D

Journal of Civil Engineering and Architecture 12 (2018) 605-614
doi: 10.17265/1934-7359/2018.08.006

DAVID

PUBLISHING

Basic Study on Elderly Tele-nursing Model for Emote
Nursing by Smart Device
Hideaki Takayanagi1, Chieko Kawakatsu2, Tatsuto Kihara3, Kazuhide Kawaguchi1, Hidetoshi Kawaguchi1,Takaaki Furukawa1 and Yuka Kimura1
1. Department of Urban Life Studies, Tokyo City University, 8-9-18-2405 Todoroki, Setagaya, Tokyo 158-8586, Japan
2. Nippon Engineering Consultants, 3-23-1 Komagome, Toshima-ku, Tokyo, 170-0003, Japan
3. General Design Planning KIHARA, 7-11-19-102, Kitami, Setagaya, Tokyo, 157-0067, Japan
Abstract: This study was carried out to examine the development of an “elderly tele-nursing model” for care provided in-home byfamily members and through remote nursing systems in a super-aging society. This model studied the travel time, cost, and means oftransportation of care providers. The pre-survey results regarding elderly tele-nursing show that a son/daughter can visit a parent
more than once a week. In the results, the time required for elderly tele-nursing was influenced by whether or not the visitor uses theshinkansen (bullet train of Japan). In the main survey, based on 40 questionnaires, clear differences were observed according towhether visits were “every two weeks” or “once per month”. Furthermore, this result was also indicated by t-tests.
Key words: Senior citizen, information systems, smart device, time distance, elderly tele-nursing model.

1. Introduction
1.1 Context of Study
In 2025, there will be 36.57 million senior citizens(over 65 years old) in Japan. This accounts for 30.3%of the Japanese population. In such a rapidly aging
society, we cannot care for people only in nursing
homes, and expect that in-home care will increase.
Therefore, the need for elderly care by family
members is emphasized. This type of care is generally
difficult because the population of elderly living alone
increases concurrently with declining birth rates andthe growth of the nuclear family, resulting in a heavy
burden for families (Table 1). On the other hand,substantial in-home care is gradually being enabled by
the progress of remote nursing systems (Table 2).
Based on this trend, we believe that one method of
future elderly care is in-home care by family members
or through remote nursing systems. Before realizing
Corresponding author: Hideaki Takayanagi, Dr., Eng.,
associate professor, research fields: urban and architect
planning.

these goals, we need to grasp the need for elder careand the effect of remote nursing systems on relieving
the burden on the family.
1.2 Goal and Implications of the Study
The goal of this study is to show the benefit of an“elderly tele-nursing model” based on the degree of
elderly care required so that the family is lessburdened. The degree of care required was indicatedin terms of travel time, cost, and means oftransportation. Before discussing these factors, thesurvey method and model are outlined.
This model only considers care for a parent by ason/daughter. Based on this model, we could conduct
a survey about remote nursing systems anddemonstrate their effects.
1.3 Definition of Terms
In this study, the degree of elderly care that isrequired so the family is not burdened is defined as
how often a child can visit a parent in a location far
from where he or she lives without being burdened byBasic Study on Elderly Tele-nursing Model for Emote Nursing by Smart Device

606

Table 1

Problems of elderly care by son/daughter if they live in remote location.

Category
caring inson/daughter'shouse

the Problem
Pychosis uneasy of parent who misfit new environment.
Increasing a burden of son/daughter
because it's difficult to have nursing-care servise

caring in
Dispite of using "Care Giver's Saver Fare",son/daughter
remote location is burdened with travel time and cost.
in-home care
Table 2People who is in the prime of life decline in urban because
retiredemployee for caring his/her parent is about 100,000 per year

Abstract of Remote Nursing Systems.

Tele-medicine (used by between health care providers)Category

Tele-medicine(used by between health care providers and apatient)Tele-care (care etc.)

ObjectGrasping existence, Confirming health condition, Communication

MethodSensor, Sueveillance camera, Smart phone, Tablet, Phone,
TV phone, Game, etc.

the parent. “Tele-nursing” is defined as care for aparent provided by a son/daughter who lives far away,using remote nursing systems.

to each location (Fig. 2), and their responses indicatedthe time required and means of transportation.

2. Pre-survey

Regarding each location in Fig. 3, travel time andcost level are such that D > C > B > A > E > F > G >H (H being the highest).
According to the responses, between locations Eand F, visit times decline sharply and the number ofshinkansen users increases significantly (Fig. 3).
Based on these results, it is difficult to establish
elderly tele-nursing when a child visits a parent byshinkansen. Answers regarding locations A, B, C, andD require additional analysis.

