社会医学研究．第 26 巻 2 号．Bulletin of Social Medicine, Vol.26(2) 2009

原著

Visualization of the relationship between the geographic distribution of
day service facilities for the elderly and local elderly residents using ageographic information system
地理情報システムによる通所介護施設と地域高齢者の地理的分布の可視化
Kazuyuki TAKAHASHI1）, Atsushi OGIHARA2）高橋和行 1），扇原淳 2）1) Department of Health Science and Social Welfare, School of Human Sciences,
Waseda University2) Department of Health Science and Social Welfare, Faculty of Human Sciences, Waseda
University
1) 早稲田大学人間科学部健康福祉科学科
2) 早稲田大学人間科学学術院健康福祉科学科
Kazuyuki T. and Atsushi O. contributed equally to this work.
Corresponding to: Atsushi OGIHARA Email: aogi@waseda.jp
要旨
本研究は，通所介護施設と地域高齢者の地理的分布からみた介護福祉サービスの整備状況と利用者の地理的分布から見た施設提供サービスの現状について，特に距離的アクセシビリティの点から検討することを目的とした．
対象地域を埼玉県所沢市とした（通所介護施設：25）．通所介護施設の住所データ，所沢市町丁別地図，所沢市要介
護・要支援認定者数，日常生活圏域に関するデータセットを作成した．それらのデータを ArcGIS9.1（ESRI 社製）の ArcView を用い GIS 上で統合した．さらに，一施設を対象として，施設を中心とする距離圏と利用者の地図情報
を GIS 上に表示した．
その結果，所沢市内の通所介護施設と高齢者人口の地理的分布との関連では，各通所介護施設のカバー要介護者
数でみた場合，市内の北西部で少なく，市の中心部を含む南部で多くなるという地理的な偏りがみられた．1 施設
がサービスを提供すると想定される圏域（ボロノイ領域の面積）も南部で大きくなっていた．また，市内 65 歳以上
人口の約半数は，最寄りの施設から 1,000m 圏外に居住していた．特定の 1 施設を対象とした分析では，利用者の40%以上が 2,000m 以上離れて居住している者であった．
本研究の結果から，通所介護施設の地理的空間的分布に偏りがあることが視覚的に明らかとなった．今回の方法論を用いることは，政策立案者にとって地域高齢者福祉政策・活動を評価・立案する際に大いに参考になることに加え，施設経営者にとっても利用者獲得に向けた戦略に用いることが可能と思われる．
Abstract
Objectives: The aim of this study was to investigate the relationship between the geographic distribution of day
service facilities for the elderly and local elderly residents, and the status of facilities providing services as viewed
from the geographic distribution of users.

－ 75 －

社会医学研究．第 26 巻 2 号．Bulletin of Social Medicine, Vol.26(2) 2009

Methods: The study area was Tokorozawa City, Saitama, Japan, in which the study targeted 25 day service facilities
for the elderly. We used the Voronoi tessellation to determine the facilities nearest to an elderly person’s residence,by ascertaining the distance of the users’ residences from the facilities with consideration given to distance byroad. This data was integrated with the addresses of the facilities on a geographic information system in order toexamine geographic maldistribution.
Results: Geographic maldistribution was observed in the relationship between area of service of facilities andthe number of elderly residents in need of support or care. The“covered number of elderly residents in need ofsupport or care”were few in the northwestern part of the city and many in the southern part. Further, in thesouth, the area assumed to be involved in the provision of services by a single facility (i.e., the area of the Voronoi
area) was also large. Moreover, in an evaluation of the geographic access to day service facilities for the elderly
among local elderly residents, around half of the elderly persons resided in areas <1,000 m from the nearest
facility.
In a case study of the geographic distribution of users of a day service facility for the elderly, it was estimatedthat 40% of the elderly resided persons in areas >2,000 m from the facility they used.
Conclusion: It was visually clear that the geographic distribution of day service facilities for the elderly was
uneven. Moreover, the use of the methodology applied in this study can serve as a major reference for policy
makers when planning and evaluating regional welfare policies and activities for the elderly.
Keyword: Geographic information system; long-term care insurance; day service facilities for the elderly;
geographic distribution; visualization
Introduction

policies among the elderly that have been undertaken

Among the various policies that have been

hitherto have lacked a geographic focus, such as

designed in response to Japan’s aging society, one

computing numerical infrastructure targets based onof the largest reforms in recent years was therelative population ratios7).

