認知症高齢者における疼痛の有症率と疼痛が認知症の行動・心理症状（BPSD）に及ぼす影響

Prevalence of pain among the elderly with dementia and impact of their pain on their Behavioral and Psychological Symptoms of Dementia (BPSD)

抄録

　本研究の目的は，観察法による日本語版アビー痛みスケール（APS-J）とセルフレポートによる疼痛の有症率と疼痛が認知症の行動・心理症状（BPSD）に及ぼす影響を明らかにすることである．2012年8〜10月に介護保険施設に入所する認知症高齢者131名（男性29名，女性102名）を対象に調査を実施した．セルフレポートである疼痛の有無で回答可能であった104名における疼痛の有症率は25.00％（26/104），APS-Jによる痛みの有症率は25.95％（34/131）であった．APS-Jの「表情」「身体的変化」に関して，セルフレポートで疼痛なしと回答した者に比べて回答不明の者が有意に高かった．BPSDの評価であるGottfries-Brane-Steen Scaleの「認知症に共通なその他の症状」とその下位尺度の焦燥，不安，感情の抑うつをそれぞれ目的変数とし，年齢，MMSEをコントロールした重回帰分析では，APS-JがBPSDを有意に促進する要因であった．以上の結果から，言語的な訴えのできない認知症高齢者の疼痛を十分アセスメントしていない可能性や認知症高齢者の疼痛がBPSDを促進していることが示唆された．

　The purpose of this study is to discover the prevalence of pain among the elderly with dementia as measured by an observational tool known as the Japanese version of the Abbey Pain Scale (APS-J), as well as self-reports of pain provided by the subjects. A survey was conducted between August and October in 2012, which enrolled 131 elderly people with dementia who were staying at a long-term care facility (29 males and 102 females). According to the 104 subjects, who were able to provide self-reports regarding their pain, the prevalence of pain was 25.00% (26/104). According to the APS-J, the prevalence of pain was 25.95% (34/131). With regards to the APS-J scores for “facial expression” and “physical changes”, there were significantly more subjects who self-reported an “unknown” regarding their pain, as compared to subjects who self-reported an “absence of pain”. The dependent variables included “symptoms common in dementia” (one of the subscales of Gottfries-Brane-Steen Scale to evaluate BPSD) as well as items on irritability, anxiety and depressive mood (items listed under this subscale) and a multiple regression analysis was performed, which revealed that APS-J contributed significantly to the variance in BPSD after controlling for age and MMSE. Based on these results, it was suggested that pain among the elderly with dementia who are incapable of verbally expressing their pain, is not sufficiently assessed. Also, it was suggested that pain among the elderly with dementia could increase BPSD.