アジア太平洋越境ケア人材養成連携 - 特定非営利活動法人 アジアン

国際交流基金助成事業
アジア太平洋越境ケア人材養成連携
Partnership for Training of Transnational Care Worker
and Nurses in Asia/Pacific
平成 24 年度事業報告書
特定非営利活動法人アジアン・エイジング・ビジネスセンター
Specified Non-Profit Organization Asian Aging Business Center
目
次
はじめに ................................................................................. 1
北九州アジア太平洋アクティブ・エイジング会議 2012 ......................................... 6
開催概要 ................................................................................. 7
プログラム ............................................................................... 8
大会宣言: 「高齢化は負担でなく努力の花園である」......................................... 10
基調講演：「アクティブ・エイジングの新しい側面」.......................................... 18
北九州レポート：北九州市の高齢社会対策 .................................................. 25
シンポジウム 1
テーマ：国際的介護人材教育の枠組み ...................................................... 32
「シンガポールの「多くの支援の手」アプローチ：訓練にとっての意味」
テルマ・カイ（元 UNESCAP 社会開発省ディレクター/
シンガポール自治開発省上級顧問............................................ 33
「ハワイにおける介護初級者のためのトレーニングプログラム：論点と改変の方向」
カレン・ハヤシダ（カピオラニ・コミュニティ・カレッジ/
クプナ
エデュケーションセンター） ................................... 38
「アジア太平洋介護認証システムの構想」
小川 全夫（NPO 法人アジアン・エイジング・ビジネスセンター理事長
熊本学園大学教授） ........................................................ 44
シンポジウム 2
テーマ：自立・参加・健康の支援工学 ...................................................... 49
「韓国における高齢者のためのデジタルライフの基盤づくり」
韓
東希（高齢者生活科学研究所/アンチエイジング技術開発研究センター） .................. 50
「インドネシアの高齢者のアクティブ・エイジングと障がいの程度」
トリブディ・ラハルジョ、ヴィタ・プリアンティナデヴィ、アスヴィレッティ・ヤーリー
（インドネシア大学高齢化研究所） ...................................................... 56
「高齢化と気候変化のための包括デザイン」
平井
康之（九州大学芸術工学部、准教授）............................................... 62
「アクティブ・エイジング社会における持続可能な交通システムとは」
― 日本における公共交通の事例から ―
大井 尚司（大分大学経済学部経営システム学科准教授/地域と交通をサポートする
ネットワーク in Kyushu（Ｑサポネット）世話人
代表） ....................... 71
ワークショップ .......................................................................... 76
ワークショップ１
パ ー ト 1：「質の高い介護労働力の確保に向けて：日本における外国人看護師・介護士の受
け入れから学んだこと」
議
長：小川 全夫(熊本学園大学教授)
パ ネ リ ス ト：大野俊（清泉女子大学教授）、安里和晃（京都大学准教授）、
平野裕子（長崎大学教授）、坪田邦夫（明治大学教授）、
小川玲子（九州大学准教授） .................................................... 77
パ ー ト 2：「アジア太平洋地域の介護の国際研修センターの枠組み」
議
長：キャサリン・ブラウン博士(ハワイ大学教授)
パ ネ リ ス ト：キャサリン・ブラウン博士、テルマ・カイ博士、カレン・ハヤシダ博士、
小川
全夫博士、ドンヒー・ハン博士、トリブディ・ラハルジョ博士
すべての代表団 ................................................................ 96
パ ー ト 3:「アクティブ・エイジング促進のための新しい課題：2013 年の次のステップ」
議
長：ドンヒー・ハン博士（高齢者生活科学研究所）
すべての参加者 ............................................................... 107
Poster Session ........................................................................................................................................................ 111
Session 1: Do Physical Functioning and Health Related Quality of Life differ according to the Living Environment
in Japanese Older Women? ................................................................................................................. 112
Session 2: Association of Subjective State of Health with Physical Performance and Quality of Life in Older
Women ................................................................................................................................................ 114
Session 3: MOVE WITH CARE ............................................................................................................................ 116
Session 4: Friendly Primary Health Care (PHC) Maintain Quality of Health Ageing Population in
Indonesia ........................................................................................................................................... 117
Session 5:“Posyandu Lansia Program” As The New Ways To Maintain Quality of Healthy Ageing People In
Indonesia ........................................................................................................................................... 119
Session 6: Utilization of Soursop Leaves (Annona Muricata) for Cancer Prevention and Healing ....................... 121
Session 7: General psychological survey of Indonesian elderly in Depok ............................................................. 123
Session 8: HEALTHY AGEING NEEDS AMONG ELDERLY MONGOLIANS................................................. 129
Session 9: Multiculturalism as an Asset in Senior Care
A case study in a Swiss nursing home
Summer 2012 .................................................................... 131
Session 10: Community Organization for Elderly People with Dementia Symptoms ........................................... 133
Session 11: Trends of Life Support Technology and Science in Aging .................................................................. 135
Session 12: Quality of life and related factors among young-old and old-old in Korea ......................................... 136
Session 13: The Effects of Health Programs for the elderly's health life................................................................ 137
Session 14: The Determinants of the Retirement Acceptance among the Retired elderly ...................................... 138
Session 15: Program for Dementia Prevention and Healthy Brain ......................................................................... 140
Session 16: A Case Study on Informatization Education of Senior Welfare Center ............................................... 141
Session 17: A Study on Senior Welfare Center Worker’s Burnout As Emotional Laborers ................................... 143
Session 18: Job satisfaction and turnover among foreign caregiver working in Japan
(A Case study of Indonesian caregiver candidates) ........................................................................ 145
Session 19: Indicators of Age Friendly City for Planning and Policy Formulation:
an Exploratory Analysis .................................................................................................................. 147
スタディツアー .................................................................................................................................................... 148
Contents
Introduction ................................................................................................................................................................ 1
Kitakyushu Active Aging Conference in Asia-Pacific 2012 ....................................................................................... 6
Outline ........................................................................................................................................................................ 7
Programs ..................................................................................................................................................................... 8
Opening Remark: “Aging is not a burden, but a garden of our efforts” ................................................................... 10
Keynote Speech: “New Face of Active Aging” ........................................................................................................ 18
Kitakyushu Report: Aged Society Countermeasures in Kitakyushu City (Japanese) ............................................... 25
SYMPOSIUM 1
Theme: Framework of International Training of Asia-Pacific Long-Term Care Certificate .................................... 32
“Singapore’s “Many Helping Hands” Approach: Implications for Training”
Thelma Kay（Former Director, Social Development Division, UNESCAP,
Senior Advisor, Ministry of Community Development Youth and Sports, Singapore
........................................................................................................................................................ 33
“Training Programs for Entry Level Long-term Care Workers in Hawaii: Issues and Directions for Change”
Cullen T. Hayashida, Ph.D.（Kapiolani Community College/Kupuna Education Center） ............................... 38
“Perspectives for the Asia-Pacific Long-term Care Certificate Systerm”
Takeo Ogawa, Ph.D（President of Asian Aging Business Center,
Kumamoto Gakuen University） ............................................................................................... 44
SYMPOSIUM 2
Theme: Techno-Aide for Older Persons on Independence, Participation, and Health.............................................. 49
“Making Platform for Digital Life for Old Person in Korea”
Donghee Han Ph.D（Research Institute Science for the Better Living of the Elderly/ Research Center for
Anti-aging Technology and Development） .................................................................. 50
“Active Aging and the Level of Disability among Older Persons in Indonesia”
Tri Budi W. Rahardjo , Vita Priantinadewi and Asviretty Yerly（Center for Ageing Studies University of
Indonesia）............................................................................................................................................................... 56
“Inclusive design for ageing and climate change”
Yasuyuki Hirai（Associate Professor,Faculty of Design, Kyushu University） ................................................. 62
“How will we manage the sustainable transport system for active aging society?”
― the case in Japanese Public Transport Systems―
Hisashi OOI, Ph.D.（Associate Professor, Faculty of Economics OITA University
Head Facilitator of Community and Transport Support Network in
Kyushu (“Q-suppo Net”)） .............................................................................................. 71
WORKSHOP ............................................................................................................................................................ 76
Workshop 1:
P a r t
1: “Towards the Development of Quality Care Workforce: Lessons from accepting
the Foreign Nurses and Caregivers to Japan and beyond”
C h a i r: Prof. Takeo Ogawa (Kumamoto Gakuen University)
P a n e l i s t s: Prof. Shun Ohno (Seisen University),Assoc. Prof. Wako Asato (Kyoto University)
Prof. Yuko Hirano (Nagasaki University),Prof. Kunio Tsubota (Meiji University)
and
P a r t
Assoc. Prof. Reiko Ogawa (Kyushu University) ........................................................................ 77
2: “Framework of Center for International Training of Asia Pacific Long-term Care”
C h a i r: Dr. Kathryn Braun(University of Hawaii)
P a n e l i s t s: Dr. Kathryn L. Braun, Dr. Thelma Kay, Dr. Cullen Hayashida,
Dr. Takeo Ogawa, Dr. Donghee Han, Dr. Tri Budi W. Rahardjo
and all delegations. ............................................................................................................................... 96
P a r t
3: “New challenge for Active Aging Promotion: A Next Step in 2013”
C h a i r: Dr. Dong Hee Han（Research Institute Science of Better Living for Elderly）
All delegations .................................................................................................................................. 107
Poster Session --------------------------------------------------------------------------------------------------------------------111
Session 1: Do Physical Functioning and Health Related Quality of Life differ according to the Living Environment
in Japanese Older Women? ------------------------------------------------------------------------------------- 112
Session 2: Association of Subjective State of Health with Physical Performance and Quality of Life in Older
Women ................................................................................................................................................ 114
Session 3: MOVE WITH CARE ............................................................................................................................ 116
Session 4: Friendly Primary Health Care (PHC) Maintain Quality of Health Ageing Population in Indonesia..... 117
Session 5: “Posyandu Lansia Program” As The New Ways To Maintain Quality of Healthy Ageing People In
Indonesia ........................................................................................................................................... 119
Session 6: Utilization of Soursop Leaves (Annona Muricata) for Cancer Prevention and Healing ....................... 121
Session 7: General psychological survey of Indonesian elderly in Depok ............................................................. 123
Session 8: HEALTHY AGEING NEEDS AMONG ELDERLY MONGOLIANS................................................. 129
Session 9: Multiculturalism as an Asset in Senior Care
A case study in a Swiss nursing home Summer 2012 ......................................................................... 131
Session 10: Community Organization for Elderly People with Dementia Symptoms ........................................... 133
Session 11: Trends of Life Support Technology and Science in Aging .................................................................. 135
Session 12: Quality of life and related factors among young-old and old-old in Korea ......................................... 136
Session 13: The Effects of Health Programs for the elderly's health life................................................................ 137
Session 14: The Determinants of the Retirement Acceptance among the Retired elderly ...................................... 138
Session 15: Program for Dementia Prevention and Healthy Brain ......................................................................... 140
Session 16: A Case Study on Informatization Education of Senior Welfare Center ............................................... 141
Session 17: A Study on Senior Welfare Center Worker’s Burnout As Emotional Laborers ................................... 143
Session 18: Job satisfaction and turnover among foreign caregiver working in Japan
(A Case study of Indonesian caregiver candidates) ........................................................................ 145
Session 19: Indicators of Age Friendly City for Planning and Policy Formulation:
an Exploratory Analysis .................................................................................................................. 147
STUDY TOUR IN KITAKYUSHU ....................................................................................................................... 148
Introduction
It was a year of one turning point in 2012, when considering active aging. After the 2nd World Congress on
Ageing has been held by the United Nations in Madrid in 2002 and the Madrid declaration is adopted, it has
passed ten years. It has passed also 10 years when “Active Ageing: A Policy Framework” was released by
WHO. Every country and region in the world tackles to verify and revise the Madrid declaration until now. In
Japan, the Fundamental Principles of Aged Society Measure based on the Fundamental Law of Aged Society
Measure has been revised in September in 2012, and it has emphasized the word "preparation to a life 90-year
long."
In the field of long-term care for the elderly, nurse and care worker candidates had been accepted on the
framework of EPA from Indonesia and the Philippines, they have been agreed similarly between Vietnam.
Although some candidates from Indonesia and Philippines as forerunner groups have passed the Japanese
National Examination, successful candidates go back home also. It comes out to evaluate the policy of the
acceptance measure in a framework of EPA severely. There is no other way but for liberalization of once
begun human migration to make further liberalization based on critical evaluation.
In accordance with the world trend, Japanese Cabinet Office announced the "Global Human Capital
Training Strategy" in May 2012, in which it will start to investigate several National Examination and
Qualifications for constructing an integrated system until 2015, and the plan to institutionalize will be set forth
in 2017. The target for care workers to be able to bear medical care as the competence will be set up in 2015.
In 2012, medical care was added to the care worker's training course as its preparation. Moreover, the 1st class
and 2nd class of the home helper (common name is home helper) qualification will be abolished until the end
of the 2012 fiscal year, although they were playing a part in long-term care for the elderly in spite of the
private qualification. It will be unified into the Certified Care Worker as the national qualification after 2013.
And the Care Personnel Basic Training will be the "Working Staffs Training for the Certified Care Worker".
The 2nd class of the home helper will change to "Care Personnel In-Service Training for Beginners."
Also, Japanese Cabinet Office set forth "Classification System for Caring (National Strategies: Official
Approval of Professionals) in September 2012, in which competences of caring is classified 7 grades. And an
instruction of the assessor is started, by which the judgment for care workers will be ranked in the
classification. According to this perspective, the 2nd class of home helper certificate and successful Care
Personnel In-Service Training for Beginners are set to the level 1, and the level 3 serves as the graduate of
training course for Certified Care Worker and successful Working Staffs Training for the Certified Care
Worker, and the level 4 serves as the Certified Care Worker qualification holder. About the upper levels 5-7, it
will be left behind a future consideration.
In Britain, the reconstruction of an integrative national standard has been tackled about vocational
1
qualification and high education qualification since 1997. Therefore, Qualification and Curriculum Authority
were installed, and the first National Qualifications Framework was announced in 2002. This framework was
revised with 2004 and 2008 after that, and nine classes were set upon the standard of Qualification and Credits
Framework. In this assessment system, the unit required for qualification acquisition is specified as Award
(1-12 units = 10 to 120 hours), Certificate (13 to 36 units = 130 to 360 hours), and Diploma (37 or more units
= 370 hours or more) with the number of completion time (unit). And each grade has these qualification types.
The Bachelor of university is considered as the level six, the Master is classified as the level 7, and the Doctor
is ranked as the level 8 grades. About the competence of health and social care, it is positioned from the level
2 or the level 3, and if one who engage in in caring for dementia elderly person will be required Diploma in
the level 3. One who engages in the home care for the elderly will be required the completion of Diploma of
the Level 5.
In neither Japan nor the United States, we have not still unified such vocational qualification and high
education qualification still now, but the more the human migration progresses internationally, the more
construction of such a framework will become global concerns. In such a turning point, we are continuing
discussion about standardization of the training education for recruiting long-term care workers for the elderly,
and harmonized certification system of training for long-term care with cooperation between Japan and US
and expanding toward Asian world. In order to share the concern of ageing with Asian countries and regions
in the 2012 fiscal year, we have taken a part in the planning of the Fukuoka Asia Aged Society Design
Conference which will superintend the Fukuoka Asia Aging Forum in April 2012, and a tour has been plotted
in September in Shanghai, titled as "The International Symposium of Long-term Care for the Old Age",
sponsored by the Shanghai Social Science Academy, and The Hawaii and Pacific Gerontological Society has
held simultaneously in Honolulu in September, and discussed the harmonization of the "Asia-Pacific Care
Certificate", and symposium and workshops were carried out by Kitakyushu ACAP2013 in November based
on it. Although it led a Japanese-style in-home service for Shanghai, and it served in a business deployment,
but about a trainee's acceptance, it is regrettable to have suffered a setback according to aggravation of
Japan-China relations.
There is cooperation with many people also in the current fiscal year, and our enterprise advanced
successfully. Especially I will say many thanks sincerely to the West Japan Industrial Trade Convention
Association, Kitakyushu-city, the Kyushu District Transport Bureau, Ministry of Land, Infrastructure,
Transport and Tourism, Fukuoka-city, the Fukuoka Asian Urban Research Center, Hawaii and Pacific
Gerontological Society, the Shanghai Social Science Academy, the coworker of Qsuppo-net and a former
Kyushu University Asian Studies Center, friends/acquaintances of Asia-Pacific Active Aging Consortium, and
Ms. Shizuka and the staffs of Asian Ageing Business Center who have supported in backroom, and Ms.
Caroline Vuagniaux who has participated in our work from the Geneva University in Switzerland and helped
2
as internship. Although quite many difficulties might be waiting still more, we will be able to prospect
advanced to the following step with obtaining many cooperators and a participant.
March 31, 2013
Takeo Ogawa, Ph.D.
President, Asian Aging Business Center
3
はじめに
2012 年はアクティブ・エイジングを考える上ではひとつの節目の年であった。2002 年に国連によ
って第 2 回世界高齢化会議がマドリッドで開催され、マドリッド宣言が採択されてから 10 年が経っ
た年でもある。WHO の「アクティブ・エイジング：政策フレーム」という報告書もこれに合わせて発
表された。世界の各国各地域ではこれまでにマドリッド宣言のその後の検証と改訂に取り組み始め
ている。日本では、高齢社会対策基本法にもとづく高齢社会対策大綱が 9 月に改訂され、
「人生 90
年時代」への備えという言葉までもられるようになった。
高齢者介護の分野では、EPA の枠組みで、インドネシア、フィリピンからの看護師・介護福祉士候
補者を受け入れてきたが、さらにベトナムとの間でも同じように看護師・介護福祉士候補者を EPA
によって受け入れることが合意された。先発組のインドネシア、フィリピン組の中からは、難関の
日本の国家試験に合格者を出したが、帰国する人も出てきて、あらためて EPA という枠組みでの受
け入れ策の政策評価が厳しくなっている。しかしいったん始めた人的移動の自由化は、厳しい評価
を踏まえてさらに前進させるほかない。
国内ではそうした動きとあいまって、内閣府が「グローバル人材育成戦略」を 5 月に発表し、各
種国家試験・資格試験の検討を 2015 年に始めて、2017 年には制度化するという方針を打ち出した。
2015 年には介護福祉士もその業務として医療的ケアが担えるようにするという目標が立てられてい
る。2012 年、その準備として介護福祉士の養成課程に医療的ケアが加えられた。またこれまで民間
資格として介護人材の一翼を担っていた訪問介護員（通称ホームヘルパー）資格１級、2 級が 2012
年度末で廃止され、2013 年以後は介護福祉士資格に一本化することになっている。そして介護職員
基礎研修は「介護福祉士養成のための実務者研修」に 、ホームヘルパー２級は「介護職員初任者研
修」に変わる。
さらに 2012 年 9 月には「介護段位制度（国家戦略・プロフェッショナル検定）
」が発表され、7
段位制度をとるという方針が内閣府から打ち出された。そしてその段位の判定を行うアセッサーの
養成が始まった。これによると、ホームヘルパー2 級資格や介護職員初任者研修修了者がレベル１、
レベル３が実務者研修や介護福祉士養成課程修了者、レベル４が介護福祉士資格取得者となってい
る。それより上級のレベル５から７については、今後の検討に委ねられている。
イギリスでは、職能資格と高等教育資格について、統合的な全国基準の構築に 1997 年以来取り組
んできた。そのために資格・カリキュラム局 Qualification and Curriculum Authority を設置し、
2002 年位は最初の全国資格枠組み National Qualifications Framework を発表した。その後この枠
組みは 2004 年、2008 年と改訂され、今では資格・クレジット枠組み Qualification and Credits
Framework という基準で基礎をいれると 9 階級が設定された。この評価システムでは、資格取得に必
要なユニットを、履修時間（単位）数で Award（1∼12 単位＝10∼120 時間）
、Certificate（13 から
36 単位＝130∼360 時間）、Diploma（37 単位以上＝370 時間以上）と規定している。そしてそれぞれ
4
の等級にこの資格タイプがあるようにしている。高等教育の学士は 6 等級、修士は 7 等級、博士は 8
等級とされている。Health and Social Care の業務については第 2 等級ないし第 3 等級から位置づ
けられており、認知症高齢者介護に従事するには第 3 等級で Diploma の履修が必要とされている。
高齢者に対する在宅介護に携われるのは第 5 等級で Diploma の履修が必要とされている。
日本やアメリカでは、まだこうした職能資格と高等教育資格を統合するまでには至っていないが、
人的移動の国際化が進めば進むほど、こうした枠組みの構築は世界的な関心事になるだろう。私た
ちは、こうした転機において、日米連携でアジア展開を図るべく、高齢者介護人材確保のための訓
練教育の標準化と認証の仕組みについて検討を続けている。2012 年度はアジア諸国との関心の共有
を図るために、4 月には福岡アジア・エイジング・フォーラムを主宰する福岡アジア高齢社会デザイ
ン協議会に参画し、9 月には上海社会科学院主催の「老齢長期ケア国際シンポジウム」にツアーを仕
組み、同時に 9 月ホノルルで開催されたハワイ太平洋老年学会で「アジア太平洋介護認証」の調和
化について議論し、それを踏まえて、11 月には北九州 ACAP2012 でシンポジウムとワークショップを
実施した。上海市では、日本式の居宅介護サービスを事業展開する動きにもつながったが、研修生
の受け入れについては、日中関係の悪化によって頓挫してしまったことは遺憾である。
今年度も多くの方々の協力があって私たちの事業は成功裏に進行した。とりわけ西日本産業貿易
コンベンション協会、北九州市、国土交通省九州運輸局、福岡市、福岡アジア都市研究所、ハワイ・
太平洋老年学会、上海社会科学院、Q サポネット、元九州大学アジア総合政策センターの同僚、アジ
ア太平洋アクティブ・エイジング・コンソーシアムの友人知人、そして裏方を支えてくれた佐伯静
香さん他アジアン・エイジング・ビジネスセンターの諸君、スイスのジュネーブ大学から駆けつけ
てくれてインターンシップで手伝ってくれた Caroline Vuagniaux にはこころより感謝している。か
なり多くの困難がまだまだ待ち伏せているが、多くの協力者、参加者を得て、次のステップに進め
る見通しが立てられそうである。
2013 年 3 月 31 日
特定非営利活動法人
アジアン・エイジング・ビジネスセンター
理事長
5
小川全夫
北九州アジア太平洋アクティブ・エイジング会議 2012
6
■開催概要
名称：第 7 回
アジア太平洋アクティブ・エイジング・会議 2012
自立・参加・健康のための人的開発と環境デザイン
会期：2012 年 11 月 9 日（金）∼12 日(月)
会場：[9 日∼11 日]
北九州国際会議場
〒802-0001
北九州市小倉北区浅野 3-9-30
[12 日]スタディツアー
安川電機
〒806-0004
北九州市八幡西区黒崎城石 2 番 1 号
サンアクア TOTO
〒802-0823 福岡県北九州市小倉南区舞ケ丘１丁目２−１
言語：10 日
10 日
オープニング∼シンポジウム（全日）：日英同時通訳
交流会、11 日
ワークショップ、12 日スタディツアー：逐次通訳
参加者数：のべ 450 名（内海外より 44 名）
主催：アジア太平洋アクティブ・エイジング・コンソーシアム
特定非営利活動法人
アジアン・エイジング・ビジネスセンター
共催：北九州市
助成：国際交流基金日米センター
協賛：公益財団法人西日本産業貿易コンベンション協会
後援：国土交通省九州運輸局・ハワイ大学・カピオラニ・コミュニティ・カレッジ
クプナエデュケーションセンター・インドネシア大学高齢化研究所・
老人生活科学研究所・アンチエイジング技術開発研究センター
地域と交通をサポートするネットワーク in Kyushu（Ｑサポネット）
学校法人麻生塾
麻生専門学校グループ
麻生教育サービス株式会社
7
■プログラム
レセプション
11 月 9 日(金)18：00∼20：00
北九州国際会議場
パッソ
デル
マーレ
開会式・シンポジウム
11 月 10 日(土)10：00∼17：00
北九州国際会議場
国際会議室
大会宣言
「高齢化は負担ではなく努力の花園である」小川
基調講演
「アクティブ・エイジングの新しい側面」キャサリン・ブラウン氏
北九州レポート
「北九州市の高齢社会対策」岩佐
全夫氏
健史氏
シンポジウム１
「シンガポールの「多くの支援の手」アプローチ：訓練にとっての意味」テルマ・カイ氏
「ハワイにおける介護初級者のためのトレーニングプログラム：
論点と改変の方向」カレン・ハヤシダ氏
「アジア太平洋介護認証システムの構想」小川
全夫氏
シンポジウム２
「韓国における高齢者のためのデジタルライフの基盤づくり」ドンヒー・ハン氏
「インドネシアの高齢者のアクティブ・エイジングと障がいの程度」トリブディ・ラハルジョ氏
「高齢化と気候変化のための包括デザイン」平井
康之氏
「アクティブ・エイジング社会における持続可能な交通システムとは」大井尚司氏
ワークショップ
11 月 11 日(日)10：00∼15：00
北九州国際会議場
ワークショップ１
「質の高い介護労働力の確保に向けて：日本における外国人看護師・介護士の
受け入れから学んだこと」
「国際介護人材養成のトレーニングセンター構想について」
「アクティブ・エイジング推進の新しい課題」
ワークショップ２
「アクティブ・エイジングにふさわしい移動環境とは」
「高齢化を支える『おでかけ支援』の取り組みについて」
8
ポスターセッション
11 月 10 日（土）∼11 月 11 日(日)10：00∼17：00
北九州国際会議場サブホワイエ
交流会
11 月 10 日(土)18：00∼20：00
北九州国際会議場
キャサリン・ブラウン氏による基調講演
実行委員長小川全夫による大会宣言
シンポジウムでの発表者
シンポジウム終了後の集合写真
ワークショップ 1 のパネリスト
ポスターセッション
9
Opening Remark:
Aging is not a burden, but a garden of our efforts
Takeo Ogawa
Chairperson, The Organization Committee, Kitakyushu ACAP2012
President, Asian Aging Business Center
Professor, Kumamoto Gakuen University
Ladies and gentlemen, welcome in the Kitakyushu ACAP 2012.
I am Takeo Ogawa, the president of NPO Asian Aging Business Center.
I will say a greeting on behalf of the chairman of Kitakyushu ACAP 2012.
In 2002, ten years ago, the United Nations held the 2nd world assembly on aging in Madrid in Spain,
and adopted the Madrid declaration. Now, as for population aging, not only an advanced nation but
developing countries became a policy concern. And WHO published the report an "Active Ageing: A
Policy Framework" in accordance with it. Every country is making efforts to verify about the progress
of their policies after ten years. Although every country in the world is doing the work, Japanese
government is not following the reexamination of fundamental measure-principle for the aged
society.
We organized the Active Aging Consortium in Asia-Pacific, and invited researchers, policymakers,
the man of business, and etc. As every time as we can meet, we had meetings and discussed
towards realization of active aging in each country. We call it as the Active Aging Conference in
Asia-Pacific.
ACAP is an abbreviation of it. The consortium has repeated the meeting in Fukuoka,
Suo Oshima-cho at Yamaguchi-prefecture, Honolulu, Pusan, Shanghai, Namhae County at
Cholla-namdo, Jakarta, Bali Island Kuala Lumpur, etc. And we decided to hold it in Kitakyushu in
2012. The chairman of the present consortium is Professor Dr. Kathryn Braun, University of Hawaii.
10
Thank you for your contribution.
We embrace the conference title as "the human development for independence, participation, and
health, and an environmental design." Japan has reached the stage of the super-aged society. We
need to reflect upon the sustainability of the established system which was improved so far. Also,
we need to build the knowledge and skills for surviving in super-aged society with the new way of
thinking. The awakening of the new way is looked at introduction of foreign nurses and care workers,
and at new life traffic systems, robots for care, and anti-aging medicine. Then, we decided to
advance deliberations with prospecting that these awakening will probably be inevitable policy
concerns for the super-aged society universally.
We are especially thinking about international migration of care workers as important reality. On the
one hand, there is a trend that older population is increasing and older persons to be cared will
increase in number simultaneously.
On the other hand, there is a trend that workable population will decrease its percentage relatively,
and number of workforce absolutely. If it tries to plan demand-and-supply balance of care work,
international migration will arise inevitably. It will become a big issue in near future increasingly.
How can we realize the reservation of the quality of care work and facilitation of the international
migration of care worker. It does not remain only in acceptance of foreign nurse and care worker
candidates who are invited by the framework of EPA. Then, we have accumulated research studies
and deliberations in academic and practical society. And we will like to perform the proposal towards
future. Japan Foundation, Center for Global Partnership is supporting our activity. It appreciates
thickly.
Moreover, we are cooperating with the West Japan Total Living Show and West Japan International
Exhibition of Welfare Apparatus, which are held at the next hall. Just it is the timing that we would like
to hold the concrete image of "the community-based comprehensive care system," which Japan is
going to carry forward for super-aged society in near future. Not only human services but also
innovations of the technology support the independence of older person. WHO changed the
fundamental concept of rehabilitation from “the International Classification of Impairments,
Disabilities and Handicaps” to “the International Classification of Functioning, Disability and Health.”
It is because the fact that disabled persons can live easily in a society which was greatly influenced
by not only individual efforts but the effect of an environmental improvement. From now on, older
persons themself become subjects who make up a new life-traffic system, and who should concern
and remake also in respect of the way of life, the city planning, and the job redesign. I appreciate the
11
West Japan Industrial Trade Convention Association which was allowed to share such an opportunity
sincerely.
We have been living in a society which population increases until 2008 in Japan.
Therefore, the social structure was able to exhibit the function efficiently by promoting social
differentiation: the division of labor, the professionalism, and the stratification. For example,
while I am fine, I live in my own house. While I become an illness and an injury, I will be sent
to hospital. While an illness and an injury heal up, I will go to rehabilitation facilities. While my
physical function is recovered, I will return to my house. While the aftereffect of decease or
injury, I will enter in a nursing home for requiring long-term care. Although such the social
differentiation looks rational apparently, if it continues until the society where population will be
decreasing, the workforce deficit will be occurred in medical/ health/social services, and also the
financial deficit will be occurred severely in order to maintain the differentiated society.
Moreover, there are many older persons who prefer to be “aging in place.” Then, Japanese
government has set forth the policy guidance of the community based all comprehensive care
service system, which can provide services of dwelling, life support, medical care, long-term care,
and preventive care consistently in a small regional community. Kitakyushu is also seeking an
advanced place of such a measure. One report will be presented in cooperation of the Kitakyushu
health-and-welfare office today. I will say many thanks for cooperation of Kitakyushu-city.
In holding this meeting, it was not able to realize without efforts of the staff of AABC and
many supportive organizations. In order to hold an international conference, it might be a hard time,
because of international conflicts, of high exchange rate of foreign currency around Japan. Also
many researchers in Japanese universities and institutes cannot participate in our conference
because of a lack of research grant, which is caused on deficit-covering bond issue is not performed
in confusion of National Parliament in this year.
In spite of such difficulties, you are gathering in here. I will appreciate all of participants
from the bottom of my heart.
I will say with confidence, “aging is not a burden, but a garden of our efforts.”
Let’s start our cool discussions. It is the beginning of Kitakyushu ACAP 2012.
12
大会宣言：高齢化は負担ではなく努力の花園である
小川
全夫
北九州 ACAP2012 組織委員会 委員長
特定非営利活動法人アジアン・エイジング・ビジネスセンター理事長
熊本学園大学教授
みなさん、ようこそ北九州 ACAP2012 にお越し下さいました。
私は NPO アジアン・エイジング・ビジネスセンター理事長の小川全夫です。北九州 ACAP2012 の大会
長としてご挨拶を申し上げます。
今から 10 年前の 2002 年、国連はスペインのマドリッドで第 2 回世界高齢化会議を開催し、マドリ
ッド宣言を採択しました。今では人口高齢化は先進国のみならず発展途上国でも政策課題になった
のです。そして WHO はこれにあわせて「アクティブ・エイジング：政策枠組み」という報告書を出
版しました。今年はその後 10 年間の進捗状況について検証する年です。世界各国はその作業を実施
しているのですが、日本は高齢社会対策大綱の見直しがうまく進んでいません。
私たちは、この間、アジア太平洋地域の研究者、政策立案者、実務家などとコンソーシアムを組織
し、折あるごとに、各国持ち回りで、会合を持って、アクティブ・エイジングの実現に向けて協議
を重ねてきました。アジア太平洋アクティブ・エイジング会議は、そうした会合の名称です。コン
ソーシアムは福岡市、山口県周防大島町、ホノルル市、釜山市、上海市、慶尚南道南海郡、ジャカ
ルタ市、バリ島、クアラルンプールなどで会合を積み重ねてきました。そして今回は北九州市で開
催することにしました。現在のコンソーシアムの会長は、ハワイ大学のキャサリン・ブラウン教授
に勤めていただいています。よろしくお願いします。
今回のテーマは「自立・参加・健康のための人的開発と環境デザイン」です。いよいよ日本は超高
齢社会の段階に達しています。私たちは、これまで整備されてきた制度の持続可能性を問い直す必
要があります。新しい発想でこれからの超高齢社会を生き抜く方法を築き上げることが急務です。
その萌芽は、外国人看護師・介護福祉士の導入や新生活交通システムや介護ロボットの開発に見ら
れます。そこで、私たちはこれらの萌芽が、おそらく超高齢社会にとっては避けることのできない
普遍的な政策課題になるだろうという見通しを持って、協議を進めることにしました。
とりわけ、私たちは国境を越えてケアの人材が移動するという現実を重視しています。一方では、
13
老年人口が増加し、同時に介護が必要な高齢者が増加するという趨勢があります。他方では、労働
力人口は割合としても、絶対数としても減少するという趨勢もあります。介護労働の需給バランス
を図ろうとすれば、必然的に国境を越えた人間の移動が生じます。介護労働の質の確保と、国際的
な介護労働力移動の円滑化をどのように実現するのかが、今後ますます大きな課題になっていくで
しょう。それは EPA の枠組みで実施されている看護師、介護福祉士候補者の受入れだけにとどまり
ません。そこで、私たちはこれまでの調査研究や学会での協議を蓄積し、今後に向けての提言を行
いたいと考えています。国際交流基金日米センターはこの私たちの思いを支援してくれています。
厚く感謝する次第です。
また今回、私たちは、隣の会場で催されている西日本トータルリビングショー、西日本国際福祉機
器展と協力することで、これからの日本が進めようとする「地域包括ケアシステム」の具体的イメ
ージをつかむきっかけにしたいと考えました。高齢者の自立を支えるのは単に人間の力だけではな
いのです。高齢者の自立を支援する技術の革新はめざましいのです。WHO は、リハビリテーションを
考える基本を、国際障害者分類から国際生活機能分類へと変えました。それは障がい者が暮らしや
すい社会は、個人的努力だけでなく、環境改善の効果にも大きく影響されるという事実に注目した
からです。これからは高齢者自身が新しい生活交通システムを作り上げる主人公となるのです。生
活の面でも都市づくりの面でも、職場づくりの面でも高齢者自身が関わって作りかえていくべきな
のです。こうした機会を共有させていただいた西日本産業貿易コンベンション協会に心より感謝申
し上げます。
これまでは人口が増加する社会でした。したがって、社会の仕組みは分業を推し進めることで効率
的に機能を発揮することができました。元気な内は自宅で過ごします。病気や怪我になれば入院し
ます。病気や怪我が治ればリハビリテーション施設に行きます。機能が回復すれば自宅に帰ります。
介護が必要なら介護施設に入所します。こうした分業は一見合理的に見えますが、人口が減少する
社会になると、そのような制度がいくらあっても、そこで働く人の確保ができないとか、財政的に
その制度を支えられないという問題が生じます。また高齢者は「できるかぎり住み慣れた場所で歳
をとる」ことを理想としている人が多いのです。そこで、今後、日本では、
「地域包括ケアシステム」
という「住居・生活支援・医療・介護・介護予防」のサービスを一体的一貫的に提供できるコミュ
ニティを整備するという政策指針が打ち出されました。北九州市もこうした取組みの先進地として
注目される都市です。
今回は北九州市保健福祉局の協力でご報告をいただくことになっています。
この会議を開催するにあたりましては、ＡＡＢＣのスタッフや多くの方々の努力がなければ実現で
きませんでした。この時期、国際会議を開催するには、国際情勢があまりよくなく、為替相場も円
高で、日本に来るのも容易ではない状況です。国際研究者も、国会の混乱で赤字国債発行ができず、
研究費の交付も遅れているような状態で出張旅費も出ない状況です。こうした諸困難があるにも関
わらず、お集まりいただいた方々に心より感謝申し上げます。
14
私たちは「高齢化は重荷ではなく、私たちの努力の花園である」という確信を持っています。
それでは、みなさん。いよいよ北九州 ACAP2012 の始まりです。
15
We are aging!
thousand
12000
Aging is not a Burden,
but a Garden of our Efforts
10000
Takeo Ogawa
President, AABC
4000
8000
6000
2010
2035
2000
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90-94
95-99
100+
0
National Institute of Population and Social Security Research
1
Asia is aging rapidly!
• 1998 UN, International Year of Older Persons
“Towards a Society for All Ages”
• 2002 UN, The 2nd World Assembly on Ageing
• 2002 WHO, Active Ageing: A Policy Framework
Global Network of Age-Friendly Cities
• 2004 Fukuoka ACAP 2004
Suo-Oshima, Honolulu, Busan, Shanghai, Namhae,
Shanghai, Fukuoka
Jakarta, Bali, Kuala Lumpur
25
20
East Asia
Europe
North America
10
Oceania
5
0
1950
2010
2
World is challenging!
30 %
15
Years old
2050
UN, World Population Prospects: The 2010 Revision
3
4
We need Many Hands of Care!
We need Design for Everyone!
5
6
16
Older Persons can be Contributors!
7
17
Keynote Speech:
New Face of Active Aging
Kathryn L. Braun, DrPH,
University of Hawaii
President, Active Aging Consortium Asia Pacific
As individuals live longer and longer, it is important to embrace the concept of Active Aging. This means that
older people must be encouraged to stay healthy and to contribute to society passed “normal retirement.” The
new face of active aging is “partnership.” To build an active aging society, individuals must stay healthy, and
families must plan for a long life for their elders. But a key partner is government, which must support policy
for Active Aging. In this presentation, I will share examples of policy initiatives from the United States that
encourage health promotion programs, age-friendly design, and job development for older adults. These
include the taxing of cigarettes and soda, the US Administration on Aging’s Healthy Aging Initiative, the
Americans with Disabilities Act (that mandates accessible environmental design), urban planning initiates
promoting green space and cottage communities, and employment programs of Senior Corps and the National
Park Service. Although more initiatives are needed, these and other policies are helping the United States
build an Active Aging society for older adults and their families.
18
基調講演：アクティブ・エイジングの新しい側面
キャサリン・ブラウン博士
ハワイ大学教授
アジア太平洋アクティブ・エイジングコンソーシアム代表
個人が長生きすればするほどアクティブ・エイジングの概念を取り入れることが重要です。これは、
高齢者が「ノーマルリタイアメント」を終え、健康を維持し、社会に貢献することを奨励しなけれ
ばならないことを意味します。アクティブ・エイジングの新しい側面は「パートナーシップ」です。
アクティブな高齢化社会を構築するために、個人が健康を維持する必要があり、家族は年長者の長
寿のために考えるべきです。しかし、重要なパートナーは政府でアクティブ・エイジングのための
政策をサポートする必要があります。このプレゼンテーションでは、高齢者のための健康増進プロ
グラムを奨励するアメリカからの政策イニシアチブの例、エイジフレンドリーデザインや雇用促進
開発の例をお伝えしたいと思います。
これらはタバコやソーダの課税、米国高齢化対策局、障害者差別禁止法（アクセス可能な環境デザ
インであること）
、都市計画では緑地やコテージのコミュニティの促進、シニア組織や国立公園サー
ビスの雇用プログラムを含みます。さらに取り組みが必要ですが、これらと他の政策は、米国が高
齢者とその家族のためにアクティブ・エイジング社会の構築を支援しています。
原文をＡＡＢＣで翻訳したものです
19
Active Aging Consortium Asia Pacific (ACAP)
The New Face of Active Aging
Mongolia
Canada
S. Korea
Nepal
Kathryn L. Braun, DrPH
USA
Japan
China
Hong Kong
University of Hawaii
and
Active Aging Consortium Asia Pacific
[email protected]
Hawaii
Malaysia
Indonesia
Singapore
Australia
1
2
Percent of population 60+ will double
ACAP
or triple in many regions (UN 2009)
Mission
Benefits
Japan
 To provide a forum in
 No dues! (no staff)
Korea
Asia Pacific for the
sharing of
 Research
 Policy ideas
 Monthly Bulletin
Singapore
 Conferences
China
 Conference participation
By 2050,
1 in 3
people in
East Asia
will be 60+
Indonesia
Malaysia
 Best practices for Active
Aging
Europe
 Conferences
US
 Exchange
2009
2050
World
3
4
0
10
20
30
40
50
Purpose
Question
 Define Active Aging
In a super-aged society, should people age 60
be encouraged to “drop out?”
 Discuss New Face of Active Aging
 A partnership of individuals, families, and society
Many nations are
realizing that we
cannot afford this
view.
 Feature Programs & Policies from US to
Promote Active Aging
5
6
20
The New Face of Active Aging is
PARTNERSHIP
Active Aging
Individuals and families
must prepare for old age and
adopt positive health practices
for long life.
Active Aging is the
process of optimizing
opportunities for health,
participation, and
security in order to
enhance quality of life
as people age.
Health
Promotion
Environmental
Design
World Health Organization
2002 Policy Framework
Social policy


