Factors for residents' improved QOL

There are various factors that influence the achieve-ment of a better QOL for the elderly in special nursing homes, such as human relations among residents and staff, facility equipment, nursing care and medical services, dai-ly activities, and meal services. Carrier et al. showed the importance of the relationship between meal services and a better QOL^15）. Kitabayashi et al. reported that a signifi-cant correlation was found between “satisfaction with food and food services” and “meal requests are met” as far as institutionalized elderly people are concerned^16）.

Table 4 shows the result of responses to the statement

“Please choose up to five factors from the 20 factors listed, which you think have a relationship with resident's im-proved QOL and satisfaction.” Twenty factors were

classi-Table 4 Factors related to residents' improved quality of life and satisfaction

Item Factors Unit care type

n ＝ 65 conventional

type n ＝ 129 Total

n n n ％

Individual condition of

residents Resident's good physical health condition 35 65 100

35.7

Resident's good mental health condition 37 60 97

Good relationship with family 31 54 85

Good relationship among residents 11 27 38

Good financial condition 2 5 7

Care method of facility Good relationship between care staff and residents 39 81 120

34.6

Many in-house events 13 35 48

Cared well by a sufficient number of staff 17 23 40

Spend own time relatively freely 10 25 35

Many opportunities for going out 8 27 35

Good relationship with hospitals 9 16 25

The facility is a unit care type 11 3 14

Concern about meal Meals are delicious 44 81 125

Free to take snacks and alcoholic drinks 14 27 41 22.9

Tastes and preferences of meal are well reflected 11 27 38

Residents can take part in cooking 2 4 6

Environment of facility Well-equipped facility 8 12 20

Located in a good natural environment 6 23 29 6.8

Shops and restaurants are close by 1 7 8

Public transport is convenient 0 5 5

Total 309 607 916 100

Respondents were asked to choose up to five from among the above 20 options

ties^17）. Provision of additional staff and the improvement of working conditions are needed from the government.

When the question about the improvement of residents' QOL was asked, there was little difference among the an-swers for both the unit care and the conventional type fa-cilities. “Resident's good health”, “Delicious meal”, and

“Good relationship between care staff and residents” were suggested as the important factors for residents' improved QOL. In addition, it was shown that improvement of resi-dents' QOL was achieved not because of the unit care type facility itself, but the care method delivered.

The Ministry of Health, Labour and Welfare is recom-mending the maintenance of unit care type nursing homes. When considering the dietary environment for the nutritional improvement and better QOL of the residents in the unit care type special nursing homes for the elderly, it is important to develop nursing methods that make ef-fective use of facilities such as CWLU. In addition, it is necessary to increase the number of staff in order to per-form the individual care more effectively and sufficiently.

References

　1） National Institute of Population and Social Security Research (2013).

http://www.ipss.go.jp/syoushika/tohkei/newest04/

sh2401top.html.

　2） Ministry of Health, Labour and Welfare (2011) Nu-tritional Improvement Manual (revised edition).

http://www.mhlw.go.jp/topics/2009/05/dl/tp0501-1e_0001.pdf.

　3） Sugiyama M (2006) The Revolution of Nutritional care and Management in the Revised Long-term Care Insurance. J.natl.Inst.Public Health 55(1): 32-41.

　4） Ministry of Health, Labour and Welfare of Japan (2002).

http://www.mhlw.go.jp/topics/kaigo/kentou/15kourei/

3b.html.

　5） Ohtani K, Niimi A, Tomita K, Matsui M, Aiba T, Matsumura M (2011) Effects of Shared Cooking within the Living unit of a Nursing Home for the Elderly with Independent Living Unit. Journal of Cookery Science of Japan 44(6): 381-390.

　6） Yamaguti T (2006) A study of the effects of unit-care for the elderly with dementia at a special nursing home for the elderly. Japanese Journal of Social Services 46(3): 75-86.

　7） Joh H, Fujiwara Y, Yoshii S (2006) The actual situ-ation and problem of the unit-care in facility for elderly. Bulletin of the Faculty of Human

Develop-“Resident's good mental health condition” were the high-est in terms of total numbers. Therefore, it was sugghigh-ested that “Resident's good health”, “Delicious meal”, and “Good relationship between care staff and residents” were the important factors for residents' improved QOL. In addi-tion, “the things that are believed to be better for resi-dent's QOL and satisfaction”, “the things to be proud of other facilities”, and “the things to be recommended to other facilities other than the 20 selection factors” were asked as a free comment. The most common answer was

“Individual care for residents” (76 facilities). “Individual care for residents” is one of the key themes for unit care defined by the Ministry of Health, Labour and Welfare. To achieve nutritional improvement and better QOL, the an-swers suggest that “Individual care of meal preparation for the resident” is important.

Conclusions

A questionnaire study was conducted with dietitians and registered dietitians at special nursing homes for the elderly in the Kinki district to compare the dietary envi-ronments of the unit care type and conventional type of facility. The ratio of unit care type facilities was 33.5％, and that of the conventional type was 66.5％ . When the dietary environment of the unit care type was compared with that of the conventional type, there was a significant difference with “Is the menu posted?”, “Is the dining area fixed?”, “Is the starting time of the meal fixed?”, and “How many people talk while eating?” The results suggest that in the unit care type, the place and starting time of the meal are fairly flexible, and that more people talk while eating. Furthermore, the unit care type is more like home because some of the tableware is used only by the individ-ual.

