The purpose of this study was to investigate an optimal 25-hydroxyvitamin D3 [25(OH)D] level for Japanese frail elderly people aged 65 and above from the standpoint of quality of life, functional capacity, and physical function. A longitudinal study was conducted in two towns (latitude 36 degrees north) from 2006 to 2008. The subjects were 125 frail elderly individuals living in a rural setting and attending a 3-month exercise class for prevention of age-related diseases in order that they could do without receiving nursing care. An interview was conducted based on a questionnaire, and blood data, and physical fitness tests were administered to them at baseline and at the end of the 3-month exercise class. Functional capacity and physical fitness were compared on the basis of 25(OH)D≥50 nmol/L as a usual cut-off point, and 25(OH)D≥75 nmol/L as a severer cut-off point. A comparison of changes in physical fitness between before and after exercise class was done. The mean 25(OH)D level (±SD) was 58.9±13.6 nmol/L at baseline. The ratios of 25(OH)D level less than 50.0 nmol/L and less than 75.0 nmol/L were 23.9%, and 87.2%, respectively. The rates of house-bound subjects and those with worse scores of QOL were significantly higher in the group with 25(OH)D<50.0 nmol/L compared with the group with 25(OH)D≥50 nmol/L. The rate of those with superior functional capacity was significantly higher in the group with 25(OH)D≥75 nmol/L than the group with 25(OH)D<75 nmol/L. At the end of the 3-month exercise, Timed Up & Go indicating walking ability improved significantly in the group with 25(OH)D≥50 nmol/L, and an alternate step test indicating lower extremity strength significantly improved in the group with 25(OH)D≥75 nmol/L. From these findings, it was suggested that 25(OH)D level more than 50 nmol/L would be needed to maintain walking ability of the Japanese frail elderly and that 25(OH)D level more than 75 nmol/L would be needed to maintain lower extremity strength or functional capacity.
hydroxyl group ; Nanomole/liter ; Upper case dee ; Frail Elderly ; Exercise

The purpose of this study was to examine the relationship between housebound (defined as elderly who go outside less than once a week) and physical fitness test (6 items of grip strength, situps, trunk flexion, foot balance, 10 m hurdle walk, 6 min walk), fitness test score, Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence (3 factors of instrumental self-maintenance, intellectual activity, and social role), and General Health Questionnaire (GHQ) (4 categories of somatic symptoms, anxietynsomnia, social dysfunction, severe depression), considering the differences among gender and age.
The subjects were 296 community-dwelling elderly aged≥65 (mean age ; 75.5±4.9) . Of the subjects, 32% were male, and 57% were elderly aged≥75. Seventy-nine (27.2%) were housebound. The rate of housebound subjects with a full score for intellectual activity, social role on the TMIG sub-scales, 10m-hurdle walk and 6 minute walk was significantly worse than non-housebound subjects. The scores for social dysfunction and severe depression on the GHQ sub-scales for housebound were significantly higher than those for non-housebound ; and few housebound exercised more than 2 times per week or 30 minutes a day. The mental health of male housebound and housebound aged under 75 was the worst among all groups. On the other hand, female housebound and those aged≥75 had lower TMIG and physical fitness results. The characteristics of the housebound were different between genders. Among the housebound aged≥75, grip strength correlated with TMIG and GHQ-28 ; the 10 m hurdle walk correlated with severe depression, instrumental selfmaintenance and intellectual activity ; and the physical fitness score correlated with GHQ-28 after adjusted for age and gender.
Physical fitness correlated with TMIG and GHQ among the housebound; and few housebound exercised in daily life. Improving grip strength and walking ability may reduce the number of housebound.

Objective : It is not known whether residents in geriatric facilities are satisfied with the rehabilitation they receive. The purpose of this study was to investigate the relationship between their satisfaction with facility services and their satisfaction with the rehabilitation they receive in geriatric facilities. An additional aim was to identify the factors related to customer satisfaction with rehabilitation.
Methods : One hundred residents in 19 geriatric facilities participated in this study. After obtaining informed consent from the residents, we conducted semi-structured interviews which included scales for facility services satisfaction, customer satisfaction with rehabilitation, and the Geriatric Depression Scale (GDS). The characteristics and conditions of the residents were investigated by interviewing the facilities' staff. For statistical analysis, we used Spearman's, rank correlation test, and multiple regression analysis.
Results : Sixty-seven percent of the subjects were women, and the mean age (±SD) was 78.2±10.4 years. Multiple regression analysis revealed that the total customer satisfaction with rehabilitation score was associated with facility service satisfaction (β=0.232, p<0.05). Significant associations were also observed with “female”(β=0.198, p<0.05), “support counselors” (β=0.269, p<0.01), and “GDS” score (β=-0.291, P< 0.01). Customer satisfaction with rehabilitation was associated with “age” (β=-0.296, p<0.01), “BI” (β=0.261, p<0.01), “satisfaction with rehabilitation time” (β=0.254, p<0.01), “satisfaction with the training environment” (β=0.206, p<0.05), “toilet training” (β=0.210, p<0.05), “bathing training” (β=-0.252, p<0.01), and “GDS” score (β=-0.258, p<0.01).
Conclusion : Customer satisfaction with rehabilitation was significantly associated with facility service satisfaction in geriatric facilities.
These data suggest that rehabilitation is an important service in geriatric facilities, and supplying a sufficient number of hours of rehabilitation and having adequate facilities for rehabilitation were important for improving satisfaction with rehabilitation services in geriatric facilities.