Job
Development
7
Must make healthy choices easy choices.
Must encourage and reward
participation of elders in work,
education, volunteering and family life.
8
Obesity in the US
Social Policy can promote health
Promoting health
through:
Social Policy
needed to:
 Food policy
• Tax soda
 Health promotion policy
•Limit size
that can be
sold
 Community-based care
9
Food
policy
10
 Taxing cigarettes has decreased smoking…
Food policy can make
vegetables accessible
and affordable
can we do the same with soda?
11
12
21
Health Promotion Policy
US government supports programs in 46 states
Cardio
Balance
Hawaii
has had
funding
since
2007
13
14
Strengthening
Flexibility
Social policy can favor community-based
solutions to long-term care needs
Hula for
“Gracious Ladies”
Parks & Rec
Home care
15
Adult day care
16
Age-friendly Building
Social Policy can support good
environmental design
supported by Americans with Disabilities Act
Universal design for:
 Buildings
 Transportation
 Active living and
socialization
Buildings are accessible.
17
18
22
Bathrooms are age friendly.
Safe Routes to School
Transportation
Safe streets
encourage
walking and
biking
for all ages.
Transportation accommodates
disabled people.
Transport stations are safe
and covered.
19
20
Social Policy can support active living
and socialization
Business is following with “senior” living
communities
Cottage communities
encourage socialization
and walking.
Green spaces have outdoor seating.
Cities have walking paths.
But watch out
Green trails encourage walking and biking in Anchorage. for moose!
21
22
Multi-level living
facilities include
independent and
assisted living, and
long-term care.
Senior Corps creates part-time jobs for
older people
Social Policy can support opportunities
for continued work and volunteering
 Senior Companions
 Seniors (60+) help adults
with activities of day-today living.
Elders as resources
for:
 Working
 Foster Grandparents
 Seniors (60+) help
children and young
people with exceptional
needs.
 Caregiving
 Volunteering
 Civic engagement
23
24
23
•Small stipend, Annual physical, Transportation reimbursement.
Government funds NGOs to support
volunteer programs that help elders.
US Park Service creates roles for older
volunteers
 Project Dana, Honolulu
 Tour leaders for cultural
 Buddhist temples and
sites and festivals
 Help tourists learn
 Host for foreign visitors
Christian churches
 Older volunteers help
older people who need
help:





25
26
Conclusion: The New Face of Active
Aging is PARTNERSHIP
In Line with ACAP’s Mission
Individual and
family efforts
are important.
Healthcare
Environmental
Design
27
Friendly visit
Shopping
Writing letters
Reading
Yard work
Job
Development
 Welcome to this forum in Asia Pacific for the sharing of
 Research
 Policy ideas
 Best practices for Active Aging
But government plays a critical role
in setting social policy that:
Makes healthy choices easy choices.
Encourages participation of elders in
work, education, volunteering and family
life.
28
Thank You!
Asian Aging Business Center
Japan Center for Global Partnership
Kitakyushu & Fukuoka Governments
Kitakyushu ACAP 2012
Human Development & Environmental Design
for Independence, Participation, and Health
Dr. Takeo Ogawa
Professor Emeritus, Kyushu University
Professor, Kumamoto Gakeun Univerity
Founder, ACAP and AABC
29
24
Kitakyushu Report: 北九州市の高齢社会対策
北九州市保健福祉局総務課
計画調整担当課長
□
はじめに
□
健康・福祉を取り巻く状況
□
北九州市の健康と福祉の取り組み（高齢者支援計画の主要施策）
・
健康づくり、生きがい・社会参加
・
地域での見守り・支援（相談・支援体制、認知症対策、家族介護者への支援、介護保険サービス）
□
おわりに∼共に支える地域福祉のまちづくり
25
岩佐
健史
北九州市の概要
ようこそ、北九州市へ!!
・日本列島の西端、九州の最北端に位置 ⇒ アジアのゲートウェイ
・産業集積と技術力を誇るモノづくりのまち ⇒ 鉄鋼、化学、機械、窯業、ＩＣ等
第７回 北九州アジア太平洋アクティブ・エイジング会議２０１２
・豊かな自然に恵まれたまち
⇒ 210kmの海岸線、市域約40％が森林
～北九州レポート～
北九州市の高齢社会対策
・面積：488.78km2
北九州市保健福祉局総務部
計画調整担当課長 岩佐 健史
２０１２年11月10日
・人口：972,995万人
（平成24年3月1日現在）
北九州国際会議場
1
2
昭和３８年(1963年) 五市の対等合併により発足
北九州市の食のブランド
門司・小倉・八幡・若松・戸畑による、世界に類のない多都市対等合併で発足
関門のふぐ
小倉牛
ぬかみそ炊き
豊前海一粒かき
西日本工業倶楽部（戸畑区）
若戸大橋と旧古河鉱業ビル（若松区）
JR門司港駅（門司区）
北九州市の発足（昭和38年2月10日）
東田第一高炉広場（八幡東区）
旦過市場（小倉北区）
来年２月１０日に市制５０周年を迎えます
合馬のたけのこ
3
北九州市漫画ミュージアム ８月３日開館！
関門海峡たこ
若松特選トマト 4
「B-1グランプリin北九州」 １０月２０、２１日開催！
あるあるCity内にオープン
（JR小倉駅新幹線口に直結）
漫画文化の拠点施設として
８月３日に開館！
漫画教室開催
閲覧ゾーン
国内最大級の約５万冊の漫画を自由に楽しめる
B級ご当地グルメの祭典に、過去最多の６１万人が来場！
初心者向けからプロ志向の作画指導まで
“漫画を描く楽しみ”が味わえる
5
6
26
北九州市は、来年、市制50周年を迎えます！
総人口の推移
（千人）
平成25年２月10日 北九州市市制50周年！
1,200
100%
1,042
記念キャッチフレーズ
1,058
1,042
1,065
1,056
1,020
1,026
1,011
1,000
90%
994
977
80%
65歳以上人口
800
70%
70.2%
69.4%
68.8%
600
69.1%
68.5%
68.1%
68.8%
66.8%
50%
15～64歳人口
30%
4.8%
5.9%
7.2%
8.7%
昭和40年
（1965）
昭和45年
（1970）
昭和50年
（1975）
昭和55年
（1980）
昭和60年
（1985）
平成2年
（1990）
平成7年
（1995）
125
平成22年
（2010）
15～64歳
生産年齢人口（15～64歳）の割合
8
◆ 高齢者単身世帯が、15年間で約1.8倍に増加
31.4%
19.2 %
平成17年
（2005）
高齢者世帯数の推移
133
28,546
平成7年
32.9%
25.1%
75歳以上の高齢者
（後期高齢者）
平成12年
（2000）
【出所】総務省「国勢調査」（各年10月1日現在）
◆ 75歳以上の高齢者が増加、20年後には約3人に1人が高齢者
65∼74歳の高齢者
（前期高齢者）
10%
0%
高齢者数の推移
300千人
20%
15.7%
14歳以下人口
12.7%
10.3%
25.1%
22.2%
19.2%
0～14歳
65歳以上
高齢化率（65歳以上人口割合）
7
40%
２０人に１人が高齢者
400
200
200千人
60%
61.3%
４人に１人が高齢者
記念ロゴマーク
250千人
64.4%
22,659
61,198
1,306
平成12年
96
39,122
30,051
56,752
1,833
２．８倍
高齢化率
150千人
9.1%
100千人
5.9%
50千人
0千人
12.7%
116
17
30
S45
S55
35,768
66,121
2,329
79
120
62
45
45,477
平成17年
７．１倍
51
H2
143
157
H12
52,398
平成22年
78
40,385
67,329
2,647
H22
H32
【出所】平成２２年までは総務省「国勢調査」、平成３２年以降は北九州市保健福祉局による独自推計
0
H42
20,000
高齢者単身
9
40,000
60,000
80,000
夫婦のみ（夫婦とも高齢者）
100,000
120,000
140,000
その他の高齢者のみ世帯
160,000
若年者と同居
【出所】総務省「国勢調査」
健康をとりまく状況 （死亡要因の変化）
180,000
10
健康を取りまく状況（標準的な医療費）
■生活習慣病治療等にかかる標準的医療費
■主要疾病が「感染症」から「生活習慣病」へ
（年間／一人あたり）
４大疾病（がん、脳卒中、心臓病、糖尿病） が 主な死亡要因
重症化
通院治療
主な死因別にみた死亡率の年次推移（全国）
糖尿病（内服薬のみ）
11
入院治療
・・・17万円
腎臓人工透析
・・・・ 600万円
糖尿病（インシュリン注射） ・・・50万円
下肢切断
・・・・ 100万円
高血圧症
・・・ 7万円
白内障手術
・・・・ 100万円
高脂血症
・・・ 9万円
網膜症手術
・・・・ 100万円
高尿酸血症
・・・ 7万円
心臓病で入院
・・・・ 400万円
脳卒中で入院
・・・・ 200万円
＜出典＞保健活動を考える自主的研究会「糖尿病ノート」を基に作成
27
12
要介護認定者数と出現率
健康をとりまく状況
■一人あたりの国保医療費
(平成 21年度 政令市比較）
要介護認定者数
21.2%
認定率（北九州市）
19.4%
認定率（全国）
人
（円）
60,000
400,000
349,137
350,000
50,000
300,000
16.9%
40,000
200,000
44,863
30,000
100,000
20.2% 20.0% 20.2% 20.6%
20%
16.5%
16.4%
16.5%
16.8%
50,372
47,160 48,498 46,472 47,046 48,574
15%
40,369
11.5%
150,000
10.1%
34,161
10%
28,361
50,000
20,000
北九州市
広島市
福岡市
神戸市
岡山市
堺市
京都市
大阪市
名古屋市
静岡市
浜松市
◆ 政令市でトップクラス
新潟市
横浜市
千葉市
川崎市
さ いた ま 市
札幌市
仙台市
0
15.8%
13.0%
12.7%
21.7%
16.8%
16.3%
14.5%
14.4%
250,000
21.8%
24,038
5%
10,000
0
健康の維持向上は重要な課題
0%
H12.4
13
H13.4
H14.4
H15.4
H17.4
H18.4
H19.4
H20.4
H21.4
H22.4
14
※北九州市は、「北九州市の介護保険（年報）」 全国は厚生労働省「介護保険事業報告」（暫定版）
認知症高齢者の推移
高齢者人口
H16.4
障害者の現状
認知症高齢者数
(自立度Ⅱ以上)
身体障害者手帳の交付状況
認知症高齢者
出現率
（人）
55,000
18歳以上
18歳未満
50,000
45,000
42,339
43,733
45,618
46,971
48,518
44,645
46,020
47,585
49,616
50,389
51,055
51,507
52,139
49,438
50,141
50,628
51,258
40,000
平成１６年
２１１，６９５人
１９，４９２人
９．２％
平成１７年
２１７，０２１人
２２，８７８人
１０．５％
平成１８年
２２４，０６９人
２５，０９０人
１１．２％
35,000
30,000
25,000
20,000
41,359
42,771
48,670
15,000
10,000
5,000
0
980
Ｈ13年度
962
Ｈ14年度
973
Ｈ15年度
（人）
平成１９年
２３０，１０８人
２７，６７７人
１２．０％
平成２０年
２３６，７０１人
２９，４４４人
１２．４％
平成２１年
２４２，２１０人
３０，３２５人
１２．５％
平成２２年
２４４，８６０人
３０，３９６人
１２．４％
951
Ｈ16年度
10,000
8,000
6,343
6,808
6,521
7,037
7,280
Ｈ19年度
879
914
Ｈ20年度
881
Ｈ21年度
Ｈ22年度
7,806
7,570
8,161
8,489
8,794
4,225
4,479
4,720
3,943
3,443
3,764
3,109
3,295
3,579
2,987
3,356
3,412
3,513
3,594
3,701
3,806
3,863
3,936
4,010
4,074
Ｈ13年度
Ｈ14年度
Ｈ15年度
Ｈ16年度
Ｈ17年度
Ｈ18年度
Ｈ19年度
Ｈ20年度
Ｈ21年度
Ｈ22年度
6,000
5,000
951
946
Ｈ18年度
中度・軽度
重度
9,000
7,000
933
Ｈ17年度
知的障害者への療育手帳の等級別交付状況
4,000
3,000
2,000
1,000
【出所】北九州要介護申請訪問調査・自立度別データ（各年9月末現在）
15
0
保健福祉関連予算の概要
身近な地域で健康をつくる
保健福祉費は一般会計のおよそ４分の１、子ども家庭費を含めると３分の１
■生活習慣病予防および重症化予防
地域住民、専門職、医師会、行政等の関係機関が連携、生活習慣病予備群の早
期把握、個別の健康課題に応じた効果的な保健指導を実施
平成24年度 当初予算（市一般会計）
環境費
186
教育費（3.4%）
342
（6.2%）
総務費
406
（7.4%）
その他
405
7.3%
保健福祉費
1,4 04
（ 25 .4% ）
歳出合計
土木費
485
（8.8%）
5,523億円
子ども家庭費
558
諸支出費
（10.1%）
815
（14.8%）
16
慢性腎臓病予防
連携システム
特定保健指導の充実
特定健診結果と、かかり
つけ医と腎臓専門医との連
携により、慢性腎臓病を早
期に発見、その予防及び重
症化予防と、心血管疾患の
発症抑制を目指す（政令市
初の取組み）
特定健診の結果、内臓脂
肪型肥満の方で、血糖や
脂質、血圧が基準値を超
える方を対象に、医師や管
理栄養士などが個別に特
定保健指導を実施。
家庭訪問等による
保健指導の充実
特定保健指導の対象外の
「痩せているが血圧が高い」
「受診中だが糖尿病の改善
が図られていない」などの方
を対象に、保健師や栄養士
等が家庭訪問等を行い、生
活習慣の改善や治療の継続
を支援、重症化を予防。
産業経済費
922
（16.7%）
単位：億円
（ ）は構成比
17
18
28
身近な地域で健康をつくる
身近な地域で健康をつくる
自ら進んで「健康」をつくる
■地域でGO!GO!健康づくり （市民センターを拠点とした健康づくり事業）
講演会
■公園で健康づくり事業
■健康マイレージ事業
体力測定
ウォーキング
ラジオ体操
◆平成2３年度実績
実施校区
９７校区
■百万人の介護予防事業
19
きたきゅう体操（介護予防体操）
ひまわりタイチー（介護予防太極拳）
地域における高齢者の活動①
地域における高齢者の活動②
（年長者研修大学校卒業生の活動）
（老人クラブの活動）
～地域での清掃活動～
～子どもへの折り紙指導教室～
～ペタンクで健康づくり～
（生涯現役夢追塾卒塾生の活動）
～ウォーキング大会～
～災害支援のための街頭募金～
22
健康で元気な高齢者が活躍（新たな取り組み）
■ 介護支援ボランティア制度
元気な高齢者による社会参加・地域貢献、健康増進・介護予防を促進するため、
介護保険施設等におけるボランティア活動を奨励・支援
⇒ H 26年度 17,996人/月
◆デイサービス（利用者数）
北九州市（事業実施主体）
⇒ H 26年度 15,768人/月
委託
◆ショートステイ（利用者数）
H 23年度 1,829人/月
管理機関
⇒ H 26年度
2,613人/月
①登録
ボランティア会員
②施設紹介
介護支援ボランティア活動をし、
ポイントを蓄積
（65歳以上の北九州市民）
○受入施設の受付・登録
○ボランティア会員の受付・登録
○ポイント管理
○ポイントの換金
◇施設サービス等の整備
◆特別養護老人ホーム （定員数）
H 23年度 4,159人
（多世代交流活動）
21
◇在宅サービスの充実《※予防サービスを含む。Ｈ23年度は速報値》
◆ホームヘルプサービス（利用者数）
H 23年度 13,633人/月
～「元気袋」を被災地へ～
（公園愛護会活動）
高齢者を支える介護保険サービス
H 23年度 16,586人/月
20
⑥換金の申請
⑦換金の振込み
④ポイント付与
⇒ H 26年度 5,033人 （増 874人）
介護保険施設
◆認知症グループホーム（定員数）
H 23年度 1,837人
◆介護老人保健施設
H 23年度 2,870人
⑤ポイントの通知
（定員数）
⇒ H 26年度 2,970人 （増 100人）
（特別養護老人ホーム等）
③活動
○ボランティアの受入れ
⇒ H 26年度 2,197人 （増 360人）
○ポイントの付与
○ポイントの登録
23
29
24
地域で見守り支えあう
かかりつけ歯科医
かかりつけ医
地域で見守り支え合う （いのちをつなぐネットワーク）
（いのちをつなぐネットワーク）
地域団体に加え、民間事業者による「見守り」の広がり
かかりつけ薬剤師
開業医等による気づき
友人知人
趣味を
通じた仲間
地域住民や団体による
支援や見守り
自治会・
町内会
民生委員
児童委員
近隣の
地域住民
福祉協力員
ＮＰＯ
老人クラブ
ボランティア
企業などの
団体
配達や検針など、日頃の企業活動の中で「気づき、つなぐ」
警 察
・
消 防
公的サービスの
連携や見守り
電力、ガス、新聞、
郵便、宅配、生協、
NPOなど‥
日頃の関係を活か
した協力
ケアマネジャー
支援の
必要な人と
その家族
緊急通報
システム
介護サービス
提供事業者
生活保護
（高齢者・障害者・
子ども）
訪問給食
サービス
健康づくり
介護予防事業
ふれあい
巡回員
その他
公的サービス
連携の
コーディネイト
いのちをつなぐネットワーク担当係長
コーディネーター役
迅速・適切な
支援
◆協力会員証
地域包括支援センター・
高齢者の総合相談窓口 “出前主義”
区役所・市役所の様々な部門
◆市長から企業代表へ協力会員証を授与（24.11.7）
25
認知症対策～今後の取組み
地域包括支援センターについて
■ 認知症対策
高齢者のための保健・医療・福祉の「ワンストップ相談窓口」
設置時期
→ 次のステップへ充実～理解から行動へ
◇認知症ｻﾎﾟｰﾀｰｷｬﾗﾊﾞﾝ事業
◆北九州市（直営）
◆出前主義
認知症の予防
◇予防講演会、予防教室
 来所した市民だけに対応するので
はなく、自宅などに出向き、相談を
受け迅速な支援につなげます
設置場所
◇訪問等による介護予防支援事業
◇認知症疾患医療ｾﾝﾀｰ運営事業
◇ものわすれ外来事業
＊高齢者人口約10,000人に１か所を目安
＊市民センターや出張所などの公的な場所
＊門司区：３、小倉北区：４、小倉南区：５、若松区：２
八幡東区：２、八幡西区：６、戸畑区：２
＊各区役所に設置
民間団体
家族会
専門家
医療・
福祉
◇情報共有
◇認知症地域支援事業
〔２２年度相談実績〕
◇介護のささえあい相談会
◇認知症コールセンター
地域包括
支援センター
◇各種サービスの充実（医療、施設）
◇認知症介護家族交流会
権利擁護、虐待防止
◇高齢者虐待防止事業
統括支援センター
＋
区役所
◇成年後見制度利用支援事業（みると）
◇地域福祉権利擁護事業（らいと）
◇市民後見人制度
若年性認知症対策
◇認知症介護研修事業
27
介護家族への支援
◇高齢者見守りｻﾎﾟｰﾀｰ派遣事業
認知症ｹｱにあたる専門職のｽｷﾙｱｯﾌﾟ
２１万８，２５５件
位置探索ｼｽﾃﾑｻｰﾋﾞｽ、一時保護事業
⇒登録者の増、実効性の検討
◇役割分担
◇かかりつけ医対応能力向上研修
◇認知症サポート医養成研修
◇徘徊高齢者等S0Sﾈｯﾄﾜｰｸｼｽﾃﾑ、
◇活動支援
早期発見・早期対応・連携の充実
◆地域包括支援センター ２４か所
◆統括支援センター ７か所
住み慣れた地域での生活支援の充実
認知症への正しい理解と啓発
平成１８年４月１日
◇啓発促進事業
運営主体
26
市関係課
◇実態把握 ⇒ 本人支援、家族支援へ
「地域の支え合い」とは
地域における支え合いの機能について
誰もが住み慣れた地域で、健やかに安心して暮
らすことができるよう
• しかし、制度だけでは、地域のさまざまな福祉の
課題に対応することはできません。
人と人とのつながりを大切にし、何かあったときは、
• 身近にいないと気づかない地域の問題
『お互いに助けたり助けられたりする』
• 制度の谷間にいる人の存在
関係やその仕組みをつくり
• 複合的な問題を抱えたケース
共に支え合うまちを実現していくこと。
28
これからも地域における支え合いはしっかりと
維持される必要があります。
そのために様々な制度をつくり施策を実施
29
30
30
共にささえる地域福祉のまちづくり
地域の様々な課題を解決していく上では、
自助
共助
公助
ご清聴ありがとうございました
の役割を一人ひとりが理解し、適切なバランス
を保ちながら、それぞれが積極的に役割を果た
していくことが必要です。
32
31
31
SYMPOSIUM 1:
FRAMEWORK OF INTERNATIONAL TRAINING OF ASIA PACIFIC
LONG-TERM CARE CERTIFICATE
32
Singapore’s “Many Helping Hands” Approach: Implications for Training
Thelma Kay
Former Director, Social Development Division, UNESCAP,
Senior Advisor, Ministry of Community Development
Youth and Sports, Singapore
In a rapidly ageing Singapore, demographic trends are compounded by smaller household sizes, an increase in
the older-old requiring more care, and an increased chronic disease burden. There is an emphasis to promote
active ageing for healthy life expectancy and employability.
When care is needed, a key pillar in Singapore’s
policy for the delivery of social services is the “many helping hands” approach.
This stresses individual
responsibility and self-help, with the family as the first line of care and support, followed by the community
and the government.
elders.
In reality, the family provides a high proportion of income support and caregiving to
This is complemented with programs of community based support, which include home help services,
senior care centers, and nursing homes .Training is available for various types of caregivers, including family
caregivers, domestic helpers and allied health professionals . Training is provided by a diversity of entities,
including voluntary welfare organizations (VWOs), vocational and technical institutes, and hospitals.
training needs and providers are diverse, standardization of training and certification is still a work in
progress.
33
As
シンガポールの「多くの支援の手」アプローチ：訓練にとっての意味
テルマ・カイ
元 UNESCAP 社会開発省ディレクター
シンガポール自治開発省上級顧問
急速に高齢化するシンガポールでは、人口統計学的傾向はより小さい規模の世帯、高齢者のケア需
要の増加、慢性疾患の増加による負担によって悪化しています。健康寿命と雇用の可能性のために
はアクティブ・エイジングの促進を図る必要があります。介護が必要になった時、社会サービス提
供のためのシンガポールの政策の柱は「多くの支援の手」アプローチです。
これは、介護やサポートの最初の担い手としてのファミリーとともに、個人の責任や自助を強調し
ており、次いでコミュニティや政府が続きます。現実には、ファミリーの高齢者への所得補助と介
護においては高い割合です。これは、ホームヘルプサービスや、シニアケアセンターや老人ホーム
などのコミュニティベースのサポートで補われています。トレーニングは家庭介護の人やお手伝い
さんや健康関連の専門家など様々なタイプの介護者に可能です。トレーニングは福祉団体を含む専
門学校や病院など多様な事業体から提供されます。トレーニングのニーズと提供者が多様であるの
で、トレーニングや資格の標準化はまだ進行中です。
原文をＡＡＢＣで翻訳したものです
34
Population ageing rapidly in ESCAP region
Percentage of population over age 60
Singapore’s “Many
Helping Hands”
Approach
Brunei Darussalam
Cambodia
China
Indonesia
Japan
Lao People's Democratic Republic
Malaysia
Myanmar
Philippines
Republic of Korea
Singapore
Thailand
Viet Nam
Presented by Thelma Kay
Former Director, Social Development Division, UNESCAP and
Senior Advisor, Former Ministry of Community Development,
Youth and Sports, Singapore
0
10
20
2050
30
2025
40
50
2005
Source: World Population Prospects: The 2008 Revision, United Nations Population Division, New York.
1
2
More Elderly Living Alone
and Single Elderly
Demography/ageing landscape of
Singapore
•
•
•
•
•
Total Population : 5.18 million (2011)
Residents :3.79million (2011)
Life expectancy: 65 (1965) to 82 (2010)
> 60 : 3.4% (1970), 9% (2010), 19% (2030)
Life expectancy at age 65 (for 2010)
Males 18.1
Females 21.5
• Dependency ratio:1:9(2010) 1:5 (2020)1:3(2030)
% of Elderly living alone
8.0%
6.0%
4.0%
2.0%
0.0%
1995
2005
55+
Single Elderly
75+
100
80
60
40
20
0
2005 (Male)
55-64
National Survey on Senior Citizens, 1995, 2005
3
2005 (Female)
65-74
75+
4
More Will Require Care
Smaller Household Size (HDB)
Projected no of Elderly unable to perform
>1ADL
Projected no of Elderly with Dementia
80,000
80,000
70,000
70,000
60,000
60,000
50,000
50,000
40,000
40,000
30,000
30,000
20,000
20,000
10,000
10,000
0
0
2005
60-64
65-69
2010
70-74
2015
75-79
2003
2020
80-84
85+
60-64
2010
65-74
2020
75-84
85+
HDB Sample Household Survey 2008
5
6
35
Integrated community-based
healthcare delivery system
Ministerial Committee on Ageing
• Primary, acute, step-down and palliative care
work together to deliver integrated care
• Focus not where care is currently delivered
but on where it should ideally be delivered
• Population-based instead of institution-based
• Patient-centric healthcare ecosystem
• Patient- centred instead of provider- centred
• Right-site care faciility
MCA (Chair Min i/c of Ageing)
Development of
Healthcare & Social
Care Services &
Facilities
Active Ageing
&
Employability
Home Care
& Family
Support
Manpower
Development
7
8
Integrated Health and Social Care
Primary Care
Acute and Intermediate Long-Term Care
• Sharing responsibility to help and care
• Self , family, community, government,
voluntary welfare organizations, private sector
• Family as “first line” of care and support
• But as family will be less extended, more
community care sector needed
Sheltered
Disabled
Homes
Community
Hospitals
Nursing
Homes
Polyclinics
Screening
and
Prevention
“Many helping hands” approach
Patient
Palliative
Care
Seniors
Group
Homes
Senior
Care
Centres
Seniors
Activity
Centres
Home
Care/Home
Help
Family
Physicians
Acute
Hospital
9
10
“Who, ideally, should be mostly responsible
for providing income to retired people?”
Helping hands in the LTC sector
Private Operators
VWOs
Nursing Homes
Day Facilities
Home Health Care
43%
86%
66%
25%
32%
14%
34%
Govt-subvented
Source: MOH
Portable subsidies
Privately funded
Source : CSIS
11
36
12
Caregiver Profile
Caregiver training
• Mainly family caregivers; about half who are working
• Informal caregiver training
Hospitals/nursing homes
VWO
Private
• Agency for Integrated Care
AIC Institute
• Centre for Enabled Living
Grant for caregiving training (S$200)
Employment Profile
Who they are
14%
3,400
36%
24%
5,600
26%
5,600
Children
40%
46%
8,600
FDWs
14%
Spouses
Relatives
Source: National Survey of Senior Citizens, 2005
Working (full time)
Not working
Working (part time)
Source: Family Caregiving in Singapore, 2006
13
16
Providers of Care for the Elderly
Family
Voluntary Welfare
Organizations
(VWO)
Government
• Main provider
of care for the
elderly
•Informal care
•Foreign
domestic
workers (FDW)
• Providers of
home and
community
based care
services for the
elderly
• LTC financing
•Subsidy for
nursing homes
and community
care
•Regulator of
standards
Challenges
• “Not in my backyard syndrome” to right-site
aged care facilities eg. nursing homes, senior
activity centres
• Balance affordability of aged care services
with competitive pay for aged care staff
(retention, abuse)
• Maintain standard of care providers with
need for increasing numbers
14
17
Caregiver training
Challenges
• Standardization of curriculum with diverse level of
caregiving needs
• Accreditation of nursing staff by professional
association/board especially for foreign healthcare
staff
• Opening of borders for free flow of skilled labour
e.g. ASEAN Economic Community 2015
First steps towards a framework of international
training of Asia Pacific LTC Certificate?
• Formal training
Degree in Nursing and Allied Health
Professions (University)
Diploma ( Nanyang/Ngee Ann Polytechnic)
National ITE Certificate (NITEC) in Nursing
(Institute of Technical Education)
15
18
37
Training Programs for Entry Level Long-term Care Workers in Hawaii: Issues
and Directions for Change
Cullen T. Hayashida, Ph.D.
Professor
Kapiolani Community College
Kupuna Education Center
Hawaii’s challenges related to the training of long-term direct care workers reflect those of the USA where
there is rapid population aging, smaller family size and chronic and growing worker shortages.
Direct Care
Workers are considered critical given their growing need but there is little consensus on their job titles and
their role.
This report starts with a basic definition of direct care worker and provides an overview of the
home care industry and its present challenges wit high worker turnover, low pay and no standards of training.
Before standardization can be achieved, there is a need to address the following questions:
Should training
be institutional or home oriented? How many levels of training should there be? Should the training be
universal or specialized? What are the core competencies? How do we address worker retention and
advancements? Kapiolani Community College uses the Schmieding Model for Direct Care Workers.
This
model addresses the need to training at the entry level and trains workers in an articulated multi-level
approach using a well-designed competency based curriculum used in several states in the USA.
The
Schmieding Model has the ability to create educational pathways into the professional and paraprofessional
specialty tracks.
This report suggests an approach to address social change to created universal standards.
38
ハワイにおける介護初級者のためのトレーニングプログラム：
論点と改変の方向
カレン
ハヤシダ博士
カピオラニ・コミュニティ・カレッジ
クプナ・エデュケーションセンター
ハワイの介護福祉士のトレーニングに関する課題は家族の少数化や慢性的な働き手の不足、アメリ
カの急速な高齢化を反映しています。介護福祉士は増え続ける需要に限界があると言われています
が、彼らの職名と役割についてはほとんど意見の一致がありません。この報告では介護福祉士の基
礎的な定義と在宅ケア産業の概要及び高い離職率の課題、低賃金やトレーニングの基準がないこと
についてお話しします。標準化達成の前に、以下の質問に対処する必要があります。トレーニング
は施設志向であるべきか？家庭志向であるべきか？トレーニングのレベルはどれくらいあるべきで
しょうか？トレーニングは万人向けであるべきか、専門的であるべきか？コア・コンピタンスとは？
労働者の保持や進歩にどう対応するか？カピオラニ・コミュニティ・カレッジは介護福祉士のため
に Schmieding モデルを使っています。このモデルは、アメリカのいくつかの州で初級レベルの労働
者のトレーニングに適切に設計されたコンピテンシーベースのカリキュラムでマルチレベルのアプ
ローチに使用されています。Schmieding モデルで専門職と専門職の助手になるためのパスウェイを
作ることが可能です。
このレポートではユニバーサルスタンダードを創出するための社会変化へのアプローチを提案する
ものです。
原文をＡＡＢＣで翻訳したものです
39
PROFILE OF MARGARET, 84 YEAR OLD WIDOW
TRAINING PROGRAMS FOR ENTRY LEVEL
LONG-TERM CARE WORKERS IN HAWAII:
ISSUES AND DIRECTIONS FOR CHANGE
Cullen T. Hayashida, Ph.D.
Kupuna Education Center
Kapiolani Community College
Honolulu, Hawaii
1
2
POPULATION AGING AND WORKER SHORTAGE:
SOLUTIONS?
THE PERFECT STORM
Postpone Retirement Age
 Increase Births – Have more babies
 Increase Foreign immigration – have more young
foreign workers
 Emigration - Send older people away
 Technology – Substitute for “healthcare workers”
 Active Aging – train older people to remain well
and productive
 Training - Create a more efficient care worker
training system

