A Study on Interregional Differences in Elderly Person’s ......effective “long-term care” (the Japanese word “kaigo”, hereafter in this report, “care”) within the nuclear

Journal of Civil Engineering and Architecture 14 (2020) 433-451 doi: 10.17265/1934-7359/2020.08.003

A Study on Interregional Differences in Elderly Person’s

Remote Care in Terms of Traveling Time and Expense:

Comparative Consideration in TOKYO Area and OSAKA

Area

Yuichi Sueshige1, Hideaki Takayanagi1 and Tatsuto Kihara2

1. Department of Urban Life Studies, Tokyo City University, 8-9-18-2405 Todoroki, Setagaya, Tokyo 158-8586, Japan

2. Graduate School of Environmental and Information Studies, Tokyo City University, 8-9-18-2405 Todoroki, Setagaya, Tokyo

158-8586, Japan

Abstract: This study has been carried out to examine the development of an “elderly tele-nursing model” for care provided in-home by family members and through remote nursing systems in a super-aging society. The time required for elderly tele-nursing was influenced by whether or not the visitor uses the Shinkansen or the Express train. Based on 40 questionnaires, clear differences were observed according to whether visits were “every two weeks” or “once per month”. And finally, comparing the trends and characteristics of remote care for the elderly in the TMA (Tokyo Main Area) and Kansai region clarified regional characteristic.

Key words: Super-aging society, travel time and cost, remote elderly care, family caregiving, interregional differences.

1. Introduction

1.1 Study Background and Aim

The number of older adults aged 65 or above in

Japan is expected to grow to hit 36.57 million in 2025,

and this age group is forecasted to account for 35.3%

of the total population 15 years after that, in 2040.

Furthermore, there are quantitative limits to the ability

of existing fee-funded old people’s homes, serviced

senior accommodations1, and adult day care facilities

to respond to this increase. It is clear that, given

anticipated future trends of population aging and the

falling birthrate, an adequate response using existing

Corresponding author: Yuichi Sueshige, lecturer, research

field: urban planning. 1 “Serviced senior accommodation” refers to residential facilities for older people with integral long-term care and medical services, mainly run by private-sector operators. Aimed at people aged 60 and over in need of long-term care and support but able to live independently, each individual accommodation is accessible and suitable for independent couples or single people, with a floor area for exclusive use of at least 25 m2.

relevant provisions will gradually become impossible,

and the likely consequential increase in cases of

in-home long-term care, and of older people providing

long-term care for other older people2, is cause for

concern. If this situation continues, the capacity for

effective “long-term care” (the Japanese word “kaigo”,

hereafter in this report, “care”) within the nuclear and

wider family will increasingly continue to be tested. In

addition to the emergence of an enormous care burden

for families (in many cases, the children of those

receiving care), trends such as a falling birth rate, and

households that consist only of the nuclear family

have led to an ongoing tendency for older households

to comprise a married couple or one person to be

isolated and live apart from their families, making it

2 The Japanese phrase here is “rourou kaigo”, and it refers to an older person aged 65 or older providing long-term care to another older person aged 65 or older (a parent or other family member). According to the 2013 Comprehensive Survey of Living Conditions from the Ministry of Health, Labour and Welfare, 51.2% of households involved in in-home care and support are cases of “rourou kaigo”.

D DAVID PUBLISHING

A Study on Interregional Differences in Elderly Person’s Remote Care in Terms of Traveling Time and Expense: Comparative Consideration in TOKYO Area and OSAKA Area

