title: Life concerns of elderly people living at home determined as by Community General Support Center staff: implications for organizing a more effective integrated community care system. The Kurihara Project.
abstract: BACKGROUND
  In Japan, the integrated community care system aims to enable people to continue to live in their homes. Based on the concept, one of the activities of a Community General Support Center (CGSC) is to provide preventive intervention based on a Community Support Program. Currently, a Basic Checklist (BC) is sent to elderly people to identify persons appropriate for a Secondary Prevention Program.
  
  
  METHODS
  To find people who had not responded to the BC, CGSC staff evaluated the files of 592 subjects who had participated in the Kurihara Project to identify activities they cannot do that they did in the past, decreased activity levels at home, loss of interaction with people other than their family, and the need for medical interventions. This information was classified, when applicable, into the following categories: (A) 'no life concerns'; (B) 'undecided'; and (C) 'life concerns'. The relationships between these classifications and clinical information, certified need for long-term care, and items on the BC were examined.
  
  
  RESULTS
  The numbers of subjects in categories A, B, and C were 291, 42, and 186, respectively. Life concerns were related to scores on the Clinical Dementia Rating, global cognitive function, depressive state, and apathy. Most items on the BC were not associated with classification into category C, but ≥25% of the subjects had life concerns related to these items.
  
  
  CONCLUSIONS
  Assessment of life concerns by the CGSC staff has clinical validity. The results suggest that there are people who do not respond to the checklist or apply for Long-Term Care Insurance, meaning that they 'hide' in the community, probably due to apathy or depressive state. To organize a more effective integrated community care system, the CGSC staff should focus mainly on preventive care.
authors.affiliation: Division of Geriatric Behavioral Neurology, Tohoku University, Sendai, Japan; Kunimigaoka Community General Support Center, Tohoku University, Sendai, Japan; Geriatric Behavioral Neurology, CYRIC, Tohoku University, Sendai, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Takada
authors.forename: Kenichi
authors.initials: K
authors.lastname: Meguro
authors.forename: Yuko
authors.initials: Y
authors.lastname: Sato
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Chiba
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000523:psychology*; D005260:Female; D006301:Health Services Needs and Demand; D006299:Health Services for the Aged / Q000458:organization & administration*; D006699:Home Care Services; D006801:Humans; D007353:Insurance, Long-Term Care; D007564:Japan; D008134:Long-Term Care / Q000458:organization & administration*; D008297:Male; D017063:Outcome Assessment, Health Care; D011569:Psychiatric Status Rating Scales; D012111:Residence Characteristics; D012189:Retrospective Studies
keywords: Community General Support Center; Long-Term Care Insurance; apathy; dementia