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![The proportion of bedridden elderly living at home. Source: Zaitaku rojin kihonchosa. [Basic survey of elderly people living home]. Hiroshima prefecture. 1975–1990. [in Japanese]. Data after 1990 are unavailable due to the change in definition of " bedridden " .](publication/316537556/figure/fig2/AS:488279830208514@1493426391467/The-proportion-of-bedridden-elderly-living-at-home-Source-Zaitaku-rojin-kihonchosa.png)
The proportion of bedridden elderly living at home. Source: Zaitaku rojin kihonchosa. [Basic survey of elderly people living home]. Hiroshima prefecture. 1975–1990. [in Japanese]. Data after 1990 are unavailable due to the change in definition of " bedridden " .
Source publication
Introduction:
Japan has the largest percentage of elderly people in the world. In 2012 the government implemented a community-based integrated care system which provides seamless community healthcare resources for elderly people with chronic diseases and disabilities.
Methods:
This paper describes the challenges of establishing a community-based...
Citations
... Examples include the DGIP (Dutch Geriatric Intervention Program) in the Netherlands, which contributed to participants' well-being and functionality, and the PACE (Program of All-Inclusive Care for the Elderly) model in the US, which interestingly showed an increased survival rate among its participants compared to controls, hinting at the impact of holistic care on longevity. Other studies, however, ascribe the attributes 'integrative' or 'integrated' to designate broader interventions beyond conventional or direct care, such as the Mitsugi hospital complex in Japan which is integrated into the community's public administration and includes nursing home and rehabilitation facilities, home visits, and seasonal events [22]. However, the scientific literature on the relationship between lifespan and healthcare systems remains lacking, especially in Latin America. ...
... Furthermore, many integrative healthcare models described in the studies on this matter are concerned only with the clinical angle, albeit with an interdisciplinary team, such as those featured in Marino et al. [21]. Health systems that include recreational areas for sports or social activities and housing are lacking in the literature, with a few exceptions such as a community-based integrated care system in Mitsugi, Japan, where residents' attendance to medical check-ups increased as a result [22]. This study was primarily limited by its retrospective design, which required the extraction of data from medical records leading to a risk of incomplete reporting data, and its cross-sectional design also limits its potential for establishing cause-effect relationships. ...
Background Despite the growth in the older population, there is a noticeable research gap regarding integrative health systems for older people and their impact on longevity in nonagenarians. This study aimed to evaluate the effect of an integrative health system consisting of medical services, recreational facilities, and housing on longevity in a population of nonagenarians in Northern Mexico. Methods This was a cross-sectional, retrospective, descriptive-analytical study in which we measured and analyzed medical history such as number of hospitalizations, visits to geriatric consultation, hypertension, history of chronic pain, polypharmacy, dementia, rheumatic disease, diabetes mellitus, insomnia, depression, ischemic cardiomyopathy, among others. We also measured social engagement and number of caregivers. A logistic regression was performed to evaluate the predictors of mortality in this population. Results We included one hundred and ninety-five nonagenarians with a mean (SD) age of 94 (4.2) years and of which 112 (55.7%) were female. The findings from logistic regression analysis indicated that a higher frequency of hospitalizations was associated with an elevated mortality risk (OR = 1.272, p = 0.049). Conversely, increased visits to geriatric consultation services as primary care were linked to a reduced mortality risk (OR = 0.953, p = 0.002). Additionally, social engagement displayed a protective effect (OR = 0.336, p = 0.05). Conclusions This study highlighted the role of systemic health approaches in extending life through insights into nonagenarian patients' involvement in primary care, as measured by consultation frequency, and participation in social activities, mitigating mortality risks. Meanwhile, it emphasized the potential consequences of higher hospitalization rates on increased mortality risk. Text box 1. Contributions to the literature • There are limited examples of integrative healthcare systems for elderly patients in Latin American countries and how these may provide distinct benefits in relation to longevity. • Active participation in primary care and social engagement plays a pivotal role in reducing mortality in nonagenarian patients, thus promoting longevity. • Efforts should be made to adapt existing healthcare systems , to provide elderly patients with holistic care and foster their long-term survival.
