‐to) : 2020/04 -2024/03 
    Author : 石崎 達郎; 増井 幸恵; 高橋 由光; 浜田 将太
     
    【研究１】地域在住高齢者における多剤処方の健康影響の評価： ①レセプトデータの分析～北海道後期高齢者医療広域連合のレセプトデータから75歳以上の補保険者を対象に、外来医療において処方された薬剤種類数を把握し、処方薬剤数とその後の健康アウトカム（新規の要介護認定、死亡）との関連を分析した。その結果、薬剤数が多いと要介護認定や死亡の発生リスクが高くなっていることが明らかとなった。 ②コホート研究データを用いた分析～当研究所が大阪大学らと共同で2010年から実施している長期縦断研究「SONIC研究」のデータを使用して、服用中の薬剤種類数と3年後の歩行速度や握力の変化との関連を分析した。調査参加者のうち70歳群と80歳群（合計1544人、70歳群が全体の47.5％）を分析対象者とした。薬剤種類数は内服薬に限定し調査対象者が持参したお薬手帳や薬剤情報提供書から情報を収集した。その結果、薬剤種類数は3年後の握力低下や歩行速度低下と有意に関連しており、カットオフ値は5種類以上と計算されたが予測能は低かった（ROC曲線下面積は0.55前後）。 【研究２】自治体が実施する服薬指導プログラムの実態把握： 国民健康保険や後期高齢者医療制度の保健事業として服薬指導を実施した区市町村の担当者を対象にヒアリング調査を計画したが、新型コロナウイルス感染症拡大防止の観点から、調査は実施できなかった。服薬指導事業の内容を検討しており、事業の計画準備、服薬指導対象者の選定と呼びかけ方法、参加者数、服薬指導の手続・内容・評価方法、投入した人的資源・費用等）である。
  • Developing a prediction model of readmission and strategy for preventing readmission by using big medical claim data
    Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (B)
    Date (from‐to) : 2020/04 -2024/03 
    Author : 光武 誠吾; 土屋 瑠見子; 石崎 達郎
  • ケアのサイエンスを実現する介護とテクノロジー融合が福祉のトラストに与える影響
    日本学術振興会：科学研究費助成事業 基盤研究(B)
    Date (from‐to) : 2019/07 -2022/03 
    Author : 涌井 智子; 渡辺 健太郎; 池内 朋子; 三輪 洋靖; 伊藤 沙紀子; 木下 衆; 甲斐 一郎; 石崎 達郎
     
    本研究が対象とする課題は、情報社会における介護現場にテクノロジーをいかに導入するか、およびテクノロジーの導入により介護がいかに変わるかを明らかにし、技術や介護情報、テクノロジーを導入することによって福祉そのものに対する人々の信頼をいかに維持・醸成するか？という問いである。 本年度は、地域在住の中高年（40～89歳まで）約4700名を対象に、介護におけるテクノロジー導入に対する意識調査を実施した。この調査データの解析により、現在の中高年が高齢期に希望する介護におけるテクノロジー導入状況が明らかになったとともに、介護におけるテクノロジー導入希望に対する関連要因には性差があることや、学歴などが関連することが明らかとなっている。一方、高齢者の身体・認知機能によって、テクノロジー導入に対する認識がいかに変わるを明らかにした解析からは、身体・認知機能の依存度が高くなるほど、テクノロジー導入を受容する一方で、家族の介護経験者の方が、テクノロジー導入に対する受容度が高いことが明らかになった。 わが国の介護を支えるシステムは、経済的・資源的に極めて緊迫な課題を抱えており、介護とテクノロジー融合が介護システムの持続性に必然とされている。介護施設における導入だけでなく、地域在住の一人暮らし等高齢者におけるテクノロジー導入の可能性について、今後の調査・解析によって検討をしていく予定である。
  • 学際的アプローチによるポリファーマシー発生機序の探求
    日本学術振興会：科学研究費助成事業 挑戦的研究(萌芽)
    Date (from‐to) : 2019/06 -2022/03 
    Author : 石崎 達郎; 吉田 祐子
     
    高齢者の多くは複数の慢性疾患を抱え、ポリファーマシーとなりやすく、ポリファーマシーは高齢社会における健康政策上の重要課題である。ポリファーマシー発生には医学的要因のみならず、心理・行動科学的要因、医療制度的要因等々、多くの要因が寄与していると考えられる。本研究は、①ポリファーマシーの危険因子に関するシステマティックレビュー、②地域在住高齢者を対象とする学際的研究データを用いたポリファーマシー危険因子の分析を実施することで、ポリファーマシーの発生機序を学際的アプローチによって探求することを目的とする。 【研究１】ポリファーマシー危険因子に関するシステマティックレビューの実施 患者側の医学的要因（疾患、要介護状態の有無等）、患者・家族の心理学・行動科学的要因、居住地域における医療資源等の環境要因、処方医師の要因、調剤薬局・薬剤師の要因、医療経済学・医療制度・公衆衛生行政の要因、チーム医療・多職種連携の要因など学際的観点からPubMedを使って文献を検索し、システマティックレビューの対象論文をスクリーニングした。 【研究２】学際的高齢者長期縦断研究データを用いたポリファーマシー危険因子の分析 2010年から取り組んでいる地域在住高齢者を対象とする長期縦断研究「SONIC研究」で得られたデータを使って、ポリファーマシー状態にある者を把握し、その危険因子として性格特性に注目し、男女別に分析した。ポリファーマシーであった者は男性24％、女性27％で、多剤処方に関連していた性格特性は、男性は神経症傾向が高いこと、女性では外向性が低いことであった。
  • Longitudinal study of the effect of aging and dying process on well-being of the older people.
    Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (B)
    Date (from‐to) : 2017/04 -2022/03 
    Author : 権藤 恭之; 石崎 達郎
     
