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European Journal of Applied Sciences – Vol. 11, No. 3
Publication Date: June 25, 2023
DOI:10.14738/aivp.113.14664. Hashimoto, T., Mimura, K., & Kawabata, T. (2023). Effects of the Continuity of Daily Life Record Chart and of Voluntary Training in
Elderly People with Mild Care. European Journal of Applied Sciences, Vol - 11(3). 85-97.
Services for Science and Education – United Kingdom
Effects of the Continuity of Daily Life Record Chart and of
Voluntary Training in Elderly People with Mild Care
Takayuki Hashimoto
Kinki Rehabilitation School Department of Physical
Therapy 3-3-2, mishima, Settsu City, Osaka, 566-0022, Japan
Kanichi Mimura
Jikei Medical Science University, 1-2-8 Miyahara
Yodogawa-ku Osaka city, Osaka, 532-0003, Japan
Takashi Kawabata
Kansai University Graduate School of Human Health,
1-11-1, kaorigaoka, sakai City, Osaka, 599-0011, Japan
ABSTRACT
21 elderly people receiving light nursing care were asked to fill in daily life record
charts and to do voluntary training for three months. They were then divided into
two groups, in order to assess the effects of the above activities: the “completion”
group, who were able to continue the program during the 3-month period, and the
“resignation” group, who resigned from the program without finishing the 3-month
period. Comparing the two groups of participants, we found that the resignation
group showed a significantly lower figures in the duration of home-visit
rehabilitation, daily life record chart, voluntary training, HDS-R, and frequency of
going out (p<0.05). As for the changes after the intervention, the completion group
showed an increase in ROM, MMT, and FIM (p<0.05). The resignation group showed
a significant increase only in FIM, but no significant difference in ROM or MMT. As
for the achievement of daily life record chart and of voluntary training, the daily life
record chart proved to be easier for the participants to work on. It was revealed that
those who have been using the in-home rehabilitation service for a long time are
more likely to establish the daily life record chart log and voluntary training. These
findings suggest that the continuation of daily life record charts and of voluntary
training are effective in improving physical functions and in acquiring exercise
habits.
Keywords: light care receivers, nursing care prevention, voluntary training, life record
chart, physical therapy evaluation
INTRODUCTION
In 2021, Japan ranked first in the world with an average life expectancy of 84.5 years for men
and women, and an aging rate of 28.9%, ushering in “the Age of 100 Years as a Normal Lifespan”
[4]. The increase in the elderly population is expected to peak in 2042, after which it will begin
to decline, but the aging rate is expected to increase until 2042 due to the simultaneous decline
in the total population [4]. In recent years, in terms of trends in the elderly population, attention
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European Journal of Applied Sciences (EJAS) Vol. 11, Issue 3, June-2023
has been focused on “healthy life expectancy,” or the period of time during which the elderly
are free from restrictions in their daily lives. The differences between the increase in healthy
life expectancy and the increase in average life expectancy in the last 10 years (0.4 years for
men and 0.61 years for women) shows that healthy life expectancy is becoming longer [12]. It
is important to try to increase healthy life expectancy in the future. The certification system of
long-term care insurance, which is a social security system, is the best way to grasp healthy life
expectancy in stages. As of January 2021, of the 6.79 million people certified as requiring long- term care, 4.47 million were in need of light care (Level 1 and 2 requiring Support) and 2.32
million were in need of heavy care (Level 3 to 5 requiring Care) with limited mobility [14].
Heavy care receivers accounted for 63.8% of the total nursing care benefit costs in 2021 [13].
From the aspect of social security, it is important to have a system that does not allow care
receivers to become severely ill. According to Airi Amemiya et al [1], 19.5% of the total number
of 4149 participants in the Japan Gerontological Evaluation Study showed improvement of one
or more levels of care receiving. Conversely, it suggests that 80% of the elderly who once
entered a nursing care state may have difficulty in improving their care level and may become
severely ill. In recent years, as the trend of preventive medicine for the elderly has been
increasing, we believe that ingenuity is needed, especially in reviewing lifestyle habits and
acquiring exercise habits.
