Member
Purpose (1996-2001)
The Japanese
population aged 65 years and older currently numbers approximately 14
million, representing 12% of the total population, and is expected to
approach approximately 30 million, or 25% of the population, by the
year 2025. Moreover, the U.N. projects that by the year 2025 the
population of older persons will exceed 8 million in the world, comprising
approximately 10% of the overall population as opposed to 6.2% today.
In 1850 there were one billion people on the globe. A century
later, in 1950, it increased to 2 billion, a doubling! Forty years
later (i.e., in 1990), the population consisted of 5.3 billion and by
2025 a projected 8.5 billion! Thus, the rapid expansion of this
population poses a major threat unless health-care providers as well
as economic and political systems prepare for this increasing trend.
It should be noted, however, that many industrialized countries
such as Japan, Korea, the U.S., England, Wales, and Sweden are faced
with a stable or declining population and therefore need to develop
a new health-care perspective. These countries have reached a
so-called "demographic transition," the point where the birth
rate falls mainly due to an increase in income and education as well
as a societal emergence of women into the work force. Japan's
total population in 2025 will be approximately the same as it is today,
thereby resulting in an ever increasingly aging society. With
this in mind, we have to ensure adequate health-care coverage, with
universal access to medical care and advanced technologies, as well
as other related goals. It is also important to use valid and
reliable indicators that measure quality of life (QoL) to address the
growing needs in the rapidly expanding older adult population.
Additionally, because an aging population is accompanied by escalating
health-care costs, it is important to use suitable indicators that not
only measure the delivery of care but one's satisfaction with care received.
Thus, the amount of care, or type of health-care coverage one
has may affect their QoL.
It is clear that QoL requires the individuals' subjective appraisals
of function. During the past four to five decades, the concept
of QoL has emerged as a very important attribute in clinical investigation
and direct patient care. Nowadays, QoL is used as a multi-dimensional
facet for healthy, independent living and as an indicator of successful
aging. In most industrialized countries, despite the increase
in morbidity, the decline in mortality among middle-aged and older adults
has contributed substantially to gains in overall life expectancy.
Moreover, long life without good health and adequate physical functioning
is undesirable, yet a great number of people actually live their terminal
years in a state of increasing morbidity, and sometimes in almost complete
physical and/or mental dependency. Therefore, a key challenge
facing the WHO, the U.S. Surgeon General, and the Japanese Ministry
of Health and Welfare is the dissemination of useful information regarding
successful aging, particularly for older adults, to non-governmental
organizations concerned with aging-related issues, health and social
services, policy makers, informal caregivers, and all who can contribute
to maintaining optimal QoL.
Our research project is of special interest to understanding overall
QoL and includes the following dimensions; 1) physical functioning which
consists of health status, physical vitality and strength, 2) psychological
functioning which consists of mental status and resistance against stress,
3) nutritional status and food intake habits, 4) body composition, and
5) life satisfaction. A review of both the English and Japanese
literature, suggests that overall QoL is heavily dependent upon many
of the above factors. We plan to include the above dimensions
in our overall index of QoL. Because QoL is a subjective measure
in most disciplines, and is often not defined by researchers, it is
a term that requires conceptual clarity for older adults. Unfortunately,
there are presently a multitude of instruments available for different
purposes depending on the discipline. However, concensus is lacking
with respect to the precision for measuring QoL in older adult populations.
Indeed, there is a real need for more research in this area.
Accordingly, the goal of our present research project (designated
Tanaka Project in the Center for Tsukuba Advanced Research Alliance
(TARA), University of Tsukuba, Tskuba, Japan) is to develop more definitive
procedures for the measurement of overall QoL in middle-aged and older
Japanese adults (Tanaka et al., 1997).