Originals

Asian Pacific Journal of Disease Management 2020; 9(1·2), 00-00
Copyright© 2013 JSHSS. All rights reserved.

Preventive care for frail seniors living alone in the community-Special characteristics compared with seniors livingwith othersKimura Hiromi1), Nishio Midori2), Koga Kayoko1), Kukihara Hiroko1)
Fukuoka University of Medicine
Japanese Red Cross Kyushu International College of Nursing

1)
2)

Abstract
The subjects were 125 eligible people out of 142 people considered as weak seniors (hereinafter, frail seniors) according to the basic checklist in S city. A self-administered questionnaire survey using a leaving
method was conducted to investigate the frail senior’s basic characteristics, Tokyo Metropolitan Institute ofGerontology Index of Competence (TMIG-IC), Scale for the feeling that life is worth living among the aged
(K-1 Scale), Social Support Scale, Geriatric Depression Scale, and General Self-Efficacy Scale. In the statistical analysis, seniors living alone (group A) and seniors living with others (group B) were compared. GroupA had a significantly higher score in instrumental independence and significantly lower scores in emotional
support, instrumental support, negative support, and positive support. The odds ratio of each characteristic
factor between seniors living alone and seniors living with others was 4.44 in instrumental independence,
0.51 in emotional support, 0.72 in instrumental support, and 0.76 in negative support. It was found that frail
seniors living alone are instrumentally independent. However, it was also suggested that they are less likely
to utilize emotional, instrumental, and social support.
Key words: Community life, Seniors living alone, Frail, Preventive care, Characteristics

Introduction
Japan has become super aging society, and with declining birth rate and downsizing household, the number of seniors living alone is increasing1). According to
the estimation by Ministry of Health, Labor and Welfare, one-person senior households account for 27% in
2016, and 45% of the 65 years and older population
will live alone in 20301). It is easy to presume that it isgoing to be more difficult for seniors to receive living
support from their family. “Health”, “Economy”, and“Isolation” are the risk factors for long-term care needs
in seniors living alone2). The Japanese government has
been promoting the 4th National Health Promotion
Measures—Health Japan 21 (2nd), and one of the goals
Received: June 21, 2019
Accepted: March 27, 2020
Address: Kimura Hiromi, 8-19-1 Nanakuma, Jonan-ku
Fukuoka 814-0180, JAPAN Phone: +81-92-871-6631, 1-1
Asty Munakata-City, Fukuoka-Prefecture 811-4157 Japan.
Phone: +81-940-35-7001

CW6_A3238D03.indd

1

is to extend healthy life expectancy. Healthy life expectancy is defined as the period living his or her everyday
life without any support and without health problems3).
The task is finding out how to extend the period that
seniors do not need special support. Therefore, it is critical to shorten the difference between life expectancy
and healthy life expectancy, which are 9.1 years formale and 12.7 years for female.
Weakness is expressed as frailty in these days.
Buchner and Wagner first defined the concept of frailty
in 1990s as a preliminary step of ADL (activity of dailyliving) disorder, “the condition vulnerable to physicalmalfunction due to declined reserved capacity” 4). Fried
et al. also defined frailty as a physical condition including weight loss, a sense of fatigue, declined amount ofactivity, slow-moving (slow walking speed), and declined grip strength5). The number of seniors eligible
for secondary prevention through the basic checklist
assessment conducted in 2015 was approximately 10 %of the elderly population6), but the proportion of potential frail seniors is likely to be higher.