establishment of the long-term care insurance (LTCI)
1-5)

Recently, a number of reports pertaining to thesystem in April 2000 . This program ensures thatgeographic distribution of medical care facilities andall Japanese citizens who are 65 years old and above

the use of these facilities by local residents haveare eligible for benefits (institutional and community-

been published. In addition to reports stating thatbased services, but not money) based on physical andthe geographic accessibility of medical care facilities

6)

mental disabilities . The computer-aided standardized

affects the use of these facilities by local residents,

needs assessment used in this study categorizes

there have been numerous reports investigating thepeople into seven levels. With the implementation ofgeographic distribution of local health care plans by

this system, there was a major shift in the priority

medical care facilities8–11).

toward home-based welfare, with a further shift

Among home-care services, day service facilities

toward“pick-and-choose welfare”based on individual

for the elderly may be used on a daily basis bychoice. Further, ever since the establishment of thethose who require support or care The location or

LTCI system, there has been a significant increase

geographic accessibility of such facilities is perceived

in the number of LTCI users. This increase has been

as a very important factor from the perspective of

attributed to the increase in the aging rate and homepotential users.

care service users.

Nevertheless, there exist relatively few reported

In general, a greater demand for home-careinvestigations on geographic accessibility vis-à-vis

services, due to the demand for welfare services, isthe current location of day service facilities for the

expected in the future. The insurance and welfare

elderly compared with the number of related reports－ 76 －

社会医学研究．第 26 巻 2 号．Bulletin of Social Medicine, Vol.26(2) 2009

investigating health care facilities.
This study investigates the current infrastructure of

1. Relationship between day service facilities for the

long-term care welfare services from the perspective

elderly, provision areas, and the number of elderlyof the geographic distribution of day service facilities

residents in need of support or carefor the elderly among local residents, as well as theFirst, we collected data sets of the addresses ofcurrent status of services provided by the facilities

day service facilities for the elderly, an area map of

from the perspective of the geographic distribution ofTokorozawa City, the certified number of elderly

the users.

residents in need of support or care, and the dailyliving area (Table 2). This data was then integrated

Materials and Methods

into a geographic information system (GIS) using

Study area

ArcView (ArcGIS ver. 9.1) obtained from ESRI Inc.

The study area was Tokorozawa City, Saitama, Japan(California City, CA, USA).

(Fig. 1, Table 1, area: 71.99 km2; population: 337,883;

To determine the facility nearest to an elderly

population density: 4,626 inhabitants/km2; population

person’s residence using the ArcGIS ver. 9.1, Voronoi

of individuals of 65 years and above: 54,966; aging

tessellation, which assumed that each facility was

rate: 16% ).

the center, was applied. Voronoi tessellation is a

A large geographic variation was seen in the certified

mathematical method that, by drawing a verticalnumber of elderly residents in need of support orbisector toward a straight line that links two points

care among the 14 daily living areas that werethat are next to each other on a plane, divides the

publicized by the city authorities. While the area

domain nearest to each point. The figure resultingwith the largest population had 858 persons, the areafrom the Voronoi tessellation is called the Voronoi

with the smallest population had 284 persons (Fig. 2).

diagram. In this study, wherein multiple facilities

The percentage of the certified population in need of

set on a plane generate points, a division is madesupport or care was an estimated 15% in each area.

from the nearest generating point within the

There are 25 day service facilities for the elderly

entire city area. The generating point of each areain the city; the service areas for 14 comprehensive

obtained using the Voronoi tessellation shows that

regional support centers were set up in accordance

the area“at a random point within the area (i.e., a12)random residence of a facility user) is the nearestwith the daily living areas .

in a straight-line distance.”Further, areal weighting
Analytical methods

interpolation was used to compute the certified

We analyzed the data in the following three stages:

number of elderly residents in need of support or(1) investigation of the relationship between day

care within the cell of each facility. We assumed that

service facilities for the elderly, provision areas,

these calculated values“covered number of elderly

and the certified number of elderly residents inresidents in need of support or care.”The areal

need of support or care; (2) evaluation of geographic

weighting interpolation is a method whereby it isaccess to day service facilities for the elderly among

hypothesized that the population is evenly distributed

local elderly residents; and (3) a case study on thewithin a single area, and when a certain area hasgeographic distribution of elderly day service facility

been divided into two or more areas according

users.

to each areal ratio using Voronoi tessellation, theThese analyses were made using the data in Table

population is divided among those divided areas. The

2. The data presented in Table 2 can be obtained

Areal Weighting Interpolation Totaling Tool ver.

without having to apply special methods. The

1 (Exceed Corp. Saitama, Japan) was used for thisanalysis in each of the three stages is described inpurpose.

the following.

