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Potential model 1 : The living students of Humanitas

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Potential model 1 : The living students of Humanitas

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In Netherlands

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Humanitas Deventer biedt een warm en veilige woonomgeving. Respect voor de eigenheid van iedere individuele bewoner, cliënt of buur.

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The Public Impact Fundamentals - A framework for successful policy

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The Public Impact Fundamentals - A framework for successful policy

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Three factors appeared again and again in our assessment of effective policies: Legitimacy, Policy and Action.The website call these the Public Impact Fundamentals.

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For an initiative to be a well-designed policy, it needs to have clear objectives to ensure common agreement on the problem the policy is trying to solve, take into consideration the suitable evidence, as well as have feasibility, to ensure there are no legal, human resource or financial barriers that would affect impact.

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The Public Impact Fundamentals - a framework for successful policy. Discover how you can achieve public impact using a tried and tested, simple framework.

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Residents’ perceptions of their own sadness - a qualitative study in Norwegian nursing homes

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Residents’ perceptions of their own sadness - a qualitative study in Norwegian nursing homes

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Nursing home nurses and doctors should identify and respond to sadness that is a rational response to manageable causes. Further, identifying and supporting residents’ resources and coping strategies is a salutogenetic approach that may alleviate sadness.

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BMC Geriatr. 2015; 15: 21.

Abstract

Background

Mood symptoms are highly prevalent among frail old people residing in nursing homes. Systematic diagnostics of depression is scarce, and treatment is not always in accordance with best evidence. The distinction between non-pathological sadness and depression may be challenging, and we know little of the older peoples' perspectives. The aim of this qualitative interview study was to explore residents' perceptions of their own sadness.

Methods

We performed individual, semi-structured interviews with twelve older people residing in nursing homes with no dementia. The interview guide comprised questions on what made the informants sad and what prevented sadness. We recorded, transcribed verbatim and analysed the interviews using systematic text condensation.

Results

The interviews revealed three main themes. I. Decay and loss of agency. The informants perceived their sadness to be caused by loss of health and functional ability, reliance on long-term care, dysfunctional technical aids and poor care. II. Loneliness in the middle of the crowd. Loss of family and friends, and lack of conversations with staff members and fellow patients were also sources of sadness. III. Relating and identity. The informants kept sadness at bay through: acceptance and re-orientation to their current life situation, maintaining narratives about their identity and belonging, and religiosity.

Conclusions

Nursing home nurses and doctors should identify and respond to sadness that is a rational response to manageable causes. Further, identifying and supporting residents' resources and coping strategies is a salutogenetic approach that may alleviate sadness.

Keywords: Sadness, Depression, Nursing homes, Frail elderly, Coping strategies, Medicalization

Background

Sadness is probably inherent to human existence, although its occurrence and intensity differ and individuals and cultures express it in various ways. Sadness is an affect associated with various experiences and represents an internalizing response to whatever initiated it. Normal sadness is defined as context specific, its intensity corresponds to the reason for being sad, and sadness diminishes when its reason is brought to an end [ 1]. In contrast to sadness as a normal emotional reaction, sadness is also a core symptom of depression.

Most older people residing in nursing homes have complex health problems and severe functional impairment. Depression is prevalent [ 2, 3], and contributes to increased morbidity and mortality [ 4- 6]. The important task of distinguishing "meaningful sadness from counterproductive depression" [ 7] may be challenging for the following reasons: Social involvement is decreased due to loss of friends and family and a shrinking social network [ 8], the diagnostic cut-off is defined by convention [ 9], biological markers are lacking to resolve ambiguous cases, and finally, depression may have various clinical expressions [ 10]. Unfortunately, previous research in nursing homes suggests a scarcity of systematic diagnostics of depression [ 11]. It even appears that when an auxiliary nurse reports that an old person living in a nursing home appears to be sad, the skilled nurse forwards this message to the nursing home doctor who initiates treatment with antidepressants without even interviewing the person [ 12].

Frail older people residing in nursing homes need comprehensive patient-centred health services [ 13]. According to Dowrick, one should ask "why" and "what for" when people experience sadness, and try to talk about it with them [ 14]. Antonovsky introduced the concept of Sense of Coherence (SOC) to explain human coping resources [ 15]. People who possess a strong SOC are able to comprehend their present life situation, find it meaningful, and maintain a good quality of life in spite of health decline [ 16]. Previous research indicates that a strong SOC is associated with less depression in the general older population [ 17], and nursing home populations in particular [ 18, 19].

Being specialists in family medicine with broad clinical experience, we share an interest in depression in older people, nursing home medicine and medicalization. The first and second authors are experienced nursing home doctors, and the third author is qualified in ethics and philosophy. The present study has been motivated by concerns about potentially harmful medicalization of inevitable processes during the final stage of life, which can undermine the person's own coping resources. Poor diagnostic work with lack of regard for residents' perspectives, may lead to an inappropriate diagnosis of depression and overtreatment with antidepressant drugs. Nursing home staff should use person-centred approaches to deal with non-pathological sadness as well as sadness comprised by a diagnosis of depression. To supplement the perspectives of doctors and nurses, residents' perspectives can provide useful knowledge for improving the health-promoting approach of nursing home services.