2020/04/10

11:23:36

2

Asian Pacific Journal of Disease Management 2020; 9(1·2), 00-00

Suemori et al.7) focused on depression as a mental
problem of seniors living alone and pointed out thatthey need more appropriate support including prevention compared with seniors living with others. In termsof social support among the elderly, support networks
become smaller as the range of activities and social interaction with friends becomes smaller8). In this way,seniors gradually lose personal relationships and those
who do not have companions or reliable friends are increasing9). It has been reported that depression is associated with less social support10)11) and the association isespecially higher in seniors12). It is important to maintain social support for seniors living alone. Also, it has
been reported that there is a gender difference in life
satisfaction among seniors living alone13). One of thereasons is that women anticipate living alone in the future due to earlier marriage and longer life span while
men tend to feel more difficulty in living alone13).
Establishing preventive care measures to support
seniors to maintain independence in their house as longas possible is an important social task, but few companies have participated in preventive care business14).
Especially, preventive care for frail seniors with highcare needs is not sufficiently carried out15). In addition,
relocation damage including mental, social, and physical damage caused by moving from one’s old place to a
new place is another obstacle16). Frail seniors living
alone are more likely to suffer from relocation damage
by living together with their family who have separately lived for a long time or moving into the residential
care facility. As these factors interact with one another,seniors may progress from a frail condition to a careneeds condition. In this study, we clarified physical,
mental, and social living conditions in frail seniors living alone and examined how to support for preventing
long-term care needs.

Study Methods

Term Definition
Frail senior is defined as the person who is assessed
as “weak” in the aspects including “losing weight”,“declining muscle strength”, “losing energy”, “decreasing walking speed”, and “declining physical activity”
with the simple screening tool “preventive care checklist” developed by Shinkai et al.17) to identify the seniors with a risk of care needs.

1. Subjects
The subjects were 142 weak seniors (hereinafter,
frail seniors) according to the basic checklist in S city.
The valid responses were obtained from 125 people (response rate: 88.0%).
2. Methods
The study method was a self-administered questionnaire survey using a leaving method. The basic
characteristics, Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC)18), Scale forthe feeling that life is worth living among the aged (K-1
Scale)19), Social Support Scale20), Geriatric Depression
Scale (GDE)21), and General Self-Efficacy Scale(GSES)22) were included in the survey.
TMIG-IC consists of 13 items with a higher scoreindicating higher competence in daily living. It has subscales including “instrumental independence”, “intellectual activity”, and “social role”.
K-1 Scale for the feeling that life is worth living
among the aged consists of 16 items with a higher scoreindicating higher sense of worth living. It has 4 subscales including “self-realization and will”, “sense oflife fulfillment”, “will to live”, and “sense of existence”.
With the total 32 points, 0-12 point (s) were considered“very low”, 13-16 points were “relatively low, 17-23
points were “average”, 24-27 points were “relativelyhigh” and 28-32 points were “very high”.
Social Support Scale consists of 12 items with thesubscales including “emotional support”, “instrumental
support”, and “negative support”. In this study, “positive support” (emotional support + instrumental support) and “total support” (positive support - negative
support) were also evaluated. For “emotional support”,“instrumental support”, “positive support”, and “total
support”, a higher score indicates better social support.
For “negative support”, a higher score indicates poorersocial support.
GDS consists of 15 items, and 0-4 point (s) indicate“no depression symptoms”, 5-9 points indicate “milddepression”, and 10-15 points indicate “depression”.
GSES consists of 16 items and a higher score indicates higher self-efficacy. Using a standardized scoreconversion table, a degree of self-efficacy can be evaluated with the GSES 5-scale value table. 0-4 point (s)for male and 0-3 point (s) for female were evaluated as
1, which is “very low”, 5-8 points for male and 4-7

Copyright© 2013 JSHSS. All rights reserved.

CW6_A3238D03.indd

22020/04/10

11:23:36

Preventive care for frail seniors living alone in the community -Special characteristics compared with seniors living with others-

points for female were 2 “relatively low”, 9-11 points
for male and 8-10 points for female were 3 “normal”,
12-15 points for male and 11-14 points for female were
4 “relatively high”, and 16 points for male and 15-16
points for female were 5 “very high”.
3. Statistical analysis
For the statistical analysis, seniors living alone areclassified as group A and seniors living with others areclassified as group B. The basic characteristics werecompared with Chi-square test and the scores of eachscale were compared with t test. For the questions ofeach scale, Mann-Whitney U test was conducted. In addition, association between living alone and each factor
was examined using logistic regression with living
alone as a dependent variable. The explanatory variables included sex, age, lifestyle, subjective health status, TMIG-IC score, K-1 Scale score, Social Support
Scale score, GDS score, and GSES score. Windows
edition SPSS 24.0 was used for the statistical analysis,
and the significance level was less than 5%.
4. Ethical consideration
This study was approved through the ethical review of S city and by the ethics committee of S university. The written and oral explanation about the purpose
and contents of the study was provided to the subjects
and the written consent was obtained from all participants. The data was anonymized. We paid close attention to information and data leakage to protect privacy.
There is no conflict of interest to disclose in this study.