434

likely that the provision of care by the family will

become more difficult. Meanwhile, in recent years,

there has been an increase in the living arrangement

wherein adult children and parents live separately but

nearby 3 . Because they mutually set a distance

appropriate to their living environments, this

arrangement leads to a high level of satisfaction in

families that put it into practice from the viewpoint of

securing mutual privacy and independence [1]. To

maintain the state of relationships under this

arrangement requires finding the time and money to

meet face to face when necessary. In previous reports

[2-4], the current authors used the term “older person

tele-nursing model”4 to describe the concept of a

distance from which it is possible for an adult child

providing remote care and support to comfortably

travel between their own household and their parent’s

household. The reports identified the ideal visiting

frequency (monthly, weekly), the distance that it is

acceptable to travel, and the maximum acceptable cost

of travel for a putative family living in the Kansai

region in separate but nearby households. A survey

was also included about attitudes to new initiatives

related to living environment provisions for older

adults, with the aim of creating a mathematical model

that accounts, not simply for place and distance, but

also for qualitiative factors that allow people to feel

3 The Japanese phrase here is “oyako no kinkyo” (parent and child living close together), referring to parents and adult children having separate households that are a short distance apart. The distance involved is not strictly defined, but it refers to a living arrangement whereby the distance between residences enables ordinary appropriate meetings as necessary, while each household has an independent living environment. It is important to consider the time and cost of any travel, and the time-cost model in this study projects appropriate levels for such values. 4 “Older person tele-nursing” (“koureisha terenaashingu”) is a term coined to refer to care and support for a parent or other relative who lives at a distance, or nearby but separately. The reason that support is included in the definition is, because this study deals with the homes of older people able to live independently, it includes light-touch methods of providing care such as safety confirmation and continuous monitoring using smart house elements such as the Internet of Things.

settled in their “final abode”5. However, the survey

targeted only the Kansai region, which we believe has

special characteristics arising from its existing

transport conditions including rail routes and

automobile highways.

Thus, this report aims, as a continuation of an

earlier report [3], to survey the Tokyo metropolitan

region and use the older person tele-nursing model

and time-cost maps constructed from the data thus

obtained to clarify regional differences with the

Kansai region, which has differing transport

conditions, and analyze trends in remote care that are

unique to the Tokyo metropolitan region.

1.2 Research Significance

This study describes, in terms of a mathematical

model reflected in time-cost maps, the attitudes to the

time and cost of travel to provide care and support to

an older relative not only of respondents currently

engaged in essential care but also of respondents in

generations and age groups that will be engaged in

such care and support in the future. The study’s

significance lies in the fact that, by investigating

inevitable regional differences in such attitudes, it is

able to accurately discuss the differing provisions of

remote care and support in the Tokyo metropolitan

and Kansai regions.

1.3 Tokyo Metropolitan and Kansai Regions

For the purposes of this study, the Tokyo

metropolitan region comprises the city of Tokyo

(excluding its islands) and Kanagawa, Chiba, Saitama,

Ibaraki, Gunma, Tochigi, and Yamanashi prefectures,

and, in addition to Osaka and Kyoto, the Kansai

5 The Japanese phrase here is “tsui no sumika” (“final nest” according to one possible character rendition). It originally referred to an owned home or to another place in which to spend one’s old age leading up to one’s death. However, nowadays, society offers a mixture of different care and support facilities for older people (most notably fee-funded older people’s homes and serviced senior accommodation) and in-home services, and the phrase now refers to the situation in which a person will spend their retirement, including these other options as well as an owned home.


435

region comprises Hyogo, Nara, Mie, Shiga, and

Wakayama prefectures. Their respective aging rates6

are 22.5%-27.5% for the Tokyo metropolitan region

and 23.4%-30.5% for the Kansai region.

The premium for long-term care insurance in

Shinjuku ward in the city of Tokyo is set at a

proportion (0.4-3.7, according to income) of the yen

5,900 standard weekly amount, and that in Osaka city

at a proportion (0.35-2.0, according to income) of the

standard amount (yen 81,096 per annum, or 12 times

the standard monthly premium of yen 6,758).

Incidentally, the level 1 annual premium is yen 28,320

in Shinjuku ward and yen 28,384 in Osaka city (as

planned for financial year 2017). Regarding the

breakdown of reliance on important modes of

transport in each region, whereas the top two modes of

transport (railroad and automobile) in the Tokyo

metropolitan region each account for roughly the same

share, of around 30% each, in the Kansai region, only

the top mode (automobile) has a share of over 30%,

followed by “walking” and “motorcycle/motorized

bicycle/ bicycle”, with around 20% each. Furthermore,

as shown by the significant difference in average daily

number of railroad passengers (around 44.1 million in

the Tokyo metropolitan region and 13.4 million in the

Kansai region), both railroad lines and passenger

numbers are higher in the Tokyo metropolitan region

than in the Kansai region. Therefore, differences

between the two regions in terms of the ideal mode of

travel for remote care are to be expected, with a likely

impact on the one-way time and cost of relevant

journeys.

