吉本 照子

目的 中山間地の配食サービスにおけるボランティア活動者（以下，活動者）が，活動を通して認識している問題，および行政や社会福祉協議会（以下，社協）に期待する広報の内容を明らかにする。<br/>方法 調査対象地域は，高齢化率25%以上で人口 4 千人未満の 3 つの自治体 A, B, C であり，調査対象者は，A, B, C の配食サービスにおいて調理あるいは配達を担う活動者総数173人のうち，社協や保健師を通して書面で目的および方法を説明し，協力する意思のある活動者 A:28人（活動者総数に対する割合40%，以下同様に各地域の活動者数に対する割合を示す），B:11人（48%），C:22人（28%），の計61人（35%）であった。調査項目は，日頃の配食サービスの活動を通して目指していること，感じている問題とその解決方法，行政と社協に対する要望であり，5～10人のグループインタビューを行い，逐語録を作成した。複数の研究者が行政と社協に期待する広報に関連した部分を抽出してコード化し，内容の類似性をもとにカテゴリー化を行い，期待する保健福祉の広報の背後にある問題認識との関係を分析した（調査期間2003年 3～11月）。<br/>結果 活動者が行政と社協に期待する保健福祉広報の内容は 3 つのカテゴリーと，各々 2 つの内容を含んでいた。【利用者・住民が配食活動のねらいや内容を理解するための広報】として，〈高齢者が自発的に配食サービスを利用できるための周知〉，〈配食活動に関する住民の理解を促すための啓発〉を期待し，【活動者の量的・質的確保のための広報】として，〈活動者確保に行政・社協も責任を取るための募集〉，〈意欲ある活動者を誘引するための探索〉を期待し，【活動者と利用者の関係を調整するための広報】として，〈配食を円滑に行うための支援〉，〈活動への評価的支援〉を期待していた。<br/>結論 活動者による保健福祉広報への期待は，高齢者自らが自発的に配食サービスを利用できるよう，高齢者を取り巻く住民の理解を促す啓発と，活動継続のための意欲ある活動者の確保と，円滑な活動への支援とそのしくみを求める内容であった。これらは，活動者が配食サービスを効果的に機能させるための課題として認識した内容であり，行政や社協，住民と共有したい配食サービスの意味や実態を示していると考えられた。活動者の広報への期待内容の明確化は，行政と社協及び住民や活動者が共有すべき情報を明らかにすることであり，期待に応えることが連携の推進に必要である。

To estimate the change in health-promoting activities among elderly people affected by community organizing environments, we examined the relationships among health-promoting activity, going out and perceived transportation problems. A questionnaire was sent to 567 men and women aged 60 years old and over living in a small town in Kanagawa prefecture between July 27 and August 12 in 1995. The questionnaire consisted of 42 items concerning health, social ability of daily living (including the desire to participate in social activities), attitude toward health-promoting activities, and perceived transportation problems. A total of 397 people responded and the answers from 368 people were analyzed after excluding responses from those unable to go out by themselves and those who seldom went out. Single regression analysis and multiregression analysis were used with the sum of responses for each question representing factors related to health-promoting behavior. A probability level of 5 percent was considered significant. The reliability of the data was examined with Cronbach's coefficient alpha. Coefficients of determination for health promoting behavior were 42% in men and 48% in women. In both men and women, age, social ability of daily living and attitudes toward health-promoting behavior were related to health-promoting activity. In women, more actively going out was related to more active health-promoting activity. Higher perception of transportation problems had a negative effect on going out. In men, neither of these factors had any relationship with health-promoting activity. In men, poorer health conditions were related to more active health-promoting activity, but in women, there was no relationship between those factors. These results show that there are gender differences in the relationships among the factors related to health-promoting activities in elderly people. In women, a higher perception of transportation problems restrained actively going out and health-promoting activity.

We examined sex and age differences in health promotion behavior, participation in social activities, and perceived transportation problems of elderly people living in a small town far from the nearest train station. A questionnaire was sent to 567 men and women aged 60 years old and over living in a small town in Kanagawa prefecture. A total of 397 people responded. The questionnaire consisted of 42 questions concerning their health, daily activities (including their desire to participate in social activities), the frequency with which they went out, their attitude toward health promotion behavior, and their perceived transportation problems. They were also asked why they acted in ways that promote their health. The reliability of the data was examined with the coefficient κ and with Cronbach's alpha. Chisquared tests were used to examine sex and age differences. Women reported more health problems and more transportation problems, and said that they were less active in social activities than did men. Women become inactive in daily life with increasing age earlier than do men. Contrary to our hypothesis, women tended to have medical examinations more often than did men. More women under 75 years old than men answered that they acted in ways that promote their health because they did not want to give others trouble when they became ill, fewer women than men said that they wanted to enjoy their intended activities. These results seem to show that women lead less active social lives than do men and have less motivation for promoting their health because of a desire to lead an active life.

