Effective Social Support to Enable Older Adults Living Alone in Japan to Continue Living at Home
Abstract
1. Introduction
1.1. Global Trends in Home Care for Older Adults Living Alone
1.2. Home Care Situation of Older Adults Living Alone in Japan
- Support Care Level 1: Mostly independent in daily living and go out on their own although they have difficulty standing up smoothly by themselves.
- Support Care Level 2: Difficulty in getting up, standing on one leg, and shopping, but their condition may be alleviated by rehabilitation and other means.
- Nursing Care Level 1: Difficulty in getting up alone. Regularly forgetting directions or locations. Make frequent mistakes in tasks such as shopping, clerical work, and money management, which they were able to do before.
- Nursing Care Level 2: Need assistance with walking, washing, nail trimming, taking medication, managing money, and simple cooking.
- Nursing Care Level 3: Need assistance with urination, defecation, oral hygiene, putting on/taking off upper clothes, putting on/taking off pants, etc.
- Nursing Care Level 4: Need assistance turning over in bed, standing on both legs, transferring to a wheelchair, moving around, washing face, and washing hair.
- Nursing Care Level 5: Spend all day in bed and require assistance with toileting, eating, and changing clothes.
1.3. Purpose
2. Materials and Methods
2.1. Participants
2.2. Survey Items
2.2.1. Participants’ Characteristics
- Rank J1: They have a disability of some kind but are mostly independent in daily life and go out by using public transportation, etc., on their own.
- Rank J2: They have a disability of some kind but are mostly independent in daily living and can go out on their own in the neighborhood.
- Rank A1: They are generally independent in indoor living but do not go out without assistance. They require assistance when going out and live away from their bed most of the time during the day.
- Rank A2: They are generally independent in indoor living but do not go out without assistance. They go out infrequently and sleep and wake up during the day.
- Rank B1: They need some kind of assistance to live indoors. They mainly stay in bed during the day but maintain a sitting posture. They transfer to a wheelchair by themselves and eat and use the toilet away from the bed.
- Rank B2: They need some kind of assistance to live indoors. They mainly stay in bed during the day but maintain a sitting posture. They can transfer to a wheelchair with assistance.
- Rank C1: They spend all day in bed and require assistance with toileting, eating, and changing clothes. They turn over in bed on their own.
- Rank C2: They spend all day in bed and require assistance with toileting, eating, and changing clothes. They cannot turn over in bed without assistance.
- Rank I: They have some form of dementia but are largely independent in daily life both in the home and socially.
- Rank IIa: They can be independent outside the home, even if some symptoms/behaviors or communication difficulties that interfere with daily life are observed, if someone is minding them.
- Rank IIb: Even if some symptoms/behaviors or communication difficulties that interfere with daily life are observed, they can be independent if someone is minding them.
- Rank IIIa: They require nursing care, mainly during the day, due to symptoms/behaviors and communication difficulties that interfere with daily life.
- Rank IIIb: They require nursing care, mainly during the night, due to symptoms/behaviors and communication difficulties that interfere with daily life.
- Rank IV: Symptoms and behaviors that interfere with daily life and communication difficulties are frequently observed, requiring constant care.
- Rank M: Significant psychiatric or peripheral symptoms or serious physical illness are observed, requiring specialized medical care.
