Community-based healthcare design for the elderly through “field medicine”

Doctors in hospitals used to think in terms of diseases and conditions in his/her specialty and have little latitude to consider other issues. However, greater emphasis for the need for holistic medical care has increased. This represents the beginning of a transformation in the healthcare system and the evolvement of delivering a healthcare design that moves from a focus on disease care to one on maintaining health and wellness especially for the elderly.

My aim here is to discuss that the community-based healthcare design in providing field medicine is an emerging and promising concept, which addresses healthcare challenges faced in particular by the rural area in Japan.


For the future of healthcare design, look beyond the hospital

The framework of the delivery of health services differs fundamentally in the community as opposed to the hospital setting. In the hospital, the doctors lack the opportunity to invest time and effort in enquiring more about their patients’ lives and understanding the patients’ regular life routines. However in the community, the concept of field medicine (providing healthcare services outside of a hospital) is introduced particularly to the community-dwelling elderly where chronic illnesses become more prevalent. The need to integrate efforts to develop and implement both unique tools and strategies to manage quality in community-based health services is increasing. Geriatricians are also increasingly listening to the voices of the elderly as an integral consideration in the design of a community-based health design policy that bridges both the health of the elderly and the physical environment they reside in.

Disease state

In the area of public health, disease state has been widely discussed to depict the state of one’s health and ill-health – the state of being ill. The concepts of “disease”, “illness” and “sickness” are used to capture different aspects of ill-health. In the view of field medicine, we have defined them as a different nuance as below mentioned. Disease connotes a concept of the causative agent or of the scientific mechanism of cause and effect. Illness refers to the effects of the agent on a person’s health and how a person experiences a disease state, and is mingled with cultural overtones and social norms. The third word, sickness, connotes a social concept that means “something wrong”, “not normal”, “abnormal” or “anything unusual”. Disease state perceived and selected by each community-dwelling elderly might be mingled with multi-dimensional, including scientific, subjective and socio-cultural factors. From this perspective, geriatricians see a heightening importance of offering different ways of providing remedy to their illness while ensuring their social well-being is met. This is done through personal visits to the communities where the elderly reside in. The concept of field medicine is applied here.


Community-based healthcare design focus on dealing with the key issues

With this observation, geriatricians have provided a base for developing several projects to strengthen the ability to help the elderly. These projects focus on the social, health and physical environmental attributes through active involvement of geriatric researchers, the local Government, healthcare practitioners and the elderly living in the community in the whole research process. These are the projects:

1)     Questionnaire on general health matters (Frequency: Annual)

2)     Geriatric examination for all elderly aged 75 years and above (Frequency: Annual)

3)     Intervention programmes, i.e. fall prevention and cognitive rehabilitation classes

4)     Evaluation of outcome and re-planning

In addition, six common issues faced by the elderly were also identified. These six “D” issues, namely, disease, disability, dementia, depression, diabetes and death can be detected through the projects identified above.



The reality of old-age and age-related chronic illness takes place in homes and communities. To truly understand the health issues of the elderly, geriatricians need to venture into communities and to visit elderly in their homes and their cultural environments. The conditions are in place for a revolution in the healthcare delivery – moving from a focus on disease care to maintaining health and wellness for community-dwelling elderly through field medicine. Consequently, it is pivotal to nurture agreement among healthcare practitioners and elderly in providing community-based healthcare design to identify and respond to the needs of the elderly more effectively.


Dr Kozo Matsubayashi is a professor of the Center for Southeast Asian Studies at Kyoto University, Japan. He has been studying geriatric medicine in field settings in Asian countries as well as in Japan. He was a speaker at the World Health Summit Regional Meeting – Asia in Singapore in April 2013.

(* PHOTO CREDIT: Hartmut Pohling/


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