Perspective Chapter: Mountain Health Care Room

Abstract

The Kinjo University Faculty of Nursing has been running a project since 2017 as part of its community collaboration activities to help Hakusanroku residents maintain good health. First, we opened the Mountain Health Care Room for community salon participants and conducted a basic survey of Hakusanroku healthcare supporters and community residents. We then provided health education and recreational activities to help older adults maintain good health. Since 2020, we have been unable to hold community activities due to the COVID-19 pandemic, and have been attempting to determine the day-to-day circumstances of residents. In addition to in-person community activities, there is a need for new initiatives such as online activities to help people connect and help older adults living in Hakusanroku to maintain good health.

1. Introduction

The Kinjo University Faculty of Nursing is in the city of Hakusan [1], which is located in the southwestern part of Ishikawa Prefecture, Japan. Hakusan is the largest municipality in the prefecture by land area, covering a variety of terrain from hilly and mountainous zones to flat urban areas with many shopping facilities (Figure 1). With a population of 113,291 (June 2021), it is the second-largest city in the prefecture. The hilly and mountainous zone is called the Hakusanroku region, comprising five districts: Kawachi, Yoshinodani, Torigoe, Oguchi, and Shiramine. The Hakusanroku region covers 86% of the municipality’s land, but just 4.7% of its population. With an aging rate of 42.8% (June 2021), it faces serious problems as the younger age group shrinks and the older age group grows due to population decline.

Figure 1.

City of Hakusan map.

Some such problems are the weakening of district communities, a shortage of medical care, welfare, and nursing care specialists compared to the city center, and resulting depletion of social welfare resources for medical and nursing care. Hakusanroku is covered in the prefecture’s program for promoting independence in underpopulated areas. In 2015, the City of Hakusan conducted a questionnaire survey on residents [2, 3] and found that people in the Hakusanroku region resided there longer and had a stronger desire to settle down there compared to other regions. However, revealed that they were concerned about medical care and welfare and felt that transportation there is inconvenient. Compared to other regions, there was also a higher ratio of people who gave the lush natural environment and the friendliness of the people as reasons why the Hakusanroku region is a pleasant place to live.

To continue programs to help Hakusanroku community residents improve and maintain their own health as depopulation progresses, there was a need to create a learning space where residents could continue lifelong learning and a place for in-person consultations. The region needed to establish and flexibly run a place where community residents could easily come with their problems that also functions like a school nurse’s office and place of healing.

We, therefore, decided to open a Mountain Health Care Room for all ages to help Hakusanroku residents improve and maintain their health. A field survey was conducted in 2016, and the Mountain Health Care Room program was launched in August 2017.

2. Activities at the Mountain Health Care Room

2.1 Basic survey on opening a Mountain Health Care Room (January 2016–March 2017)

From February to October 2016, the Yoshinodani Clinic, which provides healthcare services to Hakusanroku community residents, and other relevant facilities and hospitals were visited and surveyed on their roles and functions in the Hakusanroku community. Specifically, we joined visiting-care visits to groups’ homes, joined house calls, participated in self-help community meetups (called “salons”), held interviews on community center activities, visited dementia cafés, intensive nursing-care homes and public hospitals, and interviewed local chief Buddhist priests.

The Hakusanroku Service Cooperation Council is a system for nursing-care facilities and clinics in Hakusanroku, the aim of which is to cooperate and protect the health of residents. In May 2016, questionnaires about the lifestyles of Hakusanroku residents from an expert’s perspective were given to doctors, nurses, long-term care support specialists, occupational therapists, social workers [4], and other professionals. In addition, starting in November 2016, questionnaires were given to residents in two districts of Hakusanroku to determine their health status and daily living needs [5]. In order to gather information to use in developing activities that reflect their inclinations, Hakusanroku supporters and residents were also asked for their opinions on what the Mountain Health Care Room should provide.

2.2 Launching of the Mountain Health Care Room project

On August 24, 2017, the Mountain Health Care Room held a joint kickoff event with the Oguchi District Sokusai Community Salon (Figure 2). Sokusai is primarily run by seven people, including the main representative, and has about 30 members. It is a self-help group that meets twice a month with the primary purpose of prolonging healthy life. The kickoff event was attended by 16 residents, 5 senior caretakers, and 6 students, and 10 faculty members from Kinjo University.

Figure 2.

“The Mountain Health Care Room” held a joint kickoff event/lecture and recreation.

At the event, students first measured participants’ blood pressure. Next, they introduced the Mountain Health Care Room and the faculty members gave a 30-minute talk on sleep. The event ended with leg-stretching exercises provided by Hakusan and a hand-holding game with participant-student pairs. Participants commented that they looked forward to the interesting lecture and interaction with the students and appeared to enjoy the Mountain Health Care Room activities, providing hints for what to do in the future.