Although a questionnaire report on the retention of voluntary training by Takahashi et al [21].
using an implementation record sheet and staff encouragement for two years and a report using
group exercises for light care receivers in order to acquire exercise habits have been published,
individualized and semi-supervised field experiments have not been known. Establishing an
exercise habit in a state where the patient is able to control his or her own body and mind as
much as possible will prevent the severity of care receiving. This study examined changes in
the physical functions of elderly subjects, who are still light care receivers, by keeping a daily
life record for three months and continuing habitual voluntary training, using physical therapy
evaluation methods: range of motions testing (ROM), manual muscle strength testing (MMT)
and functional independence measure (FIM).
SUBJECTS AND RESEARCH METHODS
Participants
The participants in the analysis were 21 elderly people (18 women and 3 men) receiving light
care, certified by nursing care insurance as Requiring Support Level 1 to Requiring Nursing
Level 2, and who were using home-visit rehabilitation at elderly care facilities or at home. For
the record, this study was conducted after explaining the purpose and main objective of the
study to all the subjects and obtaining their consent to participate in the study. The application
for review of the research plan for human subjects of Osaka Seikei University was approved
(Approval No. Dai 2020-26).
Methods
Classification of Participants:
The participants were classified into two groups, with those who recorded higher than the
group median, in the total number of days when they executed daily record chart log and
voluntary training, as the completion group, while those recording the group median or lower
as the resignation group. The basic attributes of each group (age, sex ratio: showing female ratio,
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87
Hashimoto, T., Mimura, K., & Kawabata, T. (2023). Effects of the Continuity of Daily Life Record Chart and of Voluntary Training in Elderly People
with Mild Care. European Journal of Applied Sciences, Vol - 11(3). 85-97.
URL: http://dx.doi.org/10.14738/aivp.113.14664.
height, weight, BMI, level of care needed, living with family or not) were to be indicated (Table
1). The levels of care needed were indicated with scores of 1 to 4, with the score 1 as Requiring
Support Level 1; the score 2 as Requiring Support Level 2, the score 3 as Requiring Nursing
Level 1, and the score 4 as Requiring Nursing Level 2 as 4. Also, the scores of 0 to 3 were given
to different modes of living, with the score 0 to those in facilities, the score 1 to those living
alone, the score 2 to those living with the spouse, and the score 3 to those living with their
family. Thereby, the mean values and standard deviations were to be calculated.
Table 1. Subject's basic attributes, performance group and completion group
Life Record Chart and Voluntary Training:
As for the daily life record chart, the participants themselves were to fill out a form every day
with their blood pressure, body temperature, content of their meals, whether they executed
voluntary training or not, and whether they went out or not. After every 14 days, a new form was
handed out, as the completed form was collected. The number of days of achievement out of a
maximum of 84 days was calculated (Figure 1). For voluntary training, we suggested a menu of
safe exercises that can be done while sitting, in order to minimize the risk of injuries or falls. For
voluntary training, five items of lower limb and inner muscle strength training related to walking
were adopted, namely:
(1) Knee Raise, 2 sets of 20 repetitions;
(2) Leg Extension, 2 sets of 10 repetitions for 5 seconds;
(3) Toe and Heel Lift, 2 sets of 20 repetitions each;
(4) Buttock Lift, 2 sets of 10 repetitions;
(5) Standing Leg Lift, 2 sets of 10 repetitions.
The training was to be practiced every day for three months. After the training of the day, the
participants were to enter the activities into the life record chart. Only if the sheet was filled in
by the participants themselves, was the voluntary training deemed valid. In addition, the
relationship between the achievement levels of daily life record chart log as well as of voluntary
training and the length of the rehabilitation visit was verified.