作業に根ざした実践のための認知症高齢者版作業的変化ガイドブックの開発（第1報）—〜作業的変化のカテゴリーの生成とガイドブック試作版の作成〜

Development of the “Guidebook of Occupational Change for the Elderly with Dementia (GOD)” for occupation-based practice (Part 1) : Definitions of categories of occupational change and collection cases

要旨：本研究の目的は，認知症高齢者版作業的変化ガイドブックを作成することとした．作業的変化（occupational change；以下，OC）とは，作業に取り組むことによって思考，行動，感情が相互に影響しながら変わることである．研究は2つの手続きで構成された．手順1は，過去の認知症高齢者の事例研究を参考にOCを整理し，認知症高齢者版OCカテゴリーを生成した．手順2は，作業療法士に理解しやすいように定義と事例集を作成した．結果，10の項目からなる認知症高齢者版OCガイドブックが作成された．認知症高齢者版OCガイドブックは，認知症高齢者に対する作業に根ざした実践を促進できると考えられる．

　The importance of occupational change (OC) in occupation-based practice (OBP) has been identified. OC refers to the dynamic condition of clients' actions, cognition and emotions through occupational engagement. The dynamic nature of occupational engagement has been explored by Kielhofner. OC includes processes for choice/decision, commitment, exploration, identification, negotiation, planning, practice, reexamination and sustainability, and these are sustained by MOHO (MOHOOC). However, previous studies did not investigate the correspondence of OBP with categories of OC for the elderly with dementia. The aim of this study was to develop a Guidebook of Occupational Change for the Elderly with Dementia (GOD), including definitions and case studies. A two-round study was conducted that (1) matched categories of OC for the elderly with dementia to categories of OC from Kielhofner and previous case studies of the elderly with dementia, and (2) defined OC and collected cases to better enable occupational therapists to understand OC. The results suggest that GOD is reflected in changes of occupational engagement in the elderly with dementia, and that this will contribute to a better understanding of OBP.