アキタケン ニオケル タンキ ニュウショ セイカツ カイゴ ショートステイ ノ シセツ トクセイ ノ ジッタイ ト チョウキ リヨウ ニ カンレン シタ ヨウイン

介護保険制度の短期宿泊サービスであるショートステイは施設形態、運営する法人が多様である。また30日を超えてショートステイを利用する長期利用者が存在する。本研究の目的は、ショートステイの施設特性の実態と長期利用率「長期利用者数/(長期利用者数+短期利用者数)」に関連する要因を明らかにし、今後地域包括ケアシステムの中で担うべき機能について探ることである。秋田県内全域の280事業所のショートステイ管理者を対象とした質問紙調査を行い、108事業所より回答を得た。施設形態は単独型で小規模であり営利法人の運営が多かった。平均の「長期利用率」は単独型、営利法人で割合が高かった。サービス提供状況では職員配置が充実しているショートステイでは、サービスの質の向上に関わる加算が算定される傾向があった。また、全体の傾向として常時医療職の関与が必要な医療ニーズの高い利用者を断っており、個別の機能訓練を実施している割合は低かった。秋田県は高齢化でショートステイの利用需要が高まり、営利法人が単独型ショートステイの運営へ参画している。今後医療機関から在宅へ戻る際に重要な役割を果たすショートステイは機能訓練や医療ニーズへの対応が機能として求められる。しかし単独型ショートステイでは経営面からサービスの質向上よりも利用者確保が優先されやすい。単独型ショートステイでも経営が安定するような介護報酬請求の仕組みが必要である。A short-stay, a short-term stay service of the nursing-care insurance system, is characterized by diverse facility forms and the managing corporate bodies. In addition, there are long-term facility users who remain consecutively in a short-stay service for 30 days or longer. The objective of this study was to clarify the relationship between the realities of short-stay facility characteristics and the long-term usage rate (the number of long-term facility users)/ (the number of long-term facility users + the number of short-term facility users) and to explore the functions that such facilities should bear in the future as part of a regional comprehensive care system. A questionnaire was conducted with the managers of 280 short-stay operations within Akita prefecture, with 108 of these operations responding. The most common facility format was a single-operation type, small in size, and run by a for-profit corporation. The average long-term usage rate was higher in the single-operation type, for-profit corporations. Regarding the state of service provision, short stay operations with sufficient personnel allocation, showed a tendency for an additional charge connected with an improvement in service quality to be included. Furthermore, as an overall trend, facilities rejected facility users with high medical needs that constantly required involvement of health care professionals. Furthermore, the percentage of facilities that conduct functional training for individuals was low. The demand for short-stay services has increased in Akita prefecture due to the aging of the population. Thus, profit-making corporations are participating in the management of single-operation type shortstay facilities. In the future, short-stay facilities will be required to provide functions such as provision of functional training for those who can address medical needs since such facilities play an important role for elderly patients when returning to their respective homes after being discharged from medical facilities. However, single-operation short stay facilities tend to prioritize the securing of facility users rather than improving the overall service quality due to managerial reasons. A claim system for nursing-care benefits that will help stabilize management even for singleoperation type short-stay facilities is required

An Analysis of Factors Associated with Personal and Perceived Stigma Against Talking About Suicide in a Rural Japanese Community

A cross-sectional study was conducted to clarify what factors were associated with personal and perceived stigma against talking about suicide, considered as prejudicial attitudes, prior to a community-based intervention for suicide prevention. Among 1,442 residents aged 20 years and over who lived in a rural town in northern Japan and returned questionnaire forms containing complete information, 852 answered that they avoided talking about suicide (i.e., personal stigma) and 897 answered that they thought that people avoided talking about suicide (i.e., perceived stigma). The personal and perceived stigma was observed more frequently in females and those aged 40 years and over. The perceived stigma was significantly associated with both bereavement experiences from suicide of a family member and of a friend, belief that suicide is preventable (i.e., preventability), and suicidal ideation within one month. The personal stigma was significantly associated with bereavement experience from suicide of a friend and preventability. This is the first report to demonstrate stigma against talking about suicide at the community level. In addition, these data suggest that persons with perceived stigma against talking about suicide have stronger suicidal ideation than those with the personal stigma. A community-based education is needed to reduce such prejudicial attitudes toward suicide

Sociodemographic and environmental characteristics associated with thoughts of death and suicidal ideation in community-dwelling residents of a rural town in Japan: analyses from a perspective of accompanying problems