2. Research Method

2.1 Survey Outline and Paper Survey of Participants’

Attitudes

In this report, a paper survey of participants’

attitudes was conducted using the same method as the

6 Older person ratio refers to the proportion (%) of older people aged 65 or above within the total population in each local government jurisdiction.

survey of attitudes in the Kansai region used in

previous reports [2, 3]. An outline is shown in Table 1.

The results of this attitude survey are reflected in a

polynomial approximation tele-nursing model and in

time-cost maps 7 shown below, allowing relevant

circumstances in the two regions to be compared.

The specific questions in the paper attitude survey

are broadly classified into four groups as in Table 2.

Section P relates to participants’ profile data; section

Q relates to the ideal circumstances surrounding visits

to a putative older relative requiring remote care;

section R relates to the lifestyle of an actual older

relative currently needing care; and section S relates to

the respondents’ attitude to their own putative home

when they themselves are in receipt of remote care.

Questions in sections P and S are the same for all

participants, while those in sections Q and R are

option-style questions in accordance with each

participant’s profile, with participants being directed

to the appropriate next section at the end of section P.

Besides age and gender, the details requested in

section P are type of housing and composition of

household. Information on “location of residence” is

also requested, to allow for identification of the

starting point of the journey to visit the older relative

requiring remote care for display on the relevant

regional “time-cost map”. In addition, in section Q, on

the assumption that, in the future, an older relative of

theirs such as a parent or grandparent is living alone

and some distance away, participants are questioned

as to (i) the “time” and the “cost” that would be

acceptable for the journey to make a regular visit, and

the “mode of travel” that would be acceptable and (ii)

the “ideal frequency of such visits”. This allows

identification of approximate trends for one-way

7 A “time-cost map” is a two-dimensional map on which is plotted the “travelable zone” and “marginal travel zone” for each mode of travel and each visiting frequency. In this study, the “ideal journey time and cost” for each “ideal visiting frequency” when caring for, or supporting, an older relative living some distance away is converted into what would be the actual journey using the railroad and road networks of the region in question and shown on the map.


436

journey time and cost for each visiting frequency.

Section R targets those who currently have close older

relatives in need of care and support and gathers

information in a free-comment format regarding (i)

location of residence, (ii) type of housing, (iii) living

arrangements (such as able or unable to live

independently and existence or otherwise of daycare

and similar support), (iv) how everyday contact is

made, and (v) actual frequency and number of visits.

Finally, in section S, participants are asked to answer

questions S1 through S7 in Table 2 regarding their

wishes with regard to the living environment of their

own final home when they themselves become older.

The older person tele-nursing model constructed in

this report is based on ideal comfortable values related

to remote care and support provided by adult children

who will be the future providers of such care, with no

mention of the circumstances of those currently with a

relative in need of care. Therefore, approximation in

the time-cost space is based on the answers in section

Q aimed at future providers of care. This model is

based entirely on participants’ perception of ideal

values, with the connection with information on the

current situation and on participants’ own future

lifestyle obtained from responses in section S to be

reconsidered in a further report.

3. Results and Analysis of Paper Survey of Participants’ Attitudes

3.1 Participants’ Attributes and Relevant Breakdown

The attitude survey results and analysis are as

below. First, participant attribute data in section P

show that the ratio of male to female participants was

4:6; replies were obtained from participants aged

20-60, with the 50s age group the most numerous at

38.5% of the total. In addition, the most common

place of residence was Kanagawa prefecture, at 40.4%.

Furthermore, participants currently without a close

older relative in need of care comprised 68.9% of the

total.

