Part_1_-_hypothetical_cases_eng.docx

ILC-Japan Hypothetical Cases 2017 As a research project commissioned by Japanese Ministry of Health, Labour and Welfare, we are conducting a study to compare long-term care schemes and support for older people in Japan and in other countries. In this study, we are exploring ways to promote empowerment of older people rather than comparing the number or volume of services. We would appreciate if you could read the 4 hypothetical cases regarding older people in the following pages then answer the following 3 questions regarding each case. We understand that systems are quite different from one country to another, which may make it difficult for you to answer some of the questions. Yet, we will appreciate your response, to the extent possible, regarding what kind of support each of these people, described in the hypothetical cases, might experience based on your own experience. Since this study is on long-term care schemes, you do not need to write about medical treatment by doctors for cure. However, please include the information on the following: rehabilitation services, training services for older people who are at risk of becoming or already being frail, services by local volunteers, activities by older people themselves to build networks, and advice provided to older people. As for the Cases 2, 3 and 4, we would appreciate if you could also provide information on whether and how the consultation process and/or services might differ if the older person had dementia. Please also indicate in your response if you would like your name or organization cited the final report, or if you prefer to remain anonymous. 1. Consultation (1) Where would this person go first for consultation? (2) After the initial consultation, what would the process look like until he/she starts receiving services (or what would the process look like until it is determined that he/she would not receive services)? 2. Service delivery (1) What kind of formal services and informal support do you think this person would be able to receive? (excluding medical services by hospitals, family doctors, etc.) (2) When this person receives services/support, who/what organization would conduct his/her needs assessment, and who/what organization would decide on the content of services/support?

3．Monitoring (1) Who would conduct this person’s monitoring and how?

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1．(Case 1) Becoming frail Case 1 (Support Level in Japan) Mrs. A is 80 years old. She has no child, and her husband passed away 5 years ago. She has no sign of dementia. Her economic status is about the average in the community. She visited a cardiologist 5 years ago because of dizziness; she was diagnosed with hypertension. She has been taking medication since then but sometimes forgets to do so. Three years ago, she visited an orthopedist because of foot numbness; she was diagnosed with spinal stenosis. The doctor told her that surgery could be done, but she declined because she was scared. Recently, she tends to stay at home, withdrawn from social life. While she can generally take care of herself, while slowly, it is becoming more and more difficult to cook and clean the house. She is not currently using any service, but she started making comments to other people like, “I used to do so many things. But now, gradually, I can’t do them anymore.” She keeps going to her chorus club (her hobby) once a month.

Independent

Partially dependent

Decline of muscle strength Health

ADL

IADL

Nutritional status

Partially yes

Oral health, swallowing Rolling over

Yes

Getting up

Yes

Transferring

Yes

Walking

Yes

Eating

Yes

Bathing

Yes

Toileting

Yes

Cooking

Partially yes

Cleaning

Partially yes

Doing laundry

Yes

Moving around

Yes

Going out

Yes

Using a phone

Yes

Managing money

Yes

Managing medication

Yes

Communication Family’s capacity to care Social interaction

Can communicate Yes Live with/near/far from None the person She participates in a club activity. Some interaction.

Economic status

Average

Medical conditions

Spinal stenosis and hypertension

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Dependent

Note Slightly declining (pre-frail). (e.g., she sometimes falls and gets caught in a carpet.) May be at risk in the future. Tries to eat healthy, but some nutrients are insufficient.

Can clean shelves but cannot wipe floors

2．(Case 2) Becoming more difficult to go out Case 2 (Care Level 1 in Japan) Mr. B, aged 75, lives by himself at home; his wife passed away 2 years ago. The right side of his body is paralyzed due to a stroke he had 1.5 years ago. He manages to go out with a cane. He needs some help in bathing, such as taking off/putting on clothes and washing hair. He used to enjoy exercising with friends at a park in the neighborhood, but he doesn’t go there anymore. The oldest son lives in another prefecture, who visits Mr. B about once every 2 months. Mr. B’s economic status is about the average in the community. Independent

Health

Decline of muscle strength Nutritional status Oral health, swallowing Rolling over Getting up Transferring Walking

Partially dependent

Dependent

Declining strength Tries to eat healthy, but some nutrients are insufficient. No problem so far, but he sometimes chokes when not being careful. Yes Yes Yes

Can perform if he holds something for support

Partially yes

ADL Eating

Yes

Bathing

Yes

Toileting

Yes

Cooking

Yes

Partially yes

Cleaning

Yes

Partially yes

Doing laundry

Yes

Partially yes

IADL

Communication Dementia Capacity to care Social interaction Economic status Medical conditions

Note

Moving around

Yes

Going out

Yes

Using a phone Yes Managing Yes money Managing Yes medication Can Yes communicate No. Mild to moderate dementia in an alternative scenario. Live with/near/far from the None person Little Average Paralysis due to a stroke. He goes to the doctor.