... 12) In Japan, starting in 2005, the Community-based Integrated Care System was established. [13][14][15] It consists of five key components: housing, medical care, long-term care, preventive care, and daily living support. In this system, the framework of geriatric medicine is embedded to provide person-centered healthcare and welfare service. ...
In the face of an ever-increasing wave of an aging population, this paper provides an update on the current status of geriatric medicine in Korea, comparing it with global initiatives and suggesting future directions. Older adults require a multifaceted approach, addressing not only comorbidity management but also unmet complex medical needs, nutrition, and exercise to prevent functional decline. In this regard, the World Health Organization's Integrated Care for Older People guidelines underscore the importance of patient-centered primary care in preventing a decline in intrinsic capacity. Despite these societal needs and the ongoing aging process, the healthcare system in Korea has yet to show significant movement or a shift toward geriatric medicine, further complicated by the absence of a primary care system. We further explore global efforts in establishing age-integrative patient-centered medical systems in Singapore, Australia, Canada, the United Kingdom, and Japan. Additionally, we review the unmet needs and social issues that Korean society is currently facing, and local efforts by both government and a private tertiary hospital in Korea. In conclusion, considering the current situation, we propose that the framework of geriatric medicine should form the foundation of the future healthcare system.
... Japan established a 10-year strategy to improve long-term care for the elderly (Gold Plan), together with long-term care insurance, in the 1990 s [9], and first introduced a national policy of community-based integrated care in 2017 [10]. In England, the government published its ten-year vision for adult social care reform in 2021 [11], including proposals for the integration of health and social care [12]. ...
... In March 2011, the Japan Earthquake highlighted underlying structural problems in the health system that were difficult to resolve fiscally, including those related to long-term care [42]. To help address these, a national policy of devolution to community-based integrated care was introduced for the aging population [10]. This was built upon a model of Health and Welfare Centres that had previously been established in isolated areas, as shown in Figure 1. ...
Western countries are currently facing the public health challenge of a rapidly aging population and the associated challenge of providing long-term care services to meet its needs with a reduced working age population. As people age, they will increasingly require both health and social care services to maintain their quality of life and these will need to be integrated to provide cost-effective long-term care. The World Health Organization recommended in 2020 that all countries should have integrated long-term care strategies to better support their older populations. Japan, with the most rapidly ageing society in the world, started to address this challenge in the 1990s. In 2017, it introduced a national policy for integrated long-term health and social care services at a local geographical level for older people. England has recently embarked on its first plan aiming for the integration of services for older people. In this article, we compare these approaches to the integration of long-term care systems, including the strengths of each. The paper also considers the effects of historical, cultural and organizational factors and the emerging role of technology. Finally, we identify critical lessons that can inform strategy development in other countries, and highlight the need to provide more international comparisons.
... Collaboration in the long-term care home medical team, such as visiting nursing, rehabilitation, and care guidance, has become more critical since LTCI was established in 2000. There is also a community center for connection between patient and doctor, and the center connects care managers, nurses, and social workers, and in addition to medical treatment, it also supports civil complaints 16,17) . As of 2021, 5,270 community centers are operated in Japan. ...
Background: Legal regulations and fees have been established in Korea to provide visiting oral health care services to individuals
with long-term care insurance (LTCI). However, beneficiaries of this service are very limited. Therefore, to improve the Korean
system we propose a comparative analysis with the Japanese system.
Methods: This study is a descriptive analysis based on secondary data, such as statistics, laws, and service record forms from
Korea and Japan. The most recent institutional documents were obtained through a Google search. The variables investigated
were financial resources of LTCI, co-payment structure, monthly limit of LTCI benefits, care levels of LTCI, service providers,
service costs, contents of service, and the number of cases of service.
Results: In both Korea and Japan, LTCI is financed through a combination of taxes and insurance premiums. However, the
monthly limit for receiving LTCI services in Japan is about 2.4 times higher than in Korea. Visiting medical and dental treatment
is also possible in Japan. Furthermore, nursing staff can provide daily oral health care services according to dental hygienists’
instruction unlike Korea. Oral health care services in Korea are focused on oral hygiene and prevention of oral diseases, while
Japan additionally provides oral function screening, patient education for oral health management, and training for nursing staff
to enhance oral function, eating, and swallowing of the patients.