    本研究の目的は、SONIC研究参加者に対して追跡調査を行い、感情の経時的変化に関する縦断的検討を行うことである。SONIC研究ではNarrow range age design に準拠した年齢幅が3歳の3年齢群(70歳、80歳、90歳)を関東・関西の都市部と田園地域において悉皆で対象者を抽出し参加を呼びかけ、公民館等を利用した招待型調査を実施してきた。 本年度は、70歳群の第4波調査を行うとともに、調査が早期に終了したため、データ整理をすすめた。また、これまで把握することができなかった、縦断調査からドロップアウトした参加者に関する情報を再収集した。これらのデータを整備すると共に、引き続き、国際共同研究を推進するためのデータセットの英語化を進めた。研究成果としてはIADLが抑うつ傾向に与える影響が年齢によって異なることを確認した。また、慢性疾患が認知機能に与える影響も同様に年齢によって異なることを確認した。この現象は異なる年齢群では生のプロセスと死のプロセスの比重が異なることによって生じると推察できる。したがった、両プロセスのバランスで高齢期のポジティブ感情およびネガティブ感情が決定するという本研究の中核的仮説を部分的に支持するものだといえた。また、活動の指標である余暇活動が認知機能と運動機能に対して影響することと、また認知機能と運動機能の間には両方に影響を与えあうことが明らかになった。また、精神的健康は両者の関係から独立していることが示された。この結果は70歳高齢者での結果なので、80歳、90歳においてこれらの関係がどのように変化するかを検討することで、生のプロセスが低下し、死のプロセスが上昇した時の影響を検証するための基礎的にモデルができた。
  • 職域レセプト分析：受診行動による生活習慣病の早期発見および重症化予防への効果
    日本学術振興会：科学研究費助成事業 基盤研究(C)
    Date (from‐to) : 2016/04 -2022/03 
    Author : 志摩 梓; 辰巳 友佳子; 石崎 達郎; 呉代 華容; 宮松 直美
     
    本申請課題は、職域コホートの健診データとレセプトデータを継続的に突合し、①循環器疾患のリスク因子と受療状況、疾病コントロール等の関連、②がん検診および精検受診率とがん発症との関連等を検討すること、を目的としている。 2020年度は、循環器疾患については、1) 2017年健診時にII度以上の高血圧者273人を対象として実施した、医療機関への紹介状を発行する保健介入の追跡検討を行った。その結果、紹介状発行により外来受診開始が増加するだけでなく、1年後のIII度高血圧者が従来の約半数となることを公表した（OR: 0.42、95％CI: 0.19-0.90）。2) 家庭血圧測定状況の検討を進め、降圧薬服用者に限った分析において、家庭血圧測定習慣がある者は約25%であること、男女ともに他の生活習慣病治療があることが、女性では血圧管理不良と、不健康な生活習慣であることが、測定習慣なしと関連することを公表した。3) 糖尿病コントロールについて、9年間の78536件(14556人)の健診データから、101件(61人)の血糖パニック値（HbA1c: 11.0%以上、または随時血糖: 400mg/dL以上、または空腹時血糖: 300mg/dL以上）を抽出・分析し、健診直後における個別の受診勧奨により一旦は全員が医療機関を受診するものの、翌年健診時に治療継続が確認できた者は約8割で、治療継続者でも約6割でHbA1cが8%以上であることを公表した。 がん検診については、大腸がん検診（便潜血反応検査）の受診、精密検査受療状況等のデータ整理を進めたが、大腸がん罹患との関連等の検討は、後述のとおり2021年度に行うことにした。
  • Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Challenging Exploratory Research
    Date (from‐to) : 2016/04 -2020/03 
    Author : TAKAHASHI Yoshimitsu
     
    We aimed to examine the prevalence of multimorbidity with special reference to non-communicable diseases (e.g. diabetes mellitus, hypertension and dyslipidemia). We analyzed Comprehensive Survey of Living Conditions in Japan as a self-reported survey. We also analyzed National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) (for insured people) and Fact-finding Survey on Medical Assistance (for public assistance recipients) as claims data. The highest prevalence of comorbidities was hypertension-dyslipidemia (5%), followed by hypertension-eye diseases (4%) and hypertension-diabetes (4%). The prevalence of non-communicable diseases with public assistance recipients was higher than one with insured people. Low socioeconomic status and multimorbidity were associated with cancer screening delivery.
  • Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (B)
    Date (from‐to) : 2015/07 -2018/03 
    Author : ARAI YASUMICHI; IKEBE Kazunori; INOUE Itsurou
     
    In this project, we aimed to identify key molecules of stress resistance in supercentenarians by means of induced pluripotent stem (iPS) cells, and replicate the findings in a cohort study of older adults, the SONIC study. First, we established iPS cells-derived endothelial cells from supercentenarians, and examined key molecules of oxidative stress and hypoxic stress responses. However, transcriptional study failed to identify key molecules because of small sample size. Alternatively, we performed QTL analysis for extracellular-superoxide dismutase (EC-SOD), a circulating antioxidative stress molecule, and identified SNP in rs1799895 as significant determinant for circulating EC-SOD. We genotyped this SNP in 1,890 subjects in the SONIC study, and found significant associations between the SNP and carotid atherosclerosis, and geriatric phenotype.
  • Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (C)
    Date (from‐to) : 2015/04 -2018/03 
    Author : MASUI YUKIE; ISHIZAKI Tatsuro; ARAI Yasumichi; IKEBE Kazunori; INAGAKI Hiroki; KAMIDE Kei; NAKAGAWA Takeshi
     
