都市部高齢者における閉じこもり予備群の類型化 : 介護予防対策の具体化に向けて Classification of Japanese elderly in an urban area at risk of becoming homebound Knowledge for improving prevention strategies




    • 渋井 優 SHIBUI Yu
    • 東京都西多摩保健所保健対策課 Measures for Health Division, Nishitama Public Health Center, Tokyo Metropolitan Government
    • 村山 洋史 MURAYAMA Hiroshi
    • 東京都健康長寿医療センター研究所社会参加と地域保健研究チーム Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology
    • 河島 貴子 [他] KAWASHIMA Takako
    • 世田谷区地域福祉部介護予防・地域支援課 Preventive Long-Term Care and Community Support Division, Community Welfare Department, Setagaya Ward
    • 可野 倫子 KANO Noriko
    • 世田谷区地域福祉部介護予防・地域支援課 Preventive Long-Term Care and Community Support Division, Community Welfare Department, Setagaya Ward
    • 虎谷 彰子 TORATANI Akiko
    • 世田谷区地域福祉部介護予防・地域支援課 Preventive Long-Term Care and Community Support Division, Community Welfare Department, Setagaya Ward
    • 立花 鈴子 TACHIBANA Reiko
    • 世田谷区世田谷保健所感染症対策課 Infectious Diseases Control Division, Setagaya Public Health Center, Setagaya Ward
    • 澁田 景子 SHIBUTA Keiko
    • 世田谷区砧総合支所保健福祉課 Public Health and Welfare Division, Kinuta District Administration Office, Setagaya Ward
    • 福田 吉治 FUKUDA Yoshiharu
    • 山口大学医学部地域医療推進学講座 Department of Community Health and Medicine, Yamaguchi University School of Medicine
    • 村嶋 幸代 MURASHIMA Sachiyo
    • 東京大学大学院医学系研究科地域看護学分野 Department of Community Health Nursing, Graduate School of Medicine, the University of Tokyo


<b>目的</b> 本研究は都市部高齢者における閉じこもり予備群の実態を明らかにするために,その出現状況を記述し,類型化によって既知の閉じこもり予測因子の保持状況を明らかにし,さらに類型化されたそれぞれの群の特徴について検討することを目的とした。<br/><b>方法</b> 東京都世田谷区の自宅で生活する65歳以上の全高齢者(149,991人)を対象に郵送調査を実施した。普段の外出頻度が週 2~3 回程度の者を「閉じこもり予備群」と定義した。既知の閉じこもり予測因子である,手段的日常生活動作能力(Instrumental Activities of Daily Living; IADL),抑うつ度,認知機能,交流状況を用いて非階層的クラスター分析により閉じこもり予備群を類型化し,得られた群の群間比較を行い,各群の特徴を記述した。<br/><b>結果</b> 自己回答した者のうち,「閉じこもり予備群」は11,282人(13.0%)であった。閉じこもり予備群について行ったクラスター分析の結果,全体良好群(46.4%),抑うつ傾向群(23.5%),認知機能低下•抑うつ傾向群(19.6%),IADL 低下群(6.5%),全体低下群(3.8%)の 5 群が得られた。群間の特徴比較から,「全体良好群」は身体•心理•社会的側面のいずれにおいても良好であること,「抑うつ傾向群」と「認知機能低下•抑うつ傾向群」は将来や転倒に対する不安感を有する者の割合が高く,昨年と比較して外出頻度が減少した者の割合が高いこと,「IADL 低下群」と「全体低下群」は平均年齢が高く要介護認定者の割合が高いこと,等が示された。<br/><b>結論</b> 得られた各群の特徴に基づき,一次予防介入方策を検討した。「全体良好群」:全体的に良好であるにもかかわらず外出頻度が週 2~3 回程度にとどまっている理由を同定し,生活実態に即して外出を促す。「抑うつ傾向群」:転倒不安の軽減を目的とした介入を行い,身体機能の低下を防ぐ。「認知機能低下•抑うつ傾向群」:認知機能低下を考慮したうえで,抑うつ傾向群同様,転倒不安の軽減を目的とした介入を行い,身体機能の低下を防ぐ。「IADL 低下群」:維持されている認知機能の低下を予防するために,認知症の発症を遅らせる生活スタイル等の情報提供を行う。「全体低下群」:現在導入されているサービスおよび支援が継続され,状態の変化に早期に対応できるように,地域の保健医療専門職および家族•近隣が目を配る。以上,本研究によって得られた結果は,閉じこもり一次予防対象者の状態像の把握の一助となり,その予防策の確立に寄与することが期待される。

<b>Objectives</b> This study aimed to assess the living situation and health of elderly people in an urban area of Japan at risk of becoming homebound, so as to tailor measures to prevent or delay this occurring. We identified the prevalence rate of people currently homebound and those at risk, classifying using predictors reported in previous studies. An assessment of physical and cognitive factors affecting each classified group was included.<br/><b>Methods</b> The survey targeted 149,991 people aged 65 or older living in Setagaya Ward in Tokyo. Mail-in questionnaires included items to assess respondents' demographic characteristics, physical and mental health conditions, quality of life, activities of daily living, and social lifestyles. We operationally defined people who go out (leave their home) only two or three times a week as the “at-risk” group, and “homebound“ was defined as going out only once a week or less. Then we determined the prevalence rates of the homebound and at-risk group. We sub-classified the at-risk group by conducting a cluster analysis using predictors of homebound status reported in previous studies. Then we identified each group's characteristics by comparing mental health and cognitive condition between the groups.<br/><b>Results</b> Questionnaire responses from those who did not fill out the survey themselves or who failed to fully answer questions on homebound predictors used in the cluster analysis were excluded. Also disregarded were responses from hospital inpatients or residents of elderly care facilities. The final number of respondents included in the analysis was 90,605. The prevalence rate of elderly who were at risk of becoming homebound was found to be 13.0% (n=11,282). Cluster analysis identified five clusters based on instrumental ability of daily living, mental health and cognitive condition: very good condition (46.4%), depressive (23.5%), low cognitive function and depressive (19.6%), low Instrumental Activities of Daily Living (IADL) (6.5%) and very poor condition (3.8%). The very good condition group fared favorably in nearly all aspects assessed in the questionnaire. The depressive group and the low cognitive function and depressive group strongly indicated anxieties about falling or about their future life and included people who went out less frequently compared with the previous year. The low IADL group and the very poor condition group were comparatively old and included a high percentage of people registered as requiring long-term care.<br/><b>Conclusion</b> Based on the particular characteristics of the identified groups, we propose primary strategies to help elderly people who are at risk of becoming homebound: 1) Very good condition group: Identify reasons why their frequency of outings is just two or three times a week, even though they seem to be healthy, and provide assistance with maintaining their current health condition considering those reasons. 2) Depressive group: Prevent physical decline by providing consultations addressing their anxieties about falling. 3) Low cognitive function and depressive group: Intervene in the early stages to address negative cognitive states such as loneliness. 4) Low IADL group: Intervene to help maintain their remaining abilities including cognitive function. 5) Very poor condition group: Ensure maintenance of services or support currently being provided, and have community health care providers and staff monitor health status changes.


  • 日本公衆衛生雑誌

    日本公衆衛生雑誌 58(11), 935-947, 2011-11-15


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