Table 1

3

Results
1. Basic characteristics
Group A included 51 people (2 males, 49 females,
the mean age: 78.6 years) and Group B included 74
people (13 males, 61 females, the mean age: 78.0
years). There was no significant difference in age between 2 groups. For the lifestyle, 90% of the subjects
responded they are “able to buy things necessary forliving” and “able to pay for food with no trouble” inboth groups, showing no significant difference. For the
subjective health status, approximately 70% responded“somewhat good”, and 20% responded “not so good”
or “not good”, showing no significant difference between the groups (Table 1).
2. Comparison between 2 groups in each scale
The average score of TMIG-IC was approximately
12 points in both groups, but Group A had a significantly higher score in the subscale of instrumental independence. There was no significant difference between 2
groups in K-1 Scale. For Social Support Scale, Group A
had a significantly lower score in the subscales of emotional support, instrumental support, negative support,
and positive support. No significant difference was observed in the GDS and GSES scores (Table 2). In comparison of each question of K-1 Scale, significant differences were observed in “I still have roles inside andoutside of the home.”, “I feel I am needed by others.”,“I think I’m doing things beneficial to our society andmy family.”, and “I’m trusted and relied on by my family and others.”. In comparison of each question of So-

Demographic characteristics

Average age (SD)a
Sexb
Male
FemaleSubjective health statusb
Very good
Somewhat goodNot so goodNot good
Lifestyleb
Quite blessed life
Able to buy things necessary for living
Able to pay for food with no trouble
Difficult to pay for foodGroup A
(n=51)

Group B
(n=74)

p value

78.0 (5.61)

78.6 (5.37)

0.55

2 ( 3.9%)49 (96.1%)

13 (17.6%)
61 (82.4%)

0.45

1 ( 2.0%)38 (74.5%)
10 (19.6%)
6 ( 3.9%)5 ( 6.8%)
49 (66.2%)
18 (24.3%)
2 ( 2.7%)

0.79

3 ( 5.9%)
16 (31.4%)
28 (55.0%)
4 ( 7.7%)

34.1 ( 4.1%)
36 (48.7%)
31 (41.9%)
4 ( 5.3%)

0.63

a: t-test b: chi-square test

Copyright© 2013 JSHSS. All rights reserved.

CW6_A3238D03.indd

32020/04/10

11:23:36

4

Asian Pacific Journal of Disease Management 2020; 9(1·2), 00-00

Table 2Comparison between two groups in each scaleGroup A
Average
SD

Group B
AverageSD

p value

Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC)
Total
12.1
1.5
11.8
1.9
Instrumental independence
5.0
0.2
4.6
0.9
Intellectual activity
3.7
0.7
3.7
0.7
Social role
3.0
1.0
3.4
0.9

0.04
p<0.010.80
0.04

K-1 Scale Sense of worth living

21.8

7.2

23.7

6.7

0.03

Social support scale
Emotional support
Instrumental support
Negative support
Positive support
Total support

3.5
2.4
0.8
5.8
5.0

0.9
1.3
1.2
1.9
2.2

3.8
3.1
1.4
6.8
5.4

0.7
1.1
1.3
1.5
1.9

0.04
p<0.010.02
p<0.01
0.03

GDS1) total

4.8

3.5

4.5

2.9

0.67

GSES2) total

7.3

4.6

7.7

3.8

0.55

1) Geriatric Depression Scale
2) General Self-Efficacy Scale
Table 3 Logistic regression analysis comparing seniors living alone with seniors living with others
Instrumental independence
Social role
Emotional support
Instrumental support
Negative support