2.2.2. Use of LTCI and Non-Insurance Care Services
2.2.3. IADL Support
2.2.4. Characteristics of Care Managers
2.3. Analysis
2.4. Ethical Considerations
3. Results
3.1. Characteristics of Care Managers and Older Adults in Their Charge
3.2. Differences in Participants’ Characteristics Between the Continuous and Interrupted Groups
3.3. Differences Between the Continuous and Interrupted Groups in Use of Long-Term Care Services
3.4. Differences in Support Between the Continuous and Interrupted Groups Regarding IADL
3.5. Differences Between the Support Care Level 1–Nursing Care Level 2 and Nursing Care Level 3–5 Categories
3.6. Factors That Influenced Continuous Living Alone
4. Discussion
4.1. Factors Related to Continued Living Alone Regarding Characteristics
4.2. Factors Related to Continued Living Alone Regarding the Use of Long-Term Care Services
4.3. Factors Related to Continued Living Alone Regarding IADL Support
4.4. Limitations and Future Research
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
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Item | Continuous (n = 90) n (%) | Interrupted (n = 32) n (%) | p-Value | |
---|---|---|---|---|
Age | ||||
40–49 | 35 (38.9) | 16 (50.0) | 0.302 | |
50– | 55 (61.1) | 16 (50.0) | ||
Gender | ||||
Female | 75 (85.2) | 25 (89.3) | 0.758 | |
Male | 13 (14.8) | 3 (10.7) | ||
Years of experience | ||||
1–2 | 21 (23.3) | 5 (15.6) | 0.149 | |
3–4 | 16 (17.8) | 9 (28.1) | ||
5–9 | 34 (37.8) | 7 (21.9) | ||
10– | 19 (21.1) | 11 (34.4) |
Characteristics | Continuous (n = 90) n (%) | Interrupted (n = 32) n (%) | p-Value | |
---|---|---|---|---|
Age | ||||
60–64 | 1 (1.1) | 0 (0.0) | 0.385 | |
65–69 | 4 (4.4) | 1 (3.1) | ||
70–74 | 7 (7.8) | 1 (3.1) | ||
75–79 | 13 (14.4) | 3 (9.4) | ||
80–84 | 19 (21.1) | 5 (15.6) | ||
85–89 | 25 (27.8) | 12 (37.5) | ||
90–94 | 15 (16.7) | 4 (12.5) | ||
95–99 | 6 (6.7) | 4 (12.5) | ||
100+ | 0 (0.0) | 2 (6.2) | ||
Gender | ||||
Female | 69 (79.3) | 18 (64.3) | 0.131 | |
Male | 18 (20.7) | 10 (35.7) | ||
Support/Nursing Care Level | ||||
Support Care Level 1 | 4 (4.4) | 1 (3.1) | 0.002 | |
Support Care Level 2 | 10 (11.1) | 0 (0.0) | ||
Nursing Care Level 1 | 21 (23.3) | 3 (9.4) | ||
Nursing Care Level 2 | 36 (40.0) | 9 (28.1) | ||
Nursing Care Level 3 | 10 (11.1) | 14 (43.8) | ||
Nursing Care Level 4 | 4 (4.4) | 2 (6.2) | ||
Nursing Care Level 5 | 5 (5.6) | 3 (9.4) | ||
Degree of independent daily living for older adults with disabilities | ||||
Rank J1 | 6 (6.7) | 0 (0.0) | 0.101 | |
Rank J2 | 18 (20.2) | 6 (18.8) | ||
Rank A1 | 22 (24.7) | 5 (15.6) | ||
Rank A2 | 29 (32.6) | 8 (25.0) | ||
Rank B1 | 9 (10.1) | 6 (18.8) | ||
Rank B2 | 3 (3.4) | 4 (12.5) | ||
Rank C1 | 1 (1.1) | 1 (3.1) | ||
Rank C2 | 1 (1.1) | 2 (6.2) | ||
Degree of independent daily living for older adults with dementia | ||||
Rank I and below | 36 (40.4) | 4 (12.5) | 0.018 | |
Rank IIa | 15 (16.9) | 9 (28.1) | ||
Rank IIb | 23 (25.8) | 10 (31.2) | ||
Rank IIIa | 7 (7.9) | 7 (21.9) | ||
Rank IIIb | 3 (3.4) | 1 (3.1) | ||
Rank IV | 4 (4.5) | 0 (0.0) | ||
Rank M | 1 (1.1) | 1 (3.1) | ||
Medical treatment | ||||
Used | 16 (18.4) | 12 (37.5) | 0.049 | |
Not used | 71 (81.6) | 20 (62.5) | ||
Care supporters | ||||
Family members or relatives living separately | 74 (83.1) | 27 (84.4) | 0.038 | |
Community residents | 2 (2.2) | 3 (9.4) | ||
Welfare committee members | 1 (1.1) | 0 (0.0) | ||