3.2 Acceptable Journey Time and Cost, Ideal Visiting

Frequency

3.2.1 Overview of Data as a Whole

Answers to questions in section Q of the paper

attitude survey were used to obtain acceptable journey

time and cost and preferred mode of travel for regular

visits at each ideal visiting frequency. The decision

was made to compare and classify, as the primary

decision axis, four levels of visiting frequency, from

“every week” through “every two months”, which

accounted for a high proption of answers in all age

groups and for both men and women (Fig. 1).

In addition, there were no particular biases regarding

preferred mode of travel linked to participants’

attributes, and “automobile” and “public participants’

attributes, and “automobile” and “public transport”

were the most numerous answers regardless of ideal

visiting frequency. Therefore, the decision was made

to treat these two categories as the mode of transport

when constructing the older person tele-nursing model

in this report (Fig. 2).

Table 1 Summary of the distribution-style subject attitude survey.

Investigation name “Request of the attitude survey about distant place care of the elderly person”

Implementation group Tokyo City University Faculty of Urban Life Studies Interior Planning Lab.

Implementation period 2018.7.6-10.11

Targeted for distribution The subject who is resident in Tokyo, Kanagawa, Saitama, Ibaraki, Gunma, Tochigi, Yamanashi (an island is excluded) 20 years or older.

Implementation method Mail or delivery by hand of the answer to A4 booklet vote. A choice answer and free description type to four answer items of P-S. Aim of the answer time is about 40 minutes.

Distribution number 300 copies

Collection results 161 copies

Answer rate 0.537


437

Table 2 The details of 4 items (P-S) of the distribution-style subject attitude survey.

Q number Question summary The analysis intention and method etc.

P

P1 Sexuality

Basic profile data P2 Age

P3 Occupation

P4 Living arrangement

P5 Constitution of the living together family For the plot of the starting point in case of the figure of time-expense making on the target area map. P6 Residence area

P7 Care and assistance appearance at the present To the answer group divide in Q, R, S.

Q

Q1

When I assumed that there were the staying alone elderly people such as parents: (a) Permission movement time when I visit it regularly (one way) [hour]; (b) Permission movement expense (one way) [yen]; (c) Means of transportation (on foot/by bicycle/by car/by public transport).

Item analysis according to the attribute. Plotted in the time-cost distribution space with allowable one-way travel time (x-axis) and allowable one-way travel cost (y-axis). Building an Elderly Telenursing Model Using Polynomial Trend Lines. An elderly person tele-nursing model is built by the tendency line by the multinomial expression approximation. Than the model mentioned above, display a real route when applied to the public railroad and car grid of the target sphere.

Q2

When I assumed that there were the staying alone elderly people such as parents, ideal visit frequency. Selective (weekly/every 2 weeks/monthly/every 2 months/every 4 months/every 6 months).

R

When there are really need of nursing care and an assistance elderly person to a near relation at present. Free description type about (residence place/residence form/how to get daily communication/ the real visit frequency and number of times).

Answer only for applicable subjects. Facts-finding of the care appearance at the present.

S

S1 Want to live together with one’s child household It is compared with the others in the care about a relation by every attribute. S2 The person who wants to ask for care

S3-1 Ideal residence area Based on a classification category S1 and S2, it is indentified the way of living, environment and area of the ideal in the care. Linkage examination of the applicable phase of the tele-nursing model and answer according to the visit frequency. Investigation of relationships with emigration awareness and the care family for the last home6.

S3-2 About the exchange form with family, neighborhood, others

S3-3 Daily means of transportation

S4 About a lifestyle interesting now

S5 Emigration awareness to realize the way of living of the ideal

S6 Emigration area when I answered it existence in S5

S7 Consciousness for the service that can emigrate to with continuing the exchange with others

All S1-S7 are question items asking “the ideal live image that assumed that own became need of nursing care or an assistance

elderly person”.

Fig. 1 Ratio of “ideal visit frequency”.


438

Fig. 2 “Means of transportation that want to use” according to the visit frequency.

Fig. 3 Ratio at “the permission one-way movement time” according to visit frequency and sexuality.

3.2.2 Trends by Gender and Visiting Frequency

Next, the breakdowns of acceptable one-way

journey time by gender and by visiting frequency

(Fig. 3) show that the acceptable length of time was

longer for men than for women. The breakdown of

acceptable one-way journey cost by gender and by

visiting frequency (Fig. 4) also shows a similar

tendency for men to spend more money.

