認知症高齢者の意思決定を促すための実践プロトコルに基づく作業療法の効果—単一事例実験研究

Effects of an occupational therapy practice based on a practical protocol to facilitate decision-making for an older patient with dementia: A single-case experimental design study

要旨：意思決定が困難な認知症高齢者に対し，「認知症の人の日常生活・社会生活における意思決定支援ガイドライン」に基づく作業活動の意思決定と協業を促すための実践プロトコルを作成した．この実践プロトコルに基づき，認知症のある人が作業活動を主体的に選択し，作業療法士とともに遂行状況を振り返ることによる介入の効果を，単一事例実験研究にて検証した．結果，作業活動に対する主観的な遂行度と満足度が改善し，病棟での自発的な発言や他者とのコミュニケーションの増加がみられた．本実践プロトコルは，認知症のある人の意思決定能力を最大限に活かし，作業活動に主体的に取り組み成功体験を得ることによる主観的評価の改善に有効であった．

　A practical protocol designed to facilitate decision-making and collaboration in therapeutic activities was developed for elderly patients with dementia who had difficulty making decisions. This protocol was based on the Decision-Making Support Guidelines in Daily Life and Social Life of People with Dementia (Ministry of Health, Labour and Welfare, Japan 2018). We examined the effects of this intervention by allowing a patient to proactively select therapeutic activities and assess her performance with the occupational therapist in this single-case experimental design study. The results demonstrated that subjective performance and satisfaction with therapeutic activities improved, and there was an increase in spontaneous speech and communication with others in the ward. This protocol was effective in maximizing the decision-making abilities of elderly patients with dementia and improving their subjective experiences through proactive engagement and success in therapeutic activities.