大腿骨近位部骨折患者の認知機能の重症度別にみたADLプログラムの検討

Cognitive function-based ADL programs for patients with proximal femoral fractures

要旨：大腿骨近位部骨折患者30名に対し，N式老年者用精神状態尺度を用いて認知機能の重症度を判定し，対象者を正常群，軽症群，重症群の3群に分けた．3群に対し当院の作業療法プログラムを実施し，N式老年者用日常生活動作能力評価尺度を用いて受傷前から退院までのADLの推移を得た．ADLの低下度，回復度，回復不足度を算出し比較すると3群で異なり，正常群は受傷前の92％，軽症群は88％，重症群は67％の回復を認めた．本研究の結果から，正常群では屋外の応用歩行，入浴動作，軽症群では排泄動作に伴う移乗動作，重症群では獲得が期待できる更衣動作へのアプローチを優先的に行う必要性が示唆された．

　Nishimura's mental scale (NM) for the elderly was used to classify 30 proximal femoral fracture cases into three groups : normal, moderate and severe. Occupational therapy programs designed for each of the three groups were conducted, and Nishimura's ADL scale (N-ADL) for the elderly was used to record the changes in ADL from pre-injury to discharge. Differences appeared when comparing the degree of deterioration, recovery and deficiency in recovery calculated from the changes of the ADL of the three groups. The rate of recovery from the time of pre-injury was 92% with the normal group, 88% with the moderate group and 67% with the severe group. The results of this study suggest that the programs, bathing and applied walking with the normal group, transferring to a restroom with the moderate group and dressing activities with the severe group were necessary and should be given priority.