Care helpers | 8 (9.0) | 0 (0.0) | ||
Friends | 2 (2.2) | 0 (0.0) | ||
Others | 2 (2.2) | 0 (0.0) | ||
None | 0 (0.0) | 2 (6.2) |
Items | Continuous (n = 90) n (%) | Interrupted (n = 32) n (%) | p-Value | |
---|---|---|---|---|
Home-visit care | ||||
1/week | 21 (23.3) | 7 (21.9) | 0.156 | |
2/week | 21 (23.3) | 4 (12.5) | ||
3/week | 11 (12.2) | 3 (9.4) | ||
4/week | 3 (3.3) | 4 (12.5) | ||
5/week | 7 (7.8) | 2 (6.2) | ||
6+/week | 11 (12.2) | 9 (28.1) | ||
Not used | 16 (17.8) | 3 (9.4) | ||
Home-visit bathing service | ||||
6+/week | 1 (1.1) | 0 (0.0) | 1.000 | |
Not used | 89 (98.9) | 32 (100.0) | ||
Home-visit nursing care | ||||
1/week | 12 (13.3) | 6 (18.8) | 0.474 | |
2/week | 6 (6.7) | 4 (12.5) | ||
3/week | 1 (1.1) | 1 (3.1) | ||
5/week | 1 (1.1) | 0 (0.0) | ||
Not used | 70 (77.8) | 21 (65.6) | ||
Management guidance for in-home care | ||||
2/month | 5 (5.6) | 1 (3.1) | <0.001 | |
4+/month | 1 (1.1) | 9 (28.1) | ||
Not used | 84 (93.3) | 22 (68.8) | ||
Commuting for care | ||||
1/week | 6 (6.7) | 1 (3.1) | 0.071 | |
2/week | 19 (21.1) | 7 (21.9) | ||
3/week | 10 (11.1) | 2 (6.2) | ||
4/week | 0 (0.0) | 2 (6.2) | ||
5/week | 4 (4.4) | 0 (0.0) | ||
6/week | 1 (1.1) | 3 (9.4) | ||
Not used | 50 (55.6) | 17 (53.1) | ||
Commuting for rehabilitation services | ||||
1/week | 5 (5.6) | 0 (0.0) | 0.189 | |
2/week | 10 (11.1) | 3 (9.4) | ||
3/week | 2 (2.2) | 4 (12.5) | ||
4/week | 1 (1.1) | 0 (0.0) | ||
5/week | 1 (1.1) | 0 (0.0) | ||
Not used | 71 (78.9) | 25 (78.1) | ||
Home-visit rehabilitation | ||||
1/week | 9 (10.0) | 0 (0.0) | 0.068 | |
2/week | 1 (1.1) | 2 (6.2) | ||
3/week | 1 (1.1) | 0 (0.0) | ||
Not used | 79 (87.8) | 30 (93.8) | ||
Short-term stay at a care facility | ||||
3+/month | 1 (1.1) | 0 (0.0) | 0.097 | |
1–2/month | 4 (4.4) | 5 (15.6) | ||
6/Year | 1 (1.1) | 1 (3.1) | ||
Not used | 84 (93.3) | 26 (81.2) | ||
Temporary provision of assistive products | ||||
Not used | 34 (37.8) | 5 (15.6) | 0.027 | |
Used | 56 (62.2) | 27 (84.4) | ||
House modification | ||||
Not used | 67 (75.3) | 18 (62.1) | 0.233 | |
Used | 22 (24.7) | 11 (37.9) | ||
Meal delivery service | ||||
Not used | 73 (81.1) | 21 (65.6) | 0.045 | |
1/week | 0 (0.0) | 0 (0.0) | ||
2–3/week | 8 (8.9) | 1 (3.1) | ||
4–6/week | 5 (5.6) | 6 (18.8) | ||
1/day | 3 (3.3) | 3 (9.4) | ||
2+/day | 1 (1.1) | 1 (3.1) | ||
Eating out | ||||
Not used | 73 (81.1) | 29 (90.6) | 0.804 | |
1/week | 7 (7.8) | 2 (6.2) | ||
2–3/week | 5 (5.6) | 0 (0.0) | ||
4–6/week | 1 (1.1) | 0 (0.0) | ||
1/day | 4 (4.4) | 1 (3.1) | ||
Use of take-out lunch boxes and prepared foods | ||||
Not used | 48 (53.3) | 15 (46.9) | 0.691 | |
1/week | 2 (2.2) | 1 (3.1) | ||
2–3/week | 26 (28.9) | 10 (31.2) | ||
4–6/week | 8 (8.9) | 5 (15.6) | ||
1/day | 4 (4.4) | 0 (0.0) | ||
2+/day | 2 (2.2) | 1 (3.1) | ||
Emergency alert equipment | ||||
Not used | 86 (98.9) | 26 (83.9) | 0.005 | |
Used | 1 (1.1) | 5 (16.1) | ||
Nursing care prevention support | ||||
Not used | 81 (90.0) | 29 (90.6) | 0.379 | |
Exercises | 1 (1.1) | 1 (3.1) | ||
Fun activities | 3 (3.3) | 0 (0.0) | ||
Social event | 3 (3.3) | 0 (0.0) | ||
Others | 2 (2.2) | 2 (6.2) |
Details of Support | Continuous (n = 90) n (%) | Interrupted (n = 32) n (%) | p-Value |
---|---|---|---|
Talking to others | 82 (91.1) | 30 (96.8) | 0.445 |
Frequency of outings | 81 (90.0) | 24 (77.4) | 0.120 |