The aim of this qualitative interview study was to explore residents' perceptions of sadness. The phenomenon of sadness rather than the medical diagnosis of depression was the focus of this study. Because information about the informants' diagnoses or medication could disturb our attention to sadness, we decided not to collect any background information about the informants' mental health.

Methods

In Norway, nursing homes constitute part of the primary health care system provided by the municipalities. About 40,000 citizens live in nursing homes, which corresponds to 18% of inhabitants 80 years and older. About 80% of the people in long-term care in nursing homes have dementia [ 20]. Due to the residents' complex health problems and frailty, they need extensive care round the clock, as opposed to older people residing in care homes who are more self-reliant. Part-time employed general practitioners provide most of the medical services.

We conducted a qualitative study in 2012-2013 in Rogaland County, Norway. As we intended to explore the subjective perceptions of frail persons, individual and qualitative interviews were the appropriate approach. Four nursing homes were invited and agreed to participate. The institutions were similar in their size and organisation; three had public funding and one was private. The nursing homes did not have a faith basis. None of the authors had ever worked in the participating nursing homes. The first author informed the staff members about the study protocol through meetings and letters. Registered nurses recruited residents whom they perceived as sad; they could, for example, have a sad expression or an unhappy voice, weep easily or lack the ability to enjoy pleasant events. A purposive sample of twelve long-term care residents older than 80 years without moderate or severe dementia was included; eight informants were women. The recruiting nurse checked the informants' medical record with regard to dementia. No health information about the informants was collected.

The first author performed semi-structured, individual interviews with the informants. Each interview lasted about 30 minutes. For one informant, the interview was performed on two different days. After informing the participants cautiously about the purpose of the study, KRI started each interview by asking "Do you feel sad?" Each informant gave an affirmative answer that was followed up by various questions to explore what the informants considered to be the causes of their sadness, and how they could avoid being sad. Further, they were encouraged to elaborate on topics they had introduced already and that seemed to be important to them.

The interviews were audio-recorded and transcribed verbatim. All three authors performed the analysis in collaboration and interpretations were negotiated until agreement was achieved. The method used was systematic text condensation, as described by Malterud [ 21]. We divided the analysis into four steps: (1) reading the transcripts to obtain an overall impression; (2) identifying units of meaning characterizing diverse features of sadness and coding for these; (3) abstracting the contents of each of the coded groups; and (4) generalizing the description and concepts regarding how patients perceive their sadness. We performed interim analysis after five interviews. When we had interviewed 12 informants, we decided that the interviews provided rich enough material to illuminate the informants' perceptions of their sadness. The planning and performing of the study, as well as the analysis and presentation of the results comply with the RATS-guidelines for qualitative research [ 22].

Ethics and approval

The Western Regional Committee for Medical and Health Research Ethics approved the study (2012/541). All informants provided written consent before the interviews were performed. We have removed or disguised all informants' identifiers so the informants described cannot be identified.

Results

The interviews revealed three main themes: I. Decay and loss of agency; II. Loneliness in the middle of the crowd; III. Reconciliation and identity.

I. Decay and loss of agency

The informants expressed that sadness was caused by health problems, functional impairment, dependency on care, dysfunctional technical devices and aids, and poor care. Among other conditions, they most frequently and empathetically stated urinary incontinence and care related to that condition as being humiliating and a significant cause of sadness.

"I am often sad because I have to wear diapers and need help to use the bathroom. But I don't like it when my diapers are wet and I'm completely dependent on care." (Woman)

Thus the informants described how illness would disable them and cause discomfort, pain, immobilization and make them dependent on care and on decisions made by caregivers. Several informants told stories about toilet routines that included sadness and frustration about the use of diapers, or even technical devices such as a lift used for toileting because of paretic limbs. Sometimes sadness and resignation dominated, as when a male informant reflected that diapers used for convenience interfered with his dignity:

"It is OK with diapers since I don't have to get up in the middle of the night and I can sleep well. But on the other hand...it is beneath my dignity."

In other cases frustration dominated, as in the case of the male informant with paretic lower limbs who had experienced that his wishes were ignored:

"You know they decided to use that lift against my will and ever since that day my life here has become less tolerable."

Other examples of dysfunctional aids and technical devices that would trigger sadness included a wheelchair that did not fit the user, a pillow being shaped incorrectly, or technical aids for use in the bathroom being either humiliating or not fit for the purpose.

"It is of great importance for me that I am in a good sitting position, that the food is tasty and that I am able to smoke a cigarette. But if I am not sitting well, I feel sad... Some technical devices can spoil my day." (Man)

Examples of poor care leading to sadness included nurses being mean when the informant needed to go to the bathroom at night. However, one informant explained that once she had informed the head nurse about what happened, the harsh nurses became more kind. Other informants would adjust to poor care:

"If the mean nurse is on duty, I don't dare to call for help." (Woman)

II. Loneliness in the middle of the crowd

Loss of family and friends, lack of meaningful communication with fellow residents, and staff members having little time for conversation were also sources of sadness. Many informants told that they felt lonely because they had lost their spouse or other family members. They expressed difficulty and frustration about not being able to talk with other residents, since most of them had dementia. Thus one informant described how she had to repeat the same information again and again to her fellow resident with dementia.

