[Factors which allow elderly persons living alone to continue living at home--analysis of the situation of elderly people living alone who are served by the Higashi Sapporo Hospital Home Care Support Center and Higashi Sapporo Visiting Nurse Station]

Amid the rapid ongoing shift from treating the elderly in hospitals to treating them at home, self-care by elderly people living alone is a serious and complicated problem. To investigate the support system that enables elderly living alone to maintain social independence and a high quality of life at home, the main factors which allow the person to continue living at home were sought through an analysis of the current situations of 44 elderly-persons living alone, who use the services of our home care support center and visiting nurse station. From this analysis, the elderly person who continue to live alone at home were ranked from J-A for degree of independence in daily life, and the degree of independence of in daily life of elderly suffering from dementia was normal rank I and II. It was also found that such people use multiple services and that their health is stable. In the future it will be necessary to develop systems and networks which function to coordinate multiple services and make possible the smooth transition between home and hospital or institution. The practice of informed consent must also be improved. Finally, it will be important to promote the appropriate management of disease and local rehabilitation services.

[Oral and dental health and oral and dental support of home patients--role of dental hygienist in the home service nursing station]

Home patients have few chances for going out, so communication with their family means a lot. Talking and eating are particular pleasures. Therefore, oral and dental health and oral and dental support are very important for home patients. A dental hygienist from our clinic visits and offers oral and dental health (oral care) and oral and dental support (oral rehabilitation) to home patients as part of a care plan with home care nurses. Moreover, as general conditions are closely related with oral function, maintaining oral and dental health and regular oral and dental support are very important in order to improve the quality of life (QOL) of home patients.

[Role of the visiting nurse in pain control for the terminal cancer patient at home]

Among users of our visiting nurse station in 1997, 53 (58%) were cancer patients, and among these, 35 (66%) required pain control. Because home patients, family, and health care personnel are physically separated, nurses must provide reports and adjustments to physicians that assess pain holistically on the basis of estimated patient status and condition. Nurses also play a central role in providing necessary information to the patient and family, providing drug administration guidance and other response when pain occurs, and performing reassessment. To provide an understanding of the role nurses play in pain control in the home, the current research describes how nurses assess and respond to pain among cancer patients requiring pain control by analyzing the nursing records of 9 terminal cancer patients residing at home for a period of 1 month or more. The results indicate that nurses form pain estimates by observing pain-related indicators during visits and by assessing such factors as the cause of pain, the effect of analgesics, and effects on daily life. Based on these estimates, nurses provide care independently, make adjustments with physicians, and devise plans to counter subsequent pain. These facts suggest that estimations based on appropriate nurse assessments are crucial in "at home" conditions.

[Support for and problems associated with the highly health care-dependent, single-living elderly]

As a result of trends toward nuclear families and fewer children, the proportion of elderly persons living alone has been increasing in recent years. While an expansion of regional welfare has been proposed, health care problems will intensify and complexity will increase wherever single-living elderly persons desiring treatment at home are highly health care-dependent. Our visiting nurse station is no exception, necessitating a careful consideration of support system preparation, as well as means to respond on an individual basis now and in the future. With the object of investigating a support system able to undertake appropriate health care at home for single-living elderly persons requiring some form of treatment, this study utilized case records at our visiting nurse station to study living conditions and support activities relating to the one-year period of 1997 for three particularly health care-dependent individuals among single-living elderly persons. In terms of health care support, the results include a proposal for convenient treatment regimens suited to activity schedules and degrees of dementia, adjustment of the number of visits based on patient status, efforts to cooperate with helpers and family and to share information, and emergency response preparation. Topics for future study include assessment methods for dementia and living capacity, and safety enhancement.

[The meaning of eat in home patients with end-stage cancer]

When a patient difficult to eat, he will not be only malnutrition, but loses a volition of his life and falls into depression. This time, we present a patient with relapse advanced pharynx cancer, who could not ingestion. Therefore she had said "DEATH". She tried eagerly rehabilitation of ingestion, swallowing and breathing, and she was able to eat again and could be positive posture. Ingestion is very important for human, and the patient found a meaning of her life and she was able to take home care nursing.