There was a higher number of unit care type facilities with kitchens where the resident could take part in the cooking compared with the conventional type facilities.

However, 36.4％ of the unit care type facilities with kitch-ens in the living unit were not being used. These facilities seem to do the cooking in a large-scale cooking room (and then bring meals to each unit), which is the same as the conventional type facility. Considering the effect of CWLU, it is highly desirable to have a well-considered care plan using the kitchen for the elderly. It is necessary to solve the problems of “There was a risk of accident and injury”

and “Issues on hygiene aspects” when the residents take part in cooking in a unit. It was reported that more staff are necessary than the standard number defined by the law to carry out the individual care in unit care type

facili-Journal of Nutrition and Dietetics 52(6): 307-318.

13） Ministry of Health, Labour and Welfare of Japan (2011).

www.mhlw.go.jp/toukei/saikin/hw/kaigo/service09/

dl/kaigohoken-shisetsu.pdf.

14） Imai E (2002) An Integrated Study on Table Scent at Home Ⅰ : Investigation on the Actual of Person-al Ownership Character of Tableware in Saitama Prefecture. Journal for the Integrated Study of Di-etary Habits 13(2): 121-127.

15） Carrier N, West G. E, Ouellet D (2009) Dining ex-perience, food service and staffing are associated with quality of life in elderly nursing home resi-dents. The Journal of Nutrition, Health ＆ Aging, 13(6): 65-70.

16） Kitabayashi M, Homma T, Negayama K (2008) Sat-isfaction with food and food service in institutional-ized elderly people . Journal for the Integrated Study of Dietary Habits 19(3): 266-272.

17） Hayasi T, Hayasi E (2003) A Study on Life Envi-ronment of Nursing Facilities (Part1): Conditions and Problems of Living Space and Care in newly-built Group Living Care Unit Type Nursing Home, Bulletin of the Social welfare Department Seirei Christpher College, No2: 1-12

ment Kobe University 13(2): 95-103.

　8） Mibu N (2011) Living awareness among residents in special nursing homes for the elderly,unit-style facilities versus conventional facilities: Study of peace of mind and satisfaction with living quar-ters. Japanese journal of Human Welfare Studies 4(1): 77-90.

　9） Miura K, Akazawa Y (2008) Effects and Issues of

"Cooking in a Unit Kitchen" in Special Nursing Homes for the Aged No. 1. Questionnaire asked Directors their Condition regarding Meal Service for the Aged .Architectural Institute of Japan: 393-394.

10） Yamashita Y, Akada N (2004) The Effects of Tex-ture Modifications on the Nutritional Value of Di-ets for the Elderly. Bulletin Hiroshima Bunka Two -years College 37: 15-22.

11） Kosaka K, Konishi Y, Kikunaga S (2012) The Change of Zinc Nutritional Status According to the Value of BMI, and the Level of ADL and Care in the Disabled Elderly Patients in Nursing Facili-ty. Biomed Res Trace Elements 23(3): 208-216.

12） Nagai K , Suzuki T, Shibata H, Matsumoto N (1994) The uses of Kizami (Minced Foods) Diets in Spe-cial Nursing Homes for Elderly .The Japanese

食事献立の組成を定量的に把握し，食材の摂取量と食品 成分表を用いて食事からの栄養素摂取量を把握することは，

食生活を評価する上で重要である。食事献立の定量的な把 握には，従来からの食事記録法に加えて，簡易食物摂取頻 度調査や献立の写真撮影などが開発されている^{1, 2）}。これ らの方法は，献立中の食材量と食品成分表を用いて個々の 栄養素摂取量を把握するという点において共通している。

食品成分表は個々の食品の栄養素成分値を 1 つの数値に集 約して示したものであるが，食品中の栄養素成分値は常に 一定ではなく，とくにビタミンやミネラルなどの微量成分 では変動が大きい^3）。このため，微量栄養素に関しては，

食品成分表を用いた栄養素摂取量が，献立の化学分析に よって得られる実測値と相当にずれることが報告されてい

る^{4, 5）}。このような成分表を用いた栄養素摂取量評価の欠

点を補完する目的で，尿を用いた栄養素摂取量評価の試み がいくつかの栄養素において展開されている^{6, 7）}。

一方，微量栄養素が特定の食品に偏在することはしばし

ば認められる。偏在する食品が主食や主菜を構成するもの でない場合，該当する栄養素の摂取量は同一人の中で大き な日間変動（個人内変動）が生じると予想される。たとえ ば，ミネラルの場合，昆布が特異的にヨウ素濃度の高い食 品であることから，昆布製品の摂取状況に伴って，間欠的 に高ヨウ素摂取の日が出現するとされている^{8, 9）}。

本研究では，ヨウ素摂取量の個人内変動の大きさを確認 する目的で，20 歳代成人から複数日にわたって尿を採取 し，ヨウ素濃度の個人内変動と個人間変動を求め，同じ微 量ミネラルであるセレンとモリブデンの尿中濃度のそれら と比較した。さらに，各微量ミネラルの習慣的な尿中排泄 量を試算し，対象者の日常的な摂取量について考察した。

研究方法

1．尿試料の採取

大阪近郊に在住し，研究への協力に同意した健康な 20 原　著