"She asks me the same question: where is the train heading for? And I answer her, whereby she shortly after asks me the same question again. It really annoys me and makes me sad." (Woman)

Separation from his spouse was a source of deep sadness for this male informant:

"We have been married for ages. Moving into nursing home was like getting a divorce. It was very sad, even though she visits me every day." (Male)

Many informants emphasized that they wanted to converse with the nurses, but perceived them as being preoccupied with providing bodily care, medications and meals.

"The nurses are always in short of time. They don't have time to talk with us. They have so many tasks to be carried out, and they can't be blamed for that...the nurses are very kind, but I would have preferred they sat down and talked with us... but the times they are changing. Everything and everyone is in a rush. " (Woman)

The nursing home doctors were mostly absent from the informants' accounts, the only two exceptions being one informant explaining that she would speak with the doctor when somatically ill, and another informant relating an incident when the doctor misunderstood her, since he thought she was sad because of her husband's recent death, whereas the real cause of her sadness was urinary incontinence.

"I became sad when they told me I needed to use diapers. I was really sad. Then the doctor came to visit me, and I told him I was sad because of the incontinence and the diapers I had to wear. He replied "I realize you are sad since you just recently lost your husband". So he thought this was the reason for being sad." (Woman)

III. Reconciliation and identity

According to the participants, what helped them avoid sadness was accepting the realities of old age, gratitude for remaining function and for care, relating to own and family's life history, and religious activity. During the interviews, the informants actively engaged in viewing life in a larger context, demonstrating that they were still able to tell meaningful stories about their own lives and those of their families. Own achievements and dispositions in the past were reported - with obvious pride by some, but more often with a matter-of-factness, as were the doings of younger kin. In the informants' narratives, past and current history established their identity in ways that conveyed an understanding of how to avert sadness. Sometimes the informants explicitly explained how past experiences were relevant even today:

"For I must say, I have experienced two wars. Because when you are ninety-four, you have to accept a couple of things. ... I have to accept being here since I need help. ... I'm worn out. I could wish it was like when I was young, but that doesn't help. But I'm not the kind who gives up." (Woman)

A couple of informants described how they initially felt grief and sadness when experiencing functional impairment, but after accepting the inevitability of impairment and dependence, they rather felt gratitude for their remaining level of function and for life itself.

"At my age, I just have to accept the health decline. So I don't spend much time reflecting on this." (Woman)

They also reflected on the importance of coping positively with declining health to avoid sadness:

"We cope with life in different ways. Some complain about everything. Others don't complain at all. For me...considering the circumstances... I have a good life here." (Woman)

Narratives about past achievements and family could also stand more alone, with more oblique references to their relevance for the topic of the interviews. Thus one informant proudly told about a sport badge he was awarded many years ago, another explained about his earlier profession and his granddaughter's current career.

Some informants declared their faith, explained about their religious activities in the past, and conveyed that religious beliefs and practice still were a source of comfort to them. A woman expressed how important religion was to her as it had been for her late husband, treasuring the words and prayers of the vicar who visited her regularly. Some informants would have appreciated more religious meetings and activities in the nursing home. But praying was a good alternative:

"I tell myself that I mustn't be sad. I say a silent prayer. It makes me calm." (Woman)

Discussion

When asked "why" and "how" they perceived their sadness, our informants answered in terms of health-related issues and poor care interfering with their dignity and agency, loneliness due to loss of kin and friends, and lack of communication with staff. But they also reported keeping sadness at bay through acceptance and re-orientation to their current life situation, through maintaining past and current narratives about their identity and belonging, and through religiosity.

Strengths and limitations

In this study, an experienced nursing home doctor performed the interviews in the informants' nursing homes, seeking to establish a safe atmosphere for sharing personal experiences. Because the informants were frail, individual interviews were probably the qualitative research method of choice. Recruitment performed by skilled nurses according to predefined criteria ensured the inclusion of informants who provided valuable information on the issue we wanted to explore. Selection bias because of voluntary study participation or the recruiting nurses' preferences cannot be excluded though.

The informants had received written and oral information about the study in advance, and knew that the topic of the interview was sadness. They were obviously prepared for the interview and most informants had much they wanted to convey. Each interview lasted 15-30 minutes and was performed by a doctor-researcher who was a complete stranger to the informants. The interviewer sought to pursue any topics the informants shared, based on the idea that whatever they related might be relevant to their experience of sadness. Nevertheless, she may have missed some clues or have failed to pursue some topics appropriately. Although they talked openly about loss of bladder control and other private issues, the informants may have considered existential perspectives of life and death to be irrelevant topics to discuss with a doctor researcher. It would be interesting to determine whether longer or repeated interviews, interviews performed by a priest or someone with whom the informants already had a trusting relationship would yield different results regarding existential issues, but this could not be explored with the study design chosen.

As stated in the introduction, no information was collected about whether the informants were suffering from mental illness or received medications. Knowledge about a diagnosis of depression could have influenced the researchers' preconceptions and interpretations of the interviews, and could even have introduced a bias in the conduction of the interviews themselves. Theoretically, all or none of the informants may have been suffering from depression, or anything in between. The following discussion concerns issues that are of relevance in any case.