Purpose
Long-term elderly care of the elderly (Jap. “Ro-ro Kaigo”) is a serious problem in Japan. The purpose of this study is to reveal the current state of Ro-ro Kaigo and to evaluate the factors affecting the burden on elderly caregivers.
Method
Ninety-three households of elderly subjects participated in this study. We conducted semi-structured interviews concerning the life styles of caregivers, the burden on caregivers and the condition of elderly subjects requiring long-term care.
Results
Eighty percent or more of the caregivers were spouses, and about 40 percent of the households were not supported by family members living separately.
Moreover, the burden of care borne by the caregivers was correlated with "hours spent daily providing care", "ADL of elderly requiring long-term care" (p<0.001), "hours of sleep" (p<0.01), "subjective feeling of wellbeing", "support from family living separately", and "behavioral disorders of dementia" (p<0.05).
Conclusion
These data suggest that supporting "health promotion", "reduction of hours of caregiving", "reduction of amount of assistance with toilet activity of care recipients", and "securing enough hours of sleep" were important for maintaining home care in Ro-ro kaigo.

OBJECTIVE : The aims of this study were to clarify the characteristics of outpatients with schizophrenia receiving psychiatric nursing at home and to evaluate factors related to re-hospitalization.
METHODS : The subjects were 55 outpatients with schizophrenia who were receiving psychiatric home visits and 31 non-users. An interview was conducted based on a questionnaire on age, gender, family members, psychiatric symptoms, attitude to drug use, and self-assessment of efficacy etc.; and we examined factors related to re-hospitalization.
RESULTS : Most subjects (86%) lived with their families. The percentage that lived alone was higher among those receiving nursing visits than non-recipients. Of the average age of the nursing recipients was higher than that of the non-recipients, the mean period of hospitalization was longer and the period after discharge was shorter than for the latter. The self-assessed score for efficacy among the nursing recipients who were re-hospitalized was higher than among those who were not re-hospitalized.
CONCLUSIONS : It is suggested that schizophrenia patients with serious symptoms or without family support can live in the community by using home visits by psychiatric nurses. The visiting nurses are requested to advise the patients so that they are able to assess their own capabilities and to control their own condition.

Purpose : The purpose of this study was to examine quantitative activity and determine characteristics using an activity meter in community-dwelling frail elderly people.
Methods : We monitored 25 community-dwelling elderly of support-requiring condition level1 and 2 by attaching activity monitoring evaluation system (A-MES) and measured physical activity (PA) over 24 hours as well as body information, care information, everyday life function.
We examined according to sex / care category using obtained results.
Results : Women's standing position time and walk time were significantly longer, and men's daytime lying position and sitting position time were significantly longer.
Also, in persons of support-required condition level 2 there was a significantly higher number of posture changes from sitting position to daytime lying position.
It was suggested that a quantitative evaluation of the PA could lead to discovery of activity decrease in home life in association with each PA item and low rank criteria of the functional independence measure (FIM).
Securing of enough walk time and shortening of the lying position time in the daytime tend to be important for self-care ability and maintenance of locomotiveness.
Conclusion : It was suggested that the evaluation of shortening the lying position time in the daytime and increasing the amount of position changes will supplement a decrease of the PA, which is related to preventing decrease in activity.