p value

Odds ratio

95% Confidence interval

p<0.01
0.04
0.02
0.03
0.35

4.44
0.51
0.69
0.72
0.63

1.40 - 8.75
0.36 - 3.79
0.17 - 1.64
0.38 - 1.11
0.66 - 1.52

cial Support Scale, significant differences were observed in “Is there anyone who can take care of you if
you become sick and stay in bed for several days?”, “Isthere anyone whom you can ask some work when you
are away from home?”, “Is there anyone who makes
you irritated or angry?, and “Is there anyone who puts
you in trouble?”.
3. C haracteristic factors in seniors living
alone and seniors living with others
Table 3 shows the results of logistic regression
with seniors living alone and seniors living with others
as dependent variables. In the explanatory variables,
the odds ratio of instrumental independence in TMIGIC was 4.44 (95% confidence interval [CI] 0.49-1.06),
the odds ratio of emotional support was 0.51 (95%CI
0.24-1.11), the odds ratio of instrumental support was
0.72 (95%CI 0.49-1.06), and the odds ratio of negative
support was 0.76 (95%CI 0.56-1.06). Also, in the Wald
test, seniors living alone had a significantly higherscore in instrumental independence but significantly
lower scores in social role, emotional support, and instrumental support, compared with senior living withothers.

Discussion
In this study, we used the basic checklist in Longterm Care Insurance to identify frail seniors at Community General Support Center and compared the characteristics of seniors living alone and seniors living withothers. Based on the results, we clarified their physical,
mental, and social living conditions and examined how
to maintain and improve physical functions of frail seniors living alone and provide support for preventivecare.
1. Factors that contribute to frailty development
There are many previous studies examining predic-

Copyright© 2013 JSHSS. All rights reserved.

CW6_A3238D03.indd

42020/04/10

11:23:36

Preventive care for frail seniors living alone in the community -Special characteristics compared with seniors living with others-

tive factors that contribute to long-term care needs inthe elderly in Japan and other countries 23)24). However,there are a few studies examining predictive factors that
contribute to frailty. Currently, the cutoff value of thebasic checklist for Long-term Care Insurance is mostly
3 points/4 points out of 15 items, and seniors with 4 ormore points are considered comprehensively frail25). It
has been reported that comprehensive frailty is associated with grip strength25). The previous studies also indicated that high blood pressure, heart disease, diabetes, and muscle weakness due to undernutrition are
predictive factors of frailty23)26). Frailty is more likely to
be caused by various factors including physical, mental, and social factors27), and physical functions can besignificantly improved by exercise and nutrition26).
Moreover, psychological stress, unhealthy behavior,and physiological factors complicatedly affect healthmaintenance in seniors living in the community28). On
the other hand, social participation such as hobbies cancontribute to health related QOL even in frail seniors29).
Therefore, social relationships, physical functions, cognitive functions, and social isolation due to someone’s
death are factors associated with frailty development30).
Although focusing on social isolation in frail seniors
living alone is important, seeking for how to build social relationships may be more important as a preventive measure. In general, social role functions start declining earlier than instrumental activities of dailyliving (IADL)31). In other words, seniors lose social relationships including social roles before they lose physical or mental functions and IADL. However, frailty isreversible and can be returned to a healthy condition
with appropriate intervention. The most important thingis to identify frail seniors in the early stage and properlyintervene to maintain and improve their living functions.
1. Characteristics of frail seniors living alone
In the study by Yoshida et al.23), the subjective
health status was not a predictive factor of frailty. Similarly, there was no significant difference in the subjective health status between 2 groups in this study. Whilelower subjective health status is not associated withfrailty, individual sense of values for daily living or
lifestyle are more likely to affect frailty. However, it is
known that seniors living alone lose functions more
rapidly than seniors living with others if they developed
a disease or disorder32).
Since seniors living alone have a higher level of5

