心不全により入院した認知症高齢者に対する意味のある作業を基盤とした作業療法—急性期病棟における短期的介入の一事例

Meaningful occupation-based therapy for elderly with dementia hospitalized for heart failure: A case of short-term intervention from an acute care ward

要旨：心不全症状による倦怠感のため，離床を進めることが困難な認知症高齢者を担当した．そこで，認知症高齢者の絵カード評価法を用いてクライエントの意味のある作業を評価し，作業を基盤に介入すると離床につながった．さらにその後，離床時間の延長や耐久性が向上し，短期的介入で退院に至った．急性期における認知症高齢者への心臓リハビリテーションでは，徹底したリスク管理下で，意味のある作業を基盤にした介入が早期離床を促進し，デコンディショニングの予防や，日常生活活動，認知機能の向上といった効果を短期的に示せる可能性を認めた．

　Our group attended to an elderly patient with dementia who had difficulty getting out of bed due to heart failure related fatigue. We assessed meaningful occupations of the client through APCD (the Assessment by the Picture Cards for the Elderly with Dementia), and subsequent meaningful occupation-based short-term interventions resulted in the client being able to get out of bed. Furthermore, the bedtime was shorted, and the client was discharged. During cardiac rehabilitation for the elderly with dementia in the acute phase, meaningful occupation-based intervention under adequate risk management may be an effective treatment to promote early ambulation, prevent deconditioning, elevate cognitive function, and improve the ability to perform activities of daily life in the short term.