Social activities such as visiting friends or participating in community groups have been shown to correlate positively with active health promotion, more frequent physical exercise, and maintenance of activities of daily living in older people. Social inactivity may result from personal factors such as physical condition and from environmental factors such as limited means of transportation. To study the latter factors, we focused on perceived transportation difficulties and on the influence of those perceptions on the daily activities of elderly people. We sought to test the hypothesis that perceived transportation problems restrict health promotion or social activities and accelerate the decline in activities of daily living, and also to determine how transportation can be improved. A questionnaire was sent to 238 people (a fifth of the population) aged 60 years or older who were living in a small town in Kanagawa prefecture. Buses are the principal mode of public transportation from their residences to the nearest train station and the trip takes about 50 minutes. Responses were received from 190 persons (83.3% excluding those who had died, moved, or were in the hospital). Of the respondents, 166 (74 men and 92 women) went out by themselves and their responses were subjected to logistic regression analysis. The results revealed the following points. (1) For both men and women, riding buses to the hospital was associated with a greater perception of problems with respect to convenience, physical exertion, or anxiety when crossing the road. (2) Among women, greater perceived inconvenience of transportation correlated with a lower frequency of going out for daily shopping a higher frequency of visiting friends correlated with greater perception of physical exertion. (3) Among women, the main desire was to visit friends. Men indicated that they wanted to be more active in hobbies. The women indicated that the main reason they do not fulfill their desires was that transportation is inconvenient. These findings indicate that perceived transportation problems can prevent elderly people, especially women, from going out for health promotion and social activities. This indicates that to support social activities of elderly people, the means of transportation should be made more convenient and more physically accessible, and local circumstances should be taken into consideration.

To study travel outside the home by elderly people and perceived problems with such travel, a questionnaire was sent to 238 men and women aged 60-year-old and over living in a small town in Kanagawa prefecture. Public transportation in this town consists mainly of buses, and the bus ride from the nearest train station takes abut 50 minutes. A total of 190 people responded (83.3%, after exclusion of those who had died, moved away, or were in the hospital). Of those 190 people, 166 (74 men and 92 women) went out by themselves and their responses were analyzed. About 50% of both men and women said that they go to the hospital once or twice a month and go out for hobbies less than several times a year. The means of transportation differed accordingly to sex and age: 80% of men in their 60s said that they drive alone, but many men in their 70 s and older said that they ride buses or walk. Women in all the age studied said that they ride buses or drive with others. More than 50% of men and women reported problems with transportation: men reported anxiety about driving alone and women reported difficulties with the poor means of transportation or when walking upstairs or uphill. Many men and women in their 80s said that they would rather not be driven places by others or be helped by others while riding trains or buses. These findings show the patterns of travel outside the home by elderly people of different ages, and the problems these people perceive with regard to various modes of transportation. They should be useful in the design of transportation suitable to older people.

In order to improve the adequacy and safety of the transportation for the elderly people, the effects of and the desire for continuing driving were analyzed. A questionnaire was sent to 500 car manufacturing retirees, male aged 60 years old and more, living in Kawagawa prefecture near Tokyo. Responses were obtained from 296 people (59.6%). Of these 196 were currently licensed and 149 still drove. Three quarters of the respondents drove for daily shopping and more than 50% drove for medical treatment, visiting friends and other purposes. The purposes for driving correlated with each other (p &lt 0.05: ϕtest) and 80% drove more than 3 days per week One motivating factor for driving was to pick up family members or friends (48%) in addition to daily transportation means (93%), while 61% desired to continuing driving while making full use of the safety devices of the cars. Correspondence analysis showed that the role of driving correlated with a desire to utilize automobile safety devices. It is concluded that we should consider the needs of driving for the elderly, their satisfaction in driving or being driven by them, and should plan medical assessment, improvement in the traffic environment and social support, for example, arranging contacts between elderly driver and elderly with limited transportation options. © 1995, The Japan Geriatrics Society. All rights reserved.