activities of daily living (ADL) compared to seniors
living with others33), they do not always need support
because of just living alone. In this study, Group A had
a higher score in instrumental independence, whichequals to IADL. Living alone inevitably requires playing various roles to maintain daily living, which may
contribute to prevent frailty. Therefore, living alone
does not always lead to social isolation and frailty. The
situation differs from person to person.
It has been reported that frail seniors living alone
have less social interaction and less conversation withothers34), which are risk factors of the psychological unhealthy state. Improvement of social networks for seniors living alone can reduce the development of geriatric syndrome35). Since leisure activities and work-related
activities are both related to social networks, senior’s
good mental health is associated with hobbies and volunteer activities with a sense of purpose in daily living36). In
frail seniors living alone, social participation such as active lifestyle, social roles, and social networks is closely
associated with their health status. A sense of worth living was significantly lower in frail seniors living alone inthis study. Therefore, frail seniors living alone can increase a sense of worth living and maintain physical andmental health through active social participation and frequent conversation with others.
It is indicated that frail seniors living alone are lesslikely to receive social support from private networks
and more likely to develop depression37). In terms ofsocial support examined in this study, Group A had asignificantly lower score in emotional support, instrumental support, positive support, and total support,
compared with Group B. Also, in the logistic regression
analysis after adjusting the confounding relationships
between each item, the odds ratios in social roles, emotional support, and instrumental support were significant. It has revealed that seniors living alone do not receive sufficient emotional support and instrumental
support as shown in the questions including “Is there
anyone who can take care of you if you become sickand stay in bed for several days?”, “Is there anyone
whom you can ask some work when you are away fromhome?”, and “Is there anyone whom you can talk about
worries and concerns?”. Informal and formal support
from children not living together or neighbors can provide a sense of security and hope of living in frail seniors living alone.

Copyright© 2013 JSHSS. All rights reserved.

CW6_A3238D03.indd

52020/04/10

11:23:36

6

Asian Pacific Journal of Disease Management 2020; 9(1·2), 00-00

2. To prevent the progress from frailty to careneed conditions
This study showed that frail seniors living alone
are weak but independent, and even superior in instrumental independence compared with seniors livingwith others. However, this study also showed that frail
seniors living alone do not receive sufficient social support. As physical functions gradually decline with aging, early social support is important to maintain independence as long as possible. Especially, interaction
with others is critical in frail seniors living alone fromthe viewpoint of dementia prevention.
It has been reported that frequent social interaction
with friends and neighbors is strongly associated withmental well-being38) and can prevent the progress fromfrailty to care need conditions. Social interaction among
seniors are relationships chosen mutually and voluntarily, so fun time of leisure activities can bring a senseof worth living and improve QOL. These relationships
can affect the multi-aspects of frailty including physical, mental, and social aspects.
For frail seniors living alone, maintaining instrumental independence may also lead to a sense of self-efficacy. In addition, maintaining social roles puts seniors
in a higher activity level, which is a better situation.
However, it must be kept in mind that frail seniors tend
to lose various functions more easily with small impact,even without any disease.

Conclusion

3. Study limitations and future tasks
This study is significant because it has clarified thatfrail seniors living alone live independently with goodsubjective health status, but they do not receive sufficient social support. However, this study is a cross-sectional study analyzing the characteristics of frail seniors
living alone only at the time of investigation. The subject’s background such as the reason and the period ofliving alone was not examined. In addition, the subjects
were only those who live in a small city and the sample
size was relatively small.
In the future, we need to increase the number ofsubjects and conduct a further study for seniors living
alone in a large city or a rural area. Our next task is togeneralize these results and examine long-term careprevention measures based on the characteristics offrail senior living alone.

This study showed that frail seniors living alone
are instrumentally independent, but it also suggested
that they are not utilizing emotional, instrumental, andsocial support. In recent years, “oral frailty” occurring
as a preliminary step of “physical frailty” as well as“cognitive frailty”, “mental frailty”, and “social frailty”
caused by “physical frailty” have been newly proposed29). Seniors living alone are more likely to fall into
these types of frailty. To prevent that, it is important for
those seniors to recognize that they can continue to live
independently in their community by utilizing social
support effectively. Also, it is necessary for seniors living alone to have a sense of worth living, maintainmental health even in physically frail conditions, playsome social roles, and have a connection to social networks. Promoting the connection to the neighborhoodand the participation in local activities and keeping relationships with others are essential.

