前頭葉損傷患者に標準意欲評価法を用いた自発性低下の評価—日常生活行動の意欲評価スケールにおける家族と看護師の評価の特徴

The Evaluation of Apathy by Using the Scale of Clinical Assessment for Spontaneity: Characteristics of Evaluation between Families and Nurses

要旨

　目的：前頭葉損傷に伴う自発性低下は，近年，標準意欲評価法（Clinical Assessment for Spontaneity, CAS）が開発され，客観的評価が試みられる．本研究では，CASの5つの尺度の中でも，特に看護師が評価に関わる可能性が高い日常生活行動の意欲評価スケール（以下CAS3）に着目し，看護師と家族の両者の評価について相違点や一致内容を検討することを目的とした．

　方法：前頭葉損傷患者の家族，看護師各39名が，患者の自発性を評価した．自発性の測定にはCAS3を用いた．

　結果：看護師と家族の評価結果はCAS3の合計得点において，類似した回答結果を示した．しかし，洗面，入浴，服薬，挨拶，会話，趣味では，回答が異なる傾向を認めた．

　結論：看護師と家族間の日常生活行動における自発性低下の評価が異なる要因には，観察機会の差があると推測された．評価の妥当性を高めるためには，看護師と家族両者の評価を検討する必要があることが示唆された．

　Purpose: Apathy is one kind of frontal lobe dysfunction, and patients who suffer from apathy tend to be misdiagnosed as being “lazy” by medical staff and families. Recently, apathy-measuring scales have been developed, such as the “Clinical Assessment for Spontaneity (CAS)” to try to evaluate this disability as objectively as possible. CAS consisted of five subscales to measure multiple viewpoints of apathy. In this study we used the CAS3, the scale for assessment of spontaneity about patients' ADL. The purpose of this study was to investigate the characteristics of evaluation between families and nurses in assessing patients' apathy.

　Method: Thirty-nine pairs of families and nurses were interviewed and evaluated concerning patients' apathy using the CAS3 scale.

　Results: A significant correlation was observed between the total CAS scores of families and nurses. However, the subscale CAS3 scores for specific categories, especially “grooming,” “bathing,” “medication,” “greeting,” “communication with others,” and “hobbies” did not correlate significantly.

　Conclusion: When the results of CAS3 were analyzed, the total score of CAS was correlated, but there were evaluation gaps between nurses and families for some items because of the difference of observation opportunities. These results suggest that if families participate in patients' assessment, nurses can evaluate apathy in more detail based on information about patients' characteristics and lifestyles before a stroke occurs.