2.1 Pre-survey Plan
We conducted a pre-survey prior to the main survey(Figs. 1, 2 and Table 3). The goal of the pre-survey
was to develop predictions for the results and identify
problems with the survey method. Furthermore, thepre-survey assumed that elderly tele-nursing exists
when the son/daughter visits a parent more than oncea week. Four categories of people were surveyed, i.e.,under 40 years old, 40-49 years old, 50-59 years old,and over 59 years old.
One pre-survey question asked how many times thepanelist (child) visits his/her parent who lives alone.
The panelist was asked about the travel time and cost

2.2 Results of Pre-survey

2.3 Analysis of the Pre-survey
First, based on travel time and cost, we drew
regression lines for each transportation method (i.e.,
local line, public way, and highway). Second, the answers

Basic Study on Elderly Tele-nursing Model for Emote Nursing by Smart Device

Fig. 1

Concept model in pre-survey.

Fig. 2A-H positions in pre-survey.

were drawn on the graph. This graph showed that the“number of local line and highway users: number ofpublic way users was about 2:1” (Fig. 4). Regression
equations for the answers (Eq. (1) for local line andhighway users and Eq. (2) for public way users) are
shown below. The equations include the “elderlytele-nursing model”, as shown by the pre-survey (Fig.
5).
[Regression equations]
Local line and highway users:
y = 31.5x - 823.4(1)
Public way users:
y = 5.2x - 52.2
(2)
(rounded to one decimal place).
According to the regression equations, local line
and highway users incur higher travel costs than timecosts. On the other hand, public way users require
more time than money. Moreover, the distribution ofanswers was concentrated at x < 200 and y < 4,000. In
summary, these models probably involve a broad
range of factors. This analysis excludes outliers tomaintain the reliability of the study results.

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2.4 Problems with the Pre-survey
The pre-survey was difficult to complete because
panelists were given a great deal of information,which was intentional. Furthermore, because thepre-survey assumes that elderly tele-nursing consistsof more than one visit per week, the survey could notincorporate cases when a panelist wants to visit
biweekly. Therefore, the main survey had more
precise questions for the panelists.

3. Main Survey
3.1 Main Survey Plan
The main survey comprised four items (i.e., items P,Q, R, and S). Items P and S were common questions,whereas items Q and R were choice questions,depending on answers to item P (refer to Fig. 6). Item
P assessed the panelist’s attributes (e.g., gender, age,and occupation) in addition to the items shown inFig. 6. Item Q asked the panelist, “In the future, how
do you estimate the travel time and cost per single
journey when you periodically visit your parent who

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Table 3

Basic Study on Elderly Tele-nursing Model for Emote Nursing by Smart Device

Abstract of pre-survey.

Basic Study on Elderly Tele-nursing Model for Emote Nursing by Smart Device

Fig. 3Rate of “visit times is 0” and shinkansen users.

Fig. 4

Regression lines by transportations and distribution of answers.

Fig. 5“Elderly tele-nursing model” by pre-survey.

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Fig. 6

Basic Study on Elderly Tele-nursing Model for Emote Nursing by Smart Device

Portion of the main survey.

lives alone?” based on the visit frequency set by us.
Item Q also probed the means of transportation andideal frequency of visits (Fig. 6). Item R requested thepanelist to write freely about the parent’s life. Item S
asked about an ideal life when the panelist is elderly(over 65 years old and after retirement). This studyanalyzed 40 questionnaires that were collected before
August 2014.
3.2 Results and Features of Item Question Q
Results for of item question Q are illustrated in Figs.
7 to 10. In Fig. 7, ranges under 30 min and over 120
min show clear changes. First, in the range for ofunder 30 min, “ideal frequency of visits is once perweek” accounts for approximately about 60% ofanswers and “every two weeks” accounts forapproximately about 40%. On the other hand, “onceper month” declines to about 5%. To summarize, there
is a great difference in time costs according to visit
frequencies of between “every two weeks” and “onceper month”. In the range of under 10 min range, “onceper week” accounts for about 30% of answers,
whereas “every two weeks” declines to about 5%.
Second, the percentage of responses over 120 min
increases clearly in the lower range of a frequency
than “ideal frequency of visits is every two months”.
This result is probably related to the frequency ofideal visits.
In Fig. 8, a cost level of approximately around
5,000 yen shows a clear change in visit frequency. In
the range under 5,000 yen, “every four months”
accounts for approximately about 70% of responses,
but “every half year” declines to about 20%.
Furthermore, in the range under 1,000 yen, “every twoweeks” accounts for over 80% of answers, but “onceper month” declines to 50%. In summary, there is also
a significant difference in cost according to visit
frequency between responses of “every two weeks”
and “once per month”.
Regarding the “means of preferred transportation”,
Fig. 9 shows two types of responses, i.e., “once perweek and every two weeks” and “lower frequency

Basic Study on Elderly Tele-nursing Model for Emote Nursing by Smart Device

Fig. 7

Approximate travel time required for single journey (by frequency of visits).

Fig. 8

Approximate travel cost required for single journey (by frequency of visits).