    The objective of this study was to examine the role of gerotranscendence when one experiences a negative life event during one’s old age. Three follow-up surveys spanning six years were conducted with elderly persons in their 70s and 80s as the subjects. As results, it was found that 1) A gerotranscendence development is promoted through the experience of separation from one’s spouse through death as well as caregiving experience ; and 2) The experience of gerotranscendence prior to experiencing a family member suffering from major illness will have a protective effect on the psychological health deterioration that occurs during this experience. However, events that can facilitate gerotranscendence are limited, with events in which the preventative effect of gerotranscendence had been confirmed also being limited. In the future, gerotranscendence needs to be studied in more detail by focusing on negative events in relation to which gerotranscendence is shown to be effective.
  • Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (C)
    Date (from‐to) : 2015/04 -2018/03 
    Author : Kamide Kei; GONDO Yasuyuki; IKEBE Kazunori; ISHIZAKI Tatsuro; ARAI Yasumichi; Masui Yukie; KABAYAMA Mai; SUGIMOTO Ken; YAMAMOTO Kouichi; OGURO Ryousuke
     
    The purpose of this study is to investigate the association of blood pressure (BP) level with physical frailty status and cognitive function among 70, 80 and 90 years old community dwelling Japanese. Community-dwelling older people aged 70±1 (n=1000), 80±1 (n=978) and 90±1 (n=272) years participated in the invitation survey, SONIC study. BP, grip strength, 8-feet gait speed and cognitive function (MOCA-J) were examined on site. The physical frailty was assessed by the CHS criteria. Trend-analysis showed that subjects with higher SBP had lower MOCA-J score in age 70 years and subjects with lower SBP had lower MOCA-J score in age 90 years. These significant trends were seen only in the participants with antihypertensive treatment. Frailty status modified these trends. According to these results, BP target values should be set up by considering age differences. The causal relationship should be clarified whether the cognitive decline is caused by excessive reduction of BP.
  • Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (C)
    Date (from‐to) : 2015/04 -2018/03 
    Author : ISHIZAKI Tatsuro
     
    Because the prevalence of multimorbidity is higher in older adults, we described the common three-way patterns of chronic diseases among older adults aged 75 or older using health insurance claims data. About two thirds of the patients had three or more co-occurring chronic diseases. Then we examined the extent to which each clinical guideline (CGL) took into account patients with multimorbidity and found that only a few CGL did this. To prevent adverse drug events and fragmented and inefficient medical care, a CGL that takes into account multimorbidity should be developed. Finally, we discussed an ideal management strategy for patients with multimorbidity. As Tinetti and Fried (2004) suggested, comprehensive geriatric assessment including physical, psychological, social, and other factors, as well as clinical decision making that is focused on priorities and preferences of individual patients should routinely occur in clinical practice for older patients with multimorbidity.
  • Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (C)
    Date (from‐to) : 2014/04 -2018/03 
    Author : Sugihara Takahiko
     
    The patients with elderly-onset rheumatoid arthritis (RA) can achieve clinical remission and normal physical function by therapeutic strategy targeting low disease activity(T2T). Anti-cyclic citrullinated peptide antibody, bone erosion, high disease activity, and clinical responses at initial treatment are predictors of joint destruction. Serious adverse events under T2T strategy of EORA have great impact on physical dysfunction in patients who achieved treatment goals. Peptidylarginine Deiminase 4 (PAD4) protein expression in peripheral blood is not associated with disease activity. Genome-wide association studies (GWAS) have identified new single nucleotide polymorphisms (SNPs) related to susceptibility of RA. However the SNP cannot predict treatment response of EORA in our prospective cohort. We would like to establish T2T strategy cooperated with SNP related to treatment response and adverse events, but not RA susceptibility.
  • Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (B)
    Date (from‐to) : 2014/07 -2017/03 
    Author : Gondo Yasuyuki; MASUI Yukie; NAKAGAWA Takeshi; INAGAKI Hiroki; UEDA Hiroshi
     
    This study aimed to develop a new Successful Aging model for super aging society. We adapted several successful aging model with different definition on the data from longitudinal epidemiological study. Results indicated only 17%, 4%, 0% of participants were classified as successful ager for 70, 80 and 90 years old respectively, if we applied classical definition based on physical function. On the other hand, age related increase in subjective well-being was observed. This trend was also observed in 3-year longitudinal change. We could confirm dissociation between successful aging model based on physical function and subjective well-being.
  • Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (C)
    Date (from‐to) : 2013/04 -2017/03 
    Author : Shima Azusa; OKAMURA Tomonori
     
    The purpose of this study was to investigate the relationship between the outpatient visits, as determined from health insurance claim data, and consequent hypertension control among participants with hypertension. Antihypertensive agents were taken by 66.4% of the participants and the prevalence of uncontrolled hypertension at 9 years was 62.4%. Mean annual outpatient visit days at a hospital/clinic during the 9-year period were classified within four quartiles. Uncontrolled hypertension increased significantly as the number of outpatient visits decreased (P for trend < 0.001).Logistic regression analysis was used and the multivariable-adjusted OR for uncontrolled hypertension was approximately four times higher in group with few outpatient visits (Q1) than in the group with highest number of visits (Q4, once or twice a month). This tendency did not change when participants with baseline use of antihypertensive agents was excluded.
  • Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (A)
    Date (from‐to) : 2012/04 -2015/03 
    Author : TAMIYA Nanako; NOGUCHI Haruko; MATSUI Kunihiko; MIYAISHI Satoru; YAMAZAKI Kentaro; YAMAMOTO Hideki; SAITO Tamaki; ABE Toshikazu; TAKEDA Fumi; TAKAHASHI Hideto; KASHIWAGI Masayo; IZUMIDA Nobuyuki; MATSUMOTO Yoshio; SHIBAYAMA Taiga; SANKAI Tomoko; ABE Yoshiki; ASO Hideki; KIKUCHI Jun; MORIYAMA Yoko; YAMAOKA Yui; ITO Tomoko; KOBAYASHI Yoko
     
