京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18858号 / 医博第3969号 / 新制||医||1008(附属図書館) / 31809 / 京都大学大学院医学研究科医学専攻 / (主査)教授 福原 俊一, 教授 古川 壽亮, 教授 村井 俊哉 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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The purpose of this study was to summarize the effects of physical activity (PA) as a nonpharmacological preventative measure in people at risk of Alzheimer's disease (AD) or all-cause dementia. It was hypothesized that persons at risk of AD or all-cause dementia who engage in sustained and continuous PA would fare better in terms of physical health, cognition, and activities of daily living (ADLs). A systematic literature review was conducted in the Cumulative Index to Nursing and Allied Health Literature (CINAHL) using 12 keywords. Studies were included if they were randomized controlled trials with people at risk of AD or all-cause dementia reporting outcomes of PA on three domains, namely: physical health, cognition, or ADLs. Data was extracted using the Matrix Method and results were summarized using applied thematic analyses. Out of 55 records screened, eight met the inclusion criteria for data extraction. Findings indicate statistically significant improvement in four [HLC1] metrics of physical health such as balance, strength, stamina, and oxygenation. Findings also showed statistically significant improvement in four measures of cognition (short-term memory, lucidity, executive function, and language ability). Two studies reported statistically significant improvement in two measures of ADLs (less assistance to complete daily tasks and execution of instrumental activities). Overall, studies showed that physical health, cognition, and two measures of ADLs of people at risk of AD and all-cause dementia improve with sustained and continuous PA, although the interventions and measures were extremely heterogeneous. Future research and intervention efforts should align PA efforts with current universal recommendations to improve outcomes in the general population and in those at risk of AD and all-cause dementia.

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Trough previous research we have knowledge about the connection between balance in daily life and the experience of health. The psychological or stressrelated ill health increases despite more people receiving care and treatment. It is therefore a central issue to shed further light on whether we provide the right care based on the perspective of the individuals. The purpose of the study was to describe experiences from adult individuals on sick leave due to psychological or stress related ill health regarding maintaining balance in everyday activities. Data were generated through individual narrative interviews with individuals with psychological or stress related illness, from primary care and analysed using a narrative analysis. The analysis of the data resulted in four themes called strategies for maintaining balance, barriers to balancing strategies to maintaining balance, roles and habits that affects the ability to maintain balance, new experiences that affects the ability to maintain balance. Results show that there is a complexity to maintain balance in daily living and there are many components that effects the ability and conditions to maintain a balance in daily life that promotes health. The results could give a deeper understanding about the need for care through the individuals experience and highlight occupational therapy and the occupational therapist role. This regarding working with the ability to delimit in activity as a step towards developing care and treatment for individuals with psychological or stress related illness. And raise the perspective on the importance of creating sustainability perspective and from socioeconomic gain

This work presents comprehensive analytics of trajectories of functional loss and recovery using sequence analysis and clustering techniques. The study focuses on a large dataset consisting of assessments of activities of daily living conducted among nursing home residents. The first main part of this research involves converting the assessments into sequences of disability combinations and utilizing graphical tools and various indicators to gain valuable insights into the trajectories of functional disabilities over time. In the second part of the research, a novel clustering approach is introduced that combines Markov models with distance-based techniques. This hybrid methodology results in 13 distinct clusters of trajectories. The clusters are thoroughly examined, and representative sets are carefully selected based on various criteria. This selection process ensures that the chosen sets accurately represent the characteristics of each cluster. The findings of this study have significant implications for healthcare systems, including developing predictive models which can be utilized to forecast the trajectory of individual patients based on their cluster membership. This enables healthcare providers to anticipate disease progression, tailor treatments, and dynamically adjust care plans, resulting in improved patient outcomes and the overall quality of care. Moreover, the information derived from the analytics can aid in optimizing healthcare systems by facilitating resource allocation and cost optimization. The insights gained can also guide policymakers and families in planning appropriate care for patients. This research advances healthcare decision-making and ensures appropriate support. / Thesis / Master of Science (MSc) / The ability to independently perform activities of daily living (ADLs) is a crucial indicator of an individual's health status, and the loss of this ability can have a profound impact on their overall quality of life. Our research focuses on analyzing the trajectories of patients as they experience functional decline and recovery. While various techniques have been utilized to explore ADL trajectories, this study stands out by employing clustering and sequence analysis approaches to examine different groups of trajectories. To overcome the computational challenges involved, we propose a combined clustering approach. This hybrid approach consists of two phases: applying a Markov model prior to distance-based algorithms. The findings derived from our research hold significant applications in optimizing healthcare systems, improving health outcomes, facilitating the development of targeted and effective interventions that support patients in preserving their independence, and enhancing the quality of care.

As the average age of life expectancy continues to rise, so too has the number of elderly individuals seeking long-term care. Performing daily tasks becomes a struggle while those affected by Alzheimer's disease and dementia risk their safety by living alone. Aged individuals lacking the means or faculties to live independently often seek assisted living and memory care facilities as the most viable options for the growing elderly population. Typical facilities are compact and sterile where residents are under watchful supervision to perform basic daily activities. As a result, aged individuals spend every day inside the facility with a structured, monotonous routine. A repetitive lifestyle within the same surroundings and with little autonomy can lead to feelings of isolation, depression, and disengagement from the same facility designed to care for the elderly population. My thesis aims to create an assisted living and memory care village, rather than a facility, that calls upon the comforts of home in a neighborhood setting. Within the village, residents are free to engage, explore, and take part in activities as self-sufficient human beings. Located in Frederick, Maryland, my objective is to design a small-town community that enables both on and off-site engagement. I analyzed architectural design methods that mitigate the struggles of daily activities while maintaining privacy and independence, and also researched a largely overlooked aspect of assisted living facilities: site development. This enabled me to curate a space where residents are free to explore and take part in various activities throughout the site. A monotonous routine leads to a stagnant mind. My thesis aims to create a space where exploration and independence are not only permitted but encouraged. Rather than aging in place, the goal is to live in place while the mind and body are in motion, making new memories and discoveries every day. / Master of Architecture / My aunt faced the challenge of her elderly mother experiencing white coat hypertension: an increase in blood pressure due to anxiety and stress during doctor visits. But it made a remarkable difference after she switched to a specialized geriatric office that emphasized a welcoming, homelike design. The warm ambiance, comforting decor, and personalized care reduced her anxiety, alleviating her white coat hypertension and resulting in regular blood pressure readings. This experience inspired me to emphasize the importance of geriatric-friendly design in assisted living and memory care facilities. In response to this issue, my thesis proposes the creation of an assisted living and memory care village instead of a traditional facility. The village aims to provide a homelike setting where residents can experience a sense of comfort and freedom. I have analyzed architectural design methods that address the struggles of daily activities while maintaining privacy and independence. Additionally, I have explored the often overlooked aspect of site development in assisted living facilities to curate the space thoughtfully where residents are encouraged to explore and engage in various activities throughout the village and evoke feelings of home, community, and comfort.

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