2.3 Main Mountain Health Care Room activities

The main activities were Mountain Health Care Room events at activity spots in the community, outreach lectures held jointly with the community general support center, running of Odekake Hustle Saturday events hosted by the Yoshinodani Community Center, participation in culture festivals run by the Yoshinodani Community Center, participation in Hakusanroku Service Cooperation Council meetings, and a symposium to discuss integrated community care in Hakusanroku (Table 1).

2.3.1 Mountain Health Care Room events at activity spots around the community

In 2017–2018, the kickoff event was followed by Mountain Health Care Room events held jointly with Sokusai Community Salon in September and March and with a mahjong competition ran by the Oguchi Community Center in December and March. At the Sokusai Community Salon, students measured participants’ blood pressure and ran recreational activities that they had planned. All participants ate lunch together and got involved in everything from preparation to cleanup. By spending time together, participants, students, and faculty members interacted closely, providing a look into the everyday behavior of participants. Twenty-two people attended the event including the senior caretaker, and 6 students, and 7 faculty members participated (Figure 3).

Figure 3.

“The Mountain Health Care Room “events held with Sokusai Community and the Oguchi Community Center.

The Oguchi Community Center’s mahjong competition took place as a social event for residents in winter when there are no farming activities. While the community salons had more female participants, the situation was the opposite at the mahjong competition – there were more males. On this day, there were 8 competitors, 2 Oguchi Community Center staff members, and 3 faculty members. Before the mahjong competition and between matches, body measurements such as blood pressure and body composition were taken, and health consultations were provided.

In 2018–2019, Mountain Health Care Room events were held jointly with the Sokusai Community Salon. After students took blood pressure measurements, a faculty member gave a lecture on high blood pressure and important lifestyle points with an exercise component. Participants found this topic particularly interesting, and they actively engaged in discussion about their own health management. Moreover, they were highly amicable during the recreational activities ran by the students. There was a break time in which health consultations were provided while participants enjoyed tea, snacks, and casual conversation. The event was attended by 20 participants including the senior caretaker, as well as 6 students and 5 faculty members.

In 2019–2020, the joint program with the Sokusai Community Salon that had been planned for March was canceled due to the COVID-19 pandemic.

2.3.2 Outreach lectures and Mountain Health Care Room events held jointly with the community general support center

The community general support center shared information about outreach lectures desired by each district’s salons with the Mountain Health Care Room, and the Mountain Health Care Room group provided outreach lectures when possible. The basic structure of outreach lectures is a two-hour program comprising measurement of participants’ blood pressure and other health measurements, a short lecture, and exercise or recreational activities. A tea break is provided for participants to socialize and in consideration of fatigue and concentration ability. One or two faculty members oversaw each session and students took part when needed.

Outreach lectures were held in two places in 2017–2018, two places in 2018–2019, and in five places in 2019–2020 (Table 2).

Month	Year
	2017–2018	2018–2019	2019–2020
April			April 17—Mountain Health Care Room Outreach lecture* (Kawachi Federation of Senior Citizens’ Clubs)
May			May 15—Hakusanroku Service Cooperation Council
June			June 6—Mountain Health Care Room Outreach lecture* (Yoshinodani Health Management Center)
July			July 12—Outreach lecture* (Kamiyoshitani Momijikai)
August	August 24—Kickoff event (jointly with the Sokusai Community Salon)	August 7—Mountain Health Care Room Outreach lecture* (Ichihara Community Salon); August 23—Odekake Hustle Saturday (Faculty of Nursing, Kinjo University)	August 6—Mountain Health Care Room Outreach lecture* (Ichihara Community Salon); August 21—Service Coordination Meeting; August 22—Odekake Hustle Saturday (Faculty of Nursing, Kinjo University)
September	September 20—Hakusanroku Service Cooperation Council; September 21—Mountain Health Care Room (jointly with the Sokusai Community Salon)
October	October—5 Mountain Health Care Room Outreach lecture* (Hotto Work Chugu Community Salon); October 18—Mountain Health Care Room Outreach lecture* (Yoshinodani Community Salon Michinosato); October 29—Participation in the Yoshinodani Culture Festival; Mountain Health Care Room booth	October 12—Mountain Health Care Room Outreach lecture* (Kamiyoshitani Momijikai); October 28—Participation in the Yoshinodani Culture Festival; Mountain Health Care Room booth	October 7—Participation in the Yoshinodani Culture Festival; Mountain Health Care Room booth
November	November 11—Participation in a symposium to discuss integrated community care in Hakusanroku	November 10—Participation in a symposium to discuss integrated community care in Hakusanroku; November 15—Mountain Health Care Room (jointly with the Sokusai Community Salon)	November 9—Symposium to discuss integrated community care in Hakusanroku; November 7—Mountain Health Care Room Outreach lecture* (Hotto Work Chugu Community Salon); November 27—Hakusanroku Service Cooperation Council Special Lecture
December	December 15—Mountain Health Care Room (jointly with the Oguchi Community Center Mahjong Competition)
January		January 16—Hakusanroku Service Cooperation Council	January 15—Service Cooperation Meeting
February
March	March 6—Mountain Health Care Room (jointly with the Oguchi Community Center Mahjong Competition); March 15—Mountain Health Care Room (jointly with the Sokusai Community Salon)	March 14—Mountain Health Care Room (jointly with the Sokusai Community Salon)	March 19—Odekake Hustle (jointly with the Sokusai Community Salon)

