高齢軽症脳梗塞患者の再発に関するリスク認知

Perception of Recurrent Risk among Elderly Patients with Minor Ischemic Strokes

要旨

　目的：高齢軽症脳梗塞患者の体験に基づいた再発に関するリスク認知を記述する．

　方法：65〜88歳の軽症脳梗塞患者18名を対象に半構造化面接を行い，脳梗塞の再発リスクや疾患，健康管理に関する捉えについて質的記述的に分析した．

　結果：高齢軽症脳梗塞患者の再発に関するリスク認知には，【再発への漠然とした気がかりがある】【再発に対して何に気を付ければよいかわからない】【脳梗塞になることを気にしても仕方がない】と深刻な再発の危機感を持っていないことが語られた．また，【自分の脳梗塞は軽くて回復している】【発症前から健康管理ができていた】という自身の疾患や健康管理の評価から再発を漠然と捉えていることが明らかになった．

　結論：高齢軽症脳梗塞患者は再発に対する重大性や脆弱性を認識していず，再発予防への動機づけが不十分である．したがって看護師は患者の主観的な再発に関するリスク認知を把握し，個人の理解に応じた支援を行う必要性が示唆された．

　Purpose: This study aims to describe the perceptions of recurrent risk based on the experience of elderly patients with minor ischemic strokes.

　Methods: Semi-structured interviews were conducted with 18 patients with minor ischemic strokes, aged between 65 and 88, and the interview data about their thoughts of recurrent risk, disease, and health management were qualitatively and descriptively analyzed.

　Results: Narratives of the elderly patients with minor ischemic strokes showed that they did not seriously perceive risks of recurrence, stating that [I cannot clearly imagine what the recurrence is like], [I do not know what to do to prevent recurrence], and [It is no use worrying excessively about recurrences]. It was also shown that they thought indefinitely about recurrences based on their evaluation of the own paroxysm of disease and their health management, stating that [My stroke was minor and I am recovering], and [Before the stroke occurred, I have been able to manage my health].

　Conclusion: Elderly patients with minor ischemic strokes do not perceive the significance of and vulnerability to recurrence, and are insufficiently motivated to prevent the recurrence. These findings suggest that nurses need to understand the subjective patient perceptions of the recurrence risk, and attempt to provide support as appears necessary based on the understanding presented by individual patients.