Theme I: Decay and loss of agency

Our findings suggest that health problems, functional impairment and poor care are major causes of sadness to older people residing in nursing homes, with urinary incontinence (UI) as the most empathetically stated example. This finding is in accordance with a large epidemiologic study in US nursing homes reporting that patients with UI experienced lower quality of life in the domains of dignity, autonomy and mood [ 23], and a study in Australian nursing homes and hostels showing that loss of dignity and independence caused by UI was strongly associated with quality of life [ 24]. An interview-study with older female residents residing in nursing homes with UI in Canada indicated that they felt regression to childhood and embarrassment, which led to loss of control, dignity, independence, and decision-making power [ 25]. This should raise concern because UI is a prevalent health condition affecting 67% of older women living in nursing homes [ 23]. We consider sadness a rational response to distress caused by UI and other health conditions. Therefore, more consideration should be given to understanding the lived experience from residents' perspectives. This may inform and facilitate changes toward individualized care, empowerment of those experiencing UI, and improving specific health care education [ 25].

Theme II: Loneliness in the middle of the crowd

Human life is meaningful when there is interaction with others in a social context, sharing and responding to each other's experiences and thoughts [ 26]. In a systematic review of qualitative studies on living well in various types of care homes, connectedness with others and caring practices emerged as two out of four key themes [ 27]. The review, however, highlighted care home residents' concerns about difficulty in forming appropriate relationships with others. This finding corresponds with the results of the present study; our informants voiced loneliness due to poor communication with their fellow residents with dementia, and limited contact with family, friends and nurses. This is relevant because loneliness, lack of social support and perceived inadequacy of care among older people residing in nursing homes were found to be associated with depression [ 28] and mortality [ 29]. Drageset et al. have shown that 56% of people without dementia living in Norwegian nursing homes experienced loneliness. Emotional closeness to significant others had even more impact than frequency of contact with family and friends [ 30]. They therefore advise that nurses should pay attention to emotional loneliness among nursing homes residents and especially give attention to the importance of having a close confidant who provides emotional support. Nursing homes in Norway have established special dementia care units for about 30% of institutionalized older people with dementia [ 31]. One might wonder, however, if corresponding initiatives should also be established for those without cognitive impairment to support their quality of life and functional ability.

Theme III: Reconciliation and identity

In the face of challenging life events, people act differently depending on their coping strategies. In Antonovsky's theory of salutogenesis, this coping capacity is defined as comprising a sense of coherence (SOC): a global orientation that expresses the extent to which one has a "pervasive, enduring though dynamic feeling of confidence", a feeling which derives from experiencing one's situation as meaningful, understandable and manageable [ 15]. A broad range of research has demonstrated a positive relationship between SOC and health, and probably also a positive relationship between SOC and future health [ 32]. Antonovsky anticipated that his theory on coping would specifically gain doctors working in primary care and geriatrics to understand and help people better by identifying and promoting elements that would enhance their SOC [ 15]. There is some evidence about how the SOC of older people residing in nursing homes can be supported, including the finding that social attachment was associated with a rise in SOC among residents without cognitive impairment during a five year follow-up [ 33].

Our findings regarding strategies for keeping sadness away can be interpreted in the light of Antonovsky's theory. The informants' reports about gratitude for care and acceptance of decline in old age, keeping in touch with family, narrating stories about their own identity, and engaging in religious activity indicate that the informants endeavour to re-create meaning, make sense of their predicament and maintain agency. This will render their situation meaningful, understandable and manageable and thus enhance their sense of coherence. Nursing home staff members should encourage all kinds of initiatives that may strengthen residents' coping resources, and this should include communicating with residents to reduce their loneliness. This is in concordance with a previous qualitative study in two Norwegian nursing homes where Bergland and Kirkevold through interviews and participant observation found that the residents' own attitude to their life situation and living in a nursing home was the single most important factor for their thriving [ 26]. Furthermore, in a qualitative study in Iceland, Hjaltadottir and Gustafsdottir found that people residing in nursing homes considered being recognized as a person with a family history and a meaningful life was crucial for their quality of life [ 34]. This indicates that nursing home staff members should encourage all kinds of initiatives that may strengthen residents' coping resources, and this should include communicating with residents to reduce their loneliness and confirm their identity.

Some informants expressed wishes for religious meetings and worships. According to Pargament et al., religiosity provides meaning and confidence for older people [ 35]. Bosworth et al. have shown that positive religious coping had favourable effects on depression among older residents [ 36]. Norway is a highly secular society, and this is reflected by the organization of long-term care by the municipalities; i.e. most nursing homes do not have a faith basis. Consequently, residents' needs for religious worship may be unfulfilled. Guidelines have been developed for many somatic diseases and nursing situations; the lack of corresponding initiatives with regard to spiritual needs may reflect underestimation and neglect of faith, including its meaning as a coping resource. Regardless of the religious foundation or lack of such in the nursing home, the importance of religion for many residents should be acknowledged.

Implications for clinical practice and further research

The concern that motivated this study was that normal responses to inevitable processes towards the end of life may be inappropriately medicalized in nursing homes, contributing to suboptimal medical treatment and care, and undermining of the older people's own resources. Our findings regarding sadness as a rational response to health problems, functional impairment, loneliness and poor care align with previous research on how institutionalized older people perceive their situation and what they value, highlighting priorities for patient-centred care [ 37]. Further, identifying and supporting residents' resources and coping strategies is a salutogenetic approach that may alleviate sadness. When a resident in a nursing home appears to be sad, it seems that staff should respond by engaging with the resident to establish the cause of sadness, provide company and encourage contact with relevant others, support the resident's own coping resources, as well as addressing any care-, diagnostic- and treatment issues ranging from e.g. urinary incontinence to the possibility of the resident being depressed.