Elder
Population
Growth
Severe
Worker
Shortage
Smaller
Family
Size and
Support
4
3





JOB TITLE CONFUSION!


WHAT DO WE MEAN BY A DIRECT CARE
WORKER?








5
40
Geriatric Caregiver
Paraprofessional
Nurse Aide
Certified Nurse Aide (CNA)
Personal Care Assistant
Home health Aide
Domestic Aide
Home Helper
Home Care Aide
Companion Aide
Direct support professional
Patient care technician
Personal care attendant
Resident treatment worker
Orderly
• Universal worker
• Unlicensed assistant
• Behavioral Specialist
• Hospice worker
• Dementia specialist
• Medication aide
• Medical assistant
• Medication manager
• Medication technician
• Psychiatric technician
• Rehabilitation aide
• Respite Worker
• Elder Pal
• Direct Care Worker
• Nutritional Aide
6
HOME CARE IN USA
DIRECT CARE WORKER: DEFINITION

Home Health Care
Agency
A paid individual who provides services, care,
supervision, and emotional support to people
with chronic illnesses and disabilities. This
definition does not include nurses, case
managers, or social workers.
Medicare/Medicaid
payment system
Skilled Care
Registered Nurse (RN)
Use of Certified Nurse
Aide (CNA)
Short-term for length
of rehabilitation





Works in many settings such as nursing homes,
residential care facilities, hospitals, Assisted
Living Facilities, Home Care Agencies, Day Care
Centers, and individual homes.

Private-Duty Home
Care
 Private payment
 No Medicare/Medicaid
Payment
 Non-skilled Care
 ADL/IADL personal care
 Little or no standard
training
 Relatively long term
7
8
STATUS OF STANDARDIZING DIRECT CARE
WORKER TRAINING IN U.S
DIRECT-CARE WORKER TURNOVER

Standard “minimum” criteria – Certified Nurse Aide

Home Health Aides: 40-60% leave in 1 year
80-90% in first 2 years
 CNA Turnover:
71%
 Turnover costs to Employers = $4.1 billion
$4,100,000,000
Money spent in retraining



No National Agency in National Government





National Medicare rules for minimal standards
Nursing Home focused
U.S. problem is 55 jurisdictions – 1 federal, 4 territories, and 50
states
Current political climate in U.S. is not favorable for increased
regulation, laws or new spending
No coordination or uniformity at state level
Major variations between states
No National Leadership in Training: No Coordination


Rules for minimum training only at state level
Development of caregiver training only by private industry,
professional groups and higher education
9
10
SURVEY OF EXPERTS
THE CAREGIVING PROJECT FOR OLDER ADULTS 2007
CONFERENCE
1.
2.
3.
4.
5.
6.
7.
ISSUES IN
CAREGIVER
TRAINING
DEVELOPMENT
Need for National Standards for in-home care
workers
Training should be based on Core Competencies
Certification of Care Workers needed
Accreditation of Curriculum needed
Need for Career Ladder – credit or non-credit
Caregiver Training in Community Colleges and
other 2 year educational institutions
National Organization of Care Workers - ?
11
12
41
LEVELS OF TRAINING: HOW MANY?
ORIENTATION OF TRAINING
Level 3
Home-oriented
Institutional
Level 4
Level 2
Level 1
13
14
UNIVERSAL OR SPECIALIZED?
CORE COMPETENCIES?
Child
Care
Soft
Skills
In-Home
Eldercare
Universal
Psychiatric
Nursing
Home
Ethics
Young
Disabled
Health
Safety
Clinical
Skills
Aging
Process
15
16
SCHMIEDING MODEL FOR
DIRECT CARE WORKERS
RETENTION AND PAY
How do we retain workers?
 How do we pay workers a living wage?
 How do we provide health benefits and other
worker benefits?
 How do we create jobs with the potential for
advancement and growth?

1.
2.
3.
4.
5.
6.
17
Emphasis on Elder Care at Home
Entry level, Minimal Training
Multi-Levels
Well designed Course – Instructor +
curriculum
Pre-enrollment Evaluation by Interview
Testing
18
42
TOWARDS A MORE EFFICIENT MODEL
Registered Nurse (RN) -
- Medication Assist
- Chronic Disease
- Restorative Care at Home
- End of Life

If we are facing a worker shortage, how do we
more efficiently use our human capital?
19
How do we change dead-end jobs with career
opportunities?
 Can we assure the quality of care for elders with
improved continuing education training?
 How can we create hope for better income and
advancement and improve retention?
 How can we link entry paraprofessional levels
with higher professional levels to maximize the
use of workers?
Who Takes the Lead? Government or Private Sector or
Partnership
Who Pays?
Next: Articulate paraprofessional -> Professional Careers21
22
Licensed Practical Nurse -
- Advanced Dementia Care

( 12 hrs/yr CEU)
- Dementia Care (16 hrs)
- Home Care Assistant (50 hrs)
- Personal Care Assistant (25 hrs)
- Elder Pal/Companion (25 hrs)
20
STRATEGIC PLAN









Establish
Establish
Establish
Establish
Establish
Establish
Certify
Certify
Establish
Direct Care Worker Advisory Council
Direct Care Worker Board of Directors
Certification Levels
Competencies
Standards for Training & Continuing
Education
Instructor Certification & Requirements
Home Care Workers
Workers with Specialty Skills
National Organization of Direct Care
Workers
“The best way to predict the
future is to create it”
Peter Drucker
23
43
Perspectives for the Asia-Pacific Long-term Care Certificate
System
Takeo Ogawa, Ph.D.
President of Asian Aging Business Center,
Kumamoto Gakuen University
Every country in the world is in confronting with population aging. In Accordance with population aging,
older persons who have the need of long-term care is also increasing. Though they recovered from the illness
and the injury, their needs of long-term care are rather increasing. The more population is aging, the more risk
of disabilities, the dementia, the gerontomorphic diseases, and the senility, etc are rising.
However, the family support, which was bearing long-term care for the elderly until now, is lesser and lesser
its power. Then, the demand of long-term care workforce is increasing more and more. Advanced aging
countries are requiring long-term care workforce not only from the domestic labor market but also from the
international one.
In spite of the requirement of international migration for recruiting long-term care workforce, there are many
of obstructions. Especially, it is too diverse to instruct of the program of training long-term care in each
country.
In order to maintain the quality of long-term care and to facilitate the international migration of long-term care
workforce, it should be needed to establish the Asia-Pacific Long-term Care Certificate System by
harmonizing local and domestic training programs for the long term care workforce with each country.
44
アジア太平洋介護認証システムの構想
小川
全夫
NPO 法人アジアン・エイジング・ビジネスセンター理事長
熊本学園大学教授
世界各国で人口高齢化は進んでいる。それに伴って、介護が必要な高齢者も増加している。病気や
怪我が治った後に障がいをもって生活している高齢者、認知症など老人性の進行性難病を抱えて生
活する高齢者、老衰しているがなお生活している高齢者などが増加している。しかしこれまで介護
を担っていた家族力は弱くなっているために、介護労働力の需要が高まっている。介護労働力の需
要は国内だけにとどまらずに国際的な移動を引き起こしている。だが各国の介護労働力の訓練プロ
グラムはまちまちであるために、円滑な介護労働力の国際移動が阻害されている。今後は各国の介
護労働の訓練プログラムを調和化するために、各国が協力して、アジア太平洋介護認証を構築し、
介護労働の質の向上と国際的な介護労働力の移動の円滑化を図るべきである。
45
The Active Aging focus on Realities.
Perspectives for the Asia-Pacific
Long-term Care Certificate System
1. Independent Older Person with Self
Care beyond Centenarian.
2. Older Caregiver for the Disabled.
3. All Knowledgeable Generation of
Older Persons.
4. Older Persons in Inter-generational
Relationship.
5. Environment Design including Older
Persons
Takeo Ogawa, Ph.D.
President, Asian Aging Business Center
Professor, Kumamoto Gakuen University
1
2
How can we maintain
Care Givers and Care Workers?
More Care and Lesser Workforce
Like as a
portable shrine,
older persons
were supported
by many young
persons.
Like as a fighter
on a cavalrybattle, older
persons were
supported by few
young persons.
• Promoting Knowledge and Skills of Self Care
for All Generations.
• Motivating Long-term Care with Satisfaction.
• Preventing Burn-out of Care Givers and Care
Workers.
• Establishing International Care Worker Market.
• Harmonizing Care Certificate System with Each
Country.
Like as a rider on
a person’s
shoulder, older
persons were
supported by one
young person.
What is meaning the population aging for older persons?
3
4
New Japanese Classification of LTC
Comparison of Training Programs
Grade 7
• Japanese developing training programs for
career path of long-term care workforce.
• Hawaiian training programs for recruiting
direct care workforce.
• Korean and Chinese training programs for
establishing occupational long-term care
workforce.
• German training programs for getting
assistants of long-term care.
Knowledge
Skills
Competence
7
Innovative
Research &
Development
Creativity
6
Best
Practices
Survey
Evaluator
Expert
Grade 6
Grade 4
Japanese Certified Care Worker: 1800 hours+
Grade 3
Certified Care Worker Candidate:
Grade 2
Care Worker Training: 450 hours
Grade 1
Beginner’s Training: 130 hours
Japanese Home Helper Rank 2: 130 hours
Caravan Mate: 6 hours
Dementia Supporter: 1.5 hours
5
Inter-discipline
Train the
Trainer
4
Certified
Learning
Supervise
Trainer
Director
3
Applied
Practical
Knowledge
Self
Control
Generic
Services
2
Rules
Tools
Team
Work
1
Basic
Ethics
Communication
Follower
5
Grade 5
2013
Care
management
6
46
Knowledge
Skills
Competence
7
8
Innovative
Research &
Development
Creativity
6
Best
Practices
Survey
Evaluator
Expert
USA (Hawaii) Classification of LTC
Registered Nurse: 4 years
Inter-discipline
Train the
Trainer
4
Certified
Learning
Supervise
Trainer
Director
3
Applied
Practical
Knowledge
Self
Control
Generic
Services
2
Rules
Tools
Team
Work
1
Basic
Ethics
Communication
Follower
5
Certified Nurse Aide: 100+ hours
Home Care Assistant: 85 hours
Personal Care Assistant: 50 hours
Elder Pal: 25 hours
Korea Classification of LTC
Care
management
Long-term Care Worker: 240 hours
Yoyangbohosa
The Korean Long-term Care
Worker is like as Japanese
Home Helper Rank 2.
However, it is competitive
with the Hospital Attendant.
The administrative longterm Care Worker is
proposed by some scholars.
Practically, social workers are
engaging in management of
long-term care providers.
7
8
Chinese Classification of LTC
German Classification of LTC
Expert Yanlaohuliyuan
5yrs+90 hrs
Senior Yanlaohuliyuan
8 years
4yrs+120 hrs
Middle Yanlaohuliyuan
6 years
Knowledge
Skills
1
Innovative
Research &
Development
Creativity
2
Administration
Skill up
Evaluator
Expert
Manager
Education
5 years
3
Emergency
Rehabilitation
Counseling
4
Hygienics
Life Support
Medication
5
Practical
Knowledge
Feeding
Toileting
Bathing
2 yrs+150 hrs
Beginner Yanlaohuliyuan: 180 hours
HealthEducation
Psychology
Recreation
RiskManagement
Competence
Train the
Trainer
Altenpfleger: 4600 hours
2 yrs
Ausbildung
Director
Rehabilitation
Reporting
Direct
Care
Altenpflegehelfer:
graduate secondary school+1 yr training
Hugong
European Care Certificate
Classification of Long-Term Care
Grade7
Skills
Competence
Applied
Practical
Knowledge
Geriatric
Nursing
Health &
Social
Services
2
Rules
Direct
Care
Work &
Training
1
Basic
Ethics
Communication
Attend
Tandem
9
Grade 8
Knowledge
3
Knowledge
Skills
Competence
8
Innovative
Research &
Development
Creativity
7
innovative
Research &
Development
Creativity
Grade 6
6
Best
Practices
Survey
Evaluator
Expert
Grade 5
5
Interdiscipline
Train the
Trainer
Grade 4
4
Certified
Learning
Supervise
Trainer
Director
Grade 3
3
Applied
Practical
Knowledge
Self
Control
Generic
Services
Grade 2
2
Rules
Tools
Team
Work
Grade 1
1
Basic
Ethics
Communication
Follower
10
Results
• Each country has its own training programs for
long-term care workforce.
• Differences between training programs are
too big to integrate them in the common
standard.
Care
management
11
12
47
Conclusion
• We need to harmonize every training
programs in an international grade system.
• The international grade system will be
developed on the ground work of training
period and contents.
• International organizations should establish
international training center for developing
long-term care.
13
48
SYMPOSIUM 2:
Techno-Aide for Older Persons on Independence, Participation,
and Health
49
Making Platform for Digital Life for Old Person in Korea
Donghee Han Ph.D
Research Institute Science for the Better Living of the Elderly
Research Center for Anti-aging Technology and Development
The 21st Century is leading us into the age of global information society. At the same time, Korea is one of the
most rapidly aging societies in the world. At this point, there are many questions how we can promote to
bridge digital divide and digital applications, how aging and technology be combined better life for old
persons. Even though digital divide among old persons is still high, there are increasing older population using
internet and cell phone more and more. The need of new approach to promote digital activities among old
persons is much higher.
This study overviewed Korean e-inclusion policy and best practices digital life for the elderly in Korea. From
RISBLE’s "Internet Navigator" as a good model making platform for digital life for old person showed the
result active and positive social inclusion.
50
韓国における高齢者のためのデジタルライフの基盤づくり
韓
東希（Ph.D）
高齢者生活科学研究所
アンチエイジング技術開発研究センター
21 世紀はグローバルな情報社会の時代へ私たちを導いています。同時に、韓国は世界で最も急速な
高齢化社会の一つです。この時点で、私たちは情報格差とデジタルアプリケーションをどうつなぎ、
どのように高齢化と技術を組み合わせ高齢者のより良い生活のために促進できるかについて多くの
課題があります。高齢者間の情報格差はまだ多いですが、インターネットや携帯電話を使う高齢者
は増加しています。高齢者の間のデジタル活動を促進する新しいアプローチの必要性は非常に高い
です。
この研究では韓国の e-inclusion 政策及び高齢者のためのデジタル生活ベストプラクティスを見て
みました。高齢者のためのデジタルライフの基礎を作るための良いモデルとして RISBLE の「インタ
ーネットナビゲーター」は社会包括的で良い結果を示しました。
原文をＡＡＢＣで翻訳したものです
51
Han, Dong Hee (Ph.D)
President, Research Institute of Science for the Better Living of the Elderly
Secretary General, Research Center for Anti-aging
Technology Development
www.wellageing.com, www.aging.re.kr
[email protected]
1
2
1080 Cyber Family
Game Festival
3
Cyber Family
•Research Institute of Science
•for the better living of the elderly
•Korea
gap between those people and
communities who have access to
information technology (IT) and
those who do not, as well as the
disparity in the intensity and nature
of IT use among groups
•www. wellageing. com.
4
 The
'04년
'06년
'08년
'10년
'11년
59.1
41.6
35.8
32.5
30.8
(Aphek, 2001; Carvin, 2000; Jackson, Zhao, Kolenic,
Fitzgerald, Harold, & Von Eye, 2008).
5
6
52
3-9
years
10’s
20’s
30’s
40’s
50’s
60’s
over
all
Contents
’02
’03
’04
’05
’06
’07
’08
’09
’10
’11
All
59.4
65.5
70.2
72.8
74.8
75.5
76.5
77.2
77.8
78.0
2002
91.4
91.4
89.8
69.4
39.3
17.9
2.3
59.4
’50
17.9
22.8
31.1
35.7
42.9
46.5
48.9
52.3
55.2
57.4
2003
94.8
94.8
94.5
80.7
51.6
22.8
5.2
65.5
Over 60
2.3
5.2
10.1
11.9
16.5
17.6
19.0
20.1
21.8
22.9
2004
96.2
96.2
95.3
88.1
62.5
31.1
10.1
70.2
Divide
57.1
60.3
60.1
60.9
58.3
57.9
57.5
57.1
56.0
55.1
2005
97.8
97.8
97.9
91.0
68.7
35.7
11.9
72.8
Source: National Survey 2011 Using Internet, Korea Communications Commission(2012)
2006
98.5
98.5
98.9
94.6
74.9
42.9
16.5
74.8
2007
79.5
99.8
99.3
96.5
79.2
46.5
17.6
75.5
2008
82.2
99.9
99.7
98.6
82.0
48.9
19.0
76.5
2009
85.4
99.9
99.7
98.8
84.3
52.3
20.1
77.2
2010
85.5
99.9
99.9
99.3
87.3
55.2
21.8
77.8
2011
86.2
99.9
99.4
88.4
57.4
22.9
78.0
99.9
Resources: KISA and ISIS
Age
3-9
years
Using 86.2
Rate(%)
10’s
20’s
30’s
40’s
50’s
60’s
over
70
99.9
99.9
99.4
88.4
57.4
35.9
8.7
Source: National Survey 2011 Using Internet, Korea Communications Commission(2012)
7
8
 Material Access:
few older adults own
their own computer or have network
connections
Digital Divide
=> Digital Culture for Older Person
 Usage Access:
Mental
Access
Material
Access
lack opportunities to use
the technology
Skill
Access
 Skill Access:
Usage
Access
lack digital skills caused by
insufficient user friendliness and
inadequate education or social support
9
Level
2004 2005
2006
2007
2008
2009
(%)
2010 2011
Access
66.3
73.5
82.9
90.1
92.5
93.6
93.8
94.3
Capacity
17.7
23.3
32.4
33.7
34.5
37.0
39.4
42.8
Quantities 25.9
Usage
33.6
41.7
44.4
45.7
47.7
50.0
51.9
Qualitativ
e Usage
20.7
29.7
39.5
40.6
42.9
45.9
48.3
52.0
Total
40.9
49.3
58.4
62.6
64.2
65.9
67.5
69.2
10
•Wellageing Center
•Internet Navigator
•Communities of
-Public Library
-Church
-Apartment
•Volunteerism
•Workforce
•Active aging
•Role models
•Social contribution
Source: 2011 national survey informatization over 50+
National Information Society Agency
11
12
53
Internet Navigator in Wellageing Center
Intergeneration
Showing Best Practices
Cyber Family
 Nam-gu Busan
•
•
•
•
•
 Apartment, Community Library, Church
Apartment
Community Library
Church
Cyber Spaces
Workforces
Benefits both Generations
Role Models
Positive Aging/Active Aging
Education
• Young Generation
• Old Generation
• Monitoring Own Communities
• Developing Workforce for Older
Persons
• Social Consensus
13
14
Dignity
Independence
Mental aging
Interaction
Physical aging
Social aging
Social Capital
Good Image
Psychological
aging
Social Roles
Destroy Ageism
Intergeneration
Emotional aging
Economic aging
G technology+ H technology
Smart system
Cloud computing system
Human Robot
Productive Aging
Ageing Intervention
New approach and challenge
15
16
Combining Tech and Aging
Life
Technology and
Type 1
BT
NT
Type 2
Anti-aging
Industry
Age Friendly
Industry
+Health
moving
Cultural/Art
Medical/ Day Life
Leisure/
Living
Social
participation/He
alth
Promotion/
Safety
Industry
- Economic
TYPE 3
HT, GT
Robot
Industry
+ Economic
Bad health
and Low
economic
Promoting health, Assistive technology, Monitoring
system, Smart house, Driving simulation, Telehealth workstation, Wireless Physiologic Monitoring
System with Imbedded Sensor for Electrocardiogram,
Robot, Aging intervention, Anti-aging medicine and
equipments so on
Good health
and High
economic
Good health
and Poor
economic
Bad health
and High
economic
- Health
17
18
54
How we can
change bad
image
20
21
22
Future Direction
Social
Rethinking of Aging
Health Promotion
Participation
Digital
Aging
U-health, ICT, Serious game,
(Information,
Workforce, Social Capital
leisure )
Long term care system,
Information
Safety and Security
Prevent depression and elder abuse, Age friendly environment with
Intelligent technologies, Tracking system,
Robot, Communication, PER system, Continually Life
Warm Internet
Thank you
Keeping analog culture, New filial piety
Positive image
Cyber family, International cyber family
23
24
55
Active Aging and the Level of Disability among Older Persons in Indonesia
Tri Budi W. Rahardjo Professor,
Vita Priantinadewi and Asviretty Yerly
Center for Ageing Studies University of Indonesia
The objective of this article is to describe the level of active aging and the level of disability among older
persons in Indonesia, as well as to inform the impact of socio-demographic status, physical environment,
healthy behaviour and several chronic/degenerative diseases on the level of disability among older persons.
It is based on data obtained from the National Socio-economic survey 2010 and Basic Health Research of
2007 and the number of samples of this study amounted to 79.445 people aged 60 and over. The results
indicate that the level of participation among older persons in the community is very high (80%), while the
participation in workplace is about 55 %. On the other hand, it found that the level of disability is also
relatively high (70% with light disability). In this regard, health status determinants such as
socio-demographic status, physical environment, healthy behavior and several chronic/degenerative diseases
had significant contribution in affecting the level of disability.
Based on this study a number of
recommendations have been proposed, such as improvement of education and rural development, practicing
healthy behavior and preventing chronic/degenerative diseases.
Key Words: Active Aging, Work Force, Health Status and Disability.
56
インドネシアの高齢者のアクティブ・エイジングと障がいの程度
トリブディ・ラハルジョ教授、
ヴィタ・プリアンティナデヴィ、アスヴィレッテイ・ヤーリー
インドネシア大学高齢化研究所
この論文の目的はインドネシアの高齢者のアクティブ・エイジングや障がいの程度を記述するだけ
でなく、高齢者の障がいの程度における社会人口統計状況、物理的環境、健康行動やいくつかの慢
性/変性疾患に及ぼす影響をお知らせします。これは国家社会経済調査 2010 と基礎健康調査 2007 か
ら得たデータに基づきます。この調査のサンプル数は 60 歳以上の方 79,445 名でした。結果は高齢
者の中で、職場への参加は 55％程度であるのに対し、地域社会への参加は非常に高い（80％）こと
を示しています。その一方で、障がいの程度も比較的高いことが（70％）わかりました。
この点では、社会的人口統計状況、物理的環境、健康行動やいくつかの慢性/変性疾患などの健康状
態の決定要因は、障がいの程度に影響を与えることに大きく寄与しています。
この研究に基づいて、教育の改善や農村地域の開発、健康行動の実践や慢性/変性疾患の予防など
数々の勧告が提案されました。
原文をＡＡＢＣで翻訳したものです
57
Background
It was predicted in Indonesia, that
the
increase in number of older people 60+, from
4.9 million in 1950, to 21.4 m in 2010 and to
79.8 m in 2050.
Active Aging and the Level of
Disability among Older
Persons in Indonesia
Tri Budi W. Rahardjo
80% were still active in family and
community
1, 2,
Dinni Agustin 1, Vitalia Susanti 1, Dharmayati Utoyo
Lubis 1
Nur Alvira 2, Deden Iwan Setiawan 2
74% of older persons complained of
chronic
1. Centre or Ageing Studies University of Indonesia, 2. University of Respati Yogyakarta
Presented at Kitakyushu Active Aging Conference in Asia Pacific 2012
10-11 November 2012, Kitakyushu,, Japan
50% were active in work place
1
2
Specific Objective
Purpose
To inform the impact of sociodemographic status, physical
environment, healthy behaviour and
several chronic/degenerative diseases
on the level of disability among older
persons
The objective of this article is to
describe the level of active aging and
the level of disability among older
persons in Indonesia
3
4
Active Ageing and Ageing in
Place
The National Socio and Economic
Surveys (2009)
Active Ageing is the
process of optimizing
opportunities for health,
participation, and
security in order to
enhance quality of life
as people age.
1
• There are 59% of older persons were in the position of
head of household for their extended family
2
• There are 47% were still active in workplace for more
than 35 hours per week
3
4
World Health Organization
5
2002 Policy Framework
• 20% listened to the radio
• the rest only viewed live drama or other cultural
performances
6
58
National Socio and Economic Surveys
(2009)/c The National Socio and
Economic Surveys (2009) cont
Active Ageing in Small Scale Bussiness
There are 71% also were active in social
activities such as :
religious activities (as supervisors and participants),
scientific meeting (as speakers and facilitators)
education as voluntary teachers
older persons association engaged in various kind 7
of activities
8
Distribution of Percentages of Ageing
Population in Indonesia
as Regards Some Health-related Behaviors
Morbidity:
Light Physical Activities
1.Yes
2.No
Vegetables Consumption
1.Seven-day/week consumption (Daily)
2.Less than Seven day/week (Not Daily)
43.2
56.8
Fruits Consumption
1.Seven-day/week consumption (Daily)
2.Less than seven-day/week (Not daily)
Susenas & Riskesdas 2007
Stroke
3.20%
Pulmonary Tuberculosis
2.60%
DM
3.30%
Cardiac Disease
High Blood Pressure
8.2
91.8
20.30%
22.20%
OA
9
62.40%
10
Output of analyses regression
logistic multinomial.
Level of Disability:
2.9%
23.50%
Mental Disorders
46.
1
53.
9
Majority of older people in
Indonesia have relatively good
functional capacity and only few
of them have serious problem
with functional capacity.
Inferential analyses result with multinomial logistic stated that
model totally significant, and so all free variables, accept diabetes
mellitus. This analyses result showed that total data variety can be
explained by factor formed is 72,86%
27.1%
Light
70%
Middle
Heavy
Output Of Analyses Regression
Logistic Multinomial
11
12
59
Continue…
Socio-Demographic status and living area
Output of Regression Multinomial Logistic
Probability analyses/Chance of Older People
Population in Indonesia with Medium Disability
compare to Light,
Variables
Sex
Chronic disease/Degenerative and Mental
disorder
Variable
Description of Variables
Joint
Blood Pressure
Heart
Diabetes
Tuberculosis
Stroke
Mental
Joint disorder, 1 : experience
High blood pressure, 1 : experience
Heart disease, 1 : experience
Diabetes Mellitus, 1 : experience
Tuberculosis Lung, 1 : experience
Stroke, 1 : experience
Mental disorder, 1 : experience
B
0.114
- 0.013
0.155
0.027
0.383
0.800
1.164
Siq
0.000
0.552
0.000
0.576
0.000
0.000
0.000
Education
Marital stats
Work status
Economic per
capita
Exp
(B)
Note
1.120 *
0.987
1.168 *
1.028
1.466 *
2.226 *
3.203 *
Notes : * Significant at alpha = 5%
Insignificant at alpha = 5%
Living
arrangement
Living area
Physical act
Vegetable
Fruit
Physical activity behavior, 1 :
routine
Vegetable consumption
behavior, 1 : 7 day/week
Fruit consumption behavior,
1 : 7 day/week
Sig.
Exp
(B)
0.277
0.277
- 0.440
0.000 1.319
0.000 1.319
0.000 0.644
*
*
*
0.265
0.000 1.303
*
- 0.007
0.352
0.841 0.993
0.000 1.421
*
-0.075
0.060 0.928
-
Chronic disease/Degenerative and Mental
disorder
Note
- 0.652 0.000 0.521
*
- 0.170 0.000 0.844
*
- 0.278 0.000 0.757
*
14
Output of Regression Multinomial Logistic
Probability analysis/chance of older people
population in Indonesia with heavy Severe
Disability compare to Light Disability
Health behavior
B
Exp
Sig.
Note
(B)
0.000 1.204 *
Notes : * Significant at alpha = 5%
Insignificant at alpha = 5%
13
Description of variables
B
0.186
Living Arrangement,1 : live alone
Living area, 1 : urban
Interaction var. expenditure per
capita/month & living area
1 : low (< average)*urban
Econ*living
Area
Continue…
Variables
Description of variables
Sex, 1 : Men
Level of education, 1 : finish Secondary
school & under
Marital Status, 1 : not married
Work Status, 1 : working
Expenditure per capita/month, 1 : low (<
average)
Variable
Description of Variables
Joint
Hipertention
Hart
Diabetes
Joint disorder , 1 : experience
Hypertention, 1 : experience
Hart disease, 1 : experience
Diabetes Mellitus, 1 : experience
Tuberculosis lung, 1 :
Tuberculosis
experience
Stroke
Stroke, 1 : experience
Mental
Mental disorder, 1 : experience
Notes : * Significant at alpha = 5%
Insignificant at alpha = 5%
Notes : * Significant at alpha = 5%
Insignificant at alpha = 5%
B
Siq
Exp (B)
0.000
0.011
0.187
0.876
0.822
0.869
0.931
1.018
*
*
-
0.684
2.181
2.616
0.000
0.000
0.000
1.981
8.854
13.682
*
*
*
15
16
Continue…
Socio-Demographic status and living area
Variables
Sex
Education
Marital stat
Working stat
eco_kapita
Livingarr
Living area
Econ* living
area
Exp
(B)
Continue…
Health behavior
Description of variables
B
Sig.
Sex, 1 : men
Education level, 1 : finish secondary
school & under
Marital Status, 1 : not married
Work Status, 1 : Work
Expenditure perkapita/month , 1 : low (<
average)
0.380
0.000 1.462
*
0.321
0.614
- 0.943
0.001 1.379
0.000 1.847
0.000 0.390
*
*
*
Physical act
0.068
0.453 1.070
-
Vegetable
- 0.265
0.271
0.002 0.767
0.002 1.312
*
*
Fruit
*
Notes : * Significant at alpha = 5%
Insignificant at alpha = 5%
Living Arrangement,1: live alone
Living area, 1 : urban
Interaction var. Expenditure
perkapita/month & living area
1 : low (< average)*urban
Notes : * Significant at alpha = 5%
Insignificant at alpha = 5%
Note
Variables
0.304
Note
- 0.195
- 0.140
- 0.072
0.018
0.007 1.356
17
Description of variables
B
Physical activity behavior light ,
1 : Yes
- 1.956
Vegetable consumsation behavior,
1 : 7 day/week
- 0.430
Fruit consumtion behavior , 1 : 7
day/week
- 0.316
Sig.
Exp
(B)
Note
0.000 0.141
*
0.000 0.650
*
0.005 0.729
*
18
60
Disability based on active
aging variable
Conclusion
An aged person with an active job had a
lower risk of having medium/heavy disability
than the light one. This showed that work
activities were instrumental for the aged
persons to keep their functional capacities.
By doing works, the physical entity and
brain remained active so that the chance of
being physically and mentally healthy was
greater.


