要介護高齢者の在宅生活継続に関する影響要因とケアの視点

Factors Affecting the Perspective of Caregivers on Assisting Elderly Living at Home

要旨

　本研究の目的は，在宅要介護高齢者の健康状態の改善・維持・悪化予防，介護者の介護負担の改善および過剰負担の予防に対し，在宅要介護高齢者の自立支援を促進する「ケアの視点」を提言することである．

　対象は介護保険サービスを利用する要介護高齢者282人である．研究方法は質問紙調査と居宅サービス計画書の内容抽出である．調査内容は利用者条件，身体・精神状態，介護力，ケアニーズ，サービス利用状況である．分析では介護保険の介護度群別に，在宅生活継続群と非継続群で調査項目を比較し在宅生活継続に関連する要因を抽出し，さらに在宅生活継続に影響の大きい要因を明らかにした．

　その結果，影響の大きい要因としてケアニーズに属する項目である家事援助，判断力，褥瘡が導き出された．これより要介護高齢者の自立を促すケアの視点として，要支援・要介護1群では利用者の家事遂行能力を補う援助，要介護2・3群では利用者の判断力を補う援助，要介護4・5群では利用者の褥瘡に対し介護者や専門職による利用者自身の健康管理能力への援助が示唆された．

Abstract

　The purpose of this study was to propose a viewpoint of care promoting elder's self-reliant corresponding to improving and maintaining the level of health, and to improving care burden and prevention of excessive care burden, and appropriate correspondence.

　The sample included 282 elderly over age 65 in Japan who required home care and use in-home services to support living at home by the long-term care insurance service. The questionnaire data consisted of background, physical and mental status, ability of caregiver, use of in-home services and extracted contents of the service plan sheet. The dada were divided into two groups of those who continue living at home and those who were hospitalized or moved into facilities. Analysis extracted factors about continuation at home for each degree of long-term care required. Levels of care in the Japanese long-term care insurance plan were also considered.

　Based on analysis of the factors influencing elders to continue living at home, the following recommendation is suggested: The most influencing factors are housework, judgment, bedsores, belongs to care needs category. For elderly at support required and care level 1, support should be offered to improve and maintain abilities for housework. For persons in care levels 2 and 3, caregivers should support their judgment and activity in their life that needs their judgment. In care levels 4 and 5, caregivers should pay attention to preventing aggravation of the condition of the elder's whole body such as prevention of bedsores.