認知症高齢者の血液透析導入後の生活を支える家族の体験

Experiences of Families Supporting Elderly Dementia Patients Undergoing Hemodialysis

抄録

　本研究の目的は，認知症高齢者の血液透析導入後の生活を支える家族がどのような体験をしているかを明らかにすることである．血液透析に通う認知症高齢者の家族7人を対象に半構成的面接を実施し，質的記述的に分析した．その結果，【忘れてしまう注意点に配慮する】【透析を受けることの難しさにつきあう】【透析導入前からの楽しむ力を維持する】【言葉で表せない透析による身体の不調を察し対応する】【葛藤した透析の導入を前向きにとらえられる】の5つのカテゴリーが抽出された．家族は，認知症高齢者の言動に苦心しながらも，その人に合わせた日常生活や体調の管理，透析を受ける手助けをしていることが明らかになった．看護者は，できる限り早期に，家族が認知症高齢者との生活を整えられるよう支援することが必要と考える．また，認知症高齢者のもつ力を尊重している家族を認め，透析の導入を肯定的に受け止められるように関わることが大切と考える．

　The purpose of our study was to clarify experiences of families who support the life of elderly dementia patients after the onset of hemodialysis treatment. Semi-structured interviews were conducted for 7 family members of elderly dementia patients undergoing outpatient hemodialysis treatment, and the answers were qualitatively and descriptively analyzed. The results were classified into 5 categories: 1) attentively observe the treating doctor's cautions which the patient forgets, 2) sit close to the patient and cope with difficulties in undergoing hemodialysis, 3) devise methods to enable the patient to continue personal pleasures as before starting hemodialysis, 4) find and manage physical problems related to hemodialysis which is difficult for the patient to convey by words, and 5) positively accept the fact of starting hemodialysis after going through mental conflict whether or not to choose hemodialysis for the dementia patient. Family members were noted to have been helping patients to undergo hemodialysis considering the patient's capability, while coping with words and behavior of the patient, daily life, and physical condition. Appropriate support measures by nurses is necessary as early as possible after the onset of dialysis treatment, to enable care of the patient by the family at home. Also, relationship between the nurses and the patients' family members is important though acknowledging their effort in respecting and bringing out the remaining capability of the elderly dementia patient, so that they can positively accept the fact of starting hemodialysis.