    This study is aimed at implementing the PDCA cycle (process improvement technique consisting of 4 steps:Plan,Do,Check, and Act) which has two main components, medical, long term care, and welfare care fieldsites and the university. We have planned to cooperate with the medical, long term care, welfare fieldsites by examining together the Tsukuba-city medical welfare case examination meetings, and providing feedback to Tsukuba City by analyzing their needs survey. We performed a scientific study using several types of data analysis, including big data from national long-term care benefit expenditures data and from the Comprehensive Survey of Living Conditions. We examined the regional comprehensive care promotion policy , including these findings, to clarify how to advance the cooperation between medical and long-term care, what kind of support require the persons in need of care, children with disabilities and the use situation of nursing care insurance services.
  • Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (B)
    Date (from‐to) : 2012/04 -2015/03 
    Author : TAKAHASHI Ryutaro; AITA Kaoruko; TSURUWAKA Mari; SHIMADA Chiho; ISHIZAKI Tatsuro; SHIMIZU Tetsuro
     
    Much attention is given to approaches to place proper regard on the wishes of the elderly care recipients. Of the patients enrolled in this research, 44% discussed their end-of-life care with families and friends, 12% articulated their wishes in writing, while 48% did neither. We conducted a practical intervention research by utilizing a tool named “Life Design Notebook”, which encourages the patients to envisage the end of their lives and also to communicate their advance medical directives. 114 local clinic patients were given this notebook, but only half documented their wishes with regard to the end-of-life care. We later interviewed the patients to investigate the psychosocial aspect to this outcome, and observed that they had the tendency to prioritize the circumstances of their families. They were reluctant to specify their living wills out of modesty, and the willingness to write them down in the Notebook reflected the relationship that they maintained with the families.
  • Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (C)
    Date (from‐to) : 2012/04 -2015/03 
    Author : ISHIZAKI Tatsuro; TAKAHASHI Ryutaro
     
    To establish better care coordination between medical care and long-term care (LTC) for frail elderly, it is essential to identify patterns of care transitions among elderly adults who need medical and nursing care. We described transitions in sites of care among older adults in the last year of life, and will discuss how to provide frail elderly with care coordination and health promotion. Using medical care and LTC insurance claim data, as well as death certificate data, we identified transitions in each decedent’s living place in each month during the last year of life. In the last year of life, elderly individuals with severe disabilities were more likely to move between sites of care. They must be cautiously provided with care coordination services at either medical care or LTC settings. To remedy potential problems in coordination between these care settings, a home visiting nurse would be expected to play an important role in care coordination and health promotion.
  • Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (A)
    Date (from‐to) : 2011/04 -2015/03 
    Author : AKIYAMA Hiroko; KOBAYASHI Erika; NAOI Michiko; SUGIHARA Yoko; SUGISAWA Hidehiro; SUGAWARA Ikuko; KIMURA Yoshimi; YAMADA Atsuhiro; FUKAYA Taro; SHINKAI Shoji; ISHIZAKI Tatsuro; MURAYAMA Hiroshi; LIANG Jersey
     
    Longitudinal and repeated cross-sectional analyses were conducted using the eight-wave panel data between 1987 and 2012 for the nationwide representative sample of Japanese elderly and the baseline survey in 2012 for the new elderly panel including those who were born after World War II. The analyses revealed that non-family networks, cigarette smoking, BMI, exercise habit, and mobility function decreased with age, though not always linearly, and that their mean values and rate of change varied across birth cohorts for some variables. Cohort and/or survey year differences appeared differently for males and females, namely increase of social isolation was observed only among men. Among women, co-residence with adult children was losing beneficial effect on life satisfaction (LS), while positive association between contact with friends and LS increased, suggesting that predictors of subjective well-being could also vary across cohorts and/or survey year.
  • Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Challenging Exploratory Research
    Date (from‐to) : 2012/04 -2014/03 
    Author : KIKUCHI Kazunori; ISHIZAKI Tatsuro; ITO Mio
     
    To solve elderly abuse by family caregivers, cooperation of medical institutions is necessary. However, cooperation of medical institutions is not enough. To promote cooperation to resolve elderly abuse of the medical institutions, a mail survey was conducted with relevant organizations and medical institutions in Tokyo. As a result, 1)payment of medical expenses, 2)solving of threats by family caregivers, 3)medical consent for the elderly by family, 4)temporary protection to medical institutions by the authority of local government, 5)appointment of a guardian had been required by medical institutions.
  • Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Challenging Exploratory Research
    Date (from‐to) : 2011 -2013 
    Author : MIYAZAKI Kikuko; NAKAYAMA Takeo; ISHIZAKI Tatsuro; SENGOKU Tami; URDA Kayo; OHTA Haruka; NEFU Yukiko; HINATA Miwa
     
    In Japan nearly one in every three deaths is caused by cancer. With the intention of promoting palliative care in cancer (PCC), this study examined which level of evidence for PCC research was in demand, and considered issues surrounding PCC research: (1) To ascertain the general state of Japanese PCC research, we conducted content analysis of English articles accepted for publication by the publishers outside Japan. The results suggested lack of research papers with higher levels of evidence. (2) Using large-scale receipt database, we retrieved and reviewed information related to the usage levels of opioid for palliative care by physicians. (3) Based on the findings from the two studies, we interviewed physicians with palliative care experience to explore what kind of research evidence was perceived in need. Through the content analysis, seven key categories were extracted. The findings implied that clinicians in Japan should be rendered supports for promoting palliative care studies.
  • Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (B)
    Date (from‐to) : 2009 -2012 
    Author : GONDO Yasuyuki; TAKAHASHI Ryutaro; MASUI Yukie; ISHIZAKI Tatsuro; KURETA Youichi; TAKAYAMA Midori
     
    This study was planned to evaluate the hypothesis that emphasized on the shift of adaptation strategies expected to occur along with the aging process. Three strategies of functional maintenance, logical psychological adaptation, non-logical psychological adaptation frameworks were accessed among 70(young-old), 80(old-old), 90(oldest-old) individuals, participated in the invitation survey . Results showed that the higher the age group, the lower physical function and cognitive function they have. On the other hand, scores of psychological well-being were stable among 3 age groups. Moreover, score of gerotranscendence which represent non-logical psychological adaptation strategy had increased according to age. These findings indicate that a shift of adaptation stratagem is important to maintain successful aging in the higher ages and development of non-logical psychological adaptation strategy is a key factor for accomplishing it..
  • Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Challenging Exploratory Research
    Date (from‐to) : 2010 -2011 
    Author : NAKAYAMA Takeo; ISHIZAKI Tatsuro; HIGASHI Takahiro; NODA Mitsuhiko; MIYAZAKI Kikuko; SATOU Toshihiko; IKEDA Shunya; SUZUKI Hiromichi
     
