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