Kikusui, situated in the northwestern part of Kumamoto Prefecture, is famous for its remains of ancient Japan and at the same time known as a town blessed with the natural environment. As is the case with many other rural areas in this country, graying in population has been progressing at a fast clip here in recent years. To cope with the situation, Kikusui Town has taken uponitself to implement a comprehensive geriatric health care scheme since 1973 that covers not the physical aspect alone but also the mental aspect of the lives of the senior members of the population. During the period, the social welfare council and the societies of old people linked up with public health nurses. Later, the town hospital and its health control center joined with them to establish a home visit system to take care of the aged at home with the support of the government. Further, a nursing home for old people was built on the premises of the town hospital and started the day care services to back up the home care system. Various programs for home care were carried out in the main by visiting nurses. From the standpoint of the medical institution, cooperation with welfare workers was vital. Moreover, it was important for the residents of Kikusui Town to participate in this project. In the present paper, we will report on how the home care system for old people came into being.

Backgraund/Aim/Method: Hepatocellular carcinoma (HCC) is a serious life-threatening disease. When HCC is advanced, moderate to severe pain is frequently found due to bone metastasis, requiring the administration of opioids. However, HCC develops in cirrhotic liver in most cases those are decreased in drug metabolism. Careful monitoring is therefore required when opioids are administered to patients with cirrhosis or HCC because guidelines about the administration of opioids are not established in Japan. In this report, we retrospectively analyzed cases treated by opioids and discussed about problems in current opioid treatment for advanced HCC cases. Results: The median duration of opioid treatment is about two months, and seems to be prolonged in cases with treatment of HCC. Prophylaxes for hepatic encephalopathy were done in about 10% of cases, and hepatic encephalopathy was developed in about 40% of cases after opioid treatment. Conclusion: In administration of opioids for advanced HCC, we should consider the onset of hepatic encephalopathy and make an effort to prevent it.