要介護高齢者の終末期への意思表示に関わるケアマネジャーの支援方法と心情

Support Methods and Feelings of Care-managers Pertaining to Intention for End-of-life of the Elderly in Need of Care

抄録

　本研究は，ケアマネジャー（以下，CM）による要介護高齢者（以下，高齢者）の終末期の医療や生活に対する意思表出支援の方法と心情について明らかにすることを目的とした．高齢者に対して終末期の医療と生活に対する意思表出支援経験のあるCM8人で構成するフォーカス・グループにインタビューを実施して収集した逐語録をデータとし，質的記述的に分析した．その結果，CMは，意思表出支援として【高齢者の状態の推察】【関係性の推察】【高齢者への配慮】をしながら，【支援の理由説明】，本人の【意思の活用】，【状況を設定】と【方向づけ】が抽出された．CMの心情として，【支援への不安】があったが，意思確認により【意義を実感】【必要性の再認識】をしていた．本研究では，高齢者の終末期の医療と生活に対する意思表出についてCMは，状態や関係性などの個別性に合わせて支援し，意思確認により支援の意義と必要性を認識することが示唆された．

　The present study aimed to clarify the support methods and feelings of care-managers (CMs) pertaining to intentions of elderly individuals, who were in need of care, regarding their end-of-life. Eight CMs including 7 females, with a mean age of 45.0 years (SD＝6.9) and 4 -14 years of managerial experience were interviewed in a focus group. Verbal data were collected and analyzed using a qualitative descriptive analysis.

　The results revealed that CMs supported the elderly by ＜assessing the elderly's condition＞, ＜inferring their relationships＞, ＜making it easy for them to talk＞, ＜citing reasons for support＞ ＜respecting their expressed intentions＞, ＜understanding the situation＞, and ＜guiding their intentions for their future life＞. Although CMs initially felt ＜anxious about supporting＞, they realized ＜the significance＞ and ＜needs＞ after confirming the elderly's intentions regarding their end-of-life. The present study may suggest that CMs support the elderly based on individual needs and recognize meanings and needs pertaining to intentions of the elderly in need of care by validating them.