Fig. 9Means of preferred transportation.

than once per month”. Thus, a great difference is also
seen in transportation means according to frequency
responses of between “every two weeks” and “onceper month”. For responses of “once per week andevery two weeks”, walking and bicycling accounted
for 30%-40%. However, for responses of “once permonth”, these transportation methods declined tounder 5% and car accounted for 85%. For “lowerfrequency than once per month”, the amount of public

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transportation increased steadily. Regarding thepanelists’ attributes in the “once per week” category,
only women answered “walking”. For frequencies of“once per week and every two weeks”, only men usedpublic transportation. These results are the focus of
the following study. Finally, for in “ideal frequency ofvisits” (Fig. 10), “once per week” accounted for about25%, “every two weeks” accounted for about 30%,
“once per month” accounted for about 35%, and612

Basic Study on Elderly Tele-nursing Model for Emote Nursing by Smart Device“every two months” accounted for about 10%. Finally,“lower frequency than every two months” accountedfor 0%.
Next, the distribution maps of “approximate travel
time required for a single journey” and “required cost”
are shown in Fig. 11. This graph shows single travel
time (min) on the x-axis and cost (yen) on the y-axis.
The distribution of this graph involves two factors, i.e.,“once per week and every two weeks” and “once permonth and every two months”. We expected thisresult. For “once per week and every two weeks”,
time cost was steadily in the range of x < 60 min.

However, in the range x > 60 min, there were twogrouping types, i.e., cost increases and time weresteady, or both cost and time increased. On the otherhand, for the factor in “once per month and every twomonths”, there was no clear trend.
Based on these results, the elderly tele-nursing
model should be evaluated using two frequency ofvisit factors, i.e., “once per week and every twoweeks” and “once per month and every two months”.
Thus, the distribution map shown in Fig. 12 isbased on answers that the ideal frequency of visits isonce per week or every two weeks, or once per month

Fig. 10

Ideal frequency of visits.

Fig. 11visits).

Distribution maps of “approximate travel time required for single journey” and “required cost” (by frequency ofFig. 12 Distribution maps of “approximate travel time required for single journey” and “required cost” on ideal frequencyof visits.

Basic Study on Elderly Tele-nursing Model for Emote Nursing by Smart Device
Table 4613

Result of t-test.

Category

Apporoximate travel timerequired(unit;
for single journey□◆

Apporoximate travel costrequired(unit;for single journey□◆

Average

51.9

90.0

750.0

2222.2

Variance

828.1

675.0

71428.6

2381944.4

tP(T<=t)one side
t-limit value
one sides
P(T<=t)both side
t-limit value
both sides-2.853-2.815

0.006

0.010

1.761

1.833

0.013

0.020

2.145

2.262

People who answer that the ideal frequency of visits is once per week or every two weeks
People who answer that the ideal frequency of visits is once per month or every two weeks

or every two months. Fig. 12 shows “approximate

regression line for “once per month or every two

travel time required for an ideal frequency of visits”

months” was about y = 40x-2,000 (50 < x < 120).

and “required cost for an ideal frequency of visits”.
Figs. 11 and 12 exclude outliers to maintain the4. Conclusion

reliability of the study results.

4.1 Summary

3.3 Analysis of Distribution Maps (T-Tests)

The pre-survey results regarding elderly
tele-nursing show that a son/daughter can visit aparent more than once a week. In the results, the timerequired for elderly tele-nursing is influenced bywhether or not the visitor uses the shinkansen.
However, tendencies and regression equations wereidentified, and problems were found.
In the main survey based on 40 questionnaires,clear differences between responses according to ideal
visit frequencies of “every two weeks” and “once permonth” were observed. Furthermore, this result wasalso shown by t-tests. Therefore, this study indicates
important tendencies and points to consider in future
surveys.

Distribution maps based on Fig. 12 show theanalytical methods. To test whether the previously
noted two factors (i.e., answers that the ideal
frequency of visits is once per week or every twoweeks and once per month or every two months)
differ, t-tests were conducted (Table 4). The
significance level of the test was 5%. Focusing on thet-limit value (both sides) and magnitude correlation of
the t-value’s absolute value, the results were 2.145 <|−2.853| and 2.262 < |−2.815|. Therefore, regarding
travel time and cost, the population’s average values
for these types were significantly different. In otherwords, this result is probably not accidental.
Furthermore, regression analysis of each type wasconducted based on data shown in Fig. 12.
Consequently, the regression line for “answers that theideal frequency of visits is once per week or every twoweeks” was y = 500-1,000 and 0 < x < 100. The

4.2 Future Considerations
Future surveys should expand on the limited
parameters of this study. Following this survey, weneed to conduct comparative analysis, adding thepanelists’ attributes, and clarify the conclusions of thisBasic Study on Elderly Tele-nursing Model for Emote Nursing by Smart Device

614study.

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