3.2.3 Trends by Age Group and Visiting Frequency

The breakdown of acceptable one-way journey time

by age group and visiting frequency (Fig. 5) shows a

tendency for the desired visiting frequency to increase

with age. Next, looking at trends in the breakdown of

acceptable one-way journey cost by age group and

visiting frequency (Fig. 6), the lowest sum was seen in

the 20s age group and the highest in the 30s age group,

with a tendency for reluctance to spend to increase

with age in the 40s and 50s age groups.

3.2.4 Trends by Type of Household (Parents and

Adult Children Living Together/Not Living Together)

In a comparison of households where parents and

adult children live together and households where

parents and adult children do not live together, there

was a tendency for the replies of the group of

participants not living with their parents to indicate a

short acceptable one-way journey distance, and their

acceptable one-way journey cost was high.

3.3 Overview of Answers Relating to “Ideal Lifestyle”

This report shows the zone in which it is possible,

in terms of time and geography, for adult children to

comfortably visit parents who live separately (though


439

Fig. 4 Ratio of “permission one-way movement expense” according to visit frequency and sexuality.

Fig. 5 Ratio of “permission one-way movement time” according to visit frequency and age.


440

Fig. 6 Ratio of “permission one-way movement expense” according to visit frequency and age.

perhaps nearby), and having parents who require care

living within that zone is seen as an ideal scenario. To

validate this, in questions S1 through S7 of the paper

attitude survey shown in Table 2, participants were

asked about their own “ideal lifestyle” if they

themselves were to become recipients of care. Below

is an overview of the relevant answers. Furthermore,

to identify differences with the data for the Kansai

region already unearthed in previous reports2), the

breakdowns for S1 and S2 in Fig. 7, as in Table 3, are

used to classify the respondent groups into six groups,

from a1 through b38. Figs. 8 and 9 show a tendency

for both men and women to want to live separately,

and a very high proportion wants to use care services

or similar services.

Next, looking at the breakdowns for questions S3

8 Regarding question S2, because respondents were allowed to choose up to two of the response options, the classification is not “respondent group” but “response group”.

through S5 (Fig. 10), S3-1 relates to the ideal region,

and more closely defined district, of residence, and a

high proportion of respondents in all six of the above

groups expressed a desire to live in the city center or

suburbs. In addition, question S3-3 relates to mode of

travel, and “walking”, followed by “automobile”,

were the most popular in all six groups. Question S4

relates to way of living and lifestyle currently of

interest, and answers indicating a desire to live in the

city center with interactions outside the home were

found to be more common in respondent groups a1, a2

and a3 than in b1, b2, and b3. In a3 in particular, the

proportion of respondents who desired an urban

lifestyle including “eating meals at restaurants and

using libraries and cafes instead of reading at home”

was the highest, at 39.1%. Question S5 relates to

attitude to moving home in retirement, and it was

found that the proportion expressing the desire to do

so was low in groups a2 and b2, who wished to

receive care from their children.


441

Fig. 7 Ratio of question items S1 and S2.

Table 3 6 classifications of the answer group.

Choices S1 Want to live together with one’s child household

(a) Hope for living together or the use (b) Do not hope for living together or the use

S2 The person who wants to ask for care

(1) Spouse a1 (23) b1 (28)

(2) One’s child a2 (24) b2 (26)

(3) Facilities a3 (22) b3 (77)

The number of the true answers by multiple responses in ().

Fig. 8 The number of the answers to a1-a3 according to sexuality.


442

Fig. 9 The number of the answers to a1-b3 according to age.

Fig. 10 The number of the answers to question items S3-S5.


443

4. Older Person Tele-nursing Model and “Time-Cost Maps”

4.1 Participants’ Attributes and Relevant Breakdown

In this section of the report, an older person tele-nursing

model is constructed based on ideal values for the time

and money spent on traveling as part of the provision

of remote care and support to an older relative.