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Can go out w/ a cane. May need someone to accompany him depending on where he goes. No problem so far, but he sometimes chokes when not being careful. Can be independent w/ home renovation or assistive devices Can be solved w/ home renovation Complex cooking is difficult. Can use a microwave and do simple cooking (e.g., heating, grilling) Complex movement is difficult. Difficult to bend over (losing balance) but can do simple cleaning Complex movement is difficult. Uses a tool to hang washed clothes. Can only do simple tasks Can go out w/ a cane. May need someone to accompany him depending on where he goes Cannot use public transportation to go out. Can ride a car but cannot drive

3. (Case 3) Becoming more difficult to live alone Case 3 (Care Level 2 in Japan) Mrs. C., aged 88, lives by herself at home; her husband passed away 3 year ago. Since she was diagnosed with gonarthrosis 2 years ago, she has visited her doctor to treat symptoms. However, her pain has gradually gotten worse. Now, she can do little housekeeping, and her daughter, who lives close by, has provided support. Yet, the burden on the daughter is growing. Mrs. C also has diabetes, but she takes medicines to control the condition. While she hopes to keep living at home, she now needs a lot of help in daily living. The oldest daughter lives in a neighboring town, but she works outside and visits Mrs. C about once a week.

Independent

Health

Rolling over Getting up Transferring Walking Eating

No problem Tends to choke due to loss of teeth and decline of the swallowing reflex

Lost some teeth, cannot chew well Yes Yes Yes Yes

Yes Partially yes

Bathing

Yes

Needs assistance when transferring to a toilet Yes

Cooking

Communication Dementia Family’s capacity to care Social interaction Economic status Medical conditions

Cleaning Doing laundry Moving around

Yes Yes Yes

Going out

Yes

Using a phone Yes Managing money Yes Managing medication Yes Can communicate Yes No. Mild to moderate dementia in an alternative scenario. Live with/near/far from the person

Note Declining strength

Toileting

IADL

Dependent

Decline of muscle strength Nutritional status Oral health, swallowing

ADL

Partially dependent

Some Less interaction due to difficulty in going out Average Gonarthrosis, diabetes

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Muscle strength started declining. Unsteady due to knee pain. Partially assisted while also using assistive devices (shower chair, etc.) Muscle strength started declining. Unsteady due to knee pain. Needs monitoring and some assistance when transferring Difficult to move her body. Can do simple tasks while sitting (wiping a table, simple cooking, etc.) Difficult to go out. Cannot use a mobility scooter

4. (Case 4) Being somewhat difficult to live at home Case 4 (Care Level 3 in Japan) Mrs. D, aged 80, currently lives with her husband, who devotes himself to all the housework and care. She was diagnosed with diabetes 15 years ago, and her condition has gradually worsened. Currently, she has chronic renal failure (she needs dialysis 3 times a week), diabetic nephropathy, hypertension and other conditions. In addition to her old age, osteoarthrosis in both knees, lumbar spondylosis and osteoporosis are also becoming a burden. She falls more frequently even at home, and she does not go out as much as she used to. The oldest son lives separately but visits them once a month. Independent

Partially dependent

Dependent

Declining strength. Sometimes loses strengths suddenly (unconsciously) Declining. Tends to get dehydrated

Decline of muscle strength Health?

Nutritional status Oral health, swallowing Rolling over Getting up Transferring

ADL

IADL

Dementia Capacity to care Social interaction Economic status Medical conditions

Yes Yes Yes

Cannot swallow due to paralysis

Partially yes Yes

Partially yes

Yes Yes Partially yes Yes Yes Yes Yes Partially yes

Going out Using a phone Managing money Managing medication

Communication

Yes

Walking Eating Bathing Toileting Cooking Cleaning Doing laundry Moving around

Note

Yes

Cannot keep standing. Difficult to walk without support Can sit Cannot step over the bathtub Needs assistance in toileting

Can sit on a wheelchair by herself if the seat moves

Yes Yes Yes

Somewhat difficult No. Mild to moderate dementia in an alternative scenario. Can communicate

Some Only when her family members take her out. Average She has a lot of pressure sores and edema (because she always sits). Her heart is also weakening (because she doesn’t move much). Her diabetes is also difficult to manage (visiting nurses are needed).

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