Because sadness and depression are prevalent and partly overlapping conditions among older people residing in nursing homes, future studies should examine their boundaries, misclassification, associations with clinical and institutional characteristics, as well as the impact of depression on residents' experience of sadness. Further, clinical studies are needed to examine the effects of different care- and therapeutic approaches on these conditions.

Conclusion

Nursing home nurses and doctors should identify and respond to sadness that is a rational response to manageable causes. Further, identifying and supporting residents' resources and coping strategies is a salutogenic approach that may alleviate sadness.

Acknowledgements

We thank all informants who participated and the collaborating nursing homes. This study was supported by the Foundation for Research in General Practice (PhD grant for Iden).

Footnotes

Competing interests
The authors declare that they have no competing interests.
Authors' contributions
KRI conducted the interviews and transcripts, and drafted the manuscript. KRI, SH and SR conceived the study, and analysed and interpreted the data. SH and SR critically revised the manuscript. All authors read and approved the final manuscript.

Contributor Information

Kristina Riis Iden, Email: moc.liamg@nedi.anitsirk.

Sabine Ruths, Email: on.biu.sgi@shtur.enibas.

Stefan Hjørleifsson, Email: on.biu.sgi@nossfielrojh.nafets.

References

1. Horwitz AV, Wakefield JC. The Loss of Sadness: How Psychiatry Transformed Normal Sorrow Into Depressive Disorder. New York: Oxford University Press. Inc.; 2007. [ Google Scholar]

11. Iden KR, Engedal K, Hjorleifsson S, Ruths S. Prevalence of depression among recently admitted long-term care patients in Norwegian Nursing Homes: Associations with diagnostic workup and use of antidepressants. Dement Geriatr Cogn Disord. 2013;37(3-4):154-62. [[ PubMed] Google Scholar]

14. Dowrick C. Beyond Depression : A New Approach to Understanding and Management. Oxford: Oxford University Press; 2004. [ Google Scholar]

15. Antonovsky A. Unraveling the Mystery of Health. How People Manage Stress and Stay Well. San-Francisco: Jossey-Bass Publishers; 1987. [ Google Scholar]

22. Clark JP. How to Peer Review A Qualitative Manuscript. In: Godlee FJT, editor. Peer Review in Health Sciences. London: BMJ Books; 2003. pp. 219-35. [ Google Scholar]

25. MacDonald CD, Butler L. Silent no more: elderly women's stories of living with urinary incontinence in long-term care. J Gerontol Nurs. 2007;33(1):14-20. [[ PubMed] Google Scholar]

35. Pargament KI, Smith BW, Koenig HG, Perez L. Patterns of positive and negative religious coping with major life stressors. J Sci Study Relig. 1998;37(4):710-24. doi: 10.2307/1388152. [[ CrossRef] Google Scholar]

Articles from BMC Geriatrics are provided here courtesy of BMC

# data[].attributes.attachment_link.title
Residents' perceptions of their own sadness - a qualitative study in Norwegian nursing homes

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Mood symptoms are highly prevalent among frail old people residing in nursing homes. Systematic diagnostics of depression is scarce, and treatment is not always in accordance with best evidence. The distinction between non-pathological sadness and depression ...

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The website's language is mandarin so I will write more here. The host lose his wife and family, he lived alone and he rent one room to the students just like airbnb at low price. In other hands, the students will have cheap rental room share the public area with elder. In the free time, they will go to market and shopping together. The young students help elder to do housework. The elder give the economic support to students.

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跨代同居，與其說是普通的金錢交易，更像是一種相互給予生活幫助的契約關係。
在東京，有這樣一對共居者，他們之間的 年齡相差了55歲 。

房子的主人，是76歲的宮本幸。

在父母、妻子相繼去世，孩子獨立離家後，宮本幸把空房間租給了早稻田大學的在讀生：21歲的荒木。

（圖源：產經新聞）

共居的日常，兩人基本互不干擾。宮本住一樓，荒木住二樓，除個人房間外，其他傢俱電器共用。

除了有對「公共區域注意清潔」等最基本的衛生環境要求外，雙方還約定每週共進一次晚餐。晚餐後，兩人還會一起小酌一杯，進行 一週一次人生暢談 。

別看他們年齡相差了55歲，他們幾乎無話不談。

宮本說：「荒木會和我聊哲學家柏拉圖的理論。從他口中了解至今為止不知道的世界趣事，在他身上感受到年輕人的朝氣。」

荒木也從老人那裡，學習到如何調整心態和生活中大小事的哲學。

（圖源：產經新聞）

在國內，與他人合租時通常是同輩的人，然後一起分擔房租。

而在日本，像宮本幸一和荒木這樣的「 跨代同居 」，似乎越來越多了。
日本的「跨代同居」，是老人與年輕人同住，獨居老人出租空房間，向年輕人收取較低廉房租的新型住房形式。
年齡差如此之大的他們，為何會選擇一同居住？