References
1) Cabinet Office: Senior’s health and welfare. 2018
edition Old social white paper, 1930 (2018).
2) Haruna Asano, Mio Kinoshita, Akemi Kikuta et al.;
QOL of area residence living alone seniors andabout social and life environment, and ocial capital.
(2) Hokkaido public health magazine 31 85-91(2018).
3) Naoto Nakasjima, Kohya Yano, Rika Kato et al.;
Medical expenses by age and class affecting healthy
life expectancy and study about nursing care costsby required nursing care level. Index of public welfare (6) 65 1-10 (2018).
4) Masafumi; Frailty; Overview and relation to nutrition. Japan Geriatrics Society magazine 51, 120122 (2014).
5) Hidenori Arai: Frail significance. Japan Geriatrics
Society magazine 51, 497-501 (2014).
6) Cabinet Office: 2017 edition, Old social white paper 19-30 in 2017. Senior’s health and welfare(2017).
7) Kei Suemori, Katsunori Kondo, Hideki Endo et al.;Japanese elderly people, Social epidemiology
large-scale investigation, Relationship between
health and the family. Household composition,
marriage situation and marital relationship. Japanese public health magazine 69(10) 583-587

Copyright© 2013 JSHSS. All rights reserved.

CW6_A3238D03.indd

62020/04/10

11:23:36

Preventive care for frail seniors living alone in the community -Special characteristics compared with seniors living with others-(2005).
8) Mkae Nishimura; living obstacles of living aloneseniors from the viewpoint of support network. Old
age psychiatric magazine 15, 184-, 191 (2004).
9) Masaki Nishimura, Tomoaki Ishibashi, Yukari Yamada et al.; Close relation in senile state; Others’
choice as target of “friendship” “consultation”“trust”. Old age social science 22(3), 367-374(2000).
10) Ayumi Masuji, Reiko Kishi; Bibliographical consideration about senior’s depression and the related
factor mainly with social support network relation.
Japanese public health magazine 48(8) or 435-, 448(2001).
11) Yayoi Koizumi, Shuichi Awata, Tetsu Seki et al.,Relation between social support and depressive
symptom of the city residence seniors. 41(4), 426433 (2004).
12) Reiko Kishi, Naoko Horikawa; Senior’s early stage
death and the role of social support network affecting body function. Study trend for inside and outside of the country and future obstacles. Japanesepublic health magazine 51(2) or 79-, 93 (2004).
13) Masaaki Nishimura, Yukio Hachiya and Kenjo Lee
et al.; Related factor to control sense, life satisfaction and living alone continuation will for living
alone seniors. Old age social science 25(2) and 234(2003).
14) Go Okubo, Tami Saito, Kenjo Lee et al.: Preliminary consideration of business factor related tomale participation in nursing prevention business.
From consideration of nursing prevention businesscase. Japanese public health magazine 52(12) or
1050-, 1058 (2005).
15) Koichi Nagano, Maya Kuno, Ryouhei Kinoshita etal.; Frail Relation of frail and social environmental
factor. Pilot study. Work therapy 36, 397-404(2017).
16) Misa Komatsu and Akiko Hamahata; The adaptation problem at relocating to senior facility, andcoping behavior to seniors facilities. Japan Academy for Health Behavioral Science magazine 28(1)and 82-92 (2013).
17) Shoji Shinkai, Naoki Watanabe, Hirohito Yoshida
et al.: Validation of “Nursing prevention checklist”
as weak index. (5) or Japanese public health magazine (5) 60 262-274 (2013).
18) Wataru Koyano, Hiroshi Shibata, Katsuharu Nakazato et al.; Measurement of activity ability with