We conclude that :
Health status and morbidity determinants as
well as active ageing determinants(working)
had significant contribution in affecting the
level of disability .
It means that having good health behavior,
being stay healthy, and being stay active
will prevent the severity of disability.
19
20
21
22
ACKNOWLEDMENT






PRESIDENT OF ACAP
PRESIDENT OF AABC
AABC SECRETARIAT
ACAP TEAM
CAS – UI 1
Respati University , Yogyakarta
2
61
Inclusive design for ageing and climate change
Yasuyuki Hirai
Associate Professor
Faculty of Design, Kyushu University
Our living environments are changing rapidly in both social and natural aspects.
Climate change and demographic change especially ageing are regarded as
two different movements.
Energy saving and reduction in emissions of greenhouse gases are common
actions against climate change and global warming. However, climate change is also related to social
exclusions, in both daily life and extreme natural disaster situations.
For people with less thermal capacity, extreme outdoor heat situations
act as barriers for isolation in daily social life.
According to the United States Environmental Protection Agency (EPA),
‘Particular segments of the population such as those with heart
problems, asthma, older adults, the very young and the homeless can be
especially vulnerable to extreme heat’.
As ageing society is steadily growing, inclusive design for ageing
and climate change must be considered.
There are some attempts for the integration of those two different
movements taking places, such as the International Association for
Universal Design (IAUD), and United Nations Population Fund (UNFP),
but it is just beginning.
How can we integrate inclusive design for ageing and climate change?
This research discusses the importance of designing safety and
inclusive living environment for ageing population who are vulnerable
against both social exclusion and natural climate change.
62
高齢化と気候変化のための包括デザイン
平井
康之
准教授
九州大学芸術工学部
私たちの生活環境は、社会と自然の両方の面で急速に変化しています。
気候変動や人口動態の変化、特に高齢化は二つの異なる動きとみなされます。
省エネルギーや温室効果ガスの排出削減は気候変動や地球温暖化に対する共通の動きです。
しかし、気候変動は日常生活や極端な自然災害の状況において社会的疎外と関連しています。
より少ない熱容量を持つ人々にとって、極端な屋外の熱状況は毎日の社会生活の隔離のためのバリ
アの働きをします。
米国環境保護局（EPA）によると、心臓疾患、ぜんそく、高齢者、子どもやホームレスのような人口
の特定の部分は、特に極端な暑さに対して脆弱です。
高齢化の確実な成長につれて、高齢化や気候変動のための包括的デザインも検討する必要がありま
す。
これら二つの異なる動きの統合のために、国際ユニバーサルデザイン協議会（IAUD）や国連人口基
金（UNFP）のようないくつかの試みがありますが、始まったばかりです。
高齢化のための包括的デザインと気候変動をどのように統合できるでしょうか？
この研究は社会的疎外と自然の気候変化の両方に対して脆弱な高齢者人口のために安全設計と包括
的生活環境の重要性を議論するものです。
原文をＡＡＢＣで翻訳したものです
63
Background
Inclusive design
for ageing and climate change
Yasuyuki Hirai
Faculty of Design Kyushu University
JAPAN
10 November 2012
1
2
1. Background
Background
The essential context for the
increasing urbanisation of the
21st Century is global climate
change and global population
ageing (Harper et.al, 2010)
As for the urbanisation and global
population ageing, according
to the United Nations, 70% of
the world’s population will be
urban, with half the global city
population being over 60, by
2050 (United Nations, 2008).
.
global
climate
change
According to the United States
Environmental Protection
Agency (EPA), ‘Particular
segments of the population
such as those with heart
problems, asthma, older
adults, the very young and the
homeless can be especially
vulnerable to extreme heat’.
global
population
ageing
global
climate
change
global
population
ageing
3
4
2. Purpose
The research question of this study is how we can integrate
population ageing and climate change.
These two major global drivers of 21st Century change are in different
contexts, it is necessary to understand the relationship to know
future opportunities and challenges for effective solutions for both
at different levels from convergences and conflict points of views.
Purpose
5
6
64
2. Purpose
This study is an initial research for
this new challenging area,
prior to field user research.
Method
In this research, Japan is chosen
as a case study. Because
Japan is facing world’s fastest
ageing population society,
The proportion of older persons
over 65 expected to become
25.2% in 2013, 33.7% in 2035
and 40.5% in 2050 (Fig.1).
Figure 1:
Total Population by Major Age Groups
7
8
3. Method
What is
Climate
Change?
Issue matrix is created to research
to gain holistic understanding,
what are available in the
current urban environment,
that could be considered as
means to protect ageing
population (Fig.2).
Figure 2. Issue Matrix
9
10
Solutions/ Issues
4. What is climate change?
Influence to
Environment
Influence to
Ageing
Air/Light
Warming, Heat and
Cold Wave
Ground/S
oil
Heat Island, Sultry
Night by Heat
Retention in the
Pavement,
Earthquake
Heat Exhaustion,
Respiratory
Problems, Poor
Health, Sickness,
Heart Attack,
Stroke, Serum
Osmolality Control
in Winter
Type of Environment
Climate change is a long-term
shift in the climate of a
specific location, region or
earth.
Direct impacts
Both natural and human factors
that can cause climate
change are called ‘climate
forcing’, since they push, or
‘force’ the climate to shift to
new values (Fig.3).
Indirect impacts
Water
Rise in Ocean Level,
Rainfall Precipitation
（ Shortage of Water,
Drought, Flood,
Tsunami)
Water Shortage,
Disaster, Dehydration
by Weakened Thirst
Sensation
Plants/An
imals
Decrease in
Agriculture
Production,
Increased Weeds
Mulnutrition, Poor
Health, Sickness,
Food Shortage
Air/Light
Acid Rain,
Photochemical
Smog, Bacteria,
Germs, Particles
Ground/S
oil
Pollutant Elements
Water
Plants/An
imals
Figure 3: What is climate change?
Disposal
s
11
Polluted Water
Flood
Increase of Harmful
Insects, Molds,
Pollens, Vectors,
Decrease of Useful
Insects
Harmful Elements,
Load to
Environment
City/ Community
Home
Communal Bath
Green Material (Diatomite)
Heat Alert
Heat Insulation
Green House, Green Planted Roof
Natural and Indirect Lighting (Biorythm)
HeatShelter
Natural Ventilated Underground Stn.
Park, Farm, Veg Farm, Eco Park,
Biotope
Green Road Design
Dyke, Levee (Water, Mountain)
Retention Pond, Reservoir
Housing Relocation
Eco LED Light
Structure against Flood
Water Saving System
Eco Sanitary
Desearted City (New Convenient Store)
Vegitable Factory at Home
Pollution Alert
Particle Shield
Bacteria Shield
Epidemic, Chronic
Respiratory
Problems such as
Asthma, Allegy,
Diarrhea, Poor
Health, , Dengue
and Chikungunya
Fever, Sicknes
Lead to Increased
Mortality
Improvement of Water (River, Sea)
Water Purification Facilities
(Milenium City)
Revitalization of Ecology
Ecological Development/ Milleniuum
City
Harmful Insects Shield and Treatments
Bacteria Shield and Treatments
Use of Disposed Heat (Hot Bath for
Older People)
Septic Tank, Disposal Facilities
(sewage treatment facilities )
Bio Toilet
Figure 2. Issue Matrix
65
Geothermanl Energy, Saving Heat, Cold)
Natural Air System for Older, Radiant
Heat, Solar with Heat, Heat Exchange,
Cool Tube, Kita-Kyushu Eco House
12
5. What could happen if the climate changes?
What could
happen if
the Climate
Changes?
Climate change could affect health and well-being.
Many larger cities could experience a significant rise in the number of
very hot days.
The World Health Organization (WHO) estimated 166,000 worldwide
deaths and about 5.5 million disability-adjusted life years were
attributable to climate change in 2000 (Campbell-Lendrum, D, et
al. 2007).
13
14
6.Direct Impact of
Climate Change
Direct
Impact of
Climate
Change
6-1.Heat by air circulation and
direct sunlight
In terms of the effects caused by
heat, there have been reports
on an increase in the mortality
rates of patients with
cardiovascular and respiratory
diseases, and an increase in
the number of heatstroke
patients (Figure 4).
Figure 4:
Trends in Number of Heat Stroke Patients Per City
16
In Japan, 2007
15
6.Direct Impact of
Climate Change
6.Direct Impact of
Climate Change
Consequently, Japanese
researchers examined the
differences in sensory
perceptions to cold and hot
conditions between young and
elderly subjects to gain a better
understanding of the
physiological limitations of the
elderly.
CASE STUDY: Heat Shelter
The results showed significant
digression in elderly subject’s
physiological response to
temperatures, in cold conditions.
(Tochihara et al., 1993).
For the protection of older people
at home without air
conditioning and at outside,
the fire station in Suita city in
Osaka started Heat shelter,
where the temperature is kept
at 28C.
Elderly people are more prone
to heat stress than younger
people (Centers for Disease
Control and Prevention,
2012).
Figure 5. Heat Shelter
17
18
http://www.asahi.com/special/mousho/OSK20100820007
0.html
66
6.Direct Impact of
Climate Change
Indirect
Impact of
Climate
Change
6-2.Water/floods
CASE STUDY:
Housing Relocation
For the protection of local
residents in Tohoku who were
hit by Tsunami in March 2011,
housing relocation to higher
ground is planned and carried
out.
Figure.7
Housing Relocation Plan by Minami Sanriku-cho
19
(Minami Sanriku-cho Homepage,2012)
20
7. Indirect Impact of
Climate Change
7. Indirect Impact of
Climate Change
Urban environments trap various
pollutants that create acute
and chronic diseases.
7-2.Plants/ Animals
Some species of agricultural crops will
be adversely affected by higher
temperatures, increased weeds
and harmful insects.
This diffuse pollution appears as
photochemical smog in Japan
and Korea and acid rain; in
addition, recent years has
seen an increase days when
fine particulate matter (Kosa)
from dessert sand storms
from the increasing
desertification in China and
the Southeastern sector of
Inner Mongolia.
It is also possible that global warming
will lead to global food shortages.
High Temperature Injury of Ripening
in Rice
Figure.9 Agriculture-Quality Degradation
Figure 8. Air Pollution
Source:
22
http://www.icharm.pwri.go.jp/news/news_e/apws1_ed_presentation
s/01_kadomatsu.pdf
21
8.Discussion
8-1. Findings
Those climate change issues are
important, but not designed
from user centered design
point of views, that may create
exclusion of older people.
Discussion
We need to identify what design
criteria is necessary for older
population to use and
experience each solution, and
how to connect those different
solutions from human centered
points of views.
23
Figure 5. Heat Shelter
http://www.asahi.com/special/mousho/OSK20100820007
0.html
24
67
8.Discussion
8.Discussion
There are new attempts in Japan,
such as ‘Smart Design’ Award
by Nikkei Design Magazine
that started this year. It looks
at all kinds of designs
including not only product but
also service designs, and
focuses on dual values, both
‘daily (itsumo)’ and ‘if only
(moshimo)’ contexts.
‘daily’
(itsumo)
Smart Design
‘if only’
(moshimo)
8-2. Four categories
Connect
For holistic understanding, a
simplified hypothesis chart is
created based on the issue
matrix.
Traditional Design
Separation
Figure.10 Smart Design
‘Concentration’ of city efficiency
and ‘Reduce’ for home
efficiency are two key issues
for climate change,
Case Study :
Panasonic
LED light for disaster
Smart Design Award 2012
Figure.11 LED Light
25
26
8.Discussion
8.Discussion
City/Community Level
Concentration
Communal Bath
Clean Mobility (EV, Bicycle)
Green Material (Diatomite)
E&U House by Panasonic
Natural Ventilated
Underground Station
Walking City (within 400-500m)
Green House
Natural Air System for Older,
Radiant Heat, Solar with Heat,
Heat Exchange, Cool Tube,
Kita-Kyushu Eco House
Green Planted Roof
Micro Climate Control Clothing
Environment to Maintain Proper
Body Fluid Balance
Visitability (Semi Public at
Home)
Natural and Indirect Lighting
(Biorhythm)
Park, Farm, Veg Farm, Eco
Park, Biotope
Use of Disposed Heat (Hot
Bath for Older People)
Ecological Development/
Milleniuum City
Multi Generational Dwellings
(Eucalyptus Hill)
Plutinum City Network (Older,
Ecology, Low Carbon)
Place for Interaction (Yame
Interaction Centre)
Green Road Design
Reduce vs Comfort
(Convergence) From climate
change, green housing
planning are good to reduce
energy consumptions while
supporting activities for older
people with flexibility,
hopefully with less running
cost, if they are planned
balance in mind.
Geothermal Energy, Saving Heat,
Cold
NEXT21 (Human and Eco
Housing)
Reduce vs Safety
Concentration vs Safety
Safety
Against
Nature
Home Level
Reduce
Reduce vs Comfort
Concentration vs Comfort
Comfort
By Nature
Figure.12 Hypothesis Chart
While solutions for ageing
population can be categorized
in ‘Safety against nature’ level
and ‘Comfort with nature’ level.
Heat Shelter
Pollution Alert
Heat Alert
Housing Relocation
Shrinking City
Particle Shield
Eco Compact City by MLIT
Improvement of Water (River,
Sea)
Bacteria Shield
Convenience Green Grocer
Store
Revitalization of Ecology
Dike, Levee (Water, Mountain)
Happy Network (Eucalyptus Hill)
Retention Pond, Reservoir
Medical Convenience Store
Dispersed Care by Care by
MHLW
Water Purification Facilities
(Milenium City)
Septic Tank, Disposal Facilities
(sewage treatment facilities )
Figure.12 Hypothesis Chart
Bio Toilet
Eco LED Light
Heat Insulation (Insulated
Window→Bathroom→Safety）
Structure against Flood
Eco Sanitary (Warm seat)
Harmful Insects Shield and
Treatments
Vegetable Factory at Home
Water Saving System
28
27
Figure.12 Hypothesis Chart
8.Discussion
8.Discussion
Concentration vs Comfort
(Conflict) For climate change,
minimizing city size is
important for effective and
efficient city infrastructure, but
this may create uncomfortable
environment for older people.
Reduce vs Safety
(Convergence) From climate
change, insulations and
shields are important to
minimize heat and other
losses, and those can be
protectors for older people’s
health against hazards.
Figure.12 Hypothesis Chart
Figure.12 Hypothesis Chart
29
30
68
8.Discussion
8.Discussion
Concentration vs Safety
(Convergence) For climate
change, ensuring
counteractions against
hazards by effective
concentration is important,
and there is convergence with
life support service for older
people.
8-3. Convergence and Conflict
CASE STUDY: Communal Bath
Communal bath in a block of flats,
where residents including
lonely older people and/or
young children can interact,
that can secure older people’s
bathing safety, and achieve
efficient use of energy.
Figure.13 Communal Bath
Figure.12 Hypothesis Chart
32
31
8.Discussion
8.Discussion
CASE STUDY:
‘Eco Compact City’
8-4. Simulation Thinking
If we look at those solutions from
older people point of view,
there are possible scenarios.
by Ministry of Land, Infrastructure
and Transportation (MLIT) for
local cities in Japan, in order
to minimize the size of social
infrastructure for efficiency,
especially for transportation,
and realize effective social
services at the centre of a city,
including health care.
Figure. 14 Eco compact city by MLIT
http://www.gyosei.co.jp/home/topics/jichi_kasumi09112.html
33
For example, the Ministry of
Environment carried out a
simulation of a walking person
under a hot day.
Figure. 15 Heat Map and Photo of a Street
8.Discussion
8.Discussion
The result suggested to create
roads with shadows
underneath green trees.
Underground shopping mall is
common as it is all weather
proof, and comfortable for
shopping. However, the
artificial climate does not fit
older people’s needs.
If we think this way,
Convenience shop may be
utilized as heat shelters.
34
Also, it needs huge energy
consumption to warm and
cool vast space.
Figure. 16 Natural Lawson
Tadao Ando designed new
Shibuya underground station
in 2010, the world first
naturally ventilated
underground station.
35
Figure. 17 New Shibuya Station
69
36
9. Conclusion
Climate change and population change are found side by side in case
studies, but not connected well yet.
Conclusion
However, by creating issue matrix, we can start to think about visions
and solutions.
In 2010, the Japanese Government set New Economic Growth
Strategy.
This means that there is a strong opportunity in Japan to integrate
climate change and population ageing for economic growth.
Design thinking can inspire such fusions with users’ view points and
imaginations, for new visions.
37
Dba
‘mo.
38
earth heart
Thank you for listening!
39
70
How will we manage the sustainable transport system for active aging society?
― the case in Japanese Public Transport Systems―
Hisashi OOI, Ph.D.
Associate Professor, Faculty of Economics OITA University
Head Facilitator of Community and Transport Support Network in Kyushu (“Q-suppo Net”)
In order to achieve active aging society, for social participation and everyday life, such as shopping,
commuting, medical care and so on, I think public transportation is one of the most necessary social
infrastructure.
Most Japanese public transportation are operated by the private sector, which is unusual in the world. In recent
years, the management circumstance and sustainability are seriously worsen due to significant decline in
demand. Entry and exit deregulation of omnibus industry has been introduced in 2002, and subsidy and
planning institutions have recently been changed. These changes of institutions are with the intention that all
actors actively need to do what to improve issues of public transportation, but a number of problems have
been left yet. Facing an aging society and declining populations in Japan, it is necessary to change the way of
public transport management.
From the issues in Japanese public transportation, I’m going to discuss how to plan, design and manage the
sustainable transportation for the active aging society, social participation and regional development.
71
アクティブ・エイジング社会における持続可能な交通システムとは
― 日本における公共交通の事例から ―
大井
尚司
大分大学経済学部経営システム学科准教授
地域と交通をサポートするネットワーク in Kyushu
（Ｑサポネット）世話人代表
アクティブ・エイジング社会を実現するにあたって必要な通勤・通学・買い物・医療などの日常生
活や社会参加において、公共交通はそれらを支える重要なインフラである。日本の公共交通は、世
界でも珍しく民間事業者によりそのほとんどが運営されてきたが、近年は著しい需要の減少により
その持続可能性が懸念される状況にある。2002 年に乗合バスの需給調整規制緩和が導入され、補助
金や交通計画を支える制度の変更が行われた。これらの制度変更は、すべての当事者が交通問題に
ついて能動的に考えあるいは取り組む必要性があるということを意図していたが、実際は意図通り
には進んでおらず、依然として数多くの問題が残されているのが現実である。人口減少・高齢化社
会を迎える中、公共交通のマネジメントのあり方を大きく転換して行く必要がある。
この報告では、持続可能な公共交通をどう設計・運営すべきかについて、アクティブ・エイジング
社会を支えるまちづくりや雇用・社会参加などの問題も念頭に置きながら、日本の公共交通におけ
る問題点を題材に議論を行いたいと考えている。
72
Agenda
How will we manage
the sustainable transport system
for active aging society?
1. Issues of Public Transport Sustainability in
Japan
- the case in Japanese Public Transport Systems -
2. Features and Barriers for solving the issues
about public transport
ACAP2012 in Kitakyushu Symposium 2
November 10, 2012 (Saturday)
3. Concluding Remarks
Speaker: Hisashi OOI, Ph.D.
Associate Professor, Faculty of Economics OITA University (Transport Economics)
Head Facilitator of Community and Transport Support Network in Kyushu(“Q-suppo Net”)
2012/11/10
ACAP2012 in Kitakyushu(ⓒH.OOI)
1
2012/11/10
ACAP2012 in Kitakyushu(ⓒH.OOI)
2
The Present Situation of Japanese Public Trasnportation
（Index of Passenger carried : normalized at 1970fy=100）
※Note: “Car” before 1985 except “Kei” Cars. （Source: Ministry of Land, Infrastructure, Transport and Tourism)
1. Issues of Public Transport
Sustainability in Japan
300
250
Compared
1970 to 2005 fy
（４）ピーク時に比べた輸送指数
（縦軸は1970年を100とする指数）
Car : Doubled ⇔ Omnibus : Less than Half
バス（全国）
Omnibus(all Japan)
Omnibus(except
バス（地方のみ）
metropritan area)
200
鉄道
Rail
旅客船
Ferry
2. Features and Barriers for solving the issues
about public transport
150
自動車
Car
100
3. Concluding Remarks
50
0
1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005
2012/11/10
ACAP2012 in Kitakyushu(ⓒH.OOI)
2012/11/10
3
(mainly focused on omnibus industry)
• Serious Decline of Demand
Decrease about 20 % both revenue and cost before and after Deregulation:
No Improvement of Operational Environment by deregulation
⇒ Shown at Slide 4
600 （円／キロ）
600
• Worsened the management environment
550
550
東北
500
東北
関東
関東
450
北陸信越
中国
近畿
400
― omnibus deregula on of entry and exit (2002)
the rule of national subsidy for omnibus (2001 fy)
Introduce Management Incentive and Competition in
Rural Transport Subsidy System
(2006, revised 2010)
中国
四国
九州
• Widely Institution Changed
中部
近畿
350
⇒ Shown at Slide 5
北陸信越
450
中部
400
― some company bankrupted(especially, in Kyushu
area)
北海道
北海道
500
四国
350
九州
300
300
250
250
200
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 （年度）
2012/11/10
4
Issues of Public Transport
Operating Conditions of Omnibus Operators
［Left: Revenue(JPY) per 1 car km / Right: Operating Cost(JPY) per 1 car km］
（円／キロ）
ACAP2012 in Kitakyushu(ⓒH.OOI)
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
ACAP2012 in Kitakyushu(ⓒH.OOI)
（年度）
2012/11/10
5
73
ACAP2012 in Kitakyushu(ⓒH.OOI)
6
Features and Barriers for solving issues
about public transport
(1) Mismatch between service supplied by
operators and demand (needs, lifestyle, etc.)
(2) Knowledge level and Skills of planning public
transport systems (especially, municipal staff)
(3) No change of transport operators’ business
model
(4) No change of inhabitants’ attitude for
transport sustainability
1. Issues of Public Transport Sustainability in
Japan
2. Features and Barriers for solving the
issues about public transport
3. Concluding Remarks
2012/11/10
7
ACAP2012 in Kitakyushu(ⓒH.OOI)
2012/11/10
◎ Not matching between transport service and needs…
• Municipal Staff’s Job Rotation System
• Destination such as Hospitals, Stores, City Office
⇒ Move from Central Area
― 2 or 3 years after, changed another section
― Not enough me to be specified his skill
⇔ Bus route: Central Area – Suburb
• Change jobs by change of institution
• Changed Lifestyle of School Students, Office Workers
Multi and Complicated Pattern of their life
⇔ Transportation Schedules:
match specific (single) pattern only
― “Only Account Subsidy”→”Totally Operating
Transport”
― Need to manage all except for running buses
• Changed User’s Favor
• Organization of Transport management and
planning
― more flexible mode(cars, bikes, personal mobility)
－ simple, cheap, easy to access information
ACAP2012 in Kitakyushu(ⓒH.OOI)
― few has specified division
9
2012/11/10
(3) No change of transport operators’
business model
10
• Heavily depend on Public Sector or Operators
― before and a er deregula on, no change
― not needed marketing skills, change of business model
― No responsibility for sustaining public transport
― Opera ng by private operator for a long me
― Compensating loss by public, not residents
• Worsen operating circumstance
― No change of fare since 1998(before deregulation)
― Decline demand, revenue, public subsidy, operating staffs
―Increase operating cost, but hard to exit (stop) service
• Lack of awareness of public transport situation
― Most of residents = car user ( few public transport user)
― No one don’t think there is no public transport in her town…
• Public transportation operators need to manage by selffinancing system in Japan
• No Skill of discussion about transport
― Only need to achieve “ reducing cost “ or “unchanged ”
― Managing “Cross Subsidy”, but impossible after deregulation
ACAP2012 in Kitakyushu(ⓒH.OOI)
ACAP2012 in Kitakyushu(ⓒH.OOI)
(4) No change of inhabitants’ attitude for
transport sustainability
• Effect of No competition for long time
2012/11/10
8
(2) Knowledge level and Skills of planning
public transport systems
(1) Mismatch between service supplied by
operators and demand
2012/11/10
ACAP2012 in Kitakyushu(ⓒH.OOI)
― Only petition to Operators or Local Government …
11
2012/11/10
74
ACAP2012 in Kitakyushu(ⓒH.OOI)
12
Points of designing and managing sustainable
transport system for active aging society
- from Japan experience • Need to optimize social planning and
management for supporting active aging
society by using public transport
1. Issues of Public Transport Sustainability in
Japan
2. Features and Barriers for solving the issues
about public transport
• Active Participation of all people concerned and
their discussion
3. Concluding Remarks
2012/11/10
ACAP2012 in Kitakyushu(ⓒH.OOI)
• Need to jointly own and disclose all
information, resources, data, and knowledge
13
2012/11/10
Point 1
◎ Active Participation of all people concerned and
their discussion
• (Now) Car user
⇒(Future) Public Transport user !
• Paying many cost for public transport !
user’s lifestyle (students, workers, mothers, etc.)
making chance of social participation (health, employment, etc.)
direction of that city(town) management
－ think how to manage both efficiently and impartially
• “Can we live there for the future?”
― Recognize “Public Transport is the essential
Social Infrastructure and System for sustainable life”
― Need to Change
business model of transport operator
municipal staff awareness for public transport management
ACAP2012 in Kitakyushu(ⓒH.OOI)
15
2012/11/10
Point 3
16
If you need to contact,
please feel free to send me e-mail
(address : shown below).
such as costs, passengers, revenue, etc.)
Hisashi OOI , Ph.D.(Transport Economics)
Associate Professor, Faculty of Economics OITA University
(Head Facilitator of “Q -suppo net”)
• Need to discuss transport problem objectively
⇒ Such information is very necessary !
ACAP2012 in Kitakyushu(ⓒH.OOI)
ACAP2012 in Kitakyushu(ⓒH.OOI)
THANK YOU
FOR YOUR ATTENTION!
◎Need to jointly own and disclose all
information, resources, data, and knowledge
• Existence many information, resources, data,
knowledge about transport
⇒ They are unevenly distributed or owned,
not disclosed (especially transport modes’ data,
2012/11/10
14
Point 2
◎ Need to optimize social planning and management for
supporting active aging society by using public transport
― Not focusing only optimization transport modes or
management
― Concern about (for example)
2012/11/10
ACAP2012 in Kitakyushu(ⓒH.OOI)
E-mail: [email protected]
17
2012/11/10
75
ACAP2012 in Kitakyushu(ⓒH.OOI)
18
WORKSHOP
76
Workshop 1:
Part 1; Towards the Development of Quality Care Workforce: Lessons from
accepting the Foreign Nurses and Caregivers to Japan and beyond
Chair: Prof. Takeo Ogawa (Kumamoto Gakuen University)
Panelists: Prof. Shun Ohno (Seisen University), Prof. Yuko Hirano (Nagasaki University), Prof. Kunio
Tsubota (Meiji University), Assoc. Prof. Wako Asato (Kyoto University) and Assoc. Prof. Reiko Ogawa
(Kyushu University)
Commentator: Deden Iwan Setiawan, and Nur Avia Pasca Wati, and others.
Responding to the rapid ageing society, many countries are facing the major challenges in how to cope with
the chronic and pervasive shortage of quality care workforce. In Europe and Asia, increasing number of
migrants are entering into the care labor market and filling the gap between the state provision to provide care
and actual need for care. Japan has also started to accept migrant nurses and caregivers since 2008 as
“candidates” for accredited professionals under the Economic Partnership Agreement (EPA). In our research
findings, the foreign care workers have demonstrated their capability to be able to work in Japanese hospitals
and care facilities. However, this system seems to be posing heavy burdens on both candidates and receiving
hospitals/facilities to fit the migrant workers into the Japanese system and require them to pass the national
exam within a limited period of time. Certain contradictions are inherent in the way this migratory scheme has
been designed and the chance for the migrants to be fully incorporated within the Japanese system is not very
promising. The panel aim to discuss the pressing issues and strategies towards standardization of care work in
order to secure the care workforce and ensure the safety and quality of care.
77
ワークショップ１
パート１：質の高い介護労働力の確保に向けて：日本における外国人看護師・
介護士の受け入れから学んだこと
議長：小川
全夫（熊本学園大学教授）
パネリスト：大野俊（清泉女子大学教授）、平野裕子（長崎大学教授）、坪田邦夫（明治大学教授）
安里和晃（京都大学准教授）、小川玲子（九州大学准教授）
急速な高齢化社会に対応するため、多くの国々が慢性的に広がる質の高い労働者不足にどう対処す
るかという大きな課題に直面しています。ヨーロッパとアジアでは増加する移民が介護労働市場に
参入し、介護において国家の供給と実際に必要な介護の間のギャップを埋めています。日本は経済
連携協定【EPA】に基づき認定された専門家のための「候補生」として 2008 年から移民看護師や介
護士の受け入れを開始しました。私たちの研究成果では、外国人介護労働者は日本の病院や介護施
設で働くことができることを証明しています。しかしながら、このシステムは移民労働者を日本の
システムに入れて制限期間内に国家試験に受かることを要求し候補生と受入れ側の病院や施設に重
い負担を強いているようです。
特定の矛盾がこの固有な移動スキームに設計され、日本のシステムの中に組み込まれる見込みはあ
りません。介護労働力を確保し、介護の安全性と質を確保するために、介護の仕事の標準化に向け
た喫緊の課題と戦略を議論することを目的としています。
原文をＡＡＢＣで翻訳したものです
78
Active Ageing Conference in Kitakyushu, 2012
Current Status of Globalization of Care
 In the OECD countries, in average, 11% of the employed nurses
and 18% of the employed doctors are foreign born(OECD, 2007).
 In UK, migrant workers account for 19% of care workers and 35%
of nurses in care of older people. In London more than 60% of
all care workers are foreign born (Cangiano et al., 2009).
 In Taiwan, 62% of the long term care is provided by the migrant
care workers (Wang, 2010).
 In Japan, 32% of the care facilities in Tokyo (n=316) has
employed a foreign staff(Tokyoto shakai fukushi kyogikai, 2009).
 In Japan, 42% of the care facilities which accepted migrant
caregivers under EPA (n=86) has employed the foreign staff
(Tsubota et al. 2012).
Reiko Ogawa
Kyushu University
1
2
Framework of Migration of Care Workers
Employment of migrant caregivers
 Migrant nurses/care workers are expected to pass the
 Difficulties in recruiting caregivers from the domestic
labor market due to low wages and poor working
conditions
national exam within a limited period of time
 Migrant nurses/care workers will have free Japanese
language training for six months to one year before they
start working
 Hospitals and care facilities are expected to provide
Japanese language training & preparation for the exam
 Equal salary and labor standard law is applied as the
Japanese co-workers
 Expenses: The Japanese government shouldered approx.
US$30,000 per person including recruitment, airfare, six
months Japanese language training and the elderly homes
shouldered approx. US$6,000 per person including
matching, partial cost for training and domestic
transportation.
 Even though the language proficiency and lack of
cultural knowledge of migrant caregivers serves as
constraints for quality care, there are widespread
appreciation for their social skills and work ethics
3
4
Transition of Numbers of Indonesian Candidates
Entering Japan(2008～2012)
Transition of Numbers of Filipino Candidates
Entering Japan (2009～2012)
200
189
180
160
173
140
Care Worker
120
100
104
104
77
80
58
72
60
40
39
47
20
Nurse
29
0
2008
2009
2010
2011
2012
5
6
79
Are you satisfied with the migrant
care worker you have employed?
Do you have any expectations about the
future of the migrant workers? Yes-90%
Hospital
7.1
hospitals
35.7
42.9
11.9
2.2
20
51.1
6.7 2.2
17.8
2.4
16.2
Care Facility
21.6
48.6
1.4 10.8 1.4
n=45
0%
4.9
care facilities
53.7
34.1
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
For those who are capable, we expect them to become managers
4.9 2.4
Expect them to become educators of the newly arrived migrants
n=84
Expect them to stay as long as possible
0%
10%
very satisfied
20%
30%
satisfied
40%
50%
average
60%
70%
80%
not so satisfied
90%
Expect them to stay for the contract period
100%
Expect them to become our partners in their home countries
dissatisfied
Source: Tsubota et al., 2012
Others
Source: Tsubota et al., 2012
7
8
Experience of EPA migrants to pass the
national exam of certified care worker
Difficulty in passing
 In 2012, first exam for the 95 Indonesian care workers
who arrived in 2008
 The field that the EPA candidates have to study covers
social welfare for the elderly and disabled, social
security systems, rehabilitation, caregiving skills,
psychology, home economics and medicine.
 36 migrants passed. Passing ratio was 36.7%. c.f.
Japanese 63.9%
 They have to answer 120 questions within 210 minutes.
 Difficult to learn the Japanese language
 Those who have passed had
 Difficult to cope with the stress
good support from the care
facility and the staff
 Difficult for the care facilities to provide support
9
10
Effort by Care Facility A
Effort by Care Facility B
 Vocabulary
 Handout
book of
Japanese
Indonesia
 5,420 words
which
includes
basic
terminology,
caregiving
terminology,
and
terminology
from the
national
exam
that goes
along with
the
textbook
 Repeatedly
study the
important
points
11
12
80
Experience of the migrants
Experience of the care facilities
 We don’t have a clear concept of social welfare in
Indonesia. After I studied I learned how the social
security systems have been developed in post war
Japan and came to understand that Japan also used to
be very poor. (Indonesian caregiver)
 The migrant caregivers had to study very hard because
they don’t know the background of Japanese society.
For example, in order to learn about social security,
you need to know the Japanese Constitution which
states the basic human rights. (Educator in care
facility)
 In order to provide quality care, we have to go back to
the Article 25 of the Japanese Constitution which
states the right to life （生存権）and unless you
understand the fundamental idea of social welfare, it
is difficult to be proud of your work as a caregiver.
(Educator in care facility)
 Initially, I thought that caregiving is only about
helping the elderly in their daily activities. But after I
started studying for the exam, I came to know that
social welfare is about the protection of human rights
and respecting their dignity. (Indonesian caregiver)
13
14
Configuration of
Migrants in the Care
Workforce in Japan
Risk Management in Caregiving
Permanent
Residence
Spouse Visa and
Special Resident
Visa holders i.e.
 Unexpected accidents leading to death in care facilities. In
EPA Certified
Care worker
who pass the
national exam
(36)
Chinese, Koreans and
Filipinos
Osaka, there were at least 2122 cases of accidents happened
during caregiving in 2004, among which 67 resulted in
death of the elderly. (Yomiuri Shimbun, 2005)
 Industrial compensation in care facilities. In 2010, there
were at least 5533 cases of caregivers falling or breaking
their back while providing care. (Asahi Shimbun, 2012)
 Law suites for compensation: falling, suffocation/food get
into the respiratory tract and other unexpected accidents
 →Both the caregiver and care receiver should be protected
from these risks
Without
certificate
Resident
Visa holders
Nikkei
With
certificate
EPA Care
worker
Candidates
International
Students
Temporary
Residence
15
16
Conclusion
References
 Asahi Shimbun, February 15, 2012
 Cangiano, Alessio et al., 2009, Migrant Care Workers in Ageing Societies:
 Without the structural improvements in public
funding for care provision, the long term care sector
will continue to rely on the significant number of
migrant caregivers
 Working conditions, opportunities for training and
career development of migrant caregivers and the
quality for care has to be dealt with as a related issue
 Quality care is not just about language proficiency and
practical skills but based on the concept of human
rights and respect the dignity of both elderly and the
migrants alike
Research findings in the United Kingdom, COMPAS, University of Oxford.
 OECD, 2007, International Migration Outlook
 Rhacel Salazar Parrenas, 2003, Servants of Globalization: Women, Migration
and Domestic Work, Ateneo de Manila University Press
 Tokyoto shakai fukushi kyogikai, 2009, Kaigo rojin fukushi shisetsu ni okeru
gaikokujin jujisha ni kansuru chosa
 Tsubota, Kunio; Ogawa, Reiko; Ohno, Shun, Hirano, Yuko, 2012, Gaikokujin
kaigofukushishi kohosha ukeire anketo chosa
 Wang, Frank Tsen-Yung, 2012, Globalization of Care in Taiwan: From undutiful
daughter-in-law to cold-blooded migrant killer, Reiko, Ogawa eds.
Transnational Migration from Southeast Asia to East Asia and the
Transformation of Reproductive Labor, KFAW Visiting Researcher’s Research
Report
 Yomiuri Shimbun, June 27, 2005
17
18
81
General Background
Foreign Nurses & Care-workers
Introduced under the J-EPA:
Costs for Hospitals/care-facilities
EPA
Push
Pull
•Rapid aging
•Less youths
•LTC insurance
•Aversion 3K jobs
•High incomes
•Many youths
•Higher education
•Few jobs for nurses
•longing overseas
•Low income
Tsubota, kunio (Meiji Univ.)
Sending
countries
Japan
Immigration
Policy
1
2
Training process for the candidates
Specific features of nurses/CWs accepted under J-EPA
Prudent/costly approach
• Part of bilat. trade agreements
- compromise
• Retain immigration policies
- entry as “professionals”
• Conditional on:
- high qualification requirements
- NB Exam (J-language)
- equal pay to Japanese staff
- strict J-Govt. guidance
Home
country
Protection of:
1. Foreign workers
2. J-labor market
3. Quality of services
Japan
High cost for:
1. HSPs and CFs
2. candidates
3. J-Govt
Application, Matching, Selection
Cost born by:
J-language training (0-6 months)
J-Gov.(MOFA)
Group training (6 months)
J-language, culture, skills
Partly HSPs/CFs
and J-Gov.(MHLW)
OJT and study for NB Exam
2 ½ years (nurse) or 3 ½ (CW)
Mostly HSPs/CFs
partly J-Gov.(MHLW)
Must return
home country
National Board Exam.
Nurses, Certified CW
OJT & study
1 year extension
Can stay Japan for unlimited period
3
Economic costs for HSPs/CFs
Fixed costs
Actual
expense
accrued
Variable costs
－(subsidies)
Incremental
staff labor
Remuneration
of candidates
Govt. subsidies for training
backstopping
Mediation with other staff,
Paper works, mental health
Salaries
• Objective：to study the economic costs for
HSPs and CFs who received candidates and to
examine whether these costs would affect
their decisions.
• Target：187 hospitals and 265 CFs who have
received EPA candidates during 2008-2011
• Analysis: questionnaire sheets sent and
collected (37 for HSPs & 76 CF) January 2012.
Training cost, rental/food
allowance, transport cost
J-language/culture training ,
teaching for national exam.
4
Survey
commission fee to public
agents, travel cost to JPN etc
Training &
Teaching
Mostly HSPs/CFs partly
J-Gov.(MHLW)
Salaries equivalent to
Japanese staff
bonus
5
6
82
Additional labor required
-hidden costs-
Estimated expense per candidate for HSPs/CFs
Commission fee paid to
designated agencies,
travel costs and others
Fixed
cost
300
200
Variable
cost
183
133
Training costs, allowance
for accommodation,
food, transportation etc
X 36(48)
30%
months
25%
72
71
看護
介護
Nurse
CW
可変的経費（契約期間全
体） costs
Fixed
Variable
costs (all period)
固定的経費
（N=33,67)
nurse
Nurse
15%
CW
71
(36)
135
(51)
206
(87)
218
10%
5%
0%
Hour/month
Management/pape
r work
J-language
training
Teaching for
National Exam
Support in private
life
Other labor
Av.hours /month
CW
11%
7%
26%
58%
55%
24%
8%
10%
0%
1%
42
21
N=34,65
7
Economic viability viewed
Composition of additional
labor hours per candidate
CW
介護
20%
Unit：10,000yen
nurse
Fixed costs
72
(of which training fee)
(36)
Variable costs (whole period) 180
(of which for training)
(97)
Total（whole period）
251
(of which for training)
(133)
Ref.
235
0
■
35%
100
50
40%
0-10
10-20
20-40
40-60
60-80
80-100
100-120
120-140
140-160
160-180
180-200
200-260
150
45%
＋
250
80% are for
training
8
Economic viability viewed by HSPs & CFs
Not viable
Investment for future intl. operation
• Few considered it to be economically viable