First, the necessary mathematical criteria were

extracted from Q1 and Q2, and a trendline [A:y = A(x)]

was derived by plotting data on a two-extreme

time-cost space {x, y}, in which the X value is

“approximate one-way journey time (minutes)” for

ideal visiting frequency and the Y value is

“approximate one-way journey cost (yen)” for ideal

visiting frequency. Please note, 3D polynomial

approximation was used to draw the trendline, and

whether or not to use a datapoint cluster was

determined by R2 value, with the decision made to rely

on at least three overlaps and disregard points where

there were two or fewer (Fig. 11).

Next, on the same track, trendlines B through E [B

= every week; C = every two weeks; D = every month;

and E = every two months, taken respectively as B(x),

C(x), D(x) and E(x)] were found for each of the four

levels of putative visiting frequency (every week,

every two weeks, every month, every two months)

(Fig. 12), and a tele-nursing model was constructed

for each visiting frequency based on {x, y} being [0 ≤

x ≤ xmax] and [0 ≤ y ≤ ymax] and comprehensive

relevant concentration according to trendline A and

trendlines B-E (Fig. 13). Here, in 30 ≤ x ≤ 60 in the

figure, the reason for C(x) < A(x) could be that the

groups of respondents saying that their ideal visiting

frequency is every month or every two months are

concentrated at the plot point {x = 45, y = 0.3} in the

A(x) distribution of one-way journey time and cost.

Additionally, trendlines D and E give rise to D(x) <

A(x) and E(x) < A(x) when 150 ≤ x ≤ 180 because,

whereas the y = A(x) value when x = 180 is

concentrated at the two points 1.0 and 2.0, the D(x)

and E(x) y values, which are the distribution of the

acceptable range for one-way journey time and cost,

are disparate. Taking the above into account, we

constructed an older person tele-nursing model for the

Tokyo metropolitan region, as shown in Table 4, for

mode of travel categories “automobile” and “public

transport” and for each visiting frequency.

4.2 Method of Evaluation according to the “Time-Cost

Map” for Each Mode of Travel

The older person tele-nursing model derived in the

previous section was used to evaluate the degree of

onerousness for a city-center household of an adult

child when visiting and supporting an older relative

living in the suburbs, and a “time-cost map” Note 9

for each mode of travel was drawn and evaluated. In

this report, to allow later comparison with the Kansai

region, in the same way as for the Kansai region

Fig. 11 The tendency line A by the ideal visit frequency.

Fig. 12 Extraction of the common part of tendency lines A-E.


444

Fig. 13 The tendency lines B-E according to the visit frequency (this report model).

model evaluation, a journey time derived from a rough

acceptable value was reflected in a “time-cost map”,

with “rough” equaling plus or minus five minutes.

Furthermore, when setting starting points (location of

the adult child’s household) for the time-cost maps,

the decision was made to use Kanagawa and Chiba

prefectures, for which the relevant numbers were the

highest according to the participants’ attributes in

Table 2 obtained from the survey, specifically JR

Yokohama Station and JR Tsudanuma Station. There

was no issue when producing “time-cost maps” for

those using automobiles, but for users of public

transport, because the so-called “marginal travel zone”

for the “visiting every month” and “visiting every

two month” groups is shown as a one-way journey

time of 180 minutes or more and a one-way journey

cost of yen 16,000 or more, a maximum value was not

set. Therefore, in the time-cost maps for users of

public transport, for the “every month” and “every

two month” groups, only the so-called “travelable

zone” is shown. Relevant results are shown in Figs.

14-17; for those driving, tolls for accessing

automobile highways are calculated at the ETC rate

and, for those using public transport, JR Yokohama

Station or JR Tsudanuma Station are taken as the

starting point, the weekday timetable is used to

calculate time required, and fares are calculated at

ticket prices and do not include IC card or other

discounts.

With the “time-cost map” in Fig. 14, it is possible

to grasp how far the acceptable range stretches from

the starting point just by looking at the map. For

example, it is clear that those driving to make a

weekly visit, taking JR Yokohama Station as the

starting point, find it acceptable to travel as far as the

Ebina and Chigasaki districts in the eastern part of

Kanagawa Prefecture and as far as the Shinagawa and

Kichioji districts in the southeastern part of the city of

Tokyo.

