独居の高齢糖尿病患者の食事療法の自己管理の取り組みと関連する要因

Self-Management of Diet Therapy and Related Factors in Elderly Diabetic Patients Living Alone

目的：独居高齢糖尿病患者の食事療法の自己管理の取り組みおよび関連する要因を明らかにし，看護への示唆を得ることとした．

方法：70歳以上で外来通院中の独居糖尿病患者16名を対象に，半構成的面接法でデータ収集し質的に分析した．

結果：独居高齢糖尿病患者の食事療法の自己管理の取り組み程度は，悪い，中程度，良いの3段階に分類された．自己管理と関連して，ソーシャルサポート，孤独感，経済状況，知識，自己管理の必要性の認識，食事作り，負担感，食べる楽しみ，工夫，取り組みの成果の10要因が抽出された．特に自己管理が悪いグループの特徴として，人との交流が希薄な孤独感を抱いている男性が浮かび上がった．

結論：独居高齢糖尿病患者は，ソーシャルサポートを中心とした要因を考慮した自己管理支援，負担感の軽減，食べる楽しみを大切にしQOL維持・向上を目指した看護支援の重要性が示唆された．特に人との交流が希薄な孤独感を抱く男性は，より留意して支援する必要がある．

Purpose：This study aimed to 1) determine the current scenario in self-management of diet therapy in elderly diabetic patients living alone and its influencing factors, and 2) offer suggestions regarding nursing interventions for effective self-management of diet therapy.

Method：The participants were 16 type 2 diabetic outpatients aged 70 years or older and living alone. Semi-structured interviews were conducted for data collection and qualitative data analyses were performed.

Results：The self-management approaches were classified as “Low,” “Moderate,” and “High.” The following 10 main factors associated with self-management were extracted：social support, sense of isolation, economic conditions, knowledge, awareness of the necessity of self-management, preparation of meals, feelings of burden, enjoying eating, devising and integrating self-management into life, and results of self-management. The group with particularly low self-management was characterized by men with a sense of loneliness who rarely interacted with others.

Conclusion：The results confirmed the importance of nursing support for the promotion of self-management-considering social support in particular, among other relevant factors-as well as measures for improving the quality of life in elderly diabetic patients living alone by reducing the burden and emphasizing enjoying eating. In particular, men with a sense of loneliness who rarely interact with others need to be given more attention and support.