• HSPs are more pessimistic
Investment for staff shortage
CW
Balance with indirect benefits
– But some HSPs consider investment for future international
business while others say economically balanced even now
Nurse
Viable if candidates stay longer
• Care facilities tend to be less pessimistic especially;
Balance if counted as professionals
– If candidates are counted as formal staff for which
minimum numbers are set by Govt.
– When labor shortages are further aggravated
Balance even now
0%
5%
10%
15%
20%
25%
30%
35%
N=34,74
9
10
Most burdensome items felt
(physical and mental)
Most burdensome expenses
35%
30%
25%
Nurse
看護
20%
15%
介護
CW
10%
5%
0%
Others
Rent sub.
Training
Travel
Manage
Com.fee
salaries
• Views split between
HSPs & CFs
• For HSPs, costs for
training/exam are high
• For CFs, remuneration
and fees paid to Govt.
agencies are more
burdensome.
Others
response to
Media/policy makers
management/paper
work
Trouble shooting with
patients
Mediation with other
staff
CW
Nurse
Support private life
Teaching NB Exam
J-language training
0%
N=61,134
20%
40%
60%
• Similar views shared
by HSPs and CFs
• Extremely high for Jtraining and teaching
for national exam
• These two items alone
account for 80%
• Coordination with
other staff or troubleshooting with
patients/elderlies are
almost nil.
N=72,149
11
12
83
Economic factors are hidden behind?
Wish to continue to receive candidates?
Reasons for not receiving
Nurse
response
Yes
No
Total
8
29
37
Others
CW
％
response
22%
78%
100%
37
37
74
Opac future of EPA system
％
Less than
expected
J-language capacity
50%
50%
100%
Communication with patients
nil
Relation with other staff
CW
Qualifications of candidates
Nurse
Too costly
No assuarance of longer stay
These unexpectedly high rates of NO suggest that the introduction
of foreign nurses and CWS under the current EPA is not so attractive
for many HSPs and CFs.
Hidden
economic costs?
Hard to pass NB Exam
Physical/mental buden of staff
Management/adm
0%
Summaries
1.
2.
3.
4.
5.
6.
The current EPA framework asks HSPs and CFs to share
considerable costs.
Among cost items, expense and staff’s time for language training
and teaching for national board exam are outstanding. This is
typically so in HSPs.
Most HSPs and many CFs are reluctant to receive foreign
nurses/CWs further for various reasons.
Economic factors seem to be hidden behind or will gradually come
up.
Unless some measures are taken, demand for foreign nurses and
CWs would fall sharply, leaving a growing number of elderlies
unattended.
J-Gov. has made best efforts but fundamental reforms of EPA
framework may be required especially for care workers.
Thank you
5%
10%
15%
20%
N=62(nurse)、65(CW)
13
15
84
14
Introduction
Encounter Nursing Care in Japan:
• Concept of care varies by culture and socioeconomic and medical condition.
Experiences of Foreign Nurses under EPA program
• Acculturation is one of the most important
factors indicating Job Satisfaction of the Filipino
nurses in the USA. (Emerson et al, 2008)
Yuko Ohara-HIRANO, Ph.D.
Nagasaki University
[email protected]
1
2
Follow up Survey of Hospitals Accepting 1st
Batch Indonesian and Filipino Nurses
The Evaluation of Foreign Nurses
by hospitals in Japan
Hospitals Accepting 1st Batch
Indonesian Nurses (N=47)
Hospitals Accepting 1st Batch
Filipino Nurses (N=45)
<Respondents of the Study>
• Number of Subjects: 27
hospitals
• Average Number of Beds:
297(SD198) Beds
Middle Sized Hospitals
• Respondents:
Head Nurse: 25.9%
Secretariat : 18.5%
Others: 48.1%
<Respondents of the Study>
• Number of Subjects: 30
hospitals
• Average Number of Beds:
386(SD267) Beds
Middle Sized Hospitals
• Respondents:
Head Nurse: 70.0%
Others: 30.0%
3
4
Evaluation of Foreign Nurses
They are skillful to physical assistance.
Reason to Accept Foreign Nurses under EPA
They have knowledge of body and sickness.
To contribute a national policy.
They are cheerful.
To fulfill the shortage of nurses.
They work patiently.
To expect them to work as a nurse in our
hospital.
They are eager to study.
To develop a nursing skills.
They have cooperativeness.
They are punctual.
They are attentive.
To activate the work place.
They have appropriate attitude toward patients.
To prepare for the 'internationalization' of our
hospital.
They have minds to respect elders.
0
0.5
1
1.5
2
2.5
3
They don't have any problems to communicate with patients in
Japaneses.
3.5
They don't have any problems to communicate with Japanese
staff in Japaneses.
Hospitals Accepting 1st Batch Filipino Nurses
Hospitals Accepting 1st Batch Indonesian Nurses
They know necessary Japanese to make nursing record.
0
5
Hospitals Accepting 1st Batch Filipino Nurses
85
0.5
1
1.5
2
2.5
3
Hospitals Accepting 1st Batch Indonesian Nurses
3.5
4
6
Correlation Between Satisfaction Score
Changes Occurred in the Work Place After Accepting
Foreign Nurses
Satisfied
.748
They are attentive.
.734
They are punctual.
.725
They have knowledge of body and sickness.
.687
They work patiently.
.661
They are eager to study.
They have appropriate attitude toward patients. .657
They don't have any problems to communicate
.643
with patients in Japanese.
.611
They have cooperativeness.
They don't have any problems to talk with
.563
Japanese staff in Japanese.
They know necessary Japanese to make
.507
nursing record.
.439
They are skillful to physical assistance.
The work place has become activated.
The Japanese Staff becaome to speak politely.
Japanese staff became to communicate more precisely.
Japanese staff became to understand differenct cultures.
communicate more precisely.
Patients became more alive.
Japanese staff becoame to reconsider what is 'nursing'.
The work held by the person in charge of education has been
increased.
The financial burden of hospitals has been increased.
The religious concnerns became necessary.
The cases of intervention to the troubles between candidates
and patients has became necessary.
The cases of intervention to the troubles between candidates
and Japanese staff has become necessary.
0
Hospitals Accepting 1st Batch Filipino Nurses
0.5
1
1.5
2
2.5
3
3.5
(Evaluation of Filipino 1st Batch Nurses)
4
Hospitals Accepting 1st Batch Indonesian Nurses
7
8
Correlation Between Satisfaction Score
(Changes Occur in Work Place in Hospitals Accepting
1st Batch Filipino Nurses)
Satisfied
The work place has become activated.
.696
Japanese staff become to reconsider what is 'nursing'.
.653
Japanese staff became to understand different cultures.
.638
The Japanese Staff became to speak politely.
.595
Patients became more alive.
.503
Japanese staff became to communicate more precisely.
.402
The religious concnerns became necessary.
.379
The cases of intervention to the troubles between candidates and
patients has became necessary.
-.553
The cases of intervention to the troubles between candidates and
Japanese staff has become necessary.
-.665
Dissatisfied
‘The foreign nurses share more times with patients. They speak slowly to patients,
looking at patients’ eyes, try to listen carefully. It reminds me of the essence of
nursing, which we almost forget about due to the hectic working schedule.’
(A Japanese nurse working with Indonesian nurses)
9
10
‘When I bed-bathed patient with Indonesian nurses, I
found they use a different style from ours. Then we
discuss why the nursing practice differs by country.
Then we ended up that nursing practice is based on
culture, so if culture is different, the nursing practice
is different. It is not a matter of ‘right’ or ‘wrong’
practice. We have a Japanese way of nursing
practice, and Indonesians have an Indonesian way of
nursing practice.’
Voices of foreign nurses (nurse candidates)
who are not satisfied with their work
environment in Japan
(A Japanese Nurse Instructor for 1st batch Indonesian Nurses)
11
12
86
Why Japanese head nurses assign
foreign nurses to general ward?
Division that Foreign Nurses are Assigned（n=58）
(Answered by Hospitals Accepting 1st Batch Indonesian Nurses)
0
5%
4%
‘The best way to brush up the foreign nurses’
Japanese language skill is to communicate with
patients. So I assign them to general ward.
Through communication with patients, they are able
to learn how to communicate in terms of
managing language, body language and customs,
which offers them basic of nursing practice in
Japan. It is an essential knowledge in the exam.’
5%
General Ward
Operation Theater
Others
Out Patients
DN
86%
(A head nurse of a hospital accepting 1st batch Indonesian nurse)
（Source: Ministry of Health Labor and Welfare, 2010）
13
14
‘I was an ICU nurse in Indonesia, but now I am assigned
to a mental hospital, and I have to clean windows
with patients---’
(Ms. A, a 1st batch Indonesian nurse)
“Although we are qualified nurses in
Indonesia, all we are allowed to do
in Japan is to distribute meals,
change linens and towels, and
bathing patients. But no nursing
intervention are allowed (before we
pass the board examination.) On
Sundays, we even clean the patients’
room. It is a work of an ‘office boy’
in Indonesia.”
• In her hospital, cleaning windows is part of an
occupational therapy. Japanese nurses also join
such occupational therapy as part of their job.
However, Ms. A were less likely to recognize the
importance of nursing intervention in the
general ward.
Hierarchical system of nurses by division in
Indonesia.
The Indonesian nurse does not consider that distributing meals,
changing linens and bathing patients are nursing intervention.
However, these are considered to be important nursing care in
Japan. The nursing intervention is justified when it meet with the
social status of nurse in their cultural context.
15
16
Conclusion
• The foreign nurses introduce Japanese society
nursing care with cultural diversity.
• It brings us opportunities to observe ‘nursing
care’ from a relativistic perspective, with
which we can develop the concept of care
with diverse and prosperous in global health
care settings.
17
87
purpose
2012年11月11日
ACAP @小倉
• This presentation clarifies how the movement
of natural persons particularly healthcare
migration were politicized in the process of
negotiation and how qualification
harmonization made progress so as to
implement the entire EPA program.
Politicization of healthcare migration
and harmonization of qualification
ASATO Wako
Kyoto University
[email protected]
1
2
What is a legitimacy of EPA healthcare
migration?
Population estimate in 2050, Japan
• Demographic change and care deficit?
75+
[70-74]
[65-69]
[60-64]
active
[55-59]
inactive
[50-54]
active
[45-49]
inactive
[40-44]
Active and inactive labor force
[35-39]
[30-34]
[25-29]
[20-24]
Male
-10000
10thousand
450
400
10
Annual increase rate
認知症数(II
以上)
250
4
200
150
2
100
4
0
5000
10000
15000
• Not based upon the voices of demand for
more healthcare workers
• Discourse upon trade liberation and politicized
healthcare migration in order to accelerate
EPA
8
6
-5000
Legitimacy to healthcare migration
under EPA
No. of dementia pts.(Japan)
350
300
Female
[15-19]
3
年間増加
率
0
50
0
-2
5
6
88
1987
2000
2002
2004
2004
2006
2007
2007
2008
2009
2010
2010
2010
2011
2012
Certified Social Workers and Certified Care Workers Act promulgated
the Long-Term Care Insurance started
Free Trade Agreement negotiations with the Philippines started
Inter-ministerial coordination started for the smooth negotiation
Some applications on deregulation of nursing and careworkers in Special Districts
for Structural Reform program
Immigration Ordinance revised. Duration of stay for foreign RN up to seven years
from four years.
MHLW announced to establish associate certified care worker
the law was revised to reflect the new care needs such as care for the dementia
under long-term care insurance
Arrival of EPA candidates from Indonesia
Arrival of EPA candidates from the Phlippines
Tailored care program implemented in Indonesia
Cabinet decision to include medical care such as suction, FGT and gastric fistula,
Cabinet decision of national exam revision as special consideration of EPA
Stop of tailored care program in Indonesia
Duration of stay for non-Japanese RN abolished
Foreign nurses holding Japanese RN increased rapidly
Philippine government stopped school track of certified care worker candidates
Cabinet decision of revision of national exams.
7
Start of a medical care such as suction, FGT and gastric fistula
1.Structural reform program
• Japanese government carried out a deregulation
program for the activation of economic activities
called kozokaikakutokku or Structural Reform Special
Zone. This is a part of deregulation during the Prime
Minister Koizumi and the deregulation program is
such that private sector or local government
proposes deregulation to carry out local economy
activation program extra-legally, so that government
might apply the deregulation that cover not only
locally but also nationally.
8
skills harmonization under EPA
Structural reform2
• In case of the fifth application due in June of 2004,
there were more than 10 application regarding nursing
and care work mainly on receiving foreign nurses/care
workers, on education program, skills recognition and
abolishment of recruitment and limited duration of
working contract. The series of applications were taken
up by media and impressed nationals of lack of
nursing/care work staffs in the country. According to
author’s research, this is in fact lobbied by the Ministry
of Economy and Trade towards medical/welfare
organizations to apply for the deregulation program. In
other words, deregulation program was tooled as
public advertisement.
Nurse
Skills recognition
Recognition of credits
Candidacy for nursing examination
×
○
○
Recognition as care worker under medical insurance
○
job description prior to acquisition of skills
Nursing aide
Certified care worker
Skills recognition
Training care workers abroad
Recognition of work experience prior to Japan
Recognition as care worker under long-term care
insurance
Recognition of corresponding skills
job description prior to acquisition of skills
9
Kaigofukushishi careworker
N/A
△
×
×
○
10
Care work
Recruitment of careworkers
At that time when the deregulation program was
implemented in 2004, it was not allowed to bring care
worker from abroad because care work was not in the
list of designated occupational category that foreigner
can get. Therefore, it was not surprising one of the
proposals was to allow foreign care workers to work in
Japan by adding care work in the designated visa
category within the Immigration Law. However, MHLW
refused to the proposal on the ground of crime
prevention and negative impact on labor market, and on
the ground of on-going EPA negotiation with the
Philippines.
12
11
89
Recognition of working experience
abroad
Training careworkers abroad
Another proposal was to allow and recognize care
related human resource development in foreign
countries such as home helper certificate, which was
also rejected by the Ministry. This is because of the fact
that a course provider and issuer of certificate should be
the one authorized by a local government within Japan
to assure the quality of educational environment by
thorough management upon course provider, lecturers,
facilities and so forth. Human resource development in
other countries was all rejected including care work
education in English in foreign countries. This can be
termed as “domesticity of human resource
development”. The reason of the rejection is also due to
13
ongoing EPA negotiation with the Philippines.
certified care worker candidates are given fouryear preparation period, within which the first
three year is for work experience to receive
candidacy for national exam and within which the
last year for taking national exam. The difficulty in
care worker candidate lies in the fact that MHLW
does not recognize work experience outside Japan
despite the fact that many have nursing
experience in the home country.
14
CORE
COMPETENCIES
COMMON
COMPETENCIES
BASIC
COMPETENCIES
COMPETENCY MAP
CAREGIVING NC II
Participate in
workplace
communication
Work in team
environment
Practice career
professionalism
Practice occupational
health and safety
procedures
Foreign care workers (institutional)
names
Taiwan
Korea
Implement and
monitor infection
control policies and
procedures
Respond effectively to
difficult/ challenging
behavior
Provide care and
support to
infants/toddlers
Provide care and
support to children
Foster social,
intellectual, creative and
emotional development
of children
Provide care and
support to elderly
Provide care and
support to people
with special needs
Maintain healthy
and safe
environment
Clean living room,
dining room,
bedrooms, toilet
and bathroom
Wash and iron
clothes, linen and
fabric
Prepare hot and
cold meals
Apply basic first aid
Maintain high standard
of patient services
Number of
persons
Contract Qualification
duration requirement
Caregiver
8000
Ganbyugnin
10000-30000
Yoyangbohosa
400
Health attendant
100%
Nursing aide
90%
nurses
1500
4 yr college,
caregiver,
nurse
OJT
none
none
none
Respond to
emergency
Japan
Certified
careworker, nurse
candidate
none
2 yrs+
Spore
Foster the physical
development of
children
Qualification Change in
attainable visa status
3-4yrs
yes
Certified care
worker, nurse
Possibly PR
Certified care
worker
Asato, Lee Hye-Kyung
16
15
International
healthcare migration
Sending
countries
nurses
Absence of
qualification
Overqualification
Deskilling
Several tens of
thousands
Absence of equivalent
qualification
Receiving
countries
conclusion
Nurses
Certified/non
-cerfitied
Care workers
• Towards global harmonization and
management
広
– Deskilling and naturalized care(gendered,
ethnicized)
– Skills harmonization needed in Asia towards the
sustainability of care
義
の
Domestic
worker
spouses
others
介
Immature skills
problem
Up to several
million
Asato (2012) 厚生労働科研報告書
Domestic
worker/care
worker
Family carer
護
17
18
90
2. Establishment of Associate Certified
Careworker
• In 2007, MHLW announced to establish associate certified
care worker. This is attributable to school course of EPA
certified care worker. As part of the partnership with the
Philippines, a school course that followed the Japanese
curriculum was prepared. School course candidates do not
have to undergo national examination as is the case in
Japanese, which is different from work track that passing
examinations is required after three years of working
experience. However, accordingly to the change in Certified
Social Workers and Certified Care Workers Act in Japan,
examination is imposed on school course students. This
standardization of examination is to the direction of care
work as more specialized occupation. Because candidates
still had to take exams even after this course, the
government created the position of associate certified care
worker so that there would be no contradiction to EPA with
the Philippines.
19
20
A series of revision to raise passing
ratio
Associate care worker
• Within Japan this system was criticized for being
geared toward the EPA and for contradiction that
certificate should not be given to those who failed
examination. The Filipino government strongly
opposed it as well, saying that unifying the exam
system had not been part of the negotiations and that
this is to hierarchize Filipinos under Japanese certified
care worker rather than a safety net. In 2011 the
Filipino government suspended recruitment through
this school course. However, since the unification of
exam was not enforced as expected in 2012, and since
the school track was suspended, there was no one who
were trapped in this.
21
22
Language as non tariff barrier
Gov. support for EPA
41 mil. yen (2007) institution visit, introductory training
69 mil. (2008) institution visit, introductory training
83 mil. (2009) institution visit, introductory training
870 mil. (2010) institution visit, introductory training,
Japanese language training, study support in institution
• 790 mil. (2011) institution visit, introductory training,
Japanese language training, study support for institution
(in cash)
• 380 mil. (2012) institution visit, introductory training,
Japanese language study support (excl. cash support for
institution)
• The government was criticized for passing the
task of educating foreign workers for
examinations onto accepting organizations such
as hospitals and care homes – organizations that
are not educational institutions. Later, the
government invested over ¥800m in e-learning,
development of educational materials, schooling,
visiting students, and assisting with educational
costs in 2010, in order to create a proper
educational environment.
•
•
•
•
23
24
91
Passing Rates for EPA Nurse Candidates（National Exam
conducted in Feb.2012) (source: Ministry of Health, Labour and Welfare)
ACAP Conference in Kitakyushu
Indonesian Nurses
Acceptance of Overseas Nurses and Care
Workers in Multicultural Societies:
Implications for Establishment of Japan’s
Model
Year of Entry
into Japan
2008（Those
remaining in
Japan）
2008(Those
returned to
homeland)
November 11, 2012
by Shun Ohno
(Department of Global Citizenship Studies, Seisen University)
1
Passers
Passing
Rate
Examinees
Passers
Passing
Rate
27
8
29.6%
――
――
――
4
1
25.0%
――
――
――
2009
152
22
14.5%
60
9
15.0%
2010
33
3
9.1%
39
4
10.3%
2011
41
0
0.0%
59
0
0.0%
2
Private Company Plays an Important Role in
Screening Foreign Nurse Applicants
Outline of Australia’s Nurses
320,982 nurses in all（as of 2009）
• Australian Nursing and Midwifery Accreditation Council
Limited, which was established in 2010, has a
Registered Nurse (RN) 260,121人（81%）
Enrolled Nurse (EN)
60,861人（19%）
mission to evaluate skills of foreign nurses and
midwives who apply to Australia’s Skill Migration
Program.
• This company has board members composed of
nursing experts. It has gathered various
information on nursing and educational levels in
the sending countries.
・ Requirements for overseas RNs and midwives are
14.9% of them obtained a nursing license out
of Australia before their arrival in Australia.
(Source) Australian Institute of Health and Welfare, 2011, “Nursing and
midwifery labour force 2009”, Bulletin 90, Canberra: Australian Institute of
Health and Welfare
Examinees
Filipino Nurses
determined by the government’s Nursing and Midwifery
4
Board.
3
Requirements for Foreign Nurses
Map of Australia
（as of August 2011)
・Applicants should get IELTS score 7.0 or higher
in its four areas (Hearing, Reading, Writing
and Speech). Or, they should achieve OET
(Occupational English Test) Level “A” or “B” in
its four areas. This language policy was
introduced nationwide in 2010.
• Applicants should obtain a bachelor degree in
nursing or experiences to work as
RN(registered nurse) for a certain period.
• Applicants can be ENs (enrolled nurses）if they
have obtained Certificate IV（１ year or more
years）issued by the vocational school.
5
6
92
Bridging Courses for Migrant Nurses in Perth①
Bridging Courses for Migrant Nurses in Perth ②
Case 1: School of Nursing and Midwifery, Curtin University
Case 2. Institute of Health and Nursing Australia
（vocational health school）
Degree-conversion Program
・Foreign applicants should obtain IELTS score 7.0 or more in the case
・Foreign Applicants should have IELTS score 7.0 or more, and
working experiences as RN for more than one year.
・In general, foreign students can complete their study course for 2
years (The other students will usually take 3.5 years for completion)
・Special language(English) classes are provided for foreign students
twice per week.
・The amount of tuition fees is 28,000AU$ （1 AU$≒90 yen）for two
semesters.
of one-year working experience as RN. Those
having two-year or longer working experience
should should obtain IELTS score 6.5.
・Students are required to study theories for
160 hours, and perform clinical works at
hospital for 240 hours. They are also provided
special English classes.
・Tuition fees ー 11,000 AUS
◇ Curtin University has established exchange programs with Bali
Stikes(Indonesia) and Burapha University(Thailand), and exchanged
their students and faculty members.
・Around 2,000 students completed this course,
and 90% of them were employed in Australia.
7
Bridging Courses for Migrant Nurses in Perth ③
8
Aged-care Workforce in Australia
Case 3: Hollywood Private Hospital
・ Foreign applicants should obtain IELTS score 7.0 or more,
• 33% of workers, (around 57,000) ,employed by all
of residential aged-care facilities were born out of
Australia（surveyed by the Department of Health
and Ageing in 2007）.
• RNs and ENs working in residential aged-care
facilities consisted only 29.3% of all care workforce
in 2007 (They consisted 35.8% in 2003).
• The Department of Immigration and Citizenship has
a important skill list, which was revised in 2010. It
includes Registered Nurse, but does not include
Care worker(Caregiver).
or OET Level B or higher. They are also required to have
working experience as RN at the hospital having
departments for acute-disease patients.
・During the course, they have to pass exams for physiology,
anatomy and other medical & nursing fields.
・Their nursing skills are also examined by the experts.
・Tuition fees (3600 AU$) ＋ exam fees（2700 AUS） (in the
case of 10 weeks)
9
10
Certificates for Aged-Care Workers in Australia
Increasing Number of African Aged-Care
Workers in Australia
・Certificate III in Aged Care ー required for care at home or
care facility. It can be taken at the vocational school for 9
weeks-9 months.
・Certificate IV in Aged Care ー required for medical care
under guidance of the nurse. Care leaders are required to
obtain this certificate. It can be taken at the vocational
school for 14-16 months.
A Nigerian man working at
the care facility in Canberra
(photo taken in Dec. 2011）
African women under training at
the health vocational school in
Perth (photo taken in Dec. 2011)
12
11
Photos taken at the aged-care facility in Canberra in Dec. 2011
93
Registered Nurses(RNs) and Enrolled Nurses
(ENs) Working in Singapore (as of 2010)
English Proficiency Needed for
Fresh Foreign Students
The case of Canberra Institute of Technology
(vocational health school)
Locals
Certificate in Aged Care ー IELTS 5.5 or higher
Registered Nurse－ IELTS 7.0 or higher
13
352 (87.3%)
51 (12.7%)
403
Enrolled
Nurses
361 (94.5%)
21 (5.5%)
382
7 (77.8%)
2 (22.2%)
9
720 (90.7%)
74 (9.3%)
794
Midwives
Total
(Chinese,
Malaysians,
Myanmerese
etc.)
18,176
1,760
1,639
21,575
(84.2%)
(8.2%)
(7.6%)
(100%)
Enrolled
Nurses
5,025
1,188
1,265
7,478
(67.2%)
(15.9%)
(16.9%)
(100%)
14
Care Workers(Caregivers) in Singapore
A total of around 1,700 foreign care workers were
placed in 23 aged-care facilities across Singapore as of
Dec. 2011. They are categorized as low-skilled workers
or semi-skilled worker, and thus not given a right to
become permanent residents in Singapore,
Many of them are graduates of nursing schools, and
some of them have obtained
nurse license in the country of
their origin.
Total
Registered
Nurses
Total
(Source) Singapore Nursing Board, 2011, Annual Report 2010.
Passing Rate of Foreigners who Passed
Singapore’s Nursing Exam（in the case of 2006）
Fails
Other
Foreigners
Registered
Nurses
Enrolled Nurse－ IELTS 6.5 or higher
Passers
Filipinos
（including
foreign
permanent
residents）
(A photo was taken at a carefacility in Singapore)
15
16
“Promotion Course” for Care Workers
to become RNs in Singapore
Requirement for Overseas Workers
to be RNs in Canada
・ Nursing Aid （certificate issued by vocational school）
Around 400 SG$ for basic monthly salary
↓ ↓ Try to take a national exam after completing 1,880-hour OJT,
and being given recommendation by their employers.
• Enrolled Nurse (national licensure)
Around 750 SG$ for basic monthly salary
↓ ↓ Try to take a national exam after completing 1-year study, and
being given recommendation by their employers. Having
qualification for applying to permanent residency.
• Registered Nurse (national licensure)
Around 1,200 SG$ or more（in the case of care facilities）
Having qualification for applying to permanent residency.
• Each state has its own exam for native and overseas nurse
candidates. They have to pass the exam composed of 240260 optional questions written in English and French.
• Each state requires a certain high level of English
proficiency for incoming overseas nurses.
• Due to high hurdle for overseas nurses, the number of
Filipino nurses who passed the nursing exam in Canada is
still limited. As a result, over 5,000 Filipino nurses
emigrated to Canada as live-in caregivers.
(Source) New South Wales Government,2006, New South Wales
Registration of Overseas Educated Nurses and Midwives, Sydney: Community
Relations Commission for a multicultural NSW.
18
17
（Note） The amounts of salaries were as of March 2010.
94
Conclusion ①
Canada’s Live-in Caregiver Program(LCP)
1．Registered nurses are recognized as skilled workers
in the world, and many or most developed countries
require migrant nurses to obtain a national license and
high-level language proficiency of host countries.
2．“Bridging Courses”(intensive studies and no work)
already introduced in Australia will be more
effective in terms of increasing a passing rate in
nursing licensure exam. But, both governments have
to resolve the issue of costly tuition payment.
3．Many migrant nurses wish to be enrolled nurses
(called “licensed vocational nurse” in the US) before
passing more difficult RN exam abroad. The
Japanese government has to look at such global
reality in the future employment.
20
• The program was introduced in 1992 in order to overcome
shortage of native live-in care workers.
• Under the LCP, a total of 36,640 overseas workers
immigrated to Canada since 1993 until 2006. The majority
of them are Filipinos who took a caregiver license, which
was created based on Canada’s caregiver system.
• In 2009, the Canadian government introduced a new rule,
which allows live-in caregiver migrants to obtain
permanent residency after their complete 3,900-hour livein care works in Canada.
(Main source) Spitzer, Denise and Sara Torres.2008. Gender-based Barriers to
Settlement and Integration for Live-in Caregivers: A Review of the Literiture
19
(CERIS Working Paper No.71). Toronto: The Ontario Metropolis Center.
Conclusion ②
Conclusion ③
4．On the other hand, care workers(caregivers)
are recognized as semi-skilled or low-skilled
workers in most developed countries. They are
usually not required to equip high-level language
proficiency of host countries.
6．Foreign applicants’ language proficiency is usually
examined in the process of screening. Until now, the
Japanese government have shouldered a big portion
of costs for the candidates’ Japanese-language
studies before and after their arrival in Japan. This
measure is quite costly and exceptional among the
receiving countries.
5．Thus, applicants (including nurses) dreaming
for migration to the developed country tend to
become caregivers upon arrival, and utilize this
job category as “entry-point” for newcomers.
7. The Japanese government had better set up a
minimum level of language requirement for foreign
candidates during the process of screening, but it is
not necessary same level for nurse candidates and
care worker candidates.
22
21
References
Australian Institute of Health and Welfare, 2011,
“Nursing and midwifery labour force 2009”, Bulletin 90,
Canberra: Australian Institute of Health and Welfare．
Martin, Bill and Debra King, 2008, Who cares for older
Australians?, Canberra: Department of Health and
Ageing．
New South Wales Government,2006, New South Wales
Registration of Overseas Educated Nurses and
Midwives, Sydney: Community Relations Commission
for a multicultural NSW.
Spitzer, Denise and Sara Torres.2008. Gender-based
Barriers to Settlement and Integration for Live-in
Caregivers: A Review of the Literature, Toronto: The
23
Ontario Metropolis Center.
95
Part 2： Framework of Center for International Training of Asia Pacific
Long-term Care
Chair: Dr. Kathryn Braun
Dr. Kathryn L. Braun, Dr. Thelma Kay, Dr. Cullen Hayashida, Dr. Takeo Ogawa, Dr. Donghee Han, Dr.
Tri Budi W. Rahardjo and all delegations.
We will sum up our discussion in Kitakyushu ACAP 2012, and will propose the Kitakyushu ACAP declaration
in 2012.
The United Nations issued the Madrid Declaration about aging in 2002. And the United Nations Population
Fund announced "Ageing in the Twenty-First Century: A celebration and A Challenge.” in October, 2012 after
ten years. The necessity of "the capacity development for an ageing world" is explained there. According to
the Report, service providers, including health care professionals and social workers, should receive training
in medical and social care for older persons. Moreover, informal care givers, family caregivers and volunteers
who care for older persons should be able to access training in the care of the aged. Furthermore, regional
training centres should be established for policymakers, government officials, researchers, academics and
health-care professionals and social work personnel to study and to share good practices, in which training
seminars, conferences, expert meeting and researches will be provided. This is just like as the Declaration of
Fukuoka ACAP 2010. We are hoping that the training center about international aging will be realized in near
future.
96
パート 2：アジア太平洋地域の介護の国際研修センターの枠組み
議長：キャサリン・ブラウン博士
キャサリン・ブラウン博士、テルマ・カイ博士、カレン・ハヤシダ博士、小川
ドンヒー・ハン博士、トリブディ・ラハルジョ博士
全夫博士、
すべての代表団
北九州 ACAP2012 での議論を総括し、2012 年の北九州 ACAP 宣言を提案させていただきます。
国連は 2002 年に高齢化に関するマドリッド宣言を発令しました。そして、10 年後の 2012 年 10 月に
国連人口基金は「21 世紀の高齢化：祝福すべき成果と直面する課題」を発表しました。
「高齢化世界のための能力開発」の必要性がそこに説明されています。報告書によると、医療専門
家やソーシャルワーカーなどのサービス提供者は高齢者のための医療と社会的ケアのトレーニング
を受けるべきである。また、非公式の介護者、家族介護者や高齢者の世話をするボランティアは高
齢者のケアトレーニングにアクセスできるようにするべきです。さらには、政策立案者や、政府関
係者、研究者、学識経験者や医療専門家が勉強したり、成功事例をシェアし、そこでは、トレーニ
ングセミナーや会議、専門家ミーティングや研究が提供される地域研修センターが設立されるべき
です。これはちょうど福岡 ACAP2010 の宣言と似ており、国際的高齢化についてのトレーニングセン
ターが近い将来実現されることを願っています。
原文をＡＡＢＣで翻訳したものです
97
Population Aging and Worker
Shortage: Solutions?
 Postpone Retirement Age
 Increase Births – Have more babies
 Increase Foreign immigration – have more young foreign
workers
 Emigration - Send older people away
 Technology – Substitute for “healthcare workers”
 Active Aging – address ways for older people to remain
well and productive
Cullen T. Hayashida, PhD
Kupuna Education Center
Kapiolani Community College
November 2012
 Training – Need to improve the efficiency and effectiveness
of direct care worker training
2
1
….
A deficit or an asset?
Gerontology has emphasized the
deficit side of aging.
How do we shift from a Sick Care
to a Well Care model of aging?
SICK CARE
WELL CARE
Long-term care
Active Aging;
Chronic illness
Wisdom – gratitude, forgiveness, altruism
Geriatric pathology
Independent
Dementia
Family heritage, legacy,
Unproductive
Generativity, Returnment, Okaeshi?
Ageism
Productive Aging
Caregiver Burden
Centenarians
Family Stress and obligations
Encore careers
Anti-aging medicine
Third Age
3
4
5
6
Age as an Asset will promote
1. Economic Opportunity
2. Roleless Role  Positive Elder Role: A
stronger intergenerational role of older
adults for a sustainable community
3. Intergenerational Community or Age
Friendly Community
98
Promoting Age as an Asset
 Academics – Create more classes with Age as
an Asset perspective. Create a degree or
certificate with Age as an Asset perspective.
 Marketing (Propaganda):
 TV show
 Photo contests – promote age as asset,
intergenerational relations
 Senior Volunteer of the Year contests –
change criteria
7
P
R
I
M
A
R
Y
S
E
C
O
N
D
A
R
Y
Economic Opportunity Projects
Category
Examples
Non-Med Caring
Direct care workers, non-medical home care, adult day care
Equipment
Assistive technology, Universal Design
Information
Elder-friendly programs, DVD, Books, Software
Leisure
Active aging Tourism, Senior Tourist activities, Exercise club
Finance
Pension products, Reverse Mortgage, Asset Management
Housing & Facilities
Smart Homes, Care Homes, ALF, Universal designs
Alternative Medicine
Anti-Ageing Medicine, Hawaiian brand of aging & wellness
Farming
Gardening, Self-sufficient Farming
Transportation
Barrier-free Bus, Improved Traffic Signals
Foods
Gerontological culinology and new food products
Medicine
Geriatric care, pharmaceuticals, liposuction, professionals
End of Life Care
Ocean funeral, mortuaries, grief counseling , hospice
Clothing
Generational style, orthotic shoes, Velcros, Anti-UV clothing
Education
Lifelong learning, Encore careers, Certificates, CEUs
Adapted Source: Takeo Ogawa, Asian Aging Business Center, Fukuoka, Japan . 2009
8
 Promotion of “Age as Economic Opportunity” with
students
 Creation of an “Age as an Economic Opportunity”
Conference for Business Community
a. Technology
b. Banking
c. Hospitality – hotel, travel
d. Culinary
e. Housing and Universal Design
f. Clothing, Cosmetics
10
g. Others
9
Roleless Role  Positive Elder Role
 One-stop Shop for Boomers and Retirees to find
Opportunities
 Encore Careers, Second Career
 Volunteer Opportunities with NPO
 Recreational, Travel Opportunities
 Grand-parenting
 New handbook; website; life coaching
Too many do not know at to with the rest of their lives!
How can we create the infrastructure to capture this
social capital for the greater good and for a
Sustainable Future planet?
12
11
99
One Stop Shop for Active Aging
 Inventory of any and all activities related to active aging – name,
address, phone, email, description, cost
 Categorize
 Travel, Work Opportunities, Volunteer Opportunities, Tips for
Grandparenting, Physical Fitness, Nutrition Fitness,
Calendar of Events, Genealogy, News, Educational
Opportunites, Enrichment Activities, Financial Planning,
Discounts, Elder Rights and Protection, Emergency
Planning
 Website development
 Create Printed Guide
 Market and Promote One-stop Shop
13
14
Generational Conflict vs.
Generational Integration
1.
Politics of the Future : From Democrats vs
Republicans to a Politics of the Old vs the
Politics of the Young!
Intergenerational
Conflict or Support?
Elderly = 13% of Population but use 40% of Budget;
Children = 25% uses 8.5% of Budget
2. Can we organize geographic communities to
create age friendly, inter- Generational
communities?
3. Should we work towards more segregated and
gated senior communities?
15
16
Age-Friendly Intergenerational
Communities
Potential Project To Create Change
 Age Friendly City, Age Friendly Community – WHO
Projects include Fukuoka city, Portland (USA) and
many other places in the world.
 Work underway with Prof. Ogawa in Fukuoka
Intergenerational
Communities
 Concepts
 Livable Communities
 Aging in Place
 NORC – Naturally Occurring Retirement Communities
 Age Friendly Cities: Transportation, Business,
Walkability, Universal Design, etc.
17
18
100
19
101
Presentation
Multiculturalism as an Asset in
Senior Care




