中山間地で暮らす糖尿病のある高齢者が在宅療養を継続する上での障害要因と課題の構造

Structure of obstacle factors and challenges ongoing home-care for elderly people with diabetes living in semi-mountainous regions

　中山間地で暮らす糖尿病のある高齢者が在宅療養を継続する上での障害要因と課題の構造を明らかにし，支援方法の示唆を得ることを本研究の目的とした．保健師，訪問看護師，介護支援専門員を対象とし，パルス討論を併用した質的統合法（KJ法）で分析した．その結果，【糖尿病のある高齢者故ゆえの自己管理の難しさ：病識の乏しさと症状出現の非定型性，運動・食習慣の変容困難】【中山間地故ゆえの自己管理の難しさ：栄養が偏る山の恵みと疾病を悟られたくない思い】【中山間地故ゆえの支援を受ける難しさ：地の利の悪さと人材・家族介護力の不足】【糖尿病高齢者の支援体制：保健・医療・福祉職の認識のずれと情報共有システムの未整備】【訪問看護師・保健師による支援の限界：糖尿病だけに焦点を当て難い幅広い業務範囲】【糖尿病のある高齢者と家族の関係調整の難しさ：両者をストレス関係に陥らせない訪問と連携】が抽出された．糖尿病のある高齢者と家族を含めた当該地域で暮らす人々の繋がりを意識した関わりが重要であることが示唆された．

　The purpose of this study was to clarify the structure of obstacle factors and challenges for elderly people with diabetes living in semi-mountainous areas to ongoing home-care and to obtain suggestions for support methods. The following are the results of a qualitative synthesis method（KJ method）analysis with a pulse discussion of public health nurses, visiting nurses, and care managers:“ Self-care issues due to the patients’ age: a lack of awareness of their own condition, the uncharacteristic nature of their diabetes symptoms, and an inability to change established patterns of exercise and eating”；“Self-care issues due to living in semi-mountainous regions: unbalanced eating patterns based on locally-available food, and an unwillingness to let others find out about their condition”；“Difficulty of receiving care due to living in these regions: geographical disadvantages, and a lack of trained caregivers and care-giving family members”；“Support-system issues: lack of goal-uniformity among public health, medical and welfare workers, and an absence of information-sharing systems”；“Limits on the services provided by visiting nurses and public health nurses: the difficulty of focusing on the diabetes, due to the wide range of care services required”；and“ Relationship issues between elderly people with diabetes and their families: home visits and cooperation done in order to avoid stress-relationships between the patients and their families.” It is important to be aware of the connection between the elderly with diabetes and the people living in the community, including their families.