一人獨居現狀，老人與學生抱團取暖
隨著社會發展，日本家庭由多代同堂的大家族形式向核心小家庭轉變。

有的老人老伴去世的早，兒女獨立離家，或者未婚未孕，以至於他們一人獨居。

根據日本社會保障·人口問題研究所的調查， 一個人居住的65歲以上的男性幾乎兩週都沒有和其他人說過話。

（圖源：Unsplash）

老人需要有他人的陪伴來度過退休生活， 跨代共居就像順應了社會的發展，給老人提供了一個與他人交流的契機。

和老人居住的年輕人基本是離家求學，靠打工和獎學金度日，手頭緊湊的窮學生。 老人和年輕人在跨代同居中各取所需，一起抱團取暖。
這就是「跨代同居」出現的契機了。

跨代同居的好與壞
跨代共居，與其說是普通的金錢交易，更像是一種相互給予生活幫助的契約關係。

根據雙方的具體情況，老人收取的房租和年輕人付出的勞力沒有固定標準， 甚至還有免費入住這等好事。

對於老年人來說，跨代共居讓他們有了聊天對象，一定程度上可以 防止孤獨老死，身體突然出現問題時也有人可以幫忙叫救護車；和年輕人交流過程中 生活也會變得更加意思 ，還能活用空房間。

對於年輕人來說，就算年老的時候沒有多餘的房子，也可以過上夢寐以求的分租生活， 還有人幫忙分擔家務，畢竟日本垃圾分類最麻煩了。

日本漫畫 《房東和我》 就講述了跨代共居的高齡女性和搞笑藝人溫馨相處的故事。

下雨天婆婆會把乾的衣服收進屋內；每天回家打開電燈就會有人說「歡迎回家」。

在網上偶然看到家用棉花糖機，想著房東應該沒吃過棉花糖，於是下單棉花糖機和婆婆一起製作。

漫畫的原型矢部先生說，9年的跨代共居生活讓他感受到家庭的溫馨。
在京都還有一對70代夫婦，雖然並非一人獨居，他們還是選擇了和19歲男大學生跨代同居。夫人晚餐準備也從2人份變為3人份，只要有時間3人就會一起吃飯。
這對夫婦也並非沒有孩子，對他們來說跨代同居像和孫子生活一樣讓他們感到開心。
對於男大學生來說，可以和新地方的人交流，獲得新的經驗。

（圖源：コレクティブハウジング社）

在日本，房租是生活的大頭， 跨代共居減輕了年輕人的房租和水電負擔 ，與老人相處也可以學習生活方面知識。

（圖源：HELPMAN JAPAN）
當然，並不是所有人都能找到滿意的生活伴侶。
在學生時代有過宿舍生活經驗的小夥伴一定深有體會，同齡人之間就存在許多矛盾，何況相差幾十歲的長輩呢。

年輕人和老作息時間不一樣；

不能帶戀人和朋友來家裡；

雙方沒有共同話題；

在小家庭成長的年輕人不習慣和老人相處

......

畢竟天下沒有十全十美的事，享受到低租金總要付出點什麼。

（圖源：HUFFPOST）

日本網友對跨代同居有所期待，也有一定顧慮。

在我那時候，要是有一個像跨代同居一樣的房間共享服務就好了。一人生活且還有負債的人對此表示羨慕。但話說回來，讓我適應集體生活的也是不太可能...

看電視好像現在年輕人住在老人家的這樣跨代同居的形式很流行，我認為如果能雙贏的話，互相學習會很有趣，但我個人而言，還是喜歡一個人獨居，家裡有其他人的話有點...

不過， 跨代共居帶來的影響肯定是利大於弊 ，老人能得到他人陪伴，年輕人可以減低生活支出，而生活上兩代人之間的摩擦如何解決，就看後續的相處了。

老齡化勢不可擋 日本的未來住房新思路
眾所周知，日本是目前人口老齡化程度最高的國家。

據日本總務省統計局統計，2020年老人佔總人口的28.7%，且呈上升趨勢。

龐大的高齡人口數量，只會越來越壓迫日本的醫療資源，看護行業的缺口也無法跟上人口老化的速度。

日本老人獨居人數不在少數，據日媒調查，約有一半的高齡者一個人居住在家中。
跨代共居為高齡者相關行業提供了一個新思路，也確實可以緩解老人孤獨的問題。
時代在進步，不斷有新的生活方式出現，社會也更加包容接受多樣化的生活形態。

在日本，除了像 ISEDAI這種專門 募集共享住宅的民間中介 ，大學和民間組織也在積極推動跨代共居。

這樣的服務不僅限於東京首都圈消費高的區域，例如在關西地區大阪、京都都有跨代共居。

目前京都政府也和東京、福井地方政府一樣，與民間組織積極合作，把跨代共居納入「京都ソリデール」（防止人才外流，引進人才在地方居住，向年輕人提供低廉高質的住宅，促進和高齡者的交流）的政策裡， 政府也向此項目投入大量補助金。

據調查，想嘗試跨代共居的學生佔調查人數的36%，有很多學生期待跨代同居，和高齡者交流增加自己知識。

即使沒有血緣關係，跨代同居這種新型住宅服務或許會成為一種新的生活方式。

隨著近年我國二胎、三胎政策的推出，可以看出我國也將面臨人口老齡化的問題，新生兒出生率和結婚率都在降低。一方面是育兒有經濟上的壓力，另一方面是年輕人思想上的轉變。
當「養兒防老」不再是主流思想時，養老院和居家養老成了我們必須要做出的選擇。 跨代共居不能解決根本問題，但一種新的生活方式出現總是有趣的，在未來我們為養老擔憂時，有了新的選擇。
參考資料：

