[Thoughts of older adults living in an isolated community on a remote island while continuing to live in familiar surroundings]

Objective This study clarified the thoughts of older adults living in an isolated community on a remote island while continuing to live in familiar surroundings. Additionally, suggestions for health policies were obtained.Methods Island B, a remote island in Prefecture A, is isolated and surrounded by the sea. It has a population of 138 people and an aging rate of 48.6% (R2). We conducted semi-structured interviews with seven older adults living on Island B and qualitatively and inductively analyzed the contents, which consisted of (1) thoughts about living in one's own home in a familiar community; (2) nursing, medical, and preventive care as well as social and human resources that could help support one's life; and (3) continuing to live on the island. Codes, subcategories, and categories were generated based on verbatim transcripts of the interviews.Results The average age of the study participants was 76.9 years. The daily life independence level for older adults with disabilities was J1-2. They thought that "their life on the island was easygoing and enjoyable" but also that "the strong ties among the islanders may become a hindrance." They expressed that "life on the island is founded on mutual support" and the availability of life support services allows them to "live a comfortable life on the island." Additionally, because of the insulation provided by the sea, "connections outside of the island were regarded as minimally essential." Regarding life on the island in the future, they stated that "they cannot do anything about the island's decay," "life on the island will become critical due to the scarcity of living resources," "life on the island will not be possible under any circumstances in the future," and "they need to accept that they will not be able to die on the island as they would like to." Regarding continuing to live on the island, they believed that "self-help efforts are essential to preserve independence" and "a resolute spirit is necessary when facing your last days."Conclusion The results of the study highlight the importance of providing support for physical fitness activities to maintain links with the world off the island, providing opportunities to promote mutual assistance among older islanders, strengthening the medical system using ICT, and encouraging islanders to regularly discuss with their distant family members how they would like to spend the final days of their lives.