7

area old people, Development of Roken-type activity index score. Japanese public health magazine(3) 34 109-14 (1987).
19) Tsutomu Kondo, Jiro Kamata; Definition of creating life worth living sense scale for seniors (K-I
method) Social welfare 43 93-101 (2003).
20) Yuji Noguchi; Senior’s social support-, the concept
and measurement, Social gerontology 34: 37-48(1991).
21) Morihiro Sugishita, Takashi Asada; About creating
depressed scale for seniors short edition-Japaneseedition (Geriatric Depression Scale - Short Version-Japanese, GDS-S-J). Recognition neuroscience (1) 11 87-90 (2009).
22) Yuji Sakano, Mitsuhiko Tojo; Tryal of generality
self efficacy scale creating. Behavior therapy study
12(1) 73-82 (1986).
23) Hirohito Yoshida, Mariko Nishi, Naoki Watanabe,
et al.; “Weak” predictive factor related study using
FI-J (Frailty Index for Japanese elderly). Japan
Geriatrics Society magazine 49, 442-448 (2012).
24) Takao Suzuki; Weak seniors distinction, the living
function evaluation for nursing prevention and theutilization. Focusing on relation between vitamin
D density and weak seniors. THE BONE 22(4)475-480 (2008).
25) Noriko Yoshiyuki, Ayumi Kono, Tomoko Soga, etal.; Relation between nursing insurance service utilization pattern and weakness for required support
seniors. Japanese public health magazine 63(3)135-142 (2016).
26) Masafumi Tsutaya; The importance of Sarcopenia&Frailty in geriatrics. Japan Geriatrics Society
magazine (4) 46 279-285 (2009)27) Gobbens RJ, van Assen MA, Luijkx KG, et al.: The
tilburg frailty indicator; Psychometric properties. J
Am Med Dir Assoc 11, 344-355 (2010).
28) Cohen S:Social relationships and health. Am Psychol 59, 676-684 (2004).
29) Touken Ikeda, Takumi Yamada; Development offrail of area residence and socially involved index
draft of certified nursing care necessity degree seniors. Japan Geriatrics Society magazine 54, 154164 (2017).
30) Hughes TF, Flatt JD, et al. :Engagement in social
activities and progression frommild to severe cognitive impairment the MYHAT study.Int Psychogeriatr 25, 587-595 (2013).
31) Fujiwara Y, Shinkai S, Kumagai S, et al.; Longitu-

Copyright© 2013 JSHSS. All rights reserved.

CW6_A3238D03.indd

72020/04/10

11:23:36

8

Asian Pacific Journal of Disease Management 2020; 9(1·2), 00-00

dinal changes in higher-levelfunctional capacity ofan older population living in a Japanese urban community. Arch Gerontol Geriatr 36, 141-153 (2003).
32) Keisuke Fujii, Seiki Kitano, Takashi Shinto, et al.;The relation between participation for area activity
and depression of living alone seniors. 32(1), 105110 (2017).
33) Itsuko Akamine, Masaki Araki; Support of area seniors at home from viewpoint of family unit form,
focused on loving alone household. Race hygiene(5) 72 1991-2007 (2006).
34) Haruhiko Honda, Shouzou Ueki, Tetsu Okada etal.; Relation of participation for voluntary activities
for area seniors at home, social health and living
functions. Japanese public health magazine (11) 57
968-976 (2010).
35) Yumi Okinaka; The factor related living will for

weak seniors living alone. Japanese nursing scientific magazine 37, 76-85 (2017).
36) Masashi Sugiura, Tomihiro Hayakawa; Analysis ofvarious factor related to daily life situation of seniors (1st Report). Roken-type activity index scoreand extraction of depression tendency evaluation
related factor. Japan rural community doctor magazine 64 (2) or 114124 of proceedings (2015).
37) Masami Hasebe, Takashi Koike, Kumiko Nonaka
et al.; Consideration about living support at homeusing monitoring sensor for living alone seniors.
From health survey for seniors and actual state ofuse survey to local care center. Old age social science (1) 38 66-77 (2016).
38) Lee GR, Ishii-Kuntz M: Social interaction, loneliness, and emotional well-being among the elderly.
Res Aging 9, 459-482 (2007).

Copyright© 2013 JSHSS. All rights reserved.

CW6_A3238D03.indd

82020/04/10

11:23:36