食事の問題を抱える高齢者に対する作業療法効果

The effect of occupational therapy on the elderly with feeding-swallowing problems

要旨：食事の問題を抱える高齢者に対する介入効果を示すと共に，介入方法の一助とすることを目的とした．カナダ作業遂行測定（以下，COPM）で食事を重要な作業としてあげた高齢者27名に対して，介入前と3ヵ月後にCOPM，機能的自立度評価表（FIM）食事項目，摂食・嚥下障害臨床的重症度分類（DSS），摂食状況スケール（ESS），運動とプロセス技能評価（AMPS）により変化を調べた．その結果，作業療法前後で全ての評価尺度に有意差を認めた．作業療法により，食事自立度や摂食・嚥下障害の重症度，摂食状況が大きく改善することは困難でも，食事遂行の質や満足度に変化を与えることが示唆された．

　The purpose is to find out how to intervene and to demonstrate the effectiveness of occupational therapy in the treatment of dysphagia in the elderly within geriatric health service facilities. Changes were assessed by comparing scores before therapy and three months later, using the following scales: the Canadian Occupational Performance Measure (COPM); the eating content from the Functional Independence Measure (FIM); the Dysphagia Severity Scale (DSS); the Eating Status Scale (ESS); and the Assessment of Motor and Process Skills (AMPS). The study included 27 elderly patients from a geriatric health service facility, who had the meal as meaningful occupation. A range of occupational therapy techniques, specific for each client, was used in the treatment of the feeding-swallowing problems. There was a statistical significance in all outcome measures. There were significant effects on AMPS and COPM satisfaction, and moderate effects on DSS, FIM, ESS and COPM performance. Despite difficulties with meal independence and dysphagia severity, there was improvement in the eating status. Clients' satisfaction improved with regard to their eating and the quality of their performance in the feeding-swallowing problems.