Abstract Objective Suicide prevention has been focused on primary prevention as a group rather than individuals. However, we aimed to identify sociodemographic and environmental characteristics of individuals with suicidal thoughts among rural residents in Japan. Methods In 2015, a cross-sectional home visit survey was conducted in a rural town in Akita Prefecture. A total of 1,844 residents aged ≥ 20 years (response rate, 65%) answered a self-administered questionnaire about suicidal thoughts in the past one month. Multivariate logistic regression analyses were used to investigate sociodemographic and environmental characteristics associated with suicidal thoughts in models with accompanying problems for human relations problems (HRP), health problems (HP), and financial problems (FP), or with no accompanying problems. Results In total, 218 (men 9.4%, women 13.8%) had suicidal thoughts with accompanying problems for HRP (n = 104), HP (n = 112), and FP (n = 72). The risk characteristics were Kessler Psychological Distress Scale scores ≥ 9 in models with HRP, HP, and FP or with no accompanying problems; being a woman and current smoking with no accompanying problems; absence of a person for help in a model of FP; and absence of family member for help in a model of HRP or with no accompanying problems. The mitigating factor were being optimistic (a domain of resilience skills identified by factor analysis) in models of HRP, HP, and FP or with no accompanying problems; being aged 70–79 and being aged ≥ 80 in a model of HRP. Conclusions Suicidal thoughts among rural residents in Japan were associated with multifactorial sociodemographic and environmental characteristics

Study into Perceptions of Suicide in Areas of High Suicide Rate

本研究は自殺率が高い地域の住民が,1)身近な人を自殺で喪うという体験をどれだけ持っているか,2)自殺に対してどのような意識を持っているか,3)自殺予防に何が必要だと考えているかを明らかにすることを目的として行った.対象は秋田県A町の40歳以上の住民を対象に無作為に抽出された438名で,281名を分析の対象とした.結果として1)住民の38.4%が自殺による死別体験を持っていた.2)自殺に対する意識としては「悲しいこと」という感情反応が最も多かった.意識については年齢段階や自殺による死別体験の有無によって傾向に違いがあった.3)予防については「家族関係」と「経済的支援」が多かった.以上の結果から,今後の自殺予防対策では,「悲しい」という感情に配慮し,家族関係や経済的困難に対してより具体的な支援をすることが望まれる.The purpose of this study into people living in areas of high suicide rate was to clarify how many people had experienced the loss of a person close to them by suicide, what perceptions they have of suicide, and what they consider necessary to prevent suicide. A questionnaire was distributed to a random sample of 438 residents of a rural town in northern Akita aged 40 years or over. A total of 281 replies were received. The results showed that 38.4% of people had lost a person close to them through suicide. The most prevalent emotional reaction was sadness. Perception differed depending on age and whether or not the person had experienced bereavement. The most frequent answers concerning prevention of suicide were family relations and economic support. From these results, it is desirable to take these feelings of sadness into consideration and to offer more concrete support for family or economic difficulties

Relationship between Social capital and Mental health : A community-based study

本研究の目的は, 地域住民のソーシャル・キャピタルと精神的健康の実態を明らかにし, その関連を検証することである. 特に, ソーシャル・キャピタルが精神的健康のネガティブな側面だけでなく, ポジティブな側面についても関連していることを明らかにする.調査は秋田県N 市T 地区の20歳以上の全住民880人を対象に行い, 対象地域の人口に対する有効回答率は69.1％であった. 男性が43.6％, 60歳以上が60.3％, 一人暮らしが5.6％であった.結果として, ソーシャル・キャピタルについては, 社会的サポートが得られている人が88.8％, 互酬性を肯定的に感じている人が26.3％～53.8％であったが, 信頼は24.7％であった. 精神的健康について, K6が15点以上が18.6％,1ヶ月以内に希死念慮を持った者が2.3％であった. 精神的健康を従属変数, 属性とソーシャル・キャピタルを独立変数としたロジスティック回帰分析を行った結果, 精神的健康のネガティブな側面(K6が15点以上､一ヶ月以内の希死念慮) には, ｢年代(80歳以上)｣｢社会的サポートの不足｣｢信頼の欠如｣が影響していた. ポジティブな側面(精神的健康満足, 友人満足, これからの人生の希望) には, ｢社会的サポートがあること｣｢信頼があること｣｢互酬性(地域の優しさ, 地域の愛着) の認識｣が影響していた.The state of social capital and mental health of community residents were investigated and the relationship between the two, especially, the effects of social capital on negative and positive aspects of mental health was examined. A questionnaire survey was conducted with all inhabitants over 20 years of age living in a community in the T area of N city in Akita Prefecture (N＝880). The percentage of valid responses was 69.1％ (43.6％ male; 60.3％ were over 60 years and 5.6% were living alone). The results on social capital indicated that 88.8％ of the participants received social support, 26.3％～53.8％ of the participants felt positive reciprocity. On the other hand, the percentage of “trust” was 24.7％. Regarding mental health, 18.6％ marked over K6 15 points, and 2.3％ had suicidal ideation within the last month. Regression analysis was conducted with mental health as the dependent variable, and attributes and social capital as independent variables. The results indicated that the negative aspects of mental health (over K6 15 points and suicidal ideation within a month) were affected by age (over 80 years old), insufficient social support, and a lack of trust. On the other hand, the positive aspects of mental health (satisfaction with mental health, satisfaction with friends, and expectations for future life) were affected by having social support, having trust, and reciprocity (kindness and attachment to the community)