Outpatient rehabilitation for an older couple in a repopulated village 10 years after the Fukushima nuclear disaster: An embedded case study

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Abstract

Background

Little information is available on the role of community-based rehabilitation after a nuclear disaster. Here, we report the case of an older couple living in an area repopulated after the Fukushima nuclear disaster of 2011 who received outpatient rehabilitation.

Case presentation

An 84-year-old woman underwent total hip arthroplasty (THA) after she fell and sustained a trochanteric fracture while caring for her husband with Alzheimer's disease. The 85-year-old husband experienced worsening behavioral and psychological symptoms of dementia (BPSD) following his wife's hospitalization. The couple received rehabilitation at an outpatient facility in a nearby village using a shuttle service. The woman’s postoperative anxiety was relieved and her physical function improved. Moreover, the husband's BPSD symptoms decreased.

Conclusion

A wife and husband showed improvement in physical function after THA and alleviation of BPSD, respectively, following rehabilitation. In post-disaster, resource-scarce areas, older adults may benefit from utilizing the outpatient rehabilitation services available in the surrounding area.

Related collections

Most cited references 31

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A Systematic Review of Access to Rehabilitation for People with Disabilities in Low- and Middle-Income Countries

Tess Bright, Sarah Wallace, Hannah Kuper (2018)

Rehabilitation seeks to optimize functioning of people with impairments and includes a range of specific health services—diagnosis, treatment, surgery, assistive devices, and therapy. Evidence on access to rehabilitation services for people with disabilities in low- and middle-income countries (LMICs) is limited. A systematic review was conducted to examine this in depth. In February 2017, six databases were searched for studies measuring access to rehabilitation among people with disabilities in LMICs. Eligible measures of access to rehabilitation included: use of assistive devices, use of specialist health services, and adherence to treatment. Two reviewers independently screened titles, abstracts, and full texts. Data was extracted by one reviewer and checked by a second. Of 13,048 screened studies, 77 were eligible for inclusion. These covered a broad geographic area. 17% of studies measured access to hearing-specific services; 22% vision-specific; 31% physical impairment-specific; and 44% measured access to mental impairment-specific services. A further 35% measured access to services for any disability. A diverse range of measures of disability and access were used across studies making comparability difficult. However, there was some evidence that access to rehabilitation is low among people with disabilities. No clear patterns were seen in access by equity measures such as age, locality, socioeconomic status, or country income group due to the limited number of studies measuring these indicators, and the range of measures used. Access to rehabilitation services was highly variable and poorly measured within the studies in the review, but generally shown to be low. Far better metrics are needed, including through clinical assessment, before we have a true appreciation of the population level need for and coverage of these services.

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The effect of age on pain, function, and quality of life after total hip and knee arthroplasty.

Christopher Johnston, D Voaklander, Alison Jones … (2001)

As utilization rates for total joint arthroplasty increase, there is a hesitancy to perform this surgery on very old patients. The objective of this prospective study was to compare pain, functional, and health-related quality-of-life outcomes after total hip and total knee arthroplasty in an older patient group (> or =80 years) and a representative younger patient group (55-79 years). In an inception community-based cohort within a Canadian health care system, 454 patients who received primary total hip arthroplasty (n = 197) or total knee arthroplasty (n = 257) were evaluated within a month prior to surgery and 6 months postoperatively. Pain, function, and health-related quality of life were evaluated with the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index and the 36-Item Short-Form Health Survey (SF-36). There were no age-related differences in joint pain, function, or quality-of-life measures preoperatively or 6 months postoperatively. Furthermore, after adjusting for potential confounding effects, age was not a significant determinant of pain or function. Although those in the older and younger groups had comparable numbers of comorbid conditions and complications, those in the older group were more likely to be transferred to a rehabilitation facility than younger patients. Regardless of age, patients did not achieve comparable overall physical health when matched with the general population for age and sex. With increasing life expectancy and elective surgery improving quality of life, age alone is not a factor that affects the outcome of joint arthroplasty and should not be a limiting factor when considering who should receive this surgery.

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Rural health around the world: challenges and solutions.

Roger Strasser (2003)

Despite the huge differences between developing and developed countries, access is the major issue in rural health around the world. Even in the countries where the majority of the population lives in rural areas, the resources are concentrated in the cities. All countries have difficulties with transport and communication, and they all face the challenge of shortages of doctors and other health professionals in rural and remote areas. Many rural people are caught in the poverty- ill health-low productivity downward spiral, particularly in developing countries. Since 1992, WONCA, the World Organization of Family Doctors, has developed a specific focus on rural health through the WONCA Working Party on Rural Practice. This Working Party has drawn national and international attention to major rural health issues through World Rural Health Conferences and WONCA Rural Policies. The World Health Organization (WHO) has broadened its focus beyond public health to partnership with family practice, initially through a landmark WHO-WONCA Invitational Conference in Canada. From this has developed the Memorandum of Agreement between WONCA and WHO which emphasizes the important role of family practitioners in primary health care and also includes the Rural Health Initiative. In April 2002, WHO and WONCA held a major WHO-WONCA Invitational Conference on Rural Health. This conference addressed the immense challenges for improving the health of people of rural and remote areas of the world and initiated a specific action plan: The Global Initiative on Rural Health. The "Health for All" vision for rural people is more likely to be achieved through joint concerted efforts of international and national bodies working together with doctors, nurses and other health workers in rural areas around the world.

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Author and article information

Journal

Journal ID (nlm-ta): Fukushima J Med Sci

Journal ID (iso-abbrev): Fukushima J Med Sci

Title: Fukushima Journal of Medical Science

Publisher: The Fukushima Society of Medical Science

ISSN (Print): 0016-2590

ISSN (Electronic): 2185-4610

Publication date (Electronic): 11 November 2023

Publication date (Print): 2024

Volume: 70

Issue: 1

Pages: 49-54

Affiliations

[1 ] Department of Rehabilitation, Hirata Central Hospital

[2 ] Hirata Rehabilitation Care Center

[3 ] Department of Internal Medicine, Hirata Central Hospital

[4 ] Department of Internal Medicine, Kawauchi Village National Health Insurance Clinic

[5 ] Department of Health Informatics, Kyoto University School of Public Health

[6 ] Department of Public Health, Fukushima Medical University School of Medicine

[7 ] Seireikai Home Nursing Station Hirata

[8 ] Department of Radiation Health Management, Fukushima Medical University School of Medicine

[9 ] Department of Surgery, Jyoban Hospital of Tokiwa Foundation

[10 ] Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation

Author notes

Corresponding author: Yoshitaka Nishikawa, MD, PhD　E-mail: ynishikawa-tky@ 123456umin.ac.jp

Article

Publisher-manuscript ID: 2023-01

DOI: 10.5387/fms.2023-01

PMC ID: 10867431

PubMed ID: 37952979

SO-VID: 02c320c4-ac17-4d3d-afeb-7d3e1820cf90

License:

This article is licensed under a Creative Commons [Attribution-NonCommercial-ShareAlike 4.0 International] license. https://creativecommons.org/licenses/by-nc-sa/4.0/

History

Date received : 6 January 2023

Date accepted : 21 September 2023

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