Field medicine: A new paradigm of geriatric medicine

Abstract

It is only during the last half century that aging came to be truly thought of as a societal issue rather than simply a personal one, as well as a challenge to be tackled by science and medicine. Diseases used to be studied only in hospitals and laboratories, centering on patients treated there. However, caring for elderly people in hospitals provides only a small glimpse into their world. With an advancing aged population, the reality of old age and age-related chronic illnesses takes place in homes and communities. To truly understand the health issues of the elderly, we ventured into communities and visited elderly persons in their homes and cultural environments in Kochi prefecture. The Department of Geriatric Medicine, Kochi Medical School, was the first in Japan to incorporate the Comprehensive Geriatric Assessment in preventive intervention and evaluation of the medical problems of elderly people in field settings, which could not be completely resolved in the hospital. Geriatric findings in field settings in Kochi before (1990-2000) and after (2000-2010) the introduction of the nationwide long-term care insurance system throughout Japan were reviewed. Field medicine also enables us to explore the aging of people living not only in Japan but also in several Asian communities and, further, into those living in atypical environments such as the Himalayan highlands. Based on the geriatric findings of field medicine carried out in sites with different ecology and cultures, we reconsidered the optimal aging situation based on the activities of daily living and quality of life, as well as chronic diseases of elderly people throughout the world. In this review article, we would like to highlight the importance of field medicine as a new paradigm of geriatric medical research.

Health and happiness among community‐dwelling older adults in Domkhar valley, Ladakh, India

“…Participants were also rated from 3 to 0 in terms of help required; scores had a range of 3 = completely independent, score 2 = need some help, score 1 = need help much and score 0 = completely dependent. The items from these two assessments were added to provide scores in the range of 0–21, with low scores indicating disability . To assess a broad range of activities, each participant rated his/her level of independence on the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG‐IC), a self‐reported, standardized multidimensional, 13‐item index of competence .…”

“…They were required to indicate his/her contentment in health status, family relationships, friendships and economic status, along a 100‐mm horizontal line. This rating was then measured from the left edge of the line (0) to the right edge (100) …”

“…Data are presented as mean ± standard deviation or as percentages. An age‐ and sex‐specific population in Tosa constituted the control group . The control group was extracted from the original group of 240 people aged 60–89 years who completed the questionnaire and undertook a health check‐up.…”

Effect of Early Diagnosis and Lifestyle Modification on Functional Activities in Community‐Dwelling Elderly Adults with Glucose Intolerance: 5‐Year Longitudinal Study

“…All subjects were invited to participate in the five annual glucose intolerance and geriatric functional analyses and education about lifestyle modification during the 5‐year study period . To analyze the preventive effect of follow‐up participation of participants with NGT, IGT and DM on IADL decline, all subjects were assigned to one of two groups: more participation (≥4) or less participation (≤3).…”

Effect of Early Diagnosis and Lifestyle Modification on Depressive Symptoms in Community‐Dwelling Elderly Adults with Glucose Intolerance: 5‐Year Longitudinal Study

“…All subjects were invited to participate in the five annual glucose intolerance and geriatric functional analyses and education about lifestyle modification during the 5‐year study period . To analyze the preventive effect of follow‐up participation of subjects with NGT, IGT, and DM on the incidence of depressive state, all subjects were assigned to one of two groups: more (≥3) or less (≤2) participation.…”