To clarify what are contributing factors associated with the place to die (home or hospital) in a rural area, we investigated several background factors of 107 patients who died at home or in hospital after receiving home care service during the period of four years from July 1995 to June 2000. The subjects were divided into two group those who died at home (39 cases, 36%) and those who died in our hospital (68 cases, 64%). The ratio of deaths at home increased every year, and reached a half of those who died after receiving home care service. The average age in those who died at home were 87.1±9.5 years, that was higher than that of those who died in our hospital (82.2±9.8 years). There was no difference betwe two groups about sex, basic diseases and the time required to get to the hospital by car. Death at home was more preferred by patients, whereas death in the hospital was preferred by patients' families. The level of activities of daily living (ADL) in those who died at home was lower compared with that in those who died in the hospital. Those who died at home significantly had lesser complaints (pain, dyspnea and so on) and had more care-givers in the family, than those who died in the hospital. These results revealed that the major factors in death at home are: 1) low level of ADL, 2) preference to death at home expressed by patients, 3) presence of additional care-givers, and 4) no complaint of symptoms from patients.

This paper proposes a method for evaluating and scoring the activities of rehabilitation service users in order to pinpoint the problems with the health service of this kind and set the adequate targets for each user. Sincs the Nursing Care Insurance System was introduced in Japan in 2000, it has been argued that home-visit rehabilitation services should be excluded from home-nursing care services. However, the methods of certifing that nursing care is required are not fully established yet for setting the rehabilitation targets for service users. As things stand, it is recommended that such a method as the Functional Independence Measure (FIM) or the Barthel Index (BI) should be utilized. However, these methods only evaluate “performing activities” (the activities that a user usually performs). In order to set the users' targets, we thought it necessary to establish a method for evaluating “possible activities” (the activities that a user is able to perform at his/her full capacity). We have established a method called Functional Scoring (FS) which evaluates and scores the both performing and possible activities based on the same evaluation items. We conducted experimental evaluations on the home-visit rehabilitation users for one year from October 2005 to September 2006. When the first evaluations in 2005 were compared with the second evaluations in 2006, the total score of the performing activities significantly increased from 44.1±13.7 to 47.8±14.2 (P<0.05). Although the total score of the possible activities did not significantly increase, it demonstrated an upward trend from 49.6±13.2 to 51.6±13.5. The result suggests that our method is useful for distinguishing between the performing and possible activities. The proposed method enables us to adequately recognize the problems each user has, and to set the rehabilitation target for each user, which can be shared between the user, care personnel, and care service provider.
Rehabilitation aspects ; Functional ; FS ; Care given by nurses ; Published Comment

We examined the relationship between masticatory ability and bone mineral density (BMD) and the role of muscle strength in those relationships in 156 female university students. Masticatory ability was assessed using a color-changeable chewing gum method. The BMD of the calcaneus was measured using quantitative ultrasonography and represented by a T-score, the standard deviation (SD) from the mean BMD of young adults. Body composition, grip strength, physical activity level, and daily nutrient intake were also assessed. Osteopenia, defined as the T-score < ‒1.0 SD, was present in 43 participants (27.6%). There was no significant relationship between masticatory ability (ΔE) and T-score in all participants. In participants with normal BMD (T-score ≧ ‒1.0 SD: the normal BMD group), masticatory ability significantly correlated to BMD (r = 0.289, p = 0.002). There was significant correlation between ΔE and grip strength neither in all participants nor in either group, although the grip strength in the normal BMD group was greater than that in the participants with osteopenia (the low BMD group) (p = 0.039). Physical activity level was positively correlated to the total daily energy intake (r = 0.193, p = 0.041) only in the normal BMD group. The present results suggest that masticatory ability is associated with BMD in young females with normal BMD, but the role of muscle strength in those relationships remains unclear. Meanwhile, there was no relationship between masticatory ability and BMD in young individuals with lower BMD.