Conclusion: We concluded that the possibility of visiting dental treatment, differences in monthly limit of LTCI benefits, oral
function assessment and guidance, as well as collaboration with other healthcare professionals contributed to the difference in
the frequency of utilization of visiting oral health care services between Korea and Japan.
... Elderly care issues have also garnered international attention, as highlighted in countries such as Germany (Steinbach 2017), Sweden (Songur 2022), and Japan (Hatano et al. 2017;Inaba 2016). Furthermore, public health emergencies like COVID-19 have exacerbated the difficulty of providing care for elderly individuals. ...
In the post-COVID-19 era of green economic recovery, this paper analyses the elderly care environment of cities in the Yangtze River Delta (YRD) region and investigates the future development direction of the elderly care industry based on comparative advantages and resource endowment. Firstly, an evaluation index system of the elderly care environment is constructed, then the entropy weight method is used to calculate the weight, and finally the comprehensive evaluation index of the elderly care environment in each city is obtained by weighted calculation. The development directions of the elderly care industry for each city in the YRD region are proposed based on the results. The study shows that the suitable development direction of the elderly care industry differs among cities. Cities suitable for residential elderly care are mainly distributed in the central and western regions, cities fit for the leisure and tourism of elderly care are mainly located in the southeast, and cities suitable for the treatment and rehabilitation of elderly care are mainly provincial capitals and cities with better economic development levels. Additionally, Wenzhou City in Zhejiang Province is eligible for the development of a comprehensive elderly care industry.
... It began to deploy community-embedded elderly care facilities in major cities across the country in 2006. A facility's service scope corresponds to the area of the school district it belongs to, which approximately equals an accessible area of a 30-minute walk for older adults (Hatano et al., 2017). In the developing process, the Japanese government further subdivided the community-embedded elderly care facilities into nine types based on the characteristics of service objects (dementia and disability) and service forms (day care, live-in care and night care). ...
Automatic monitoring of pavement structure health has always been a significant problem for transportation engineers. Although the generative adversarial network (GAN) has proven to be an effective tool for improving pavement distress recognition accuracy, it may lead to increased computational cost, which inconsistent with the requirements of engineering practice. This paper describes a lightweight GAN structure for automatic pavement distress identification with high computation efficiency and low computation cost. Squeeze and expand (SE), multiscale convolution (MC), and depthwise separable convolution (DSC) were selected as alternative lightweight methods, and two series of comparative experiments were conducted. The results showed that the GAN-based model with SE implemented on its fully connected layer, MC&DSC implemented on its transpose convolution layers in the generator, and MC implemented on its convolution layers in the discriminator could reduce the largest proportion of model parameters (94.8%) while achieving satisfactory classification accuracy (85.4%).
... Community elderly care can reduce the financial burden associated with aging (1) and meet the demands of the elderly in their homes (2)(3)(4). Therefore, community elderly care is an important model for assisting elderly people in adapting to the trend of social development and improving their quality of life in their later years. ...
... Notably, the existing research on community elderly care is mainly focused on the concept of community elderly care (19), the demand for community elderly care (20,21), the technology of community elderly care (22)(23)(24)(25), and the model of community elderly care (1). However, there is little research on the quality of service in community elderly care. ...
Background
As an upgraded form of the elderly care service industry, “Internet + Community Elderly Care” integrates information technology, artificial intelligence, Internet thinking, and the construction of community elderly care service mechanisms. Research on “Internet + Community Elderly Care” has become a focus.
Methods
The four-party evolutionary game model of elderly service regulations was presented, which consists of the government, providers, platforms, and elderly people. By using Lyapunov stability theory, the stability of each player's strategy selection was analyzed. Furthermore, the sensitivity analysis of the key parameters was discussed in detail using system dynamics.