－ 77 －

The certified numberof elderly residents inneed of support orcare

65 years old and above

Daily living area
Male

Female

Total

A
2,297
2,603
社会医学研究．第 26 巻 2 号．Bulletin of Social Medicine, Vol.26(2) 2009
B
1,994
2,984

Table
characteristics
C
1,985
Table 1.
1 Demographical
Demographicalcharacteristics
D

Daily living area

1,321
65 years
old and above

1,585

1,641 Female

Total
1,976

Male

E

2,637

Aging rate

4,900

760

18.4

4,978

858

16.2

4,622

763

16.2

404
Aging rate

19.1

557

17.4

The 2,906
certified numberof elderly residents inneed of support or
care
3,617

A F

2,297 1,531

2,603

1,779

4,900

3,310

760

494
18.4

15.8

B G

1,994 2,448

2,984

2,837

4,978

5,285

858

16.2
820

15.0

C H

1,985 2,270

2,637

2,706

4,622

4,976

763

16.2
760

15.6

D

1,321

1,585

2,399

2,906

4,299

404

19.1
672

19.1

15.3

557

17.4

I

E
F
G
H
I

1,641

J

1,531

K

2,448

L

1,900
1,072
1,964
800

2,270

M

1,900

1,756

1,976
1,779
2,837
2,706
2,399

1,350
2,411
1,018
2,005

3,617
3,310
5,285
4,976
4,299

2,422
4,375
1,818
3,761

494

284

15.8

15.6

703

19.5

376

9.5

672

583
15.3

17.5

820
760

15.0
15.6

J N

1,072 1,752

1,350

1,945

2,422

3,697

284

570
15.6

17.1

KTotal

1,964 24,731

2,411

30,235

4,375

54,966

703

19.5
8,604

16.2

L

800

1,018

1,818

376

9.5

M

1,756

2,005

3,761

583

17.5

N

1,752

1,945

3,697

570

17.1

Total

24,731

30,23554,966

8,604

16.2

Table
sets
Table2. 2Data
Data
sets
Data baseDate of issue①Addresses of day service
facilities

July, 2006

Table 2 Data sets
Data base②Area mapof Tokorozawa

City①Addressesof day service
facilities

Date of issue
February,
2003
July, 2006

③The Certified number ofJune, 2006
elderly residents in need of
②Area
map
Tokorozawa
February, 2003
supportorofcareCity④Daily living area

March, 2006

SourceList of companies concerned with Long-Term Care Insurance inTokorozawa city
(Department of Long-Term Care Insurance, Tokorozawa city)
Source(Geographical survey institute, Japan)
Digital map 2500 Kanto-2
List of companies concerned with Long-Term Care Insurance inTokorozawa city
Planofof
Health andwelfareplanTokorozawa
for the elderly(Department
Long-Term
Care
Insurance,city) and Long-Term Care

Insurance services in Tokorozawa city

Digital map
2500 Kanto-2(Geographicalsurveyinstitute, Japan)(Department
of Long-Term
Care
Insurance,
Tokorozawa city)

Plan of Health and welfare plan for the elderly and the Long-Term Care

③The Certified number of
elderly residents in need ofsupport or careJune, 2006

Plan of Health and welfare plan for the elderly and Long-Term Care
Insurance service in Tokorozawa city
Insurance services in Tokorozawa city
(Department
of Long-Term
Care
Insurance,city)
Tokorozawa city)(Department
of Long-TermCare Insurance,
Tokorozawa⑤Entirecityareamap of④Dailyliving

2003
March,February,
2006

Digital2500(Geographicalsurvey institute,Japan)
Plan of HealthandmapwelfareplanKanto-2
for the elderly
and the Long-Term
Care
Insurance service in Tokorozawa city
(Department of Long-Term Care Insurance, Tokorozawa city)

Tokorozawa city

⑥Road map of Tokorozawa⑤Entirecity city map ofTokorozawa city

February, 2003

February, 2003

Digital map 2500 Kanto-2 (Geographical survey institute, Japan)