In addition, on the “time-cost map” in Fig. 15, it is

clear that, when visits are assumed to have a

frequency of every two weeks, every month, or every

two months, the “marginal travel zone” is much

bigger than when a weekly visit is assumed.


445

Table 4 Elderly person tele-nursing model in the capital region.

Specifically, almost all of Kanagawa prefecture, the

city of Tokyo, and Saitama prefecture can be included,

as well as part of Kanto-Koshinetsu and Shizuoka

prefecture.

Fig. 16 shows that those making a weekly visit

starting at JR Tsudanuma Station find it acceptable to

travel as far as the northwest part of Chiba prefecture

and the city of Tokyo (Konshicho and Shinkiba districts).

Furthermore, as shown in Fig. 17, for those visiting

every two weeks, every month, or every two months,

this acceptable range extends along Tokyo Bay in the

eastern parts of the city of Tokyo, Kanagawa prefecture,

and Saitama prefecture, and they find it acceptable to

travel as far as the Shimodate district in Ibaraki

prefecture and the Oyama district in Tochigi prefecture.

The scope of both the “travelable zone” and the

“marginal travel zone” is greater for those using

public transport than for those driving. In particular, it

can be seen that the scope of their “travelable zone” is

significantly greater than that for drivers.


446

Fig. 14 Figure of time-expense (from Yokohama Sta./by car/weekly).

Fig. 15 Figure of time-expense (from Yokohama Sta./by car/every 2 weeks-every 2 months).


447

Fig. 16 Figure of time-expense (from Tsudayama Sta./by car/weekly).

Fig. 17 Figure of time-expense (from Tsudayama Sta./by car/every 2 weeks-every 2 months).


448

5. Regional Differences between the Tokyo Metropolitan and Kansai Regions

Here, based on the results of paper attitude surveys

for existing reports [2, 3] and this report, regional

differences between the Tokyo metropolitan region

and the Kansai region are investigated in terms of

remote care and support for older relatives. First, as in

Fig. 18, there were noteworthy differences in the

answers to question S3-3 in Table 2 (“mode of travel

desirable for ordinary journeys”). Whereas in the

Tokyo metropolitan region, “automobile” (34.5%) and

“public transport” (27.3%) were at similar levels, in

the Kanzai region, “automobile” alone accounted for a

large 66.7% of the total. In our opinion, this result can

be partially attributed to the high number of bus and

rail routes in the Tokyo metropolitan region and to a

lifestyle in the Kansai region that sees use of one’s

own car as essential.

In addition, there was no great regional difference

in terms of ideal journey time (Fig. 19) for regular

Fig. 18 Comparison of the question item S3-3 “means of transportation that want to use daily”.

Fig. 19 Comparison of the question item Q1-(1) “permission one way movement time”.


449

Fig. 20 Comparison of the question item Q1-(2) “permission one way movement expense”.

visits to a separate parental home. However, in terms

of ideal journey cost (Fig. 20), a tendency was seen

for respondents in the Tokyo metropolitan region to

name a higher acceptable cost. Particularly large

differences were seen for the “every month”

visiting-frequency groups (average yen 4,178 Tokyo,

yen 3,109 Kansai) and the “every two months”

visiting-frequency groups (average yen 5,422.4 Tokyo,

yen 3,870.4 Kansai). In addition, whereas in the

Tokyo metropolitan region, there were respondents in

all visiting-frequency groups who named yen 10,000

or more as an acceptable cost, in the Kansai zone,

there were few such respondents in the “every month”

and “every two months” visiting-frequency groups.

Moreover, when comparing the replies to questions

S1 through S3 for the two regions, as shown in Fig. 21,

a low proportion of respondents in the Tokyo

metropolitan region expressed a desire to live with

their children when older. Among responses to the

question as to who the respondents would look to for

care when older, there was also an obvious difference

between the Tokyo metropolitan region (where many

respondents opted for “businesses” including

accommodation for older people, group homes, and

visiting adult daycare) and the Kansai region (where

the numbers opting for “spouse” and for “businesses”

were high). Meanwhile, in both regions, more

respondents mentioned a desire to live near their

children than near friends and acquaintances and, in

our opinion, regardless of region, those receiving care

consider it ideal to live near their children.