Cleaning | 75 (85.2) | 28 (90.3) | 0.558 |
Garbage disposal | 52 (58.4) | 25 (80.6) | 0.030 |
Medication management | 45 (50.6) | 24 (77.4) | 0.011 |
Money management | 42 (46.7) | 21 (67.7) | 0.060 |
Laundry | 39 (44.3) | 21 (67.7) | 0.036 |
Meal preparation | 37 (41.6) | 22 (71.0) | 0.006 |
Temperature control | 26 (28.9) | 27 (87.1) | <0.001 |
Sanitary | 22 (24.7) | 12 (38.7) | 0.166 |
Oral care | 16 (17.8) | 18 (58.1) | <0.001 |
Item | Support Care Level 1–2 and Nursing Care Level 1–2 (n = 84) | Nursing Care Level 3–5 (n = 38) | |||||
---|---|---|---|---|---|---|---|
Continuous (n = 71) n (%) | Interrupted (n = 13) n (%) | p-Value | Continuous (n = 19) n (%) | Interrupted (n = 19) n (%) | p-Value | ||
Characteristics | |||||||
Medical treatment | |||||||
Used | 10 (14.3) | 6 (46.2) | 0.016 | 6 (35.3) | 6 (31.6) | 1.000 | |
Not used | 60 (85.7) | 7 (53.8) | 11 (64.7) | 13 (68.4) | |||
Care services | |||||||
Management guidance for in-home care | |||||||
2/month | 3 (4.2) | 0 (0.0) | 0.019 | 2 (10.5) | 1 (5.3) | 0.020 | |
4/month | 1 (1.4) | 3 (23.1) | 0 (0.0) | 6 (31.6) | |||
Not used | 67 (94.4) | 10 (76.9) | 17 (89.5) | 12 (63.2) | |||
Home-visit nursing care | |||||||
1/week | 8 (11.3) | 5 (38.5) | 0.022 | 4 (21.1) | 1 (5.3) | 0.626 | |
2/week | 4 (5.6) | 2 (15.4) | 2 (10.5) | 2 (10.5) | |||
5/week | 1 (1.4) | 0 (0.0) | 1 (5.3) | 1 (5.3) | |||
Not used | 58 (81.7) | 6 (46.2) | 12 (63.2) | 15 (78.9) | |||
IADL support | |||||||
Temperature control | |||||||
17 (23.9) | 10 (76.9) | <0.001 | 9 (47.4) | 17 (94.4) | 0.003 | ||
Oral care | |||||||
8 (11.3) | 6 (46.2) | 0.007 | 8 (42.1) | 12 (66.7) | 0.191 | ||
Medication management | |||||||
30 (42.9) | 10 (76.9) | 0.034 | 15 (78.9) | 14 (77.8) | 1.000 |
Variable | Odds Ratios | 95%CI | p-Value | VIF |
---|---|---|---|---|
(Intercept) | 693.00 | 9.79–49,000.00 | 0.003 | |
Support/Nursing Care Level | 0.80 | 0.52–1.23 | 0.299 | 1.298 |
Degree of independent daily living for older adults with dementia | 1.53 | 0.95–2.48 | 0.084 | 1.616 |
Management guidance for in-home care | 1.32 | 0.92–1.87 | 0.129 | 1.038 |
Emergency alert equipment | 0.14 | 0.01–1.76 | 0.129 | 1.114 |
Temperature control | 0.06 | 0.01–0.24 | <0.001 | 1.358 |
Oral care | 0.52 | 0.15–1.79 | 0.300 | 1.424 |
Meal preparation | 1.08 | 0.32–3.70 | 0.901 | 1.363 |
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Naoe, M.; Kawahara, Y. Effective Social Support to Enable Older Adults Living Alone in Japan to Continue Living at Home. Int. J. Environ. Res. Public Health 2025, 22, 1084. https://doi.org/10.3390/ijerph22071084
Naoe M, Kawahara Y. Effective Social Support to Enable Older Adults Living Alone in Japan to Continue Living at Home. International Journal of Environmental Research and Public Health. 2025; 22(7):1084. https://doi.org/10.3390/ijerph22071084
Chicago/Turabian StyleNaoe, Miwako, and Yasuhiro Kawahara. 2025. "Effective Social Support to Enable Older Adults Living Alone in Japan to Continue Living at Home" International Journal of Environmental Research and Public Health 22, no. 7: 1084. https://doi.org/10.3390/ijerph22071084
APA StyleNaoe, M., & Kawahara, Y. (2025). Effective Social Support to Enable Older Adults Living Alone in Japan to Continue Living at Home. International Journal of Environmental Research and Public Health, 22(7), 1084. https://doi.org/10.3390/ijerph22071084