Digital map 2500 Kanto-2 (Geographical survey institute, Japan)⑥Road
city map of Tokorozawa
city⑦Population of Tokorozawa

February, 2003

April, 2000

Digital map 2500 Kanto-2 (Geographical survey institute, Japan)⑦Population of Tokorozawa
city⑧Addresses of users ofApril, 2000

December, 2006

Census mesh data (Japan Statistical Association)
From research facility[533953 Tokorozawa・533954
Shiki・533963 Southern part of Kawagoe ]Facility⑧Addressesof users⑨Residential
mapofof
Facility
Tokorozawa city

December,
2006 2004
December,

Census mesh data (Japan Statistical Association)[533953 Tokorozawa・533954 Shiki・533963 Southern part of Kawagoe ]From researchfacility map 200602 Saitama eastern and western parts of Tokorozawa
Residential(Zenrin Co, Japan)⑨Residential map ofDecember, 2004
Residential map 200602 Saitama eastern and western parts of Tokorozawa
Analysis1（①，②，③，④），Analysis
2（①，⑤，⑥，⑦），Analysis3（①，④，⑧，⑨）
Tokorozawa
city(Zenrin Co, Japan)
Analysis1（①，②，③，④），Analysis 2（①，⑤，⑥，⑦），Analysis3（①，④，⑧，⑨）－ 78 －

社会医学研究．第 26 巻 2 号．Bulletin of Social Medicine, Vol.26(2) 2009

2. Evaluation of geographic access to day service

areas (Zenrin Residential Map 200602 SAITAMA,

facilities for the elderly among local elderly residents

Zenrin Co. Ltd., Fukuoka, Japan) was made andFirst, data sets of the addresses of day service

displayed on the GIS with a road map. Using thefacilities for the elderly, an area map of Tokorozawa

Network Analyst function of ArcGIS ver. 9.1, we

City, a Tokorozawa City road map, and Tokorozawa

calculated, in the five stages, the distance areas from

City population data were tabulated (Table 2). Using

facilities with consideration of the distance via road.

these data sets, the Network Analyst function of

Finally, keeping the facility as the center, the distance

ArcGIS ver. 9.1 was used to calculate, in five stages

areas and map information of users were displayed( <500 m, 500–1,000 m, 1,000–1,500 m, 1,500–2,000 m,

on the GIS.

>2,000 m), the distance areas from the facilities taking
into consideration the distance via road.

Results

Next, population data was entered into the GIS using

1. Relationship between day service facility for thegrid square statistics from the National Census

elderly, provision areas, and the number of elderly

data for the year 2000 (Japan Statistical Association,

residents in need of support or care

Tokyo, Japan). Then, the Areal Weighting

The locations that served as generating points afterInterpolation Totaling Tool ver. 1 was used toapplying the Voronoi tessellation to the locations ofcalculate the number of elderly residents (population

day service facilities for the elderly in the city areof individuals of 65 years and above) for each of theshown in Fig. 3 and Table 3. The certified number

five stages and the overall number of residents in theof elderly residentse in need of support or carecity.

(the covered number of elderly residents in need ofsupport or care) within Voronoi areas is also shown.

3. Case study on the geographic distribution of elderly
day service facility users

Geographic deviation was observed in the day
service facilities located in the city such that there

Among the day service facilities for the elderly

are many such facilities in the northwestern partwithin the city, Facility No. 1 in Fig. 2 and Tableof the city, but few in the southeastern part. The

3 was selected. The fixed number of users of thismaximum number of covered elderly residents

facility was 45 in December 2006. The procedure ofin need of support or care was 1,121, while thethe present study was reviewed and approved byminimum was 57. Geographic differences were

the staff. The subjects were then informed about

confirmed, with few such numbers (the minimum,

the study, and were requested to sign an informed

57) in the northwestern part of the city and many

consent form. Further, this study was approvedin the southern part. Further, in the south, the areaby the Ethical Committee of the School of Humanassumed to be involved in the provision of services

Sciences, Waseda University.

by a single facility (i.e., the area of the Voronoi area)

The subjects included 70 users who gave informed

was also large.

consent for this study. We did not use personal
information such as users’ names, gender, or age.