Table 1.

Mountain Health Care Room activities from 2017–2018 to 2019–2020.

*

Canceled due to the COVID-19 pandemic.

Target	2017–2018	2018–2019	2019–2020
Hotto Work Chugu Community Salon	Lecture: “Being able to swallow helps you live longer” (thickened food tasting), fun quiz		Lecture: “How to practice relaxation—Breathing techniques to help yourself” (performing breathing techniques with respiratory rehabilitation tools)
	14 residents took part		24 residents took part
Yoshinodani Community Salon Michinosato	Introduction to community general support center activities, introduction to Mountain Health Care Room activities, lunch get-together
	18 residents took part
Ichihara Community Salon		Lecture: “Living a rich life during old age—Preventing frailty”	Lecture: “Preventing heat illnesses,” social gathering for participants and students
		14 residents took part	10 residents took part
Kamiyoshitani Momijikai		Lecture: “Talking about sleep,” exercise for brain	“Heat illnesses and oral rehydration solutions”
		20 residents took part	15 residents took part
Kawachi Federation of Senior Citizens’ Clubs			Lecture: “High blood pressure and important lifestyle points”
			40 residents took part
Yoshinodani Health Management Center			Lecture: “Eating safely—Swallowing basics and approach” (repetitive saliva swallowing test)
			23 residents took part

Table 2.

List of results of outreach lectures.

Lecture topics were decided after discussion with community salon senior caretakers and community general support center staff. Care was taken to avoid overlap of topics when the lecture was provided for a salon more than one time. Group participation was emphasized, and the events proceeded with consideration given to the participants’ conditions (Figure 4). Outreach lectures enabled direct confirmation of residents’ health status and health concerns.

Figure 4.

Outreach lectures by “The Mountain Health Care Room”.

2.3.3 Odekake Hustle Saturday event

On one Saturday a month, the Yoshinodani Community Center holds an activity called Hustle Saturday for local elementary and junior high school students to do crafts and outdoor activities. The Mountain Health Care Room ran a program in conjunction with these activities in which Hakusanroku elementary and junior high school students, as well as older adults, were invited to Kinjo University to try nursing-care techniques and to interact with the university students. This event was called Odekake Hustle Saturday, and took place once in 2018 and once in 2019. The event began at 10:00 am with a stamp rally in which the participants went to four practical training rooms at the university and tried nursing-care techniques. The university students and faculty members joined the attendees for lunch altogether. In the afternoon, the participants split into groups to compete in games planned by the university students. This event ended with tea time and reflection on the day’s activities, finishing at 3:00 pm.

In the nursing-care technique practice, the participants gave a bath to a baby doll, tried a wheelchair, practiced hand washing, and used a stethoscope to listen to sounds in the body. Children and older participants alike enjoyed the event. Activities took into account fatigue and the burden on older participants, as well as the creation of a safe environment. In 2018, 15 elementary and junior high school students, 16 older adults, and 10 staff members came to the university, and 11 university students and 10 faculty members ran the program. In 2019, 11 elementary and junior high school students, 14 older adults, and 9 staff members came to the university; 14 university students and 10 faculty members ran the program. Visiting the university was a special experience for older adults and children alike. Participants rated the program highly, saying they were able to experience something different from the usual and greatly enjoyed interacting with the students (Figure 5).

Figure 5.

“Odekake Hustle Saturday” event/nursing experience and breaks.

2.3.4 Participation in the culture festival held at the Yoshinodani Community Center

The Yoshinodani Community Center holds a culture festival every year on the last sunday in October. It is one event for all age’s residents look forward to and features craft presentations as well as booths opened by local residents.

The Mountain Health Care Room took part in the Yoshinodani culture festival in 2018 and 2019 and opened a Mountain Health Care Room booth in a room in the Community Center where people could take various health measurements. University students and faculty members took blood pressure and body composition measurements, measured grip and back strength, and measured oral cavity hydration. Meanwhile, visitors could try handwashing, crafts, and hand massages. About 60 people of all ages visited and developed community connections through health (Figure 6).

