痴呆高齢者の摂食困難の改善に向けた環境アレンジメントによる効果

Effect on Arranging the Environment to Improve Feeding Difficulties in the Elderly with Dementia

　本研究の目的は，6か月間の継続的な参加観察法によって，痴呆高齢者の改善可能な摂食困難の存在と，改善に有効な環境アレンジメントを見いだし，介入の効果について介入群と非介入群を比較分析し検討することである．対象は，摂食困難のある痴呆高齢者16人（介入群8人，非介入群8人）である．本研究の対象にみる摂食困難には，摂食開始困難と摂食中断があり，いずれも改善の可能性があることが示された．介入群の自発摂食割合は，介入開始時と終了時の比較では，重度は30.7％から66.8％，中等度は97.0％から98.9％と改善し，摂食困難度が重度ほど改善の可能性が高くなっていた．痴呆高齢者の摂食困難の改善に有効な介入には，「セルフケア能力を引き出すための環境アレンジメント」と「対象が順応できるような物理的・社会的環境アレンジメント」の2つがあげられた．すなわち，摂食時のみならず，痴呆高齢者の生活全般の自発性を呼び起こす環境アレンジメントによる介入が有効かつ重要であることが示唆された．

　The purpose of this study is to identify "improvable feeding difficulties "for the institutionalized elderly with dementia and to explore effect on arranging the environment. The subjects were 16 demented elderly with feeding difficulties. The intervention and non-intervention groups were matched by the severity of feeding difficulties, sex, and age. The six-month prospective intervention study was based on re-arranging the environment. Self-feeding was increased in the intervention group, from 30.7% to 66.8% with severe feeding difficulties and from 97.0% to 98.9% with moderate feeding difficulties at the initial and final evaluations, respectively. Subjects with more severe feeding difficulties were found to be more readily affected by excessive environmental stimuli. Conversely, their self-feeding behaviors were more sensitive to the arrangement of their environment. Effective interventions to improve feeding difficulties included, (a)enhancing subjects' self-care agency, (b)arrangement of the physical and social environmental factors. Interventions creating suitable modifications of the environment dose enhance self-feeding behaviors in institutionalized elderly patients with dementia, thus contributing to their quality of life.