2. Evaluation of geographic access to day service

We used only the addresses for plotting on the map,

facilities for the elderly among local elderly residents

confirmed by the lot number information. The data

The population of local elderly residents wassets are shown in Table 2, and the address of theestimated at 43,131 persons based on grid squarefacility was displayed on the GIS.

statistics values using areal weighting interpolation.

Next, a map displaying each town (machi) and

The population of local elderly residents in the five

district (cho) of the entire area was entered andstages was arranged according to the road distances

displayed. Based on the address data of the users,with each facility serving as a center, and are as

a comparison of the city’s east portion and western

follows: <500 m: 6,910 persons (16.0 % ); 500–1,000 m:－ 79 －

社会医学研究．第 26 巻 2 号．Bulletin of Social Medicine, Vol.26(2) 2009

17,187 persons (39.8% ); 1,000–1,500 m: 12,310 persons(28.5% ); 1,500–2,000 m: 4,561 persons (10.6% ); >2,000 m:
2,163 persons (5.0% ) (Fig. 4).

Table 3. C apacity of day service facilities for the elderly and the covered number of elderly
Table 3 Capacity of day service facilities for the elderly and the covered number of elderly
residents in need of support or care*

residents in need of support or care*Num. of
Facility

Capacity

The covered
number of elderly
residents in needof support orcare*

DistrictNum. of
Facility

554

A

14

25

1

40

2

15

117

A

15

3

40

1,121

B

16

4

40

545

C

17

5

9

191

C

6

18

330

D

7

43

808

E

20

8

25

338

F

9

30

613

F

10

40

614

11

20

12
13

Capacity

The covered
number of elderly
residents in needof support orcare*

District

384

J

40

57

K

30

116

K

10

110

K

18

30

100

K

19

40

89

L

40

205

L

21

6

526

M

22

40

129

N

G

23

30

142

N

591

H

24

40

84

N

30

312

I

25

25

83

N

45

439

I

Total

751

43,131*The number of elderly residents needing support or care in each Voronoi diagram

Tokorozawa City, Saitama Prefecture, Japan

Fig. 1 Study area
Fig. 1 Study area

Tokorozawa City, Saitama Prefecture, Japan

Fig. 1 Study area
－ 80 －

Fig.1 Takahashi

社会医学研究．第 26 巻 2 号．Bulletin of Social Medicine, Vol.26(2) 2009

Day service facilities for the elderly

1 0.5 01

2 キロメートル
kilometer
The certificated number of elderly residents in need of support or care : Total : 8,604
Max.：District “B”：858
Min.：District ”J”：294

Fig. 2Day service facilities
for the elderly and daily living areas
Fig. 2 Day service facilities for the elderly and daily living areas◆ Day service facilities for the elderly

The number of elderly residents in need of support orcare in Voronoi diagram

1 0.5 01Max.: Facility Number 3
Min.: Facility Number 15

kilometer
2 キロメートルFig. 3byThecity represented
by Voronoi diagrams
Fig. 3 The city represented
Voronoidiagrams－ 81 －

社会医学研究．第 26 巻 2 号．Bulletin of Social Medicine, Vol.26(2) 2009

Facilities

Distance fromfacility (meters)

1 0.5 01

2 キロメートル
kilometer

Population of 65
years old and above

％

0～500

6,910

16.0

500～1,000

17,18739.8

1,000～1,500

12,31028.5

1,500～2,000
,
,

4,561
,

10.6

2,000 over

2,163

5.0

43,131

100

Total

Fig.
Geographicalaccessibility
to day facilities
serviceforfacilities
forusing
the roadelderlyFig. 4
4 Geographicalaccessibility
to day service
the elderly
mapusing road map

Distance from thefacility (meters)

Facility

Users within

Users outsideofdaily living

daily living

users

area

area

Number

0～500

17

8.6

16

1

500～1,000

52

26.4

46

6

1,000～1,500

47

23.9

32

15

1,500～2,000

11

5.6

1

10

Over 2,000

70

35.5

32

38

Total

197

100

127

70

user
Borderline of daily living area

Fig. 5Distribution of users of the day service facility for the elderlyFig. 5 Distribution of users of the day service facility for the elderly－ 82 －％

社会医学研究．第 26 巻 2 号．Bulletin of Social Medicine, Vol.26(2) 2009

Furthermore, it was estimated that in the eastern,including the central area of the city, the covered

western, and central parts of the city, some elderly

numbers were comparatively larger. A regional

persons resided at a distance of 1,500 m or moredifference was also observed for the respectivefrom the nearest facility. Overall, it was deduced thatareas assumed to be responsible for the provision

around half of the elderly persons resided in areasof services by a single facility (i.e., the area of the<1,000 m from the nearest facility.

