日本における認知症高齢者のアドバンス・ケア・プランニングの概念分析

Concept Analysis of Advance Care Planning for Older Adults with Dementia in Japan

要旨

　目的：日本における認知症高齢者のアドバンス・ケア・プランニングの概念を概念分析により明らかにすることである．

　方法：42文献を分析対象としRodgersの概念分析の手法を用い分析した．

　結果：分析の結果，【本人・多職種・関係者全員がチームを組み関係構築】，【代理意思決定者の選定】，【倫理的に適切な事前指示書の共有】，【人生の最終段階に向けた家族の準備】，【早期から最期まで継続した本人中心の意思決定】，【望む生き方の最善を考える取り組み】の6属性と，4先行要件，3帰結が抽出された．

　結論：本概念は，「認知症の変化，進行，不安に伴い，将来の意思決定に向けて環境を整備し，認知症早期から本人と関係者全員が関係構築しながら，事前指示書の共有，代理意思決定者の選定，人生の最終段階に向け家族も準備し，最期まで継続した本人中心の意思決定と望む生き方の最善を考える取り組みのプロセス」と定義した．

　Objective: The purpose is to clarify the concept of advanced care planning for older adults with dementia in Japan by concept analysis.

　Method: Forty-two documents were analyzed using the method of concept analysis by Rodgers.

　Result: The 6 attributes are “Person, multi-professional, all related parties form a team to build a relationship”, “Selection of proxy decision makers”, “Share ethically appropriate advance directives”, “Final of life family preparation for the stage”, “Person-centered decision-making that continued from early to final”, “Efforts to think about the best way of life desired”. In addition, 4 prerequisites and 3 consequences were extracted.

　Conclusion: This concept is defined as follows: “With changes, progression, and anxiety of dementia, we will prepare an environment for future decision-making, and from the early stage of dementia, while building relationships between the person and all concerned, sharing advance directives, proxy decision-makers selection, family preparation for the final stages of life, a process of personal-centered decision-making that continues to the end and efforts to think about the best way of life.”