施設で生活する中等度・重度認知症高齢者の自己決定の機会を提供する看護介入の効果

A Study on the Efficacy of Nursing Intervention for Supporting Self-determination in Elderly Nursing Home Residents with Moderate to Severe Dementia

　本研究の目的は，施設で生活する中等度・重度認知症高齢者の自己決定の機会を提供する看護介入の効果を明らかにすることである．条件を満たした20名（介入群10名，対照群10名）を対象とし，「食事」「間食」「更衣」「排泄」「レクリエーション」について連続2週間，自己決定の機会を提供する看護介入を実施した．

　結果として，精神機能（MENFIS）の有意な改善，特に下位尺度「動機づけ機能障害」の改善傾向，「体操」場面での活動への意欲・関心（PAFED）の有意な改善がみられた．認知機能（MMSE）の有意な改善はみられなかった．

　選択肢を提示された際の意思表示の明確さの程度については，調査者が作成した順序尺度を用い，「間食」「更衣」場面で評価した．その結果，介入開始時点と2週間後では，意思表示の明確さの明らかな改善はみられなかったが，評価得点が上昇した対象者がいたことから改善の可能性は否定できないと考える．

　以上より中等度・重度認知症高齢者に対して，自己決定の機会を提供する看護介入が行動への動機づけとなり，生活への意欲を向上する可能性があることが示唆された．

　The objective of the present study is to clarify the efficacy of nursing intervention for supporting self-determination in elderly nursing home residents with moderate to severe dementia. Subjects were 20 elderly nursing home residents with moderate to severe dementia (intervention group: n = 10, and control group: n = 10), and nursing intervention was administered for two consecutive weeks to support self-determination for “meals,” “snacks,” “dressing,” “toileting” and “recreation.”

　The results showed that although no significant improvements were seen in Mini-Mental State Examination (MMSE) scores, significant improvements in Mental Function Impairment Scale (MENFIS) scores, tendency toward improvements in “motivation function” (subscale) scores, and significant improvements in Psychological Assessment Scale by Facial Expression for Demented People (PAFED) scores for “exercise” were seen.

　The clarity of intent expression when asked to make a choice was assessed using an originally developed ordinal scale in the settings of “eating snacks” and “dressing.” The results showed no clear improvements before and after two weeks of intervention, but since scores improved in some subjects, the possibility of improvements could not be ruled out.

　The above findings suggest that a nursing intervention for supporting self-determination motivates elderly nursing home residents with moderate to severe dementia to be active and improves their willingness to carry out activities of daily living.