Figure 6.

Participation in cultural festival held at Yoshinodani Community Center/health check and hand massage.

2.3.5 Participation in Hakusanroku Service Cooperation Council meetings and a symposium to discuss integrated community care in Hakusanroku

The Hakusanroku Service Cooperation Council is run by people involved in medical and nursing care in the Hakusanroku community. Aiming to help Hakusanroku residents live with peace of mind in the community they know well, it holds various programs once every other month.

The objective of the Hakusanroku Service Cooperation Council is to build face-to-face connections. To boost awareness of home-based medical and nursing care, it chooses its own topic for each meeting, assesses the social resources in the community, exchanges information, discusses problems in multidisciplinary collaboration and solutions for them, and holds seminars to share case reports. Local issues raised by the Service Cooperation Council are discussed by the Hakusan Home Healthcare Cooperation Support Council, which is the umbrella organization and is used in policy formation, reflecting them in long-term care insurance program planning. The Hakusanroku Service Cooperation Council comprises 17 facility offices and has over 30 members. The Mountain Health Care Room has been participating since February 2016 as a member of both the Council and its preparatory committee.

In November 2017 and 2018, the Council held a symposium to discuss integrated community care in Hakusanroku. The goals of the symposium were to introduce current activities and initiatives underway to enable residents to continue living with peace of mind in the Hakusanroku community they know well and to provide a platform for residents to discuss the future of Hakusanroku community activities. About 100 people took part, including community residents and related individuals, as well as students and faculty members from Kinjo University. During the symposium, a health measurement booth was also set up, and university students were in charge of health measurement and venue reception.

2.4 Activities during the COVID-19 pandemic (April 2020–March 2021)

In 2020–2021, COVID-19 infections spread rapidly and all activities that had been carried out before were canceled. The Mountain Health Care Room was held on September 17 in collaboration with the Sokusai community salon, which is the only self-help group resuming activities, with sufficient infection control measures in place. It was attended by 23 participants including senior caretakers, as well as 2 university students and 4 faculty members. The program comprised a practical lecture on the correct way to wash your hands and recreational activities led by university students (Figure 7). To prevent infection, the program was shorter and did not include tea time.

Figure 7.

“ The Mountain Health Care Room “ was held while taking measures against infection.

With the COVID-19 pandemic expected to continue for some time, there is concern that less intervention into the health-related activities of Hakusanroku residents may lead to a decline in how they maintain their own health. As such, the Mountain Health Care Room collaborated with the Kinjo University Faculty of Health Sciences’ Yuyu Health Club to determine the effects of online health classes. One feature of the Mountain Health Care Room was intergenerational exchange among Hakusanroku residents and university students. Even without an in-person meeting, online classes could potentially foster connections online and lead to self-initiated health maintenance activities. The program was for 20 people who take part in the Sokusai community salon.

An online outreach lecture took place on March 4, 2021 (Figure 8).

Figure 8.

Online outreach lectures.

Participants listened politely to the lecturer on the screen, but they began smiling and laughing when the university students called on them to do health exercises, and they began exercising together. After it ended, they commented that it was fun, indicating that online outreach lectures have the potential to support health. Online activities are a new challenge for older adults, and may also serve as good stimulation and an important way for them to recognize their own ability to carry out all sorts of activities.

2.5 Educational aspect of university student participation

University student volunteers also took part in Mountain Health Care Room activities. Interaction with Hakusanroku residents was a form of intergenerational exchange for the students, serving as an opportunity for them to create mutually supportive relationships and grow at a social level. It was also a chance for them to think about health issues from physical, psychological, and social perspectives through health measurement and health consultations. Furthermore, their experience of planning and running recreational activities helped them develop their creativity, coordination skills, and execution capabilities.

3. Mountain Health Care Room challenges and future prospects

Although online activities are planned, it will be difficult to continue programs if circumstances that prevent meeting in person continue. Even with online activities, many people lack Internet access, so careful planning is needed.

The Mountain Health Care Room has been focused on providing health support in a place where people gather, taking advantage of the community’s strength. Although the basic activities will not change, a challenge going forward will be to consider ways to support individuals. To achieve the Mountain Health Care Room goals of providing a place for lifelong learning and a place where local people can feel free to consult face to face, we must value the endeavors undertaken to date while also incorporating new methods in flexible ways. Possible examples include creating a package for outreach lectures and developing health management tools that use information and communication technology. In this light, we will consider ways to provide Mountain Health Care Room activities to Hakusanroku residents that are available anytime, anywhere, for both groups and individuals.

Conflict of interest

The authors declare that they have no competing interests.