作業参加が外出頻度やストレス反応に与える影響─デイサービスを利用する地域在住高齢者への横断的調査による検証

The influence of occupational participation on going outside and stress response: A cross-sectional study on community-dwelling elderly in a day-service center

要旨：介護予防事業では，高齢者の活動と参加に焦点を当てたリハビリテーションが期待される．本研究の目的は，デイサービスを利用する217名に対して，作業参加と外出頻度や障害重症度，歩行能力，ストレス反応との関連を検討することであった．研究仮説に基づく構造方程式モデリングでの検証の結果，障害の重さは作業参加に抑制的に働き，作業参加は外出頻度を促し，ストレス反応を抑制する効果があった．また，歩行能力は外出頻度を促す働きがあった．作業療法士は，クライエントの障害重症度に配慮しながら，本人にとって大切な活動への関わりを改善することで，社会参加の充実や精神的に安定した生活に結びつける支援が行えると考えられた．

　Purpose: Activity and participation focused rehabilitation is known to alleviate severe burden brought on by caregiving. The aim of this study was to identify the influence of occupational participation on going outside, stress response, severity of disability, and walking ability of elderly people using a day-service center. Method: Subjects included 217 participants (88 males, 129 females; mean 76.21±8.99) who responded to a questionnaire based on demographic data, Self-Completed Occupational Index (SOPI), Stress Response Scale-18 (SRS-18), the severity of disability and the Timed UP & Go test (TUG). The data was analyzed using descriptive statistics and a structural equation modeling (SEM) approach. Results: The SEM approach indicates that the modified model was an excellent fit:CFI=0.983，TLI=0.982，RMSEA=0.051. The results suggest that occupational participation has a positive effect on going outside (standardized direct effect=0.28) and a negative effect on the stress response (standardized direct effect=-0.34). In addition, the severity of disability affected occupational participation and going outside, and TUG affected going outside. Conclusion: This study indicates that occupational therapy leads to satisfaction of social participation and mentality by improving engagement in the important activities for clients.