ウチシルベ，高齢者の孤獨感を解消する方法

產經新聞，異世代ホームシェア...シニアと學生の新しい互助

ISEDAI，世代間交流を利用したWIN-WINの次世代型下宿方法？

Gooddo，高齢化社會による問題とは？日本の現狀や対策について知ろう

Suumo，新居に「大家さんがいない家」を選んだ理由とは？　矢部太郎さんの住まいの歴史

HUFFPOST，カラテカ矢部太郎さんは、88歳の大家さんとこうやって家族になった

NPO法人，若者 × 高齢者の異世代ホームシェアHatenaBlog, 高齢者宅に大學生が住む「異世代ホームシェア」という試みが著実に広がりつつある件

NHK，コロナ禍でどうなる？　異世代ホームシェア

コレクティブハウジング社，【case11】京都ソリデール

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日本的「跨代同居」：老人和年輕人合租，提供廉價住房，還包做家務

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跨代同居，與其說是普通的金錢交易，更像是一種相互給予生活幫助的契約關係。 在東京，有這樣一對共居者，他們之間的年齡相差了55歲。 房子的主人，是76歲的宮本幸。 在父母、妻子相繼去世，孩子獨立離家後，宮本幸把空房間租給了早稻田大學的在讀生：21歲的荒木。 （圖源：產經新聞） 共居的日常，兩人基本互不干擾。宮本住一樓，荒木住二樓，除個人房間外，其他傢俱電器共用。

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According to a Dutch idea, older people need on-site restaurants, bars, village squares and beauty parlours. Is the UK is ready for a revolution in care home design?

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A Study into the Influence of Governance Context on Public Value Orientation 

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A Study into the Influence of Governance Context on Public Value Orientation 

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Overview of Civil Leaders and their Societal Cases (30 cases)

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人賺了大錢，到老都能保證會幸福嗎？看現在很多有錢人晚年子孫爭產、妻離子散的狀況，很多人都知道不是，那麼，真正決定老年幸福的因素又是什麼呢？在日本趨勢預測大師三浦展眼裡，「朋友資本」才是最重要的。有了興趣相投、年紀相仿的好友，日子好像也好過許多。在他的著作中，他細細道出那最理想的老後生活。

我總認為照護機構有種封閉感，因為連我也找不到一間自己想去的地方，便試著打造了一些我自己也希望參與的事情。
[啟動LINE推播] 每日重大新聞通知
沒多久之前還乏人問津的老公寓，現在有許多重視它的人出現，感覺這裡變成了幸福的「光齡舍」。

一般來說，在住宅區當中建立社福機構會遭到反對聲浪。耕耘大藏之所以沒有遭遇強烈反對，不單只是因為外觀無太大變化，而是多虧了地區居民的溫暖支持才得以營運至今。

Gojikara村 ‧ 悠閒長屋
希望打造出高齡者認為「活著真好」的生活
「悠閒長屋」於2003年在名古屋市郊外的長久手市創立至今，這裡充滿了令人驚奇卻又有些懷舊的閒適氣氛。

「真讓人心情舒暢，我還是最喜歡這裡。」官網上這麼寫著。這裡的氣氛正是如此，乍看之下會以為是由古民家所改建的建築，其實是特意營造出古民家風格的新房子。稍微斜斜錯開並排的三棟建築，那彎曲的部分，讓人莫名有種放鬆感。

長屋旁邊是同一團體建立的日間照護中心「平庵」，兩者合稱「悠閒橫丁（小巷）」。

「無論什麼事都是『恰到好處』的狀態最好。每個人都會犯錯，也會有不順利的時候。有時候開心愉悅，也有時會心煩憂悶。這就是『生活』呀......。大家互相寬容、彼此協助、一同歡笑，『悠閒放鬆』地度過吧！」介紹手冊當中寫著這段敘述。

目前有十五位需要照護的老人以及四位ＯＬ（女性上班族）、一個家庭（夫婦與一個小孩）居住在此。 不過，建物本身並非社福機構，而是租賃住宅。一樓提供需要照護的高齡者居住，「社會福祉法人愛知太陽森林」組織以及「向日葵看護中心」的工作人員全年無休地派駐在此，協助高齡者生活起居。

住客在簽約時先繳交訂金、押金，入住後每個月支付房租與管理費（需要照護的高齡者則另加餐費），與一般的租賃狀況並無差別。住宅是由「Gojikara村行政股份有限公司」統一向屋主租下，並負責營運事務。建設費用由屋主出資。住客支付房租以及餐費給「Gojikara村行政股份有限公司」，照護費用則是支付給「愛知太陽森林」。餐點是由「Gojikara村行政公司」的員工到隔壁的「平庵」烹煮後再配餐給高齡者。

包含了房租以及照護費用的總額費用，其實與付費的老人院相差無幾。不過，「悠閒長屋」的最大魅力就是古民家風格的木造、土壁建築，也或許是能夠與ＯＬ們以及一般家庭等其他成員一同生活，抑或是融合了這些因素而形成的特殊氛圍吧。