A case study in a Swiss nursing home
Summer 2012

Context and purpose of the case study
Swiss Demographic Data
Presentation of the case study
Results
Conclusion
Caroline Vuagniaux
Institute of Socioeconomics and Centre for Interdisciplinary Gerontology
Faculty of Economic and Social Sciences
University of Geneva, Switzerland
Contact: [email protected]
1
2
Context / Purpose
The Swiss population is aging.
The growth rate is still positive,
thanks to a young migrant population.
What do seniors patients think of this situation?
Because of the general shrinking workforce
and of the growing needs of the Eldercare sector,
the Health field is dependant of foreign workforce.
3
4
Switzerland is a multicultural country

At the centre of Europe, long history of migration and cultural sharing with neighbors

Various cultural and language areas gather together under one nationality
Swiss Demographic Data
5
6
102

Population
7.9 million

growth rate
0.199%

65 years old and over
17%

Dependancy rate
27.1%

Life Expectancy
Swiss Nationals ~75%
Foreign Permanent Residents ~25%
male: 78.34
female: 84.16
ʺ Who is Swiss? ʺ
7
8
A case study in a Swiss nursing
home
Summer 2012
9
10
Method
A panel was chosen amongst the patients
Semi-structured interviews were conducted
Lausanne
Genève
Issues
Small size of the panel (difficulty to find interviewees able to
understand and answer)
 Due to cognitive and old age problems, reformulating the
questions could induce bias

La Fondation Les Baumettes
is a nursing home near Lausanne in the
French speaking part of Switzerland
11
12
103
The population of the nursing home reflects the
multicultural face of Switzerland and illustrates the
successive waves of immigration of the last decades
Description / Data
The patients are the cohort born in the Twenties and
many came to Switzerland after World War II looking for
work
The employees of the nursing home reflect the modern
migration: coming to Switzerland to work in many different
sectors, they found a job in the Health sector, massively
recruiting
13
14
15
16
17
18
Workers + Patients together =
37 nationalities
104

Majority of the panel did not know that caregivers
were of other nationalities than Swiss, and did not
care about
Results
19

20
Majority declared being surprised by the number of
different nationalities represented in the nursing
home, they did not notice it, nor pay attention to it
Majority …
was aware of the shrinking of workforce in
Switzerland
 was feeling grateful towards the foreign caregivers
coming to Switzerland to help them

21

22
Senior patients enjoy discovering many different
national food, music or habits, as a way of :
travelling without moving
and
escaping boredom and loneliness
For the Senior patients, skin color, country of
origin or nationality do not matter, as long as
the caregiver speaks French, and does his/her
best to communicate with the patient clearly
and politely
23
24
105
Conclusion

Swiss tradition of multiculturalism and openmindedness is integrated by the patients and
important to them

Multiculturalism is internalized as the positive norm
and perceived by the patients as the proper behavior
to display

For the patients, personality of workers and ability to
communicate are more important than nationality