Voronoi area). In this regard, the southern part ofthe city is large. For residents of an area with a

3. Case study on the geographic distribution of users

large number of covered elderly residents in need ofof a day service facility for the elderly

support or care, it is possible that, considering the

Following is the current status of geographic

fixed number of users of a facility within that area,

distribution of 70 users of a day service facility

such residents are unable to fully utilize their area’s

located in the northeastern part of the city: <500 m: 5

facility services. In other words, it is possible that thepersons (7.1% ); 500–1,000 m: 20 persons (28.6% ); 1,000

needy are unable to use the services of the nearest–1,500 m: 10 persons (14.3% ); 1,500–2,000 m: 4persons

facility. Moreover, one could imagine that when a(5.7% ); >2,000 m: 31 persons (44.3% ) (Fig. 5).

covered area is large, the distance between someusers’ residence and the services may also be large.

Discussion

The users of a day care facility generally utilize

In the process of planning for the construction of

the transport service provided by the facility, andpublic and commercial facilities, it is necessary to

depending on the extent of care required, an increase

consider the user accessibility of those facilities. GIS

in transport distance and time could increase theenables comprehensive management and information

physical and mental burdens of users. In fact, whenprocessing with regard to the geographic location,

an elderly person desires to use a facility located far

as well as the visual display of such information.

from his or her residence, there may be instances

Moreover, since it enables the analysis of spatialwhen the person has to refrain from using thefactors, GIS is widely used not only in resource

facility because of the transportation cost. From thismanagement

13)

and land use planning14) but also inenvironmental pollution
facilities

18, 19)15, 16, 17), planning of health care

Increased transport distance and time could also

, and decision-making in public healthincrease the physical and mental burden of those in

20, 21)

services

perspective alone, the use of a nearby facility is ideal.

.

charge of transportation at these facilities.

This study, we investigated the current status of the

It is believed that, while expanding the number

long-term care welfare service infrastructure fromof users of a facility or establishing a new facility,

the perspective of the geographic distribution of daypriority should be given to improving areas

service facilities for the elderly among local elderly

maldistribution area such as those shown in thisresidents, as well as the current status of services

study. In the Voronoi division based on direct distanceprovided by facilities from the perspective of thefrom a facility, since the population distribution

geographic distribution of users.

characteristics within a district thus divided wereFirst, in terms of the relationship between the day

not taken into consideration22), actual road distances

service facilities for the elderly within Tokorozawa

were used in this study, which has not been done inCity and the geographic distribution of elderly

previous studies22–25) that investigated the geographic

residents, regional differences were observed in theaccessibility of day service facilities.

number of elderly residents in need of support orThus, this study investigated the relationshipcare who were covered by each facility. In the city’

between the distance from facilities and thes northwestern part, the covered numbers were

geographic distribution of local elderly residents. We

less than that in the southern area. Furthermore, on

found that around half the individuals who were 65－ 83 －

社会医学研究．第 26 巻 2 号．Bulletin of Social Medicine, Vol.26(2) 2009

years old and above resided within 1,000 m of thefor users. This information would be beneficial tonearest facility. Visual clarification also illustrated thepeople responsible for operating the facilities. Despite

existence of users who reside in the area outside thethe above-mentioned limitations, the use of the(i.e., farther than) 2,000 m distance. The estimatedmethodology employed in this study can serve as apopulation of elderly persons calculated frommajor reference for policy makers while planning andgrid square statistics values using area weighting

evaluating regional welfare policies and activities forinterpolation was 43,131 persons; however, thethe elderly population. In addition, this methodology

actual elderly population was 40,404 persons. Areal

could also be used by facility operators in designingweighting interpolation is a method used to estimate

strategies to ensure that their services are used.

a population of an area based on population data suchas census data. This error was assumed to havebeen due to the characteristics of this method

26).

Acknowledgments
This study was supported by Pfizer Health Research

Although this study clarified the number of elderly
persons residing at relative distances from a facility,

Foundation and the Waseda University Grant forSpecial Research Projects.

some individuals may not be able to use the nearest
facility for a variety of reasons. Moreover, previous

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