When comparing regional differences for the Tokyo

metropolitan region and the Kansai region using the

older person tele-nursing model, they are explained by

polynomial approximation formulas At(x) and Ak(x),

and rounding the point of inflection to the nearest

decimal point gave y = 52,129 for the Tokyo

metropolitan region and y = 59,726 for the Kansai

region, and a seven-minute difference in one-way

journey time and a yen 565 difference in one-way

journey cost arose. While “automobile” is the only

mode of travel in the Kansai region, the Tokyo

metropolitan zone has the two modes of “automobile”

and “public transport” and, because it is possible to


450

travel further using public transport than using an

automobile, for respondents with a high visiting

frequency, the acceptable range for journeys in the

Tokyo metropolitan region is more extensive.

Polynomial approximation formulas for the two

zones, At(x) and Ak(x):

At(x) = 0.053x^3 - 0.8279x^2 + 71.875x - 950.04

(16 ≤ x ≤ 180) (R2 = 0.8672)

Ak(x) = 0.0103x^3 - 1.821x^2 + 106.48x - 1333.3

(30 ≤ x ≤ 120) (R2 = 0.9623)

Fig. 21 Comparison of the answer to question items S1-S3.


451

6. Conclusion

This report defines the burden of travel between an

adult child’s household and that of their older parent

requiring remote care and support in terms of an

“older person tele-nursing model”, mathematically

calculating and evaluating that model, with reference

to the ideal journey time-cost and value concept,

based on participants’ attitude survey data. In addition,

analysis of the attitude survey items regarding the

living environment desired by the older people of the

future for their final abode, namely the items

“appropriate distance between parent and child” and

“ideal location of a new home for retirement, living

arrangements”, sheds light on the regional

characteristics of the Tokyo metropolitan and Kansai

regions. In addition, participants included not only

those currently delivering care, but also the generation

and age group set to be involved in care and support

of older relatives in the future, and the required

journey time-cost was described in terms of a

mathematical model, with the results depicted as

marginal zones on relevant regional maps and

evaluation carried out.

As a result, although no great difference between

the Tokyo metropolitan and Kansai regions in

acceptable one-way journey time was visible,

acceptable one-way journey cost was higher in the

Tokyo metropolitan region, and the time-cost map

“travelable” and “marginal travel” zones were larger,

revealing a tendency for remote care to be possible

over a greater distance.

Meanwhile, when answering from the standpoint of

someone requiring care and support, many

respondents said that they would ideally live in the

city center or suburbs, near their children, with

walking their ideal mode of travel, highlighting a

tendency to wish to live and receive care in the Tokyo

metropolitan zone.

References

[1] Yoshimi, C. 2013. “Changes in Geographical Distances

between Adult Children and Their Parents in Recent

Japan.” J. of Population Problems (Transactions of JPP)

69 (4): 4-24.

[2] Takayanagi, H., Kawakatsu, C., Shibahara, H., Nakamura,

R., and Watanabe, H. 2015. “A Study on Tele-nursing

Method for Elderly Person Based on Tracking Time and

Cost for Care and Assistance by Family.” AIJ Journal of

Technology and Design 49: 1177-82.

[3] Takayanagi, H., Kawakatsu, C., Kihara, T., Kawaguchi,

K., Kawaguchi, H., Frukawa, T., and Kimura, Y. 2018.

“Basic Study on Elderly Tele-nursing Model for Emote

Nursing by Smart Device.” Journal of Civil Engineering

and Architecture 12 (8): 401-7.

[4] Takayanagi, H., and Kihara, T. 2019. “A Study on

Clarification of Pedestrian Omnidirectional Avoidance

Area and Consideration on interregional Difference

between Tokyo Metropolitan Area and Kansai Are.”

Transactions of Japan Society for Interior Studies 29:

53-60.

Documents

A Study on Interregional Differences in Elderly Person’s ......effective “long-term care” (the Japanese word “kaigo”, hereafter in this report, “care”) within the nuclear