Cultural exchanges bring positive effects to the
patients and enhance everyday life in the nursing
home
25
26
Multiculturalism can be an asset in Senior Care
Thank you for your time!
27
28
106
Part 3: New challenge for Active Aging Promotion: A Next Step in 2013
Chair: Dr. Dong Hee Han
We will share the information of our next step in 2013: Announcement of IAGG 2013 in Seoul, Seoul &
Busan program.
All registered delegations
(1)
IAGG Submitted Symposium: Productive Aging Initiatives in Asia: Best Practices from Korea, Japan,
Singapore, and Indonesia
Counties across Asia are experiencing rapid growth of the number and percent of older adults in their societies.
Policy makers and planners are challenged to facilitate ways in which older adults can actively contribute to
society, rather than becoming (or being seen as) dependent on it. The purpose of this symposium is to share
“best practices” for productive aging from select Asian countries.
Presenters are country representatives of ACAP (Active Aging Consortium Asia Pacific), who work within
their countries to demonstrate the real and potential social capital of older adults and to advocate for social
policies that encourage and facilitate productivity aging. Dr. Braun will moderate the session. She will provide
a brief overview of the trends that have led to rapid aging and describe ACAP’s individual-family-social
policy framework for the development of active-aging initiatives. She will summarize arguments for
productive aging, as well as the criticism of productive aging from the field of critical gerontology.
Dr. Han will describe the aging situation in South Korea and share best practices from the Research Institute
of Science for the Better Living of the Elderly and from Busan National University. After reviewing Japan’s
aging situation, Dr. Ogawa will describe initiatives such as Fukuoka City’s “active aging” plan. Ms. Kay will
discuss productive-aging-related policy developments in Singapore, including increasing retirement aging and
promoting volunteerism. Dr. Rahardjo will discuss differences in the urban and rural experience of aging in
Indonesia, and describe productive-aging projects in these settings.
107
(2)
IAGG Submitted Symposium:
Towards Asian Pacific Long-term Care Certificate
Asian and Pacific population ageing is progressed in large quantities and rapid speeds. According with this
change, needs of long-term care for the elderly will be increased in this area. As the traditional ethic of filial
piety cannot function to long-term care for the elderly actually, a new long-term care system will have to be
constructed for its substitution. The system will require the workforce for long-term care. However, every
country is constructing its domestic system of long-term care, in which the requisite of workforce is different
with each other. As some countries are confronting with difficulties to recruit workers of long-term care
already, they are looking for foreign workforce of long-term care. Then, international migration of workforce
of long-term care is a big issue in Asia/Pacific. For easier migration of care workforces, the harmonization of
their qualification should be discussed internationally. The dialogue for the harmonization of qualification
should be based on the competence in long-term care for the elderly. It is also required to be standardized on
the gerontological knowledge and skills. Not only policy makers and teachers of care workforces but also
researchers should focus on this new international agenda.
Coordinator: Kathryn Braun
Frame Analysis of Training Programs for Long-term Care Workforces (Takeo Ogawa)
Training Programs for Care Workforces in Hawaii (Cullen Hayashida)
Training Programs for Care Workforce in Singapore (Thelma Kay)
Training Programs for Care Workforce in Indonesia (Tri Budi Rahardjo)
108
パート３：アクティブ・エイジング促進のための新しい課題：2013 年の次の
ステップ
議長：ドンヒー・ハン博士
2013 年の次のステップのインフォメーションのお知らせ：ソウル IAGG2013 の発表、ソウル＆釜山
全ての参加者
（１）
IAGG 提案シンポジウム：アジアのプロダクティブ・エイジングの取り組み：韓国、日本、シンガポ
ール及びインドネシアからのベストプラクティス
アジア全域の国で、彼らの社会における高齢者の数と割合は急速な増加を経験しています。政策立
案者やプランナーは高齢者が社会に依存するよりもむしろ積極的に社会貢献することができる方法
を促進しています。このシンポジウムの目的は選択されたアジアの国々のベストプラクティスを共
有することです。プレゼンターは ACAP の国々の代表で、彼らは高齢者の社会資本を実証するため、
かつプロダクティビティ・エイジングを促進する社会政策を提唱しています。ブラウン博士が司会
をし、急速な高齢化を導いた傾向の簡単な概要を説明し、アクティブ・エイジングイニシアチブ開
発のための ACAP の個々の家族社会政策の枠組みを説明します。プロダクティブ・エイジングの議論
の要約だけでなく、重要な老年学の分野からプロダクティブ・エイジングの批評についても要約し
ます。
ハン博士は韓国の高齢化の状況について述べ、高齢者生活科学研究所と釜山国立大学からのベスト
プラクティスについて説明いたします。日本の高齢化の状況を確認した後、小川博士が福岡市のア
クティブ・エイジング計画への取り組みについて説明します。カイ博士はシンガポールにおけるプ
ロダクティブ・エイジング関連の政策開発についてや、増加する退職者の高齢化やボランティア活
動の促進を含めて議論します。ラハルジョ博士はインドネシアの高齢化において、都市部と農村部
の違いや、これらの地域でのプロダクティブ・エイジングについて説明します。
109
（2）
IAGG 提案シンポジウム：アジア太平洋介護資格にむけて。
アジア及び太平洋地域の人口高齢化は大量かつ急速に進んでいます。この変化に伴い、高齢者の介
護のニーズが増加します。親孝行の伝統的な倫理は実際に高齢者の介護には機能しないので、新し
い介護システムが代わりに構築されなければならないでしょう。システムは、介護のための労働力
を必要とします。しかしながら、どの国も条件の異なる介護労働力の国内システムを構築中です。
一部の国では、既に介護労働者を募集することの困難に直面しており、外国人労働力を探していま
す。その結果、介護労働者の国際移動はアジア太平洋地域で大きな問題です。
介護の労働力の移動を容易にするには、資格の調和が国際的に議論されるべきです。資格の調和の
ための話し合いは高齢者のための介護における能力に基づくべきです。また、老年学の知識やスキ
ルを標準とすることが要求されます。政策立案者や介護の先生だけでなく、研究者もこの新しい国
際的な議題に注目すべきです。
コーディネーター：キャサリン・ブラウン
介護労働者のためのトレーニングプログラムフレーム分析（小川 全夫）
ハワイの介護労働者のためのトレーニングプログラム（カレン・ハヤシダ）
シンガポールの介護労働者のためのトレーニングプログラム（テルマ・カイ）
インドネシアの介護労働者のためのトレーニングプログラム（トリブディ・ラハルジョ）
原文をＡＡＢＣで翻訳したものです
110
POSTER SESSION
111
Poster Session 1:
Do Physical Functioning and Health Related Quality of Life differ according to the Living
Environment in Japanese Older Women?
Ricardo Aurélio Carvalho Sampaio, Priscila Yukari Sewo Sampaio, Minoru Yamada, Taiki Yukutake, Tadao
Tsuboyama, Hidenori Arai
Department of Human Health Sciences, Kyoto University
Graduate School of Medicine
Purpose: The purpose of this study was to compare the physical function and the health related quality
of life (HR-QOL) between older women living in urban and rural communities in western Japan. Methods:
Subjects were Japanese women recruited from urban (n=31, age=73.4 ± 4.09) and rural (n=45, age=73.8 ±
3.93) locations through local press. The inclusion criteria were an age of 65 years or older, the ability to
perform the physical tests, to fill the questionnaires and to give consent to participation in the study. Data were
collected from November 2011 to March 2012.
Physical functioning was assessed by the Walking speed in 10m, One leg stand (OLS), Functional reach,
Repeated chair stands (CS) and Handgrip strength (HGS) tests; while HR-QOL characteristic was investigated
by the Euro QOL index (EQ5D-3L). Socio-demographic characteristics such as age, living structure,
educational level, work status, body mass index (BMI) and waist circumference (WC), self-reported physical
activity (PA), Geriatric Depression Scale (GDS), and the Life-space Assessment (LSA) were also investigated.
Categorical variables were compared by living environment using
2 test and Fisher’s exact test, while
continuous variables were analyzed by Independent samples T test and Mann-Whitney U test. Values were
expressed as mean ± standard deviation or median [interquartile].
Results: Regarding socio-demographic characteristics, work status presented a statistically significant
difference between groups. In urban area, most of the subjects were retired (71%); while in rural area, most of
them were retired (44.4%) or farm workers (35.6%), p<0.001. Moreover, rural subjects had higher BMI and
WC (rural 23.2 ± 3.45 vs. urban 21.5 ± 2.35, p<0.05; rural 77.3 ± 8.91 vs. urban 71.2 ± 6.63, p<0.01), and
better results in HGS (rural 24.4 ± 3.43 kg vs. urban 22.5 ± 4.13 kg, p<0.05). However, urban subjects
presented better performance in CS (urban 7s [6.13 – 8.47] vs. rural 8.97s [7.11 – 10.41], p<0.001) and LSA
(urban 100 [82 – 110] vs. rural 70 [60 – 88], p<0.001). No statistical differences were found for the HR-QOL
EQ5D-3L index or all the other items assessed.
Conclusion: Differences were found in work status, anthropometric measures, physical functioning, but
not for HR-QOL between rural and urban older women. Subjects from rural area had better muscle strength
112
(HGS) than urban ones, who had higher leg muscle power (CS) and
mobility (LSA) scores. The environmental condition might require different demands and specific physical
abilities linked with daily routine and anthropometric features, but not affecting HR-QOL.
Implication/Recommendation: Health promoters should address the specific demand of each location,
enabling people to maintain functional independence and to assure HR-QOL. These findings should be useful
to target and evaluate interventions in both cohorts.
Keywords: quality of life, physical function, older adults, rural, urban, Japan
113
Poster Session 2:
Association of Subjective State of Health with Physical Performance and Quality of Life in
Older Women
Priscila Yukari Sewo Sampaio; Ricardo Aurélio Carvalho Sampaio;
Minoru Yamada; Mihoko Ogita; Hidenori Arai
Affiliation/Institutions: Department of Human Health Sciences,
Kyoto University Graduate School of Medicine
Purpose: Our study aimed to investigate the physical performance and quality of life (QOL) as associated
factors with subjective state of health (SSH).
Methods: Japanese community-dwelling women aged 65 years or older (n=51; mean age=75.3±6.0) answered
a questionnaire regarding 1) socio-demographic information, 2) SSH by the unique question “In general, how
would you say your current health is?” and the answers in a three- point Likert scale with the following
options: a) Very good to good health condition (henceforward, good); b) Normal health condition; c) Not so
good to bad health condition (henceforward, bad); and 3) QOL by Short Form-8 concerning general health,
physical function, physical fitness, bodily pain, vitality, social functioning, mental health, and emotions.
Additionally, subjects performed physical tests, such as the Timed Up and Go, Functional Reach (FR), One
Leg Stand, Five Chair Stands (CS) and handgrip strength. One-way ANOVA and Tukey’s Post Hoc were used
to verify the differences of the physical test results among the 3 groups. Additionally, chi square analysis was
used to verify the difference of subjects divided by SSH groups who had score below and above the mean of
each QOL domain.
Results: The majority of subjects evaluated their health as good condition (49%), followed by normal (35.3%),
and bad condition (15.7%). There were statistically significant differences among the groups regarding the use
of tobacco, frequency of medical consultation, and number of medications. The group of subjects who
evaluated their health as bad condition had more smokers and showed a highest frequency of medical
consultation and highest number of medications. Moreover, they had lower performance in FR
(good=24.5±5.7, normal=28.0±5.4, bad=21.8±5.7; p=0.03), and in CS (good=7.8±2.3, normal=7.8±2.1,
bad=10.7±4.2; p=0.02), aggravated by the poorer QOL condition in general health (low QOL - determined by
the value below the mean: good=12%, normal=11.1.%, bad=75%; p=0.003), bodily pain (low QOL:
good=50%, normal=76.5%, bad=100%; p=0.002), and vitality (low QOL: good=24%, normal=29.4%,
bad=75%; p=0.008) in comparison with other groups. There were no statistical differences between the good
114
and normal health condition groups.
Conclusions: The physical performance and QOL were associated factors with the SSH among older women
in Japan. The SSH “normal” is a good determinant, since the physical performance and QOL of this group
were closer to those who assessed their health as good condition in our study. However, those who assessed
their health as bad condition had worst physical performance in FR and in CS, and also presented lower QOL
scores in general health, bodily pain, and vitality than the others groups (good and normal).
Implications/Recommendation: We encourage the interpretation of the SSH based on the present findings of
this study such as relating positively the health sense of older women with their physical performance and
QOL.
Keywords: Subjective State of Health, Physical Performance, Quality of Life, Older Women
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Poster Session 3:
MOVE WITH CARE
J. PUSPO ADIJUWONO
CENTER FOR AGEING STUDIES UNIVERSITY OF INDONESIA
INDONESIAN SOCIETY OF GERENTOLOGY
Older people are still too few who are aware that falls are preventable. Due to ignorance and indifference
many older people fall. One in three people over 65 fall at least once a year. And once you fall you have the
chance to fall again.
These incidents happen mainly in or around the homes and often have unpleasant Physical (sprain, tissue
damage, cutting wounds, fractures etc), Psychological (eg. Fear of falling again, less movement, inactivity),
Social isolation (less contact and communication with others), and Economical (all these increase cost)
consequences that decrease the quality of life. Falls is even one of the leading cause of death.
The active participation and contribution of the elderly and its surroundings are of essential importance for the
success of prevention measures. Although in practice we are regularly confronted with resistance from the
elderly, because they are of the opinion that the fall prevention program is a potential threat
to their identity
and independence, but we may persistently encourage and motivate elder people by:
Active listening to their complaints, Applying phase and safe behavior program, Doing it with a smiling face,
Helping them with their needs with love and care etc.
Besides improving the unsafe habits of the elderly people, Housekeeping in the homes must also be improved,
obstacles, throw mats must be removed, appropriate lighting must be applied, pathways and stairs must be
kept clean and clear etc.
If the elderly people still can walk although in weak condition or have foot/knee/hip problems but permitted
by the Physician to use their legs, then walk by using the assistive devices or walking aids, like cane, walker
or rollator, instead of sitting in the wheelchair, which could deteriorate your health and will cause weakening
of the muscles and mobility. So they must do the physical activity as long as they can. Have always in mind,
‘move with care’.
Keyword: Keep standing on your feet. Do not fall.
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Poster Session 4:
Friendly Primary Health Care (PHC) Maintain Quality of Health Ageing Population in
Indonesia
Nur Alvira Pasca Wati and Deden Iwan Setiawan
Study Program of Public Health, and Study Program of Nursing
Faculty of Health Sciences
Respati University, Yogyakarta, Indonesia
Background: Indonesia with 200 million population become one of the 4th country in the world's with bigger
ageing population (7.5% or 15 million ageing population). Government National Statistic’s (BPS) report in
2005-2010 number of ageing people will be equal to the number of birth rates (8.5% or 19 million ageing
people from total population). Generally in Indonesia the healthy level’s of the life expectancy increasingly
(66.2 years in 2004 become 69.4 years in 2006). Estimate in 2020 the number of ageing people will reach 29
million people or 11% from total population. Unfortunately the fact ageing population in Indonesia those at
low income level, higher proportion risk of NCD’s and CD’s ageing people have more than one chronic
disease at the time. NCD’s are relatively impact costly to treat, over 29% budget increase in average public
spending on health capita. Need a new tool to solve the problems linked to ageing in Indonesia not coverage
on Health Department Regulation.
Impact: first, increase the dependency ageing from 12.12 years 2004 become 13.72 years 2008, however
ageing desolate more 2,994,330 people in Indonesia it mean 14 ageing must be supported by 100 young.
Second, resulting in upward pressure health system expenditures relatively costly. Third, change of
epidemiology transition, cause change of disease (CD’s become NCD’s), quality of life, improving CD’s
prevalence, and malnutrition disease (triple burden disease). Fourth, ageing not only has health problems but
also cultural problem (mismatch between the cultural and norms, changes in biological systems,
understanding variability and decrease activity daily living).
Conclusion:
Time is short for policy makers to act. Ageing problem need immediately to responds: making
health service care better for ageing (friendly PHC facilities). Improve the care and autonomy of disabled
ageing; in part for their own quality of life. Finally, but arguably most importantly, we must build
infrastructures that tap the real talents and potential contributions for healthy ageing can make to societies,
human rights in ageing and social protection of ageing people.
Recommendation: One beginning steps strategy identify characteristics socio-demographics, level disability
ageing, cognitive status, mental, functional, emotional, quality of life, and what ageing really need become
important tools prepared. Epidemiology assessment can applied to identified ageing needs. Improve the
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program like; ageing healthy, independent and productive ageing people in the future. Primary prevention
must include reducing incidence NCD’s at ageing, early detection (target screening) from local diseases,
treatment to impede future development and complication and public education can make more costly. In
addition reforming healthy care worker training (NCD’s prevention, early detection, treatment and care and
encouraging rural healthcare workers, focusing on technology (computer use in keeping older patient records
in real time), targeting the poor (note; cross-subsidies cannot resolve health inequalities), establishing social
health insurance program (universal coverage) and developing primary health care for ageing it offers a new
model.
Keys words: Friendly PHC, Quality of health, Ageing, Indonesia.
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Poster Session 5:
“Posyandu Lansia Program” As The New Ways To Maintain Quality of Healthy Ageing People
In Indonesia
Nur Alvira Pasca Wati
Study Program of Public Health, Faculty of Health Science,
Respati University, Yogyakarta, Indonesia
Background: The number of persons 60 years or over is expected almost to triple, increasing from 673
million in 2005 to 2 billion by 2050. Over the same period, older persons living in developing countries
expected to rise nearly 80 percent in 2050 (less developed regions). Ageing population is projected to rise 7.9
billion in 2050. Indonesia there are 17.1 billion in 2002 projected 35 billion in 2025. In Yogyakarta, 44,425
thousand (9.7%) population are ageing people. Unfortunately there are many problems linked to aging
(hearing and vision, mismatch between the cultural and norms, changes in biological systems, less of activity
daily living). Indeed, global ageing creates what may be the most important public health problem of the 21st
century. Health systems in many developing countries are not prepared to meet the burden of chronic disease
and disability that ageing populations bring with them. Honestly Posyandu Lansia should be the best way to
solve the problems linked to aging. Unfortunately, participant rate of posyandu lansia program only 20%.
Impact: Occur demography and epidemiology changes welcome direct impact, such; life expectancy will
increasingly (from 66.2 years in 2004 become 69.4 years in 2006). Survival to older ages is a common
occurrence because human must pay a heavy price for our longer lives. Unwelcome chronic and disabling
diseases (cancer, heart disease, stroke, Alzheimer’s, arthritis, etc). Decrease the dependency ageing people but
increased government spending on cost of health care payment. In additional only few of workers health
practitioners interested learn about ageing.
Conclusion: Between 2010 and 2050 the total population will increase by 2 billion while the older population
will increase by 1.3 billion. Older people who live healthy lives can continue to be productive for longer than
in the past. Government have natural and fundamental role to play in the health sector. Posyandu lansia
programs as the new alternative to solve ageing problems because Posyandu Program including: early
detection abnormalities, CD’s and NCD’s, depression status, nutrition status and activity daily living measure.
Quality of the Posyandu Lansia service program must improve such as: making target screening and good
facilities for ageing people in Public Health Centre and Posyandu Lansia must be available.
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Recommendation: Need more number of health workers who give health education related to maintain the
quality of health in ageing population at Yogyakarta Province. It is essential that we think programmatically
about investments throughout life in ageing health. Good education and social integration including family
members as lifelong investments. Improve the care and autonomy of disabled ageing people (quality of life).
We must not build but maintain infrastructures and program Posyandu Lansia because only that program real
contributions to maintain healthy ageing people.
Keys word: Posyandu lansia, New alternative, Quality of health, Ageing people, Yogyakarta
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Poster Session 6:
Utilization of Soursop Leaves (Annona Muricata) for Cancer Prevention and Healing
Dinni Agustin*, Lili Indrawati*, Rodiyah Soekardi**, Dwi Astuti**, Tri Budi W.Rahardjo*/**
Centre for Ageing Studies University of Indonesia, University of Respati Yogyakarta
Background: Cancer is the leading cause of death worldwide, responsible for 7.6 million deaths (around 13%
of all deaths) in 2008. Cancer of the lung, stomach, liver, colon and breast cancer is the leading cause of
cancer deaths the most every year. About 70% of all cancer deaths occur in low and middle income countries.
Deaths from cancer worldwide are projected to continue to increase more than 11 million in 2030 (WHO,
2011). In Indonesia, nationally, the prevalence of cancer was 0.4% (based health diagnosis). A total of nine
provinces have prevalence of cancer in the national prevalence, West Sumatra, Jakarta, West Java, Central
Java, Yogyakarta, Jakarta, Bali, North Sulawesi and South Sulawesi (Riskesdas, 2007), and became the third
largest contributor of death after heart disease (WHO, 2005). Currently, there are various treatments that have
been found to overcome cancer. One of the cancer treatment is to utilize the medicinal plants and traditional
medicine do. The use of traditional medicines and treatments are usually passed on from generation to
generation, which had been known only in certain circles then spread to the wider community.
Method: The research was conducted in Depok at two subdistricts Pancoran Mas and Beji, in Integrated
Community Post for Older Persons (Posbindu) Depok Jaya Subdistrict Pancoran Mas whose majority of its
community are
in middle up socioeconomic status and Posbindu Kurnia, Subdistrict
of its community are
Beji whose majority
in poor socioeconomic status. While in Yogyakarta the data was collected at four
location: Bantul, Sleman, Wates and Umbulharjo. The data was collected from 27 Februari 2012 until 3 March
2012, with total samples each (Depok and Yogyakarta) were 150 people, 75
consist of
subject from each subdistrict,
middle age and elderly, man and woman. The subject was asked to fulfill questioners regarding
their knowledge and attitude on herbal and report their health status. After completing the questionnaires the
subjects underwent for medical check for blood glucose, uric acid, colesterol and blood pressure.
Result: Average respondents' knowledge about the benefits of soursop leaves but not many people know how
to consume it. Most respondents only knew the benefits of herbs that have been used and consumption such
as: ginger, turmeric yellow and white, and the leaves that usually they are consumed are vegetables. While the
herbs they used to consume more in the form of herbal concoction and boiling.
Conclusion: The ability to mix nutritious crops for health have been entrenched in the community. Generally,
a medicinal herb native to Indonesia, how to manufacture, proving the efficacy, safety, and how to use based
on the traditional knowledge of Java and Madura. But now traditional medicine not only belong to the
Javanese and Madurese, but has become a resident of Indonesia (BPOM, 2006). Traditional medicine has been
a major contributor to national development, played a significant role in the national health, and boost the
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economy in rural areas. At the beginning of the 90's found that traditional medicine can cure several diseases
including cancer. Traditional treatment by using the leaves of the soursop, that contains anti-cancer called
Annonaceous acetogenin. These substances can kill cancer cells without disrupting healthy cells in the human
body. However, it is still necessary scientific studies that further to know the benefits of soursop leaves.
Key word: Cancer, prevention, healing, soursop leaves, older person
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Poster Session 7:
General psychological survey of Indonesian elderly in Depok
Dharmayati Utoyo Lubis, Edo Sebastian Jaya, Retha Arjadi, Lathifah Hanum, and Kresna Astri
Universitas Indonesia
The increasing proportion of older adults in Indonesian population warrants the attention of all kinds of
profession, including psychologists. This calls for the recognition of common psychological problems that is
unique to the age group. While there have been numerous research regarding the prevalence of common
psychological problems among the elderly, the majority of them are conducted in Western setting.
Epidemiological studies of psychological problems among Indonesian elderly are relatively rare. This is an
attempt to provide some background data regarding the psychological condition of Indonesian elderly,
specifically: stress, chronic pain acceptance, depression, and insomnia. Especially on depression and insomnia,
a prevalence estimate can be calculated using the measures’ cut-off score. The result shows that prevalence of
psychological problems is high and comparable to result from Western studies. Unfortunately, even though the
rate of psychological problems cases is similar to the West, access to psychological services is still very far
from Western standard. Therefore, it is imperative to take action and widen the access for psychological
services.
Keywords: Indonesian elderly, stress, chronic pain acceptance, depression, insomnia, epidemiology
Introduction
The proportion of older adults in Indonesia is on an increase. The last national census (2010) in Indonesia
shows that elderly occupy 7.58% of the population. Depok, a city in west Java, have an even higher
percentage at 8.6% (Hapsari, 2009). It is projected that older adults will occupy a fifth of the Indonesian
population in 2025 (Megarani, 2007). The increasing proportion of older adults in Indonesia warrants the
attention of every profession, including psychologists.
The aging process made older adults have several general problems. This is mainly due to the deterioration of
general functions (such as: eyesight, cognitive ability) that comes together with aging (Schuurmans, 2004). Of
course, the deterioration of such general functions will inevitably bring psychological problems. The most
common psychological problems among the elderly are depression, anxiety, dementia, insomnia, alcohol
addiction, and stress due to health problems (Knight, Kaskie, Shurgot, & Dave, 2006). There have been many
studies that show an unexceptionally high prevalence of those psychological problems in the elderly
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population.
Even though there have been many studies regarding psychological problems prevalence, most are done in the
Western context. The prevalence of psychological problems in Indonesian elderly is still very much in the
dark. This study hopes to shed some light on the prevalence of psychological problems among Indonesian
Elderly. This field survey research uses adapted questionnaires to measure several psychological problems.
Method
Research design
This research is a field survey research, where participants fill in self-report questionnaires. Assistance is
given to those who wish to participate but cannot fill in the questionnaire due to various reasons (e.g. forget to
bring their glasses). The questionnaires are given at an outdoor setting under guided instructions. No
incentives are given for their voluntary participation.
Participants
This survey research involves 190 participants that reside in Depok. The participants’ age ranged from 60 to
84 years (M = 62.47, SD = 9.13). The participants were 74.7% female and 22.1% male. The vast majority of
the participants were married (67.9%), followed by widowed (25.1%) and not married (3.2%). Most of the
participants have senior high school education (41.9%) and university (31.2%). Based on household
expenditure, most have monthly expenditure ranging from Rp 1.000.001,00 to Rp 3.500.000,00 (55.4%) and
Rp 500.000 – Rp 1.000.000 (21.5%).
Measures
This research involves several adapted measures that have gone through back-translation process from a
sworn translator. Perceived Stress Questionnaire (PSQ) is used to measure stress, which is defined as
subjective reaction to external events or demands from their environment (Levenstein, Prantera, & Varvo,
1993). PSQ consist of 20 items with 4-points Likert Scale that ranged from 0 (Never) to 3 (Very Often). Next,
Center for Epidemiological Studies Depression Scale (CES-D) is used to measure depressive symptoms in
general population. This research used the short version of CES-D (CES-D 10) to ease the burden of filling
questionnaires of the participants (Irwin, Artin, & Oxman, 1999). The CES-D 10 consist of 10 items with
4-points Likert Scale that ranged from 0 (less than 1 day in a week) to 3 (5-7 days in a week). The cut-off
score for the presence of depression is 10. In addition, Insomnia Severity Index (ISI) is used to measure a
range of insomnia symptoms (Morin & Espie, 2004). The measure includes 7 items with 5-point Likert Scale
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from 0 (None) to 3 (Very Severe). The optimum cut-off score for the presence of insomnia is 10. Lastly,
Chronic Pain Acceptance Questionnaire (CPAQ – 8) in short form is used to measure individuals’ acceptance
to their chronic pain (Fish, McGuire, Hogan, Morrison, & Stewart, 2010). The measure has 8 items with
7-point Likert Scale from 0 (Not true) to 6 (Always true).
Result
In this section, the descriptive data and reliability of the measures are presented first. Then, a rough
calculation of an epidemiological data regarding the prevalence of depression and insomnia in the sample will
be presented.
Descriptive data and reliability
Table 1 presented the descriptive data and the reliability of the measure. The reliability presented is Cronbach
Alpha. The reliability score shows that the scales that are in short form (CES-D 10 and CPAQ-8) suffers from
low reliability. But, this is maybe due to Cronbach Alpha’s tendency to show low reliability with scales with
small number of items. The main concern in this descriptive data is shown by the maximum score of CES-D
and ISI which is high above the cut-off score and is reaching dangerous level.
Table 1. Descriptive data and reliability of the measures
Measures
Minimum
Maximum
Means
SD
Reliability
Perceived Stress Questionnaire
0
0.65
0.29
0.14
0.83
Center for Epidemiological Studies
0
19
6.51
3.84
0.47
Insomnia Severity Index
0
24
6.15
4.90
0.87
Chronic Pain Acceptance Questionnaire
0
56
29.56
13.78
0.57
Depression Scale
Epidemiological data
The epidemiological data will roughly show the prevalence of depression and insomnia cases using cut-off
scores. Stress and chronic pain acceptance are not presented because they do not have a certain cut-off.
Prevalence of depression
Participants that met the cut-off for depression are 18.95%, which is close to a ratio of 1 out of 5 elderly. This
level of prevalence can be considered very high. Furthermore, Table 2 presents the percentiles of CES-D 10 to
show the depression range of the participants. The fact that the score 9 is at 75% percentile is quite alarming.
Table 2. CES-D 10 Percentiles
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CES-D 10 Percentiles
5
10
25
50
75
90
95
2.00
2.00
4.00
6.00
9.00
11.30
14.00
Prevalence of insomnia
Participants that met the cut-off for insomnia are 20.53%, which is close to a ratio of 1 out of 5 elderly. This
level of prevalence can be considered very high. This data can be accompanied by the percentiles of ISI to
show the score range of the participants in Table 3.
Table 3. ISI Percentiles
ISI Percentiles
5
10
25
50
75
90
95
0.00
1.00
2.00
5.00
9.00
13.00
15.00
Discussion
The result shows that the prevalence of psychological disorders among Indonesian Elderly in Depok is quite
high. The prevalence of depression among Indonesian Elderly in Depok is comparable to the epidemiological
study from United States. In the United States, the depression prevalence among older adults range from
6-24% (Gellis & McCracken, 2008). However, unlike in the United States, access to psychological services
and therapy is very much limited. Therefore, most of these depression cases are undetected. In addition, the
prevalence of insomnia among Indonesian Elderly in Depok is also quite high. The result is quite similar to a
previous study from Philips Health and Well Being Index 2010 that estimated 20% of the whole Indonesian
population has sleep problems (MetroTV news, 2012). Meanwhile, insomnia prevalence in the United States
is much higher, reaching 50% of the population (Foley, Monjan, Brown, Simonsick, Wallace, & Blazer, 1995).
This study has several limitations. First of all, the number of sample is very small for an epidemiological
study and for generalization to the population. Then, the reliability of the CES-D 10 and CPAQ-8 measures is
not very good. This made interpretation of data for depression and chronic pain acceptance to be difficult and
doubtful. However, studies of psychological disorders prevalence in Indonesia are very limited and this data
may still shed some light on the topic.
Furthermore, bearing in mind the high prevalence of psychological disorders among Indonesian Elderly, a call
for an urgent step for psychological disorder management is required. As an example, depression can lead to
deteriorating physical and psychological condition, such as anxiety, dementia, and sleep disturbance, or even
death (Alexopoulus, 2005; Knight, Kaskie, Shurgot & Dave, 2006; Satre, Knight & David, 2006; Schulz,
Beach, Ives, Martire, Ariyo & Kop, 2000). Insomnia has also been associated with the increasing risk of fall
(Avidan, Fries, James, Szafra, Wright, & Chervin, 2005) and poor cognitive performance (Cricco, Simonsick,
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& Foley, 2001). Furthermore, insomnia is also associated with an increase risk of mortality (Dew, Hoch,
Buysee, et al., 2003). Both psychological disorders are associated with deterioration of physical and
psychological condition, as well as death. Therefore, it is imperative for an action of psychological disorder
management for the elderly.
References
Alexopoulus, G.S. (2005). Depression in elderly. Lancet, 365, 1961-1970.
Avidan, A. Y., Fries, B. E., James, M. L., Szafara, K. L., Wright, G. T., & Chervin, R. D. (2005). Insomnia and
hypnotic use, recorded in the minimum data set, as predictors of falls and hip fractures in Michigan
nursing homes. Journal of American Geriatric Society, 53, 955–996.
Cricco, M., Simonsick, E. M., & Foley, D. J. (2001). The impact of insomnia on cognitive functioning in older
adults. Journal of American Geriatric Society, 49, 1185–1189.
Dew, M. A., Hoch, C. C., Buysee, D. J., et al. (2003). Healthy older adults’ sleep predicts all-cause mortality
at 4 to 19 years of follow-up. Psychosomatic Medicine, 65, 63–73.
Fish, R. A., McGuire, B., Hogan, M., Morrison, T. G., Stewart, I. (2010). Validation of the chronic pain
acceptance questionnaire (CPAQ) in an internet sample and development and prelimanary validation
of the CPAQ-8. Pain, 149, 435-443.
Hapsari, T. (2009). Depok Berpeluang Menjadi Kota Ramah Lansia. Tempointeraktif.com. Accessed on 4
March 2012, from
http://www.tempointeraktif.com/share/?act=TmV3cw==&type=UHJpb
Irwin, M., Artin, K.H, Oxman, M.N. (1999). Screening for depression in the older
adult: Criterion validity of
the 10-Item Center for Epidemiological Studies Depression Scale (CES-D). Arch Intern Med, 159,
1701-1704.
Knight, B.G., Kaskie, B., Shurgot, G.R., & Dave, J. (2006). Improving mental health of older adults. Dalam
Birren, J.E. & Schaie, K.W. (Ed.). Handbook of the psychology of aging (6th ed.). London: Elsevier
Academic Press.
Megarani, A.M. (2007). Pada 2025, seperlima penduduk Indonesia Lansia. Tempo Interaktif, Senin, 12
November 2007. Accessed in 9 November 2010.
http://www.tempointeraktif.com/hg/nasional/2007/11/12/brk,20071112-111401,id.html
Satre, D., Knight, B.G. & David, S. (2006). Cognitive behavioral interventions with older adults: Integrating
clinical and gerontological research. Professional Psychology: Research and Practice, 37, 489-498.
Schulz, R. Beach, S.R., Ives, D.G., Martire, L.M. Ariyo, A.A. & Kop, W.J. (2000). Association between
depression and mortality in older adults: The cardiovascular health study. Arch Intern Med, 160,
1761-1768.
127
Levenstein S, Prantera C, Varvo V, Scribano ML, Berto E, Luzi C, Andreoli A. Development of the Perceived
Stress Questionnaire: a new tool for psychosomatic research. J Psychosom Res 1993;37:19–32.
Morin, C. M. & Espie, C. A. (2004). Insomnia: A clinical guide to assessment and treatment. New York:
Kluwer Academic Publishers.
Morin, C. M., Belleville, G., Belanger, L., & Ivers, H. (2011). The insomnia severity index: psychometric
