[Review of the factors which make home medial care difficult]

In the patients who were managed in the diabetes treatment department, 33 patients were chosen as the difficult cases for the home medical care, and the factors were reviewed. As for the man and woman ratio, 11 were men and 22 were women. The number of female patients was twice larger. The average age was 81.7 years old. As for the mode of the medical care, 11 patients were under the long-term hospitalization, 1 was under care of the health care facility, 12 were under care of the nursing home, 5 lived in private facilities for senior citizens, and 4 were treated under home medical care. The main reason to refuse the home medical care was the decline of the self-management ability. Of the 33 patients, dementia was observed in 21 patients, and the lack of recognition on their own disease was seen in 12 patients. So, without the support, the home medical care could not be provided. It is difficult to provide home medical care because of the complications (especially impaired visual sight, or cerebral vascular disease), the complexity of illness, the state of the family involved in home care, and the reform of the healthcare system. In order to promote the home the medical care of the elderly diabetics whose medical dependency became high, the management of the dementia patient, the support to the family involved in home care, the valid utilization of the care insurance system among other issues seems to be future challenges.