    In recent years, the problem of underuse of useful clinical evidence is coming to be important-evidence-practice gap. The major concern about evidence-practice gap is insufficient implementation of evidence-based effective treatment, however, the perspective can be extended to measures to improve drug safety and prevention of drug related adverse events. At first, this study characterized the database of receipt(healthcare claims) and the usefulness for research purpose. Afterwards, two cases(implementation of recommendation of preventive drug use against steroid-induced osteoporosis, adherence to the alert indicated in revised package insert for ergot-derived anti-Parkinson drugs, of which risk of valvulopathy has been identified) were examined using this database. Through these analyses, the receipt database was proved to be useful to study evidence-practice gap.
  • Health care needs and resource use among older individuals under the public long-term care insurance system
    Date (from‐to) : 2009 -2011
  • Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (C)
    Date (from‐to) : 2009 -2011 
    Author : ISHIZAKI Tatsuro; TAKAHASHI Ryutaro
     
    This study was to identify medical care use among older frail adults during their stay in a long-term care facility under Japan's public long-term care insurance. This study revealed that the most frequently performed blood test in the facility was serum albumin concentration. Chest radiography was the most commonly performed radiological diagnostic examination. Prescription drug expenditures varied widely among users. It is important for policy makers to identify medical resource use among older frail persons who use long-term care and to ensure providing appropriate medical care with them.
  • Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (C)
    Date (from‐to) : 2008 -2010 
    Author : SEKIMOTO Miho; IMANAKA Yuichi; ISHIZAKI Tatsuro; HAYASHIDA Kenshi
     
    We studied associations between structures of health care (e.g., physician/nurse staffing, healthcare manpower), disease management systems, process of care, and patient outcomes on following 3 topics ; 1) acute care of ischemic stroke, 2) high- and low-intensity intensive care models, and 3) transfusion practices and management. The results of the study suggest that, in addition to clinical factors, clinical management systems and clinical processes, is significantly associated with better process of care and patient outcomes.
  • Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (A)
    Date (from‐to) : 2007 -2009 
    Author : IMANAKA Yuichi; SEKIMOTO Miho; HAYASHIDA Kenshi; IKAI Hiroshi; ISHIZAKI Tatsuro; TOKUNAGA Junya
     
    Clinical performance and cost indicators were developed and visualized at institutional levels, based on the nationwide multi-institutional database and causes of variations were analyzed. The study results constructed the foundation for improvement of quality and efficiency of health care. By constructing the longitudinal integrative database, it visualized and analyzed resource allocation, regional equity, and supply-demand gap in health-related care and service. This study developed the methodology to assess systematically the health care and long-term care systems at regional levels.
  • Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (C)
    Date (from‐to) : 2006 -2008 
    Author : ISHIZAKI Tatsuro; IMANAKA Yuichi; SEKIMOTO Miho
     
    本研究は、高齢者の医療・介護資源の消費状況を検討することを目的とする。某県の医療費と介護費の内訳を市町村別に比較した結果、入院医療費が低額の自治体では施設介護費が高額である傾向が認められた。次に、某市の5年間の介護給付費を分析した結果、サービス利用状況は極めて不均等であることが明らかとなった。最後に、某医療機関で入院医療を受けた患者の最終退院から1年前までの累積入院医療費を分析したところ、生存退院患者よりも死亡退院患者は累積医療費が高額で、死亡退院患者では高齢になるほど医療費が低額であることが明らかとなった。
  • Development of clinical indicators for drug utilization and its application for quality medical care
    Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (C)
    Date (from‐to) : 2006 -2007 
    Author : SEKIMOTO Miho; IMANAKA Yuichi; ISHIZAKI Tatsuro; HAYASHIDA Kenshi
     
    This study is designed to evaluate the appropriateness of drug utilization by the use of administrative data such as Disease Procedure Combination (DPC, the Japanese equivalent of diagnosis-related group) data or claims data For this research, we chose to focus on : 1) drug therapy in the treatment of cerebral infarctions, and 2) the utilization of blood products. In the first study, we used Japan's administrative (DPC) data, which includes information on tests, medications, procedures, use of intensive, or specialized care, and nursing services itemized by type, quantity, and fees. We analyzed 3,136 patients with acute cerebral infarction from 14 medical institutions. Institutions were divided into three groups according to the distribution of medical costs in the first 2 days, and patient background, treatment process, and outcomes were compared across the groups. As a result of analysis, we observed wide variations in drug utilization patterns across institutions. The differences in medical costs for the initial hospitalization period appears to be more influenced by ICU utilization and management policies of institutions than the clinical condition of patients. We observed no significant association between drug utilization and patient outcomes. In the second study, we identified patients who received a blood transfusion, and conducted a survey regarding the use of blood products and evaluated the appropriateness of their use. Our sample population consisted of two hospitals, in which we first conducted a chart review to survey the clinical situations where blood products were used, and subsequently evaluated the appropriateness of the utilization. We developed algorithms to assess the appropriateness of blood transfusion for each blood product In our survey, appropriate use was observed in 70% of red blood cell (RBC) transfusions, 15% of fresh frozen plasma (FFP) transfusions, 56% of platelet transfusions, and 30% of albumin use. The most common clinical situation where blood transfusion occurred included : acute hemorrhage, chronic anemia, and surgery in RBC transfusions ; coagulopathy, and prophylaxis for bleeding in FFP transfusions ; cardiac surgery, cardiac surgery, hematological diseases, and critical illness in platelet transfusions ; and hemorrhagic shock, cardiac surgery, and liver cirrhosis for use of albumin products. Using DPC data, we calculated the observed/expected ratio (O/E ratio) of utilization of each blood product, and attempted to identify hospitals or divisions with over-utilization of blood products. Diagnostic groups were used for estimating the expected volume of blood products utilization. Although we observed a large variation in the O/E ratios, the magnitudes of O/E ratios were not necessarily associated with appropriateness of utilization.
  • アクシデントによって発生する損失医療費およびエラー指標算出の試みに関する研究
    日本学術振興会：科学研究費助成事業 萌芽研究
    Date (from‐to) : 2005 -2006 
    Author : 竹村 匡正; 吉原 博幸; 今中 雄一; 石崎 達郎
     
