What Nurses Can Do in a Rapidly Aging Society? Nursing Care and Research Issues
Authors: Makimoto Kiyoko 
Published: March 2003

The number of aged people in Japan is increasing at the fastest rate in history. This growing proportion of elderly people has numerous implications for nursing care, nursing education, and nursing management. This paper presents some of the health problems of the elderly and related nursing research issues.

Health problems of the elderly and nursing's role : Westernization of lifestyle has led to changes in the morbidity and mortality patterns of the Japanese. Malignant neoplasm has become the number one cause of death in the 35–84‐year‐olds in Japan. Even though more than 280 000 Japanese die from cancer yearly, only 37 nurses in Japan are certified for pain control management. Nursing educators and nursing researchers need to address the current health status of the Japanese and to plan for future health‐care needs.

Health care for the elderly: the burden of care:  In response to the increasing number of demented and/or bed‐bound elders, nursing research has begun to focus on the burden of caring for patients. Assessing one's care burden seems to be the main focus of such research. Nurse researchers need to shift their attention from assessment to intervention in order to relieve one's burden of care. Other research issues include clinical judgment, outcomes, and health promotion.

Clinical judgment versus evidence‐based nursing:  In recent years, evidence‐based nursing has become popular. Clinical judgment needs to integrate the evidence that nurses have accrued. Expert nurses sometimes perform much better than assessment scales do. The following example demonstrates the importance of investigating nurses’ clinical judgment to improve nursing care. A prospective study of falls showed that the nurses’ clinical judgment was better than the assessment scale of falls for the institutionalized elderly. Expert nurses from 10 facilities evaluated 746 elders on admission and then followed them for 3 months. The incidence of falls was six times higher for elders identified as at high risk for falling than those identified as having a low risk of falling. It is believed that investigation of nurses’ clinical judgment will lead to nursing research regarding how to improve nursing care.

Outcome research:  In the USA the spiraling cost of health care has pushed the federal government to change the insurance payment system from a fee‐for‐service system to a prospective payment system. American nursing researchers have begun to examine nursing care outcomes because the cost of nursing care was not integrated into the prospective payment system. Japan is going through a similar phase in terms of health insurance reform, although the rate of change and the direction of change may differ. Outcome research will become an essential part of nursing research, in the near future, in Japan, as well as in other Asian countries.

Importance of health promotion and injury prevention:  Nurses who provide direct care to patients may not be familiar with health promotion and injury prevention for the elderly. Promoting a healthy lifestyle from early childhood appears to be the best strategy for successful aging. However, health promotion for the elderly is necessary and can be successful regardless of when it is started. Basic exercise has been shown to be effective in maintaining and improving muscle strength even among the oldest elderly.

In summary, nursing research has an opportunity to improve the health status of the elderly. However, in Japan, long‐term strategic goals for nursing research are not well laid out. Nurses have the responsibility of preparing for the aging society in the 21st century.