indicators to detect insomnia cases and evaluate treatment response. Sleep, 34(5), 601-608.
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Poster Session 8:
HEALTHY AGEING NEEDS AMONG ELDERLY MONGOLIANS
Oyunkhand R1, Enkhbayar M1, Uurtsaikh N1, Batsereedene B2, Chimedsuren O3, Byambasuren S4
1 National Gerontology center
2 “Etugen” Medical School
3School of Public Health, Health Sciences University
4 Faculty of Mental Health, Health Sciences University
Purpose:
To determine healthy ageing needs among Mongolian elderly and to develop policy recommendation and
proposal on improving quality of life and health condition of elderly.
Methods:
The research was carried out by cross sectional method. In this cross sectional study, we had chosen randomly
1 cluster from each 4 economic-geographical regions of Mongolia and was comprised of 1207 elderly aged 60
years and over for men and 55 years and over for women.
The research was conducted by using internationally recognized methods of clinical examination, Mini
Nutritional Assessment, Mini Mental Examination Test (MMET), Geriatric Depression Scale (GDS), ADL and
IADL tests and questionnaire of determining some needs.
The statistical processing was performed by using SPSS-17.0 program.
Results:
Out of survey involved 1207 elderly, 32.5 percent (392) referred to men, 67.5 percent (815) to women,
and their mean age was 68.1±8.1 (68.9±6.5 in male and 65.7±8.5 in female).
While 473 elderly were from
Ulaanbaatar city, 734 of them were from 4 regions of countryside.
Among survey respondents, 81 percent was suffered from diseases of cardiovascular system, 60
percent from urogenital, 56 percent from diseases of eye and its adnexure, 53.2 percent from musculoskeletal
and 44.2 percent from mental and behavioral diseases. In general, elders had 3 to 4 diseases.
While 4.8 percent of elderly investigated to have malnutrition, 26.2 percent of respondent was at risk of
malnutrition, while 69 percent were well nourished. Elderly malnutrition, depression and cognitive
impairment had direct correlation to income and education (P<0.001, r=0.2).
And 38.5 of elderly investigated to have depression and 44 percent - anxiety. Elderly depression had
statistically significant difference with ADL and IADL (P<0.001).
Among survey involved elderly, the mean of ADL ability was 87.4 percent, of which, the following
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abilities were better such as: continence (92.5%), toileting (91.3%), dressing (87.9%), while bathing ability
was impaired mostly or 18.2 percent.
In terms of income, 95.9 percent of elderly were supported from the retirement pension, 2.7 percent of
respondents from subsidy, 0.5 percent of them supported from conditional cash subsidy and rest 0.9 percent
from other sources.
When we classified the needs of elderly into health, economic and other, 37 percent of elderly required health,
33 percent demand economic and rest 37 percent required other needs.
Conclusion:
1. Among survey involved elderly, 14.4 percent of them found to be physically healthy, while 85.6
percent had some diseases.
2. For 95.9 percent of Mongolian elderly, the main income was their retirement pension.
3. The main need required for the elderly was health needs, subsequently the important issue tended to
be increased their income.
Recommendation:
For the policy and decision makers:
According to the population structure prospect, share of older persons in total population will increase
and due to this scenario, needs of rehabilitation, community-based rehabilitation for elderly also enhanced and
to provide intersectorial collaboration.
And due to this study result, increasing income support for elderly can improve health and nutrition
status, to give working opportunities for elderly who is physically and mentally relatively healthy.
Recommendation on individual level:
It’s never too late to go for a healthier life. As people get old, healthy eating, physical, social, and mental
activities play an important role in how well you age. Emotional and mental vitality are closely tied to
physical condition. Volunteering in community and challenging intellect on a daily living is a good training
for healthy ageing.
Keywords: Healthy ageing, Mongolian elderly, elderly needs
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Poster Session 9:
Multiculturalism as an Asset in Senior Care
A case study in a Swiss nursing home
Summer 2012
Caroline Vuagniaux
Institute of Socioeconomics and Centre for Interdisciplinary Gerontology
LIVES (Swiss National Centre of Competence in Research)
University of Geneva, Switzerland
Background and purpose: The population of Switzerland is aging. Thanks to a young migrant population,
the growth rate is still positive. Because of the general shrinking workforce and of the growing needs of the
Eldercare, the Health sector is dependent of foreign caregivers and qualified workers.
La Fondation Les Baumettes is a nursing home near Lausanne in the French speaking part of Switzerland. The
population of this institution reflects the multicultural face of Switzerland and illustrates the successive flows
of immigration of the last decades. The senior patients are the cohort born in the 1920’s: many came to
Switzerland looking for work and are growing old in the host country. The employees of the nursing home
reflect the modern migration: they found work in the Swiss Health sector.
What do senior patients think of this situation?
Method:issues and recommendations: a panel was chosen amongst the senior patients. Semi-structured
interviews were conducted.
Interviewees had to be able to understand and answer specific questions on a sensible topic. This prerequisite
reduced the size of the final panel; old age and cognitive problems also induced bias.
This case study focuses on senior patients’ perception of their foreign caregivers. Further work could be done
by interviewing caregivers to analyze how they cope with Multiculturalism, and then widen the topic to study
the effects of immigration on the workplace in the Swiss Health sector.
Results: majority of the panel 1) did not know that their caregivers were of other nationalities than Swiss, and
did not care about this; 2) declared being surprised by the number of different nationalities represented in the
nursing home, but 3) was aware of the shrinking of workforce in Switzerland and was feeling grateful towards
the foreign caregivers coming to Switzerland to help Seniors.
Therefore, for senior patients, skin color, country of origin and nationality do not matter, as long as the
caregiver speaks French, and does his/her best to communicate with the patient clearly and politely.
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Conclusions: Swiss tradition of open-mind is internalized by the senior patients and important to them.
Multiculturalism is perceived as positive by the panel, and interviewees were able to control their answers in a
politically correct manner. In everyday life and caring, whatever their nationality, it is the personality of
workers and their ability to communicate that are important to senior patients.
What is more, diversity is entertaining because patients enjoy when migrant workers speak about their
countries. Cultural Exchange brings positive effects to the senior patients and enhances everyday life in the
institution by bringing new ideas or sharing various experiences, e.g. enjoying together many different
national foods, music or habits.
In this Swiss nursing home, Multiculturalism turns out to be an asset in Senior Care.
Key words: Social Aging, Multiculturalism, foreign workers, foreign patients
132
Poster Session 10:
Community Organization for Elderly People with Dementia Symptoms
Yumi Ohshita1, Kiyoshi Kamo2
1Associate professor and 2Professor emeritus, Hiroshima Prefectural University
Purpose:
The purpose of this study was to construct a theoretical and therapeutic framework of community organization
that can improve adaptation levels of elderly people.
Method:
1. Theoretical consideration
First, the construction of a community mental health theory that can explain the dynamics of the correlational
changing process between dementia symptoms of elderly people and interpersonal relationships within a
community was examined. Based on this community mental health theory, a therapeutic community
organization methodology that can solve the problems of interpersonal networks within a community and
prevent exacerbation of dementia symptoms of elderly people was systematized. The therapeutic intervention
of this model comprises specific skills to transform a maladaptive human transactional process within a
community. These skills comprise circular question skills of the Calgary school of family therapy and the
transformation skills of Solution-Focused Brief Psychotherapy. These skills were used to trigger the formation
of small-change interpersonal networks within a community. Moreover, a measurement method of the effects
of intervention was constructed with this model.
2. Case study
Therapeutic activities based on this therapeutic community organization model were performed. Usefulness of
this therapeutic community organization model, which transforms the mechanism of deterioration of
transactional problems of interpersonal networks within a community and simultaneously improves dementia
symptoms, was exemplified through case studies of maladaptive elderly people. The effectiveness of
intervention was measured with a new measurement tool.
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Results:
The ability of this practice framework to assess the dynamics between pathological transactions within a
community system and the adaptation level of elderly persons was proven by case studies of maladaptive
elderly persons. The capability of this practice framework to transform dysfunctional relationships between
the adaptation level of these persons and transactional processes was also proven.
Conclusion:
This new intervention methodology of community organization based on community mental health theory is
an effective method with which to solve the adaptation problems of elderly people.
Implications/recommendations:
The present study involved up-to-date clinical research that aimed to improve the maladaptation of elderly
people by transformation of interpersonal networks within a community. This intervention model, the details
of which are explained in this manuscript, indicates the availability of new practice methodology that
strengthens elderly people’s adaptation ability within communities. This information will assist practitioners
who provide medical treatment to elderly patients and professionals involved in welfare services for elderly
persons.
Key words:
elderly people, dementia symptoms, community organization, improving maladaptation
134
Poster Session 11:
Trends of Life Support Technology and Science in Aging
Donghee Han(Research Center for Anti-aging Technology and Development & RISBLE)
Cheolmin, Kim (School of Medical, Pusan National University & RCATD, )
Wang Keun Yoo (Dept. of Health Science, Daegu Hanny University)
The world in the 21C is becoming a Global Information Society. At the Same time world population is
aging and Korea is one of the most rapidly aging countries in the world. Korea is making competitive
investments in research field of science and technology. Also there are a lot of government supports to
improve quality of life with aging.
Technology has the potential to make life easier to support communication with family and friends, to
assist with health care and to enable individuals to remain safe and functionally independent in their own
home (David Burdick & Sunkyo Kwon, 2004). Even though Gerontechnology has been implanted in our
society, most of gerontologist and engineers are working hard in each field, their views may be different. Thus,
gerontology and technology must be co-work to research and develop outcomes. Science now affects every
aspect of life even including aging intervention. There are many possibilities to promote better aging by life
support technology.
This study reviews trends in technology and high skill innovation and creation of designing technology
for old persons; designing technology, promoting health, assistive technology, monitoring system, smart house,
driving simulation, tele-health workstation, Wireless Physiologic Monitoring System with Imbedded Sensor
for Electrocardiogram, Robot so on. We will also discuss the benefits of digital life in super aged society
135
Poster Session 12:
Quality of life and related factors among young-old and old-old in Korea
Younghae chung, Yoo Hyang Cho
Dongshin University, Chodang University
Purpose
The purpose of this study was to investigate the difference in quality of life and related factors among the
elderly by young- and old-old.
Methods
Elderly data of 1,339 cases from National Health and Nutrition Examination Survey (Korea Center for
Disease Control, 2010) were analyzed with SPSS 20.0, using complex survey data analysis methods. Most of
the instruments were used according to the original survey while some were recategorized. Gender, education,
living area, family income, factor considered to be related to quality of life such as exercise, smoking and
drinking habit, existence of chronic disease, subjective health status, BMI were explored for their relationship
with quality of life. Significance level was set to .05.
Results
Among the elderly 58.4% were female, and approximately 3/4 had education below elementary school. There
were more female and elementary school education among the old-old, and more living with significant others
among the young-old. And there were more drinking, exercising, overweight among the young-old.
Underweight, depression, and suicidal thoughts were more prevalent among the old-old. The old-old
considered their subjective health status worse. Quality of life score was .88 for the young-old, and .77 for the
old-old, and the difference was statistically significant. Factors related to quality of life were gender,
subjective health status and BMI among the young-old and were education, family income, and subjective
health status among the old-old.
Conclusion and Suggestions
Based on the results of this study, we recommend differentiated health policy and health programs for the
young- and the old-old.
Keyword: young-old, old-old, quality of life, Korea National Health and Nutrition Examination Survey data
136
Poster Session 13:
The Effects of Health Programs for the elderly's health life
Nam Hee Eun(Kosin University), Koh Bo Sun(Jeju International University),
Jin Hye Min(Daegu Haany University)
Having 80 senior citizens aged 60 or above in Youngdo-gu, Busan as subjects for the health program research
(20 in line with laugh therapy, 20 in line with music therapy, 20 in line with massage therapy, 20 in line with
fine art therapy) which took place 2 hours a week for a year in order to observe its effect on their pre-and-post
functional physical fitness, boy composition, fall efficacy, and cognitive function and the findings are as
follows.
1) Functional Physical Fitness
From each group who had exercise therapy in line with laugh, music, massage, and fine art therapy, it
appeared that the arm strength, leg strength, leg flexibility, and agility of the subjects improved compared to
the pre-therapy state showing significant differences among the types of exercise as well.
2) Body Composition
Each of four groups have improved in their skeletal muscle mass compared to the pre-exercise state.
3) Fall Efficacy
Each of four groups didn't show much difference in fall efficacy compared to the pre-exercise state, but it
showed some significant difference among the types of exercise.
4) Cognitive Function
Each of four groups has improved in cognitive function compared to the pre-exercise state showing significant
difference among the types of exercise as well.
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Poster Session 14:
The Determinants of the Retirement Acceptance among the Retired elderly
#1 Koh, Bo Sun, Professor, Dept. of Social Welfare, Jeju International University, South Korea
#2 Ko, Eun Jung, Master’s Course Graduate School, Dept. of Social Welfare, Soongsil University, South
Korea
Purpose: The purpose of this research to explore determinants of the retirement acceptance among retired
elderly. In particular, this study focused on the effects of personal, retirement, and environment factors on the
retirement acceptance.
Methods: The respondents were limited to retirees either receiving retirement pensions or full-time working
retirees over 55 years old, who live together with spouse in Jeju, 2011. Total 200 cases were analyzed with
descriptive analysis, t-test, ANOVA, and multiple regression analysis with SPSS 18.0 program. Independent
variables consisted of three factors (personal, retirement, and environment). Personal factors were perception
of health status and self-esteem. Retirement factors were duration of retirement and prepare for retirement.
Environment factors were family life satisfaction and leisure satisfaction.
Results: The average retirement acceptance of the respondents was 20.73(SD; 3.72). The retirement
acceptance had significant difference by age and education level. The predictors of retirement acceptance
were self-esteem, prepare for retirement, and family life satisfaction. The strongest predictors were
self-esteem of the retired elderly.
Implications: Self-esteem and family life satisfaction are essential to adaptation for post-retirement life.
Acceptance of retirement is important problem for retirees and their family members. Psychological instability
among retirees owing to post-retirement economic uncertainty and suspension of income-earning activities
may have negative impacts on acceptance of retirement and psychological condition of retirees. Family
support system is helpful to adjust new roles and function. Marital relationship education and therapeutic
programs are necessary for the retired couple. It is important to prepare for the pre-retirement planning
program in both the worker and employer. This program has to focused on economic aspect for provision and
non-economic aspects as well as. Preparation for leisure time and better leisure environments are necessary
for a positive mental health in the later life. Social welfare center and social worker should help the retirees to
make their leisure time productive by implementing the various educational programs on leisure activities.
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References: Catherine, H., Nathalie, B., Michele, J., & Daniel, A. (2012). Comparative Study of the Quality
of Adaptation and Satisfaction with Life of Retirees According to Retiring Age. Psychology, 3(4), 322-327.
Maule, A. J., Cliff, D. R., & Talyor, R. (1996). Early retirement decisions and how they affect later quality of
life. Aging and Society, 16, 177-204.
M.E.Szinovacz & Daney, A. (2005). Predictors of perceptions of Involuntary Retirement. The Gerontologist,
45(1), 36-47.
Midanik, L. T., Soghikian, K. Ranson, L. J., & Tekawa, I. S. (1995). The effect of retirement on mental health
and health behaviors: The Kaiser Permanence Reirement Study. Journal of Gerontology Social Science, 50B,
S59-S61.
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Poster Session 15 :
Program for Dementia Prevention and Healthy Brain
TaeYu Kim. M.D.
Department of Neurology, Willis Hospital, Busan, Korea
This study purposed to show programs for dementia prevention and healthy brain in Willis Hospital. Four
types of mental activities and cognitive exercise programs were using and developing programs. They are as
follows;
1. Art for attention and executive function.
2. Personal Computer for multiple function (Physical, Mental, Emotional activities, Reminiscence).
3. Diary for memory and language function.
4. Cognitive Training exercise paper for easy and general use.
In our hospital dementia patients have been participated brain health program for 40 min, 4 times a week.
Some patients improved attention and mood. I would like to introduce these programs in this conference.
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POSTER SESSION 16 :
A Case Study on Informatization Education of Senior Welfare Center
Authors
Nam Hee Eun - Kosin Univ.
Kim Nam Sook – Tongmyong Univ.
Kim Jong Min – Kosin Univ.
1. Introduction
The modern society has been rapidly growing into an aging and information society. In the aspects of the
complexity, it has been causing both individual and social issues. Especially, South Korea has become one of
the strongest countries in IT section building it into a world class information society whose too speedy
growth into a compressed information society has led to the unequal distribution of information resources and
a gap of capacity in embracing information among regions, generations, and classes respectively. As for the
aged, the gap of information is quite wide making them relatively isolated. Although there are a lot of effort
made by giving education and, developing and disseminating tailored contents in order to close the gap, the
more active education and culture of information should be available in terms of senior welfare as they
typically have limited capacity and access to the information.
This study is to make a constructive suggestion for the informatization education for seniors by observing the
actual training taking place in 12 senior centers in Busan who are mainly in charge of the training programs,
as well as by taking the case of Nam-Gu Senior Center.
2. The cases of informatization education in Senior Centers
As I have analyzed the education programs to informatize seniors taking place in 12 Senior Centers in Busan,
the programs can be largely categorized into (1) Basic Computer Skills Class(Word processing, Internet
usage), (2) Multimedia class(Image& Video editing), and (3) Digital Devices(Mobile phone, Digital camera,
etc.) Usage Class. Among these, I found that the Basic Computer Skills Class is taking place in every Senior
Center while the Multi-media Class and Digital Devices Class were taking place in 5 Centers only. It is
comprehensible that the training in those Centers is focused more on basic computer skills as the subjects are
seniors not the computer generations. However, it looks like diversifying the training programs is inevitable
considering the fact that the recent IT environment has been rapidly changing.
In the case of Nam-Gu Senior Center, the training programs with a variety of themes are taking place per level
in order for more efficient education. When it comes to the Computer Skills Class, 6 classes are divided per
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level and the Photoshop &Swish Max Class for image &video editing is taking place at the same time. In
addition, the Mobile &Smart phone usage class is also given complying with the currently popular use of
mobile phones. Altogether, the above training programs appear to be a sure outcome of certain effort to create
various themes of the training programs in order to draw seniors into. Notably, these classes are taking place
through some senior citizens who volunteered to teach other seniors as the programs are sponsored by SK
Telecom, a mobile service provider.
The seniors' desire to learn IT has been increasing greatly due to their need to exchange text messages with
their children or grand-children, or e-mails with their children abroad, which will lead to more activated
seniors' informatization programs in line with the rapid social changes.
3. Conclusion
Based on the above researches about the ongoing seniors' informatization programs in Senior Centers, the
followings can be suggested.
First of all, as IT environment is turning into Smart phones or Tablet PC from PC, the relevant training
programs need beefing up so that the programs can effectively aid seniors to live a smart life.
Secondly, just like the case of Namgu Senior Center, the kind of culture and system that a senior citizen trains
the other seniors should be built up. A senior citizen who trains other seniors must be well known of the
other's urgent need and desire to be informatized, which will eventually make the training more effective.
Lastly, the network to broaden senior citizens' social involvement should be reinforced. For this, they need to
get more chances to join the official network so that it will lead to reinforcing their personal network. The
community and other informatization training institutes should devise various events or programs to assist
them to magnify their own network.
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POSTER SESSION 17 :
A Study on Senior Welfare Center Worker’s Burnout As Emotional Laborers
KIM NAM-SOOK
Tongmyong University
Purpose
Senior welfare center and the workers are growing more and more in many countries include Korea.
However, to date very few studies have been conducted on senior welfare center worker’s burnout as
emotional laborers in Korea. The workers supply the human services which are from emotional area. If they
have emotional problems as like burnout, the services qualities for the aging are lower and lower.
The purpose of this study is to further understanding of senior welfare center worker’s burnout in their daily
job stress. After understanding the factor to their emotional burnout as burnout resilience, burnout risk, the
focus on this study is how we can predict and prevent to worker’s emotional problems.
Methods
There are 17 senior welfare center in Busan metrocity among them 2 centers are opened this year, except them
15 centers are surveyed this study. About 200 workers are replied this survey. The workers are not only social
worker and also non-social worker as like physical therapist, nurse, speech therapist, the account section,
driver and so on.
This study will use a ready made scale for “burnout”, “ burnout resilience”, “burnout risk”. Gathering data
will be analized as career, age, gender, working part, position, schooling, religion. Descriptive statistics will be
computed for each of the factors of burnout, using SPSS 18.0. Analysis of variance(ANOVA) will be used
with Scheffe post-hoc means tests to determine where significant differences between pairs of respondent
characteristics will be present.
Results
This study has some hypothesis and questions.
<hypothesis 1>
The career influence on worker’s burnout
<hypothesis 2>
The age influence on worker’s burnout
<hypothesis 3>
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The position influence on worker’s burnout
<hypothesis 4>
worker’s burnout has different between gender
<some questions>
What is the most affecting factor to worker’s burnout, career? age? religion? gender?
Is there different factor to burnout between social position, working part?
Which group has the most burnout risk?
Conclusion
This study expects the younger and less experienced workers has higher burnout than 50’s.
This study expects the higher position has more burnout than lower position.
The results of this survey will show significant differences in worker burnout according to the variables of
educational level, age, service length and position. As there are also significant differences according to the
emotional labor of these groups, these appear to be consistent with the existing literature which emphasizes
the connection between burnout risk, burnout resilience.
Implication/Recommendation
Professional burnout who provide human services are result of a detrimental effect on agency operations,
impairing the quality of services for people. Target the elderly, in particular, on the day of the Senior Welfare
Center, 500-1000 people facing most workers than older, higher anti-ship coming from the client must follow
various difficulties.
It needs to pay more attention in the sense that there is a ripple effect on human services and agencies, rather
than simply staying on the problem of personal burnout leads to difficulties arising from these business
professionals.
Identifying the correct status for the exhausted and exhausted the workers, as well as institutions, and subject
to undesirable consequences such as this to understand the mechanism for the development of policies to
solve them by the results of this study to utilize expectations.
Keywords
senior welfare center, worker’s burnout, emotional labor
144
Poster Session 18:
Job satisfaction and turnover among foreign caregiver working in Japan
(A Case study of Indonesian caregiver candidates)
KREASITA
Graduate Student of Kyushu University, Sociology Department
Purpose
Since August 2008, Japan has opened the door for Indonesian nurses to work in Japan as nurse or caregiver
under Economic Partnership Agreement (EPA). During working in Japan, Indonesian candidates were facing
several cultural and social problems. Some candidates even decided to return to home country before or after
passing The National Exams. The fundamental reason that candidates leave their jobs is that they are not
satisfied. Their dissatisfaction could occur on many levels. In this study, I would like to find satisfaction and
dissatisfaction factors of Indonesian candidates during working in Japan as caregiver and to find factors that
determine Indonesian candidates to continue or discontinue their job as caregiver. .
Methods
Interview and Group Discussions.
Results
The company policies that make candidates feel satisfied are:
1. Good salary
2. Good accommodation provided (example: apartment with reasonable price)
3. Good working support system (example:
4. Good Japanese learning support system,
The company policies that make candidates feel dissatisfied are:
1. Not allow to go to come country (for temporary) before taking the Japanese National Examination
(approximately 4 year after coming to Japan).
Factors that determined Indonesian candidates to continue their job
1. Advancement in the career (Male)
2. Good leadership in the organization (Female and Male)
Factors that determined Indonesian candidates to discontinue their job
1. Loneliness (Female)
2. Lack of job security (Male)
3. Strong willingness to get married (Female)
Conclusion
1. Good benefit offering (like good salary and accommodation) and good support system (like working
145
support and Japanese learning support) are leading to candidate’s satisfaction but these factors are not leading
to the reasons for continue or discontinue their jobs.
2. Carrier is an important factor that can determine male candidates to continue or discontinue their jobs. On
the other hand, human relations are an important factor that can determine female candidates to continue or
discontinue their jobs.
Implication/Recommendation
1. Most of caregiver candidates from Indonesia are female. Since human relations seem important for female
candidates to feel safe and comfort, it is better give them social support (friendly environment) inside and
outside the working place. As I mentioned before, in my case study a loneliness may and can lead candidate to
turnover. But accepting only one candidate for elderly institution should be no problem if both parties (the
employer and the employee) can create positive chemistry between them. My studies showed that the
relationship between employer and employee could determine candidate to continue or discontinue their job.
2. For male candidates, it is important to give them security in advancement of their career. Since most of
Indonesian society is patriarchy so male is still be expecting to be a breadwinner of the family. Career issue is
really important for caregiver candidates since caregiver is not count as professional job in Indonesia yet,
having experience as caregiver for several years and holding certificate as certified caregiver cannot guarantee
they will get a good career when they return to home country. My study showed that a security in
advancement of candidate career plays an important role in upgrading the level of satisfaction and reducing
the desire to turnover. As a sample, in institution Z where candidate F was given trust to be a leader for his
juniors (candidates that came one year after him) because he speak Japanese more fluent than other candidates,
he has a privilege to choose his juniors and got an access to learn how to manage an institution. He became
the leader of his group and roles as a bridge between employer and employee. His existences help both parties
to have a positive relationship.
Keywords
EPA, Indonesia, caregiver candidate, Job satisfaction, turnover
146
Poster Session 19:
Indicators of Age Friendly City for Planning and Policy Formulation:
an Exploratory Analysis
Ni Wayan Suriastini, SurveyMETER
Bondan Sikoki, SurveyMETER
Edy Purwanto, SurveyMETER
Tri Budi W Rahardjo,CAS UI
Aging and Urbanization are two issues of the world in 21th century including Indonesia. With the rapid increase
of urbanization and aging population in Indonesia many aging will live in urban area and active as source of
family, community and economic development if supported and enabling environment. WHO indicated that
age friendly city is needed to express the aging potential for the humanity. Eight aspects indicatosr of age
friendly city formulated by WHO includes outdoor space & building, transportation, housing, social
participation, respect & social inclusion, civil participation & employment, communication & information and
communication support & health services. Indonesia aging population in 2020 has been projected to reach 29
million and preparedness toward this condition is required.The poster will present formulation of composite
index of Age friendly City and show how it can be used forplanning and policy formulation. The data is based
on a study of age friendly city conducted in five cities of Indonesia with the hope that this exploratory analysis,
which can be expanded in the future. This study could be a reference for the condition of Indonesia city on
eight key dimension of age friendly city WHO.
147
スタディツアー
平成 24 年 11 月 12 日
STUDY TOUR IN KITAKYUSHU,
JAPAN
MONDAY, NOVEMBER 12, 2012
Asian Aging Business Center
ACAP Japan Secretariat: 3-25-24 Hakataekimae, Hakataku, Fukuoka, Japan
TEL: +81-92-473-9965
FAX: +81-92-432-6610
148
プログラム
09:20-10:00
集合@ 小倉駅北口バス専用駐車場
バスにて安川電機へ移動
/ Travel by bus to Yaskawa Electric.
10:00-11:30
安川電機見学
11:30-13:00
13:00-14:20
バスにてサンアクア TOTO へ移動（ランチ休憩後）
Lunch (Lunch box) at Yaskawa Electric.
Travel by bus to Sun Aqua TOTO
サンアクア TOTO 見学
/ Observation tour of Sun Aqua TOTO
14:20-15:00
バスにて小倉城へ移動
/
15:00-16:40
小倉城見学（城内自由行動）
/
09:00-09:20
/Observation tour of Yaskawa Electric
Travel by bus to Kokura Castle
Enjoy Kokura Castle sightseeing
バスにて最初の集合地まで送った後解散
Return to the meeting place
★ATTTENTION★
*団体での行動になりますので、時間厳守にてお願いいたします。安川電機では写真撮影に関し
制限が多いので、ご注意ください。サンアクア TOTO では撮影は問題ありませんが、フラッシ
ュや働いている人の顔を近くから撮影するのは控えて下さい。
16:40-17:00
Due to the tight schedule, please be on time to the meeting place each time. Yaskawa Electric
has many limitations for photographing so please be careful when you take a picture. Do not
use flash when you take a picture at SunAqua TOTO. Also, please not to take people’s face in
short distance at work. Thank you.
★安川電機
筑豊炭田の石炭採掘に使用するモーターを開発・製造するため、事業家の安川敬一郎が
息子の第五郎らと 1915 年に設立。蒸気機関に代わり、電動機（モーター）が新たな動力に
使われ始めた時代でしたが、主要な機械や器具はほとんど輸入品であったため、安川電機は
先端技術の開発に力を注ぎ、国産電機品の製造を目指しました。
1972 年からは、産業用ロボットの独自開発を開始。1977 年に発表された「MOTOMAN」
は、これまでに世界中へ 25 万台以上も出荷され、アーク溶接など自動車産業をはじめとす
る機械組立工場には欠かせないものとなっています。
また、現在は制御技術を駆使したサーボ、インバータ製品で世界トップシェアを誇るほ
か、校内で稼働中の鉄鋼プラントには、安川電機の制御装置が 100％採用されています。
1953 年建造のモダンな本社社屋は世界的な建築家アントニン・レーモンド野代表作と
して知られ、北九州市都市景観賞も受賞。ロボットがロボットを作る世界最大規模のロボッ
ト工場「モートマンセンター」には、これまで 10 万人以上が見学に訪れています。
★YASKAWA Electric.
Enterpriser, Keiichiro Yasukawa established it in 1915 with his son, Daigoro to perform
development and production of a motor to use for the coal dig of the Chikuho coalfield.
Although it was a time which began to be used for power with a new electric motor instead of
149
the steam engine, since most of main machines or an instrument was an import, YASKAWA
Electric directed power towards development of high technology, and aimed at manufacture
of the Domestic Electric product.
It started the original development of the industrial robot in 1972.
In 1977, 「MOTOMAN」was announced and it was shipped to the world more than 250,000
so far, and it became indispensable to the machine assembly plant including the auto
industry, such as arc welding.
In addition, Yaskawa proud of a world top share with the servo which made full use of a
control technology, an inverter products, and also the control device of YASKAWA Electric is
adopted as the steel plant under operation 100 % in the country.
The modern head office building is known as a masterpiece of world-famous architect
Antonin Raymond in 1953, and award-winning urban landscape Kitakyushu.
To
“MOTOMAN Center” of the world’s largest robot factory robots build a robot, more than
100,000 people have visited so far on tour.
双腕ロボット dual-arm robot
｢スマートパルファイブ SmartPalⅤ｣
安川電機 MOTOMAN センター
人とコミュニケーションや人をアシストする
など、人とロボットが共存する新しいもの
づくりを可能にし、暮らしの中で人をサポー
トする様々なサービス・医療・介護ロボット
の実用化に向けた研究・開発を行っている。
150
★サンアクア TOTO
福岡県と北九州市、TOTO の共同出資で 1993 年に設立。重度障害者等の雇用の確保を促進
するノーマライゼーションの先駆的企業です。水栓金具や給排水器具の組み立て等を行って
います。
★Sun Aqua TOTO
It is established by joint investment of Fukuoka Prefecture, Kitakyushu city and TOTO in
1993. It is a pioneer enterprise of the normalization which promotes reservation of
employment of a severely handicapped person etc. The assembling of faucet metal fittings
and water supply and drainage metal fittings are performed.
サンアクア TOTO での障がい者にむけ改善さ
れている箇所の説明
・車イスでの作業しやすくするためのスペース
の確保
・部品の設置の高さ制限
・部品や工具を取り出しやすくするための棚の
工夫
・身体活動の不足を補うための健康器具の設置
作業用工具のそれぞれの形をかたどることに
より、使用した後にもとにあったところに戻し
やすい工夫がされている。
151
ＭＥＭＯ
152
国際交流基金助成事業
アジア太平洋越境ケア人材養成連携事業報告書
Partnership for Training of Transnational Care Worker
and Nurses in Asia/Pacific
発 行 日：2013 年 3 月 31 日
監
修：小川全夫
発行・編集：特定非営利活動法人アジアン・エイジング・
ビジネスセンター
March 31st, 2013
Edited by Takeo Ogawa
P u b li s he d b y A si a n A gi n g Bu s in es s C en t er (A A B C)