    本研究では、医療の質を定量的に測定するという観点から、インシデント・アクシデントレポートの情報及び医事情報を用いて新しいエラー指標の算出を行った。具体的には、医療事故に起因する診療行為の自動抽出を目的とし、それらの診療行為点数をエラー指標とした。本指標は、事故が経済的にどのような影響を与えているのかを示すと同時に、病院経営的には病院の抱えるリスクを示す指標となりうるものである。自動抽出の方法論としては、1.導入が進みつつあるDPC(Diagnostic Procedure Combination)の情報を利用して、標準化された同一疾患の患者情報を用いた。具体的には、患者の診療行為とは、(同一疾患に基づく診療行為)+(その患者特有の診療行為)+(医療事故に基づく診療行為)と捉え、診療プロセスに基づいて特に事故後に特異に発生した診療行為を事故に起因する診療行為候補として抽出することとした。次に、2.インシデント・アクシデントレポートの自動分析を行い、事故に起因する診療行為候補を自動的に検証することとした。具体的には、機械学習の方法を用いて、インシデントレポートの記述を、「患者プロフィール」、「事故発生・発見プロセス」、「事故対応」、「潜在理由」、に分類して、実際のインシデントレポートの各「文」が、どの項目を記述しているのかというタグを人の手で付与し、機械学習させた。結果、京都大学医学部附属病院で収集されたインシデント・アクシデントレポートに基づく医事情報も含めた患者情報について、本方法論を適応した結果、「転倒・転落」に分類された事例に対して、リスクマネージャが判断する事故に基づく診療行為を高い精度で抽出することが出来た。しかし、レポートの記述が標準化されていないことが人手でも事故の状況を把握できないことが逆に判明し、本方法論はレポート記述の自動評価の可能性があることが示唆された。
  • Multi-institutional analysis on cost and quality of health care for data-based strategic improvement
    Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (A)
    Date (from‐to) : 2004 -2006 
    Author : IMANAKA Yuichi; ISHIZAKI Tatsuro; SEKIMOTO Miho; HAYASHIDA Kenshi; TOKUNAGA Junya
     
    The clinical and financial database of the discharged patients were established and analyzed in this study. For the cost-analysis part of this study, a standardized costing methodology with reliable cost database in health care had not been established although it was increasingly important to assess standardized hospital cost information. Based on a standardized costing methodology we developed, we analyzed the characteristics of the healthcare cost, and we conducted a national questionnaire survey of the teaching hospitals in Japan. We evaluated the costs of the systems for patient safety focused on staff assignment, meetings and conferences, internal audit, staff education and training, incident reporting, infection surveillance, infectious disposal, management of medication use, clinical engineering, and patient counseling. The determinants if the volume of safety activities were also investigated. Our results showed that hospital-wide activities for patient safety posed significant costs to hospitals and national healthcare systems. For the objective assessment of healthcare quality and performance, we developed new and valid risk-adjustment methods to evaluate in-hospital acute care based on a set of data readily available in the standardized discharge data including age, gender, primary diagnosis, and coded comorbidity. To make the best use of diagnostic information, we used new strategies by use of detailed disease coding information and set classification of comorbidity. Our models were very important in handling the available data well for the risk-adjustment of mortality in specific diseases such as AMI and could offer a new approach to evaluate clinical performance at the hospital level. In addition, we analyzed the use of resources and the patterns of health care practice which would reflect some aspects of the quality and the efficiency of health care. The variation in practice was analyzed and expressed in valid and useful forms, and fedback to hospitals and professionals for further improvement of practice based on the results of scientific and objective assessment we developed.
  • Resource use in health care among older patients
    Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (C)
    Date (from‐to) : 2003 -2005 
    Author : ISHIZAKI Tatsuro; IMANAKA Yuichi
     
    It is said that population aging, the extended length of hospital stay, over use of drugs and diagnostic examinations are major causes of rising health care expenditures in Japan. In Japan, however, few studies have fully examined whether or not these factors positively associated with the increase of health care expenditures. To address these issues, we conducted this research project to examine association of age with health care expenditures and to discuss difference in resource use between older patients and younger or middle-aged patients. First, using national aggregated data derived from the Survey of National Medical Care Insurance Services, we examined the association between health care expenditures and age. This macro data analysis showed that total health care expenditures increased with age up to 70-74 and then decreased with age. Next, using individual data obtained from approximately 10,000 patients who were discharged from a hospital between 1999 and 2000, we examined association of patients' age with resource use, such as total hospital charges, charges for drugs, charges for examinations, and charges for operation. This analysis showed that the median total charges and charges for examinations rose with ages up to 55 years, but were fairly stable for age 55 and older. Among patients who died in hospital, the median length of hospital stay, the median of total charges, and the median charges for drugs decreased with age. The median charges for exams among patients who died in hospital increased with ages up to 55 years, but decreased with age. Results from these analyses revealed that neither the aggregated data analysis nor the individual data analysis identified linear association between patient age and health care expenditures. In addition, we found that there were wide variations in the age-stratified distribution of health care expenditures in terms of primary diagnosis.
  • 活動基準原価計算を活用した時間縦断的・多軸的な患者別原価測定方法の開発研究-妥当な施設間比較と政策応用に向けて-
    日本学術振興会：科学研究費助成事業 萌芽研究
    Date (from‐to) : 2003 -2004 
    Author : 今中 雄一; 石崎 達郎; 廣瀬 昌博
     