Results and discussion
Online evaluations of elderly people have more positive effects on the regulatory system than offline evaluations. Both the penalties on providers and subsidies on platforms given by the government have thresholds. Moreover, government penalties for providers and subsidies for platforms could curb their speculative behavior and enable effective steering of providers and platforms.
Conclusion
The Omni-feedback mechanism for elderly people can effectively curb the speculative behavior of elderly care service providers and elderly care service information platforms. The government should dynamically adjust penalties and subsidy policies.
... It began to deploy community-embedded elderly care facilities in major cities across the country in 2006. A facility's service scope corresponds to the area of the school district it belongs to, which approximately equals an accessible area of a 30-minute walk for older adults (Hatano et al., 2017). In the developing process, the Japanese government further subdivided the community-embedded elderly care facilities into nine types based on the characteristics of service objects (dementia and disability) and service forms (day care, live-in care and night care). ...
The severe population ageing has rapidly increased the demand for urban elderly care services in most countries. As a novel urban elderly care mode, community-embedded elderly care facilities integrate various functions and allow older urban adults to enjoy comprehensive care services in a familiar environment at an acceptable cost. Therefore, it is widely recognised as an effective way to resolve the contradiction between the increasing demand and limited supply capacity of elderly care services in large cities. However, spatial analysis of elderly care facilities in previous studies were focused on static characters, ignoring the evolution process. The traditional static analysis methods might be one-sided for the spatial analysis of community-embedded elderly care facilities, considering their highly dynamic development. This study considers Beijing as a case study and establishes a novel spatiotemporal analytical framework, augmented by big data, to analyse the spatial distribution of the local community-embedded elderly care facilities (elderly stations) from a dynamic view. The multi-source data regarding elderly stations, the elderly population and basic geographic information of Beijing were extracted and integrated into the analysis. On this basis, the proposed framework was applied to examine the distribution tendency, evolution trend and accessibility of elderly stations from 2017 to 2020. The results reveal a significant cluster development characteristic of elderly stations. Although the density of elderly stations in the downtown area is much higher than that in the urban periphery, the elderly stations might still be unable to satisfy the enormous elderly care demand in Xicheng and Dongcheng districts. Moreover, the imbalance between the urban centre and peripheries and the spatial mismatch between the elderly stations and population were identified. The research output could support the planning practice of elderly stations for relevant departments.
... Damit sollten sie besser in der Lage sein, einzelfallbezogen, möglichst passgenaue und maßgeschneiderte Hilfen bereitstellen zu können. Diese Überzeugung teilt Hiroshi Yoshida in seinem Plädoyer für eine "ungehinderte und reibungslose Umsetzung der Pflegeversicherung". Auch das in seinem Beitrag vorgestellte, allerdings noch nicht flächendeckend eingeführte "Community-Based Integrated Care System" (Hatano et al., 2017) 1 setzt auf eine umfassende funktionsfähige kommunale Verantwortung. Es verdient nicht zuletzt wegen seiner örtlichen Verankerung bereits heute den Ruf eines exportfähigem japanischen "Vorzeigemodells". ...
... In Japan soll die Pflege auf lokaler Ebene spätestens ab 2025 flächendeckend in allen japanischen Gebietskörperschaften in einem "Community-Based Integrated Care System" (Abb. 1) eingebettet sein (Hatano et al., 2017). Dem entspricht, dass die eigentliche pflegerische Versorgung der Bevölkerung in Japan in den Kompetenzbereich der Kommunen fällt, die in Japan auch Träger der im Übrigen sonst stark am deutschen Vorbild orientierten Pflegeversicherung sind (IGES, 2020). ...
... Letzteren entspricht auf japanischer Seite der Entwurf eines umfassenden Pflegesystems auf Gemeindeebene, das in dem sowohl von Matsuda und als auch von Fujita erwähnten Projekt "Share Kanazawa" umgesetzt ist. Ansätze vernetzter Versorgungsstrukturen unter Einbindung der Zivilgesellschaft gehen in Japan bis in die 70er Jahre zurück (Hatano et al., 2017 Trotz vieler Gemeinsamkeiten im Problemverständnis und bei den Lösungsansätzen gibt es auch deutliche Unterschiede, etwa bei der Konzipierung und Implementierung. Dies ist nicht zuletzt durch unterschiedliche soziale Strukturen auf Gemeindeebene bedingt. ...