Introduction : In recent years, aging of the population and the low birth rate are progressing rapidly in China, resulting in an increase in the number of elderly individuals engaged in the long-term care of an elderly family member (Jap. “Ro-ro kaigo”). We conducted a cross-sectional study to evaluate the current Ro-ro kaigo situation and the factors related to the quality of life of the caregivers in two ethnic groups : Han Chinese and Korean Chinese.
Methods : Fifty-one Korean Chinese households and sixty-one Han Chinese households (≥60 years old) in Changchun or Yanji of Jilin Province, China, participated. The quality of life of the caregivers was measured using the SF-8 health survey questionnaire. We conducted a multiple regression analysis to investigate the factors related to the caregivers' quality of life.
Results : There was no significant difference in gender ratio and caregiver age between the two ethnic groups. In both groups, a spouse was often the cargiver. Factors related to the caregivers' quality of physical life were as follows. For the Korean Chinese : the caregivers' subjective feeling of health, and the number of the caregivers' diseases ; for the Han Chinese : the caregivers' subjective feeling of health, the care period, and the frequency of participation in community activities. Factors related to the caregivers' quality of the mental life were as follows. For the Korean Chinese : the frequency of consultation for nursing-care problems ; for the Han Chinese : the care-recipients' educational history, and having assistance on ceremonial occasions.
Conclusion : The results suggest that good health is important to maintain the quality of physical life of elderly caregivers in both ethnic groups. As factors related to the physical and mental summary scores differed by ethnicity, support for the caregivers that considers their ethnic background is necessary.

The purpose of this study was to evaluate the association between subjective usefulness of pedometer and step count, exercise adherence, and the possibility of a pedometer helping exercise adherence.
The subjects were 106 community-dwelling citizens (mean age±SD, 66±5) who were put on an individual exercise program in addition to walking. The targeted step count was 8000 steps/day. Every subject wore a pedometer that registers 7 days of physical activity.
The rate of adherence was 98.1%, and about 73% of subjects answered that using a pedometer is useful for physical activity. There was no difference in exercise habit at baseline between subjects answering useful or not useful.
Only in the case of females, was step count and prevalence of targeted 8000 steps significantly higher in the group who felt a pedometer was useful than in the group who didn't feel it useful. However, in the group of males who felt the usefulness of a pedometer, step count significantly increased during the 3 months. In addition, the females who reached their targeted step count performed better in the 10 m hurdle walk and 6 min walk than those who could not reach the targeted step count.
The awareness of self-health wellness, without the anxiety of physical fitness and adherence to exercise was higher in the subjects who felt a pedometer was useful than in the subjects who didn't.
The subjects who felt a pedometer was useful achieved their targeted number of steps and increased walking ability and tended to adhere better to physical activity.
It is suggested that a pedometer motivates adherence to physical activity and is useful for helping exercise adherence in the future. However, we need a randomized control trial for determining the relationship between exercise adherence and using a pedometer.

Fall-related factors (FRFs) are classified into intrinsic factors and extrinsic factors. Intervention programs, which focused on modifiable factors (MFs) among FRFs have been designed to prevent falls. The purpose of this study was to identify easily-measurable intrinsic MFs for falls and recurrent falls. Cross-sectional analysis was carried out on the data from 483 community-dwelling older adults, aged 65-92 years (73.7 ± 5.9 yr, 138 men, 345 women). We measured history of falls in the past year and 7 domains of FRFs. Of these, 20 items were selected as MFs. Analyses of FRFs and MFs were conducted by comparing (separated by sex) those who did not report a fall with those who reported any number of falls, and those who reported no falls or one fall with those who reported recurrent falls. Using the significant items as independent variables, multiple logistic regression analysis with forward selection method was performed. The prevalence of falls and recurrent falls was: in men, 24.6% and 14.5%; in women, 26.7% and 12.5%. There were no significant differences in prevalence of falls or recurrent falls between genders. The following items were selected as the MFs most strongly associated with falls: climbing 10 steps with difficulty and tandem walk; and associated with recurrent falls: climbing 10 steps with difficulty, sit and reach, and tandem walk. These results are useful in determining the focus of fall prevention programs to be used in future community-based interventions.

Introduction: The present study was conducted to identify the influence of self-efficacy score and having an action plan on “stages of change” for exercise after one year.
Methods: Physical functions and psychological factors at baseline and after one year in 105 elderly individuals who participated in a preventive care program. The subjects were classified into four groups by using the stages of change scale for physical activity.
The cause related to impact on physical activity and action stage change (stage) after one year later with having or not having action plan for preventive care program in elderly at home in community as well as sense of self efficacy was investigated.
Results: Self-efficacy scored significantly higher in the usual activity group with continuity of stage activity both at baseline and one year later. The relative risk of having an action plan at baseline for exercise after one year was 2 . 90 (95% CI: 1.52-5.55). This value significantly influenced the maintenance of physical activity after one year.
Conclusion: The results of this study suggest that showing an action plan was effective in maintenance of physical activity.