    本研究では、活動基準原価計算のフレームをも活用してより正確に原価計算を行うしくみとして多軸的に診療の原価を患者レベルで日常的に測定するシステム構築の設計を行う。その際に、日本のデータ下部構造や会計のしくみ、病院会計準則、医事データの標準フォーマット、医薬品・検査等に関わる標準コード体系、標準的なデータセットなどの諸要素と構造を整理して当原価計算に活用できるようにした。これらに基づき、多施設で共有して使えること、それにより、妥当な施設間比較ができるようになり、医療の経営品質と政策に資することを目指すものである。また、技術的には、原価の割り当ての方法について、正確さの程度により、直課から荒い配賦まで、整理してまとめ、原価計算に活用した。日常診療の診療情報管理、医事システム、給与システム、経理や物流のシステム、勤務の割振り実態などのデータを統合して、患者ごとのデータを日常的に継続的に出すしくみである。国内のデータコーディング、財務諸表の標準化、従来使われている部門別原価計算方法も踏まえて原価を妥当に算出する方法論基盤を既に作っている。医療機関内すべてを網羅する部門を設定して部門区分の粒度を高め、各種サービス種別に対応する細部門別の原価を第一段階とし、近年の医事コンピュータの電算化や抽出データの標準化を活用して直課相当しうる部分を患者に直課し、一方で細部門にプールされた原価を原価作用因でもって活動基準原価計算の一種として患者に按分する方法である。データは日毎に分割し、しかも、人、薬剤、診療材料などの勘定項目からなる原価諸要素と、手術、各種検査などサービス内容諸要素との、多軸構成を持たせてある。その上で、諸切り口で算出した原価について、診療科目や患者分類や重症度関連指標、ならびに部署や諸機能の質や効率・経済性を含む業績評価との関係性を分析し、活動基準管理への活用方法を検討した。
  • Development and validation of methodology of multi-axial evaluation of management quality of health care organizations
    Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (B)
    Date (from‐to) : 2001 -2003 
    Author : IMANAKA Yuichi; ISHIZAKI Tatsuro
     
    The methodology of multi-axial evaluation of management quality of health care organizations was developed and validated as follows : 1 : As frameworks to evaluate hospital management comprehensively, the hospital accreditation method, management quality award assessment criteria, and ISO and BS management system requirements were compared and examined. The following elements are the commonly important for the effective management and they need to be improved. in most of healthcare organizations : Leadership integrated with policy deployment, management by objective, and clinical governance ; process-oriented intra-and inter-departmental collaboration, standardization of process, systematic planning at individual care level and at the organizational level, the system of management of complaints and incidents and thorough follow-up of improvement and corrective actions, performance measurement and feedback, customer satisfaction. The distribution, correlates and inter-relationship were analyzed on customer satisfaction, staff satisfaction and organizational improvement activities. Substantial variation among hospitals were found and satisfaction was found to be dependent upon the patient physical and mental status and also on expectation. Dimension specific interrelation was found among the subscales of job satisfaction and quality improvement activities. Clinical indicators including process and outcome aspects were measured among more than 100 hospitals in cases of ischemic heart diseases, myoma uterus, femoral neck fracture, clipping surgery. They varied among healthcare organizations, and these variation got widened after the risk adjustment. Besides income, costs were measured by use if the patient-level costing framework which was developed by the author. revenue, cost and profit were measured and analyzed at various levels of health care at model hospitals, and the methods too use these data for the organizational management were examined.
  • 要介護高齢者の在宅ケアにおける医療費・介護費用の経時的評価
    日本学術振興会：科学研究費助成事業 若手研究(B)
    Date (from‐to) : 2001 -2002 
    Author : 石崎 達郎
     
    本研究は、在宅要介護高齢者を対象に、在宅ケアの実施に必要となる医療費と介護費用を把握することを目的とするものである。今年度は、某訪問看護ステーションの利用者(60名)を対象に、平成15年7月、8月、9月の3ヶ月間の医療費と介護費用を経時的に調査した。対象者の要介護度は、要介護度5が最も多く(16名、27%)、次いで要介護度1(15名、25%)、要介護度3(14名、23%)であった。 医療費(医療保険における診療報酬請求額)は3ヶ月間でやや減少傾向にあり、一人あたりの一ヶ月の医療費は7月約6万円、8月約5万6千円、そして9月は約5万3千円であった。一方の介護費用(介護保険における介護報酬請求額)は、3ヶ月間でほとんど変化がなく、一人あたりの一ヶ月の介護費用は約11万〜12万円であった。そして、医療費と介護費用とを合計した総費用も、3ヶ月間で大きな変化はなく、一人一月あたり、7月約20万円、8月約18万円、そして9月は約18万円であった。また、総費用に占める介護費用の平均割合は、7月68%、8月70%、9月69%と、ほとんど変化が認められなかった。さらに、介護保険支給限度基準額における使用割合は、7月45%、8月45%、9月41%と、これもほとんど変化が認められなかった。介護度と医療費、介護費用との関連をみると、介護度が高い者ほど介護費用が高くなる傾向が見られたが、介護度と介護保険支給限度基準額における使用割合との関係は認められなかった。 本研究の結果、今回調査した3ヶ月間では、医療費や介護費用の顕著な変化は認められなかったものの、在宅要介護高齢者の総費用(医療費+介護費用)における介護費用の占める割合が約70%を占めていることが明らかとなった。在宅要介護高齢者の医療・看護・介護ケアに費やされる費用を考慮する際に、介護費用が大きな割合を占めることを留意する必要があろう。
  • 介護保険制度導入が在宅ケアを受ける高齢者とその介護者に及ぼす影響の経時的検討
    日本学術振興会：科学研究費助成事業 奨励研究(A)
    Date (from‐to) : 1999 -2000 
    Author : 石崎 達郎
     