Zusammenfassung
Fragen, wie im Alter Autonomie ermöglicht und Rahmenbedingungen für Lebensqualität auch bei Hilfe- und Pflegebedarf geschaffen werden können, bestimmen seit Jahren maßgeblich gerontologische Fachdebatten sowie die inhaltliche Ausrichtung in der einschlägigen Forschung in Deutschland. Relevante Fragestellungen sind in diesem Kontext beispielsweise, welche Einflussfaktoren gelingendes Altern und der Erhalt von Autonomie maßgeblich bestimmen, welche individuellen Wahlmöglichkeiten in der Gestaltung des Alltags das Erleben von Selbstbestimmung und Autonomie ermöglichen und wie dieser Prozess durch geeignete Maßnahmen und Konzepte unterstützt werden kann (Kricheldorff, 2019).
... Damit sollten sie besser in der Lage sein, einzelfallbezogen, möglichst passgenaue und maßgeschneiderte Hilfen bereitstellen zu können. Diese Überzeugung teilt Hiroshi Yoshida in seinem Plädoyer für eine "ungehinderte und reibungslose Umsetzung der Pflegeversicherung". Auch das in seinem Beitrag vorgestellte, allerdings noch nicht flächendeckend eingeführte "Community-Based Integrated Care System" (Hatano et al., 2017) 1 setzt auf eine umfassende funktionsfähige kommunale Verantwortung. Es verdient nicht zuletzt wegen seiner örtlichen Verankerung bereits heute den Ruf eines exportfähigem japanischen "Vorzeigemodells". ...
... In Japan soll die Pflege auf lokaler Ebene spätestens ab 2025 flächendeckend in allen japanischen Gebietskörperschaften in einem "Community-Based Integrated Care System" (Abb. 1) eingebettet sein (Hatano et al., 2017). Dem entspricht, dass die eigentliche pflegerische Versorgung der Bevölkerung in Japan in den Kompetenzbereich der Kommunen fällt, die in Japan auch Träger der im Übrigen sonst stark am deutschen Vorbild orientierten Pflegeversicherung sind (IGES, 2020). ...
... Letzteren entspricht auf japanischer Seite der Entwurf eines umfassenden Pflegesystems auf Gemeindeebene, das in dem sowohl von Matsuda und als auch von Fujita erwähnten Projekt "Share Kanazawa" umgesetzt ist. Ansätze vernetzter Versorgungsstrukturen unter Einbindung der Zivilgesellschaft gehen in Japan bis in die 70er Jahre zurück (Hatano et al., 2017 Trotz vieler Gemeinsamkeiten im Problemverständnis und bei den Lösungsansätzen gibt es auch deutliche Unterschiede, etwa bei der Konzipierung und Implementierung. Dies ist nicht zuletzt durch unterschiedliche soziale Strukturen auf Gemeindeebene bedingt. ...
Zusammenfassung
Die Alterung einer Gesellschaft ist im Gegensatz zu anderen langfristigen Entwicklungstrends zwar relativ gut prognostizierbar, die zugrunde liegenden Zusammenhänge und Auswirkungen sind allerdings ausgesprochen komplex, da sie alle Bereiche des gesellschaftlichen Lebens betreffen. Entsprechend sind ganzheitliche Analysen und Strategien notwendig. Zivilgesellschaftliches Engagement und Inklusion zählen zu den zentralen Anliegen holistischer Lösungsansätze. Die Beiträge in dieser Sektion zeigen auf, wie die Inklusion älterer Menschen gelingen kann, welche Rolle lokale Gemeinschaften bei der pflegerischen Versorgung im häuslichen Umfeld spielen können und welche Vorteile entsprechende Lösungen bieten. Dabei wird deutlich, dass Inklusion auf kommunaler Ebene an erhebliche Voraussetzungen gebunden ist, insbesondere die Zusammenarbeit verschiedener Stakeholdergruppen.