對ＯＬ來說，「悠閒長屋」的優點是有如住在公司的單身宿舍或共享住宅一樣，能夠感受到安心感。目前住在這裡的小家庭，也是因為爸爸必須常到其他國家出差，同樣是為了尋求安心感而選擇入住。另外，值夜班的工作人員也會因為有一般作息的人同住而感到放心不少。

ＯＬ們的房間裡有系統式浴室（Unit Bath）以及小廚房，但也有人每天早上會到一樓與高齡者一同用餐。小家庭的房間裡則無浴室，會與高齡者共用浴室。因為有許多高齡者會在白天洗澡，或是在外部的日間照護中心洗澡，所以時間不會撞在一起。其實高齡者還住在自家時，就會在日間照護中心沐浴，也在那裡交到朋友，或許對他們來說，外出到日間照護中心也算是一種放鬆吧。
沒有規則
高齡者與其他居住者共用同一個大門玄關，ＯＬ們與小家庭成員會穿越一樓高齡者家中的客廳、飯廳、廚房區域，再上到二樓。雖說是二樓，建築本身是挑高樓中樓，一二樓之間僅一牆之隔，聲音會互通（但不會侵犯到個人隱私）。另外，工作人員可以帶小孩一起來上班（「愛知太陽森林」所開設的機構皆是如此）。每當暑假之類的假期，工作人員的孩子們每天都會來。「悠閒長屋」也特別設計了一個時段讓ＯＬ們及小家庭成員與高齡者共聚一堂喝喝茶。過新年時，ＯＬ們也會跟工作人員一同舉辦新年慶祝會。

ＯＬ們與小家庭成員會定時打掃浴室、幫需要照護的高齡者摺衣服、陪同看護及受照護者外出散步，當看護需要幫忙時，也會上前協助。在這裡，受照護者、健康者、高齡者、ＯＬ、小孩、住客、工作人員都能互相交流。

不過，這裡並沒有明文規定誰負責打掃、誰應該在星期幾的幾點來幫忙。 想幫忙的時候就幫忙。沒有規則正是「悠閒長屋」的特徵。希望大家就像待在自己家裡一樣的輕鬆自在。

順帶一提，ＯＬ們與小家庭都享有在這裡被稱為「有為青年優惠」的房租補助。

「要幾點起床、幾點睡覺都隨心所欲，因為不是社福機構，不須早起做操，也沒有門禁限制。除了每天的居家照護行程之外，其他時間完全自由。雖然有時也會感到無聊，但就放輕鬆吧。在這裡能悠閒安心的生活，不管是要外出或外宿，或與家人朋友會面，隨時都可以，家人也能夠在這裡過夜。屋內總是能聽見孩子的聲音，也迴響著生活的雜音。恰到好處的熱鬧氣氛，應該說是一種不至於造成困擾的不便吧。彼此互相協助，與ＯＬ們一同用餐、聊天，最棒的是看見看護人員的笑容。雖然與各式各樣的人相處，有時也會有不順利的時候，但在這裡能夠感受到家裡沒有的樂趣。」介紹手冊裡的文案這麼寫著。

啊──讓人感到一種自由放鬆的感覺。

因為有些高齡者會在半夜發出較大的聲音，對於較神經質的人來說不太適合入住。篩選住客的條件是喜歡與人相處、當他人需要幫忙時會願意協助的人。生活中當然會發生各種麻煩問題，但，能夠去享受有麻煩的生活是很重要的。
步調更緩慢的生活
現任長久手市長吉田一平創立了「愛知太陽森林」Gojikara村。他的施政方針是「打造日本第一的福祉城鎮」。

Gojikara村的官方網站當中，在「愛知太陽森林　創立理念」這麼寫道：

「我們居住的社會極為合理化，也十分便利，人們與時間賽跑、急於得到結果，是否早已忘了小時候那份赤子之心了呢？從人類到微小的昆蟲、不起眼的小草，在被賦予了生命的那一瞬間，便有了各自的存在價值，也肩負著必須在大自然當中達成的使命，現代人卻漸漸遺忘這件事。『愛知太陽森林』重視地球上每一個生命的存在以及與各種人的相遇，希望找回步調更緩慢悠閒的生活方式，期望打造一個讓年長者能夠感到『活著真好』的生活。當你造訪這裡，所有的生物會像隨波逐流的一片落葉般，隨時光流逝、隨太陽起落，依循自然規律而生活，你會明白這才是生活該有的模樣。來到這裡，與生活在和緩時光裡的年長者相處過程當中，應該能夠發現到心中某個重要的東西吧。」

本圖/文經授權轉載自時報出版《 在下流時代，也要做幸福老人》
責任編輯／鐘敏瑜

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日本人最憧憬的新生活！讓所有長者高呼「活著真好」，最快樂的共居住宅gojikara村-風傳媒

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日本人最憧憬的新生活！讓所有長者高呼「活著真好」，最快樂的共居住宅Gojikara村-風傳媒

# data[].attributes.attachment_link.description
人賺了大錢，到老都能保證會幸福嗎？看現在很多有錢人晚年子孫爭產、妻離子散的狀況，很多人都知道不是，那麼，真正決定老年幸福的因素又是什麼呢？在日本趨勢預測大師三浦展眼裡，「朋友資本」才是最重要的。有了興趣相投、年紀相仿的好友，日子好像也好過許多。在他的著作中，他細細道出那最理想的老