    本研究の目的は、在宅要介護老人とその介護者を対象に、介護保険制度施行前後において、対象者の状況や在宅支援サービス利用状況などに変化が認められるかどうかを追跡調査によって検討することである。平成11年度の初回調査対象者(訪問看護ステーションからサービスを受けている患者とその家族40組)のうち、初回調査への参加者は21組であった。このうち、第1回追跡調査(平成12年9月)で回答が得られた者は17組であった。 被介護者のADLレベルは、厚生省自立度判定基準によると、A2:1名、B1:2名、B2:6名、C1:4名、C2:4名と、17名中16名が「寝たきり」状態にあった。8ヶ月間のADLレベルの変化は、B1からB2に低下した者1名以外には変化は認められなかった。一方、介護者の身体的状況についても、大きな変化は報告されなかった。 サービス利用に関する変化に関しては、デイサービス、ホームヘルパー、入浴サービスのいずれにおいても、第1回追跡調査の時点では、半数以上の者では利用に大きな変化は認められなかった。具体的には、介護保険制度施行前に各サービスを利用していなかった者(デイサービス:11名、ホームヘルパー:14名、入浴サービス:10名)のうち、制度施行後もサービスを利用していなかった者は、デイサービス9名、ホームヘルパー9名、入浴サービス8名であった。一方、介護保険制度施行後にサービス利用を開始した者は、ホームヘルパーで5名と最も多く、デイサービスや入浴サービスではそれぞれ2名であった。 研究代表者は平成12年10月に京都大学へ異動となるため、異動後に再度追跡調査を実施した後に、最終的な検討を実施する予定である。
  • 在宅ケアを受ける要介護老人の身体的精神的健康状態の経時的変化に関連する要因の分析
    日本学術振興会：科学研究費助成事業 奨励研究(A)
    Date (from‐to) : 1997 -1998 
    Author : 石崎 達郎
     
    本研究は、訪問看護・在宅診療を受けている在宅要介護老人とその家族(介護者)を追跡調査し、患者とその介護者の身体的精神的状況の経時的変化を調べ、その変化に関連する要因を検討することを目的とする。平成10年度の研究では、平成9年度の初回調査対象者(患者とその家族19組)を追跡すると同時に、初回調査実施後に新たに訪問看護・訪問診療の対象となった患者・家族(16組)についても新規対象者として追跡した。初回調査対象者(19名)のうち、半年後の第2回調査で再調査が可能であった者は8組で、一年後の再調査でも追跡が可能であった者は6組であったが、身体的精神的状況の大きな変化を捉えることはできなかった。一方、介護者では、身体的精神的状況の変化は半年毎の観察でも把握することができ、約半数で体調悪化や介護負担感増強が報告された。この理由として自分の身体の変化が、体調悪化と負担感増強の両方においてほぼ全員で訴えられ、自分の気持ちの変化をその理由として挙げていた者も少数いた。また、介護者の体調悪化の理由として被介護者の病状変化を挙げた者は一人もいなかったが、介護負担感増強については理由として挙げていた者が少数いた。従って、今回の調査結果より、在宅ケアを支援する訪問看護・訪問診療では、患者の病状把握はもちろんのこと、介護者についても定期的に健康管理がなされる必要があることが示唆されよう。本研究では当初3-4ヶ月毎の再評価を予定していたが、初回追跡患者の追跡開始後3-4ヶ月では身体的精神的状況の変化は認められなかったため、観察間隔を半年毎に延長して、変化を捉えようとした。しかし、観察期間を延長したところで追跡可能であった患者の状況にはほとんど変化がなく、その一方で急性疾患発症によって入院して脱落群を多く生じる結果となってしまった。要介護高齢者の追跡研究は、健常集団とは異なった研究デザインが必要である。
  • 在宅ケアを行う要介護老人の健康状態維持増進に関連する要因の分析
    日本学術振興会：科学研究費助成事業 奨励研究(A)
    Date (from‐to) : 1994 -1994 
    Author : 石崎 達郎
     
    今年度の研究では主に、同一の老人保健施設を複数回利用した者の、日常生活動作能力の変化と、利用者の家族の家庭介護力を調査した。対象:神奈川県川崎市にある帝京大学老人保健センター(定員156人)において、平成5年4月から8月の間に入所していた利用者(ショートステイを除く92名)とその家族(主たる介護者)を調査対象とした。まず、利用者の家族に自記式のアンケート用紙を渡し、後日施設内で回収した。次に、入所記録より利用者の利用状況を調べた。結果と考察:1)利用者の特徴:利用者は女性が73.1%、平均年齢は81.8(±6.2)歳であった。ADLレベル(Barthel index)の平均得点は入所時/退所時それぞれ、初回(92名)が62.1点(±30.1)/65.0点(±30.8)、2回目(72名)65.4(±31.9)/65.4(±33.1)、3回目(43名)58.3(±33.8)/55.7(±34.9)、4回目(13名)59.0(±29.6)/64.9(±30.1)と、複数回利用者は、退所後にADLが低下した状態で再入所し、入所によって一旦ADLは改善するが、家庭に戻るとまた下がってしまい、全体的には漸減傾向にあった。2)家庭介護力:主要介護者は68.9%が女性で、平均年齢54.8歳(±12.0)、平均世帯人員数3.8人(±1.7)であった。居住環境は65.6%が集合住宅に住み、平均部屋数は4.2部屋(±1.7)であった。SS平均得点は15.8点(±3.5)であった。家計状態は、49.4%が家計に「ゆとりがある」と答え、また48.3%が「家計に満足している」と答えていた。利用者-介護者間の人間関係は93.2%が仲がよいと答え、77.5%が「介護に負担を感じている」と答えていた。今回の調査では、4回以上の複数利用者が少なかったため、介護力との関連性を検討することができなかった。

Other link

researchmap


Copyright © MEDIA FUSION Co.,Ltd. All rights reserved.