施設入所高齢者の夜間のおむつ交換回数による中途覚醒時間の変化

The Effect of Reducing the Number of Nightly Diaper Changes on Wake After Sleep Onset (WASO) in Long-term Care Insurance Facilities' Residents

抄録

　高齢者の睡眠改善を目指したおむつ交換方法への示唆を得ることを目的に，介護保険施設1施設で一律定時に行われる夜間のおむつ交換回数を2回から1回に減らし，睡眠変数の変化からその効果と高齢者の特徴を検討した．ベースライン期と介入期の各2週間，アクティグラフによる睡眠変数や温度等の環境を24時間連続で測定した．対象者は女性13人で，年齢92.3±7.3歳，NMスケール9.9±7.1点，N-ADL 9.8±3.5点であった．健康状態や環境は観察期による差はなかった．全対象者の睡眠変数の中央値は観察期による差はなかったが，最大・最小値の差は大きかった．対象者の平均年齢から算出した中途覚醒時間の推定値80分を基準とし，介入期における基準値以上の日数の減少の有無により対象者の特徴を検討した．減少あり群は7人で，NMスケールは有意に高く（p＝.026），N-ADLは高い傾向がみられ（p＝.050），夜間のおむつ交換回数を減らす介入効果は，認知機能やADLのレベルとの関係が推定された．本研究の結果から，施設入所高齢者の睡眠改善に向けた排泄援助の検討では，認知機能やADLを考慮する必要があることが示唆された．

　In this study, the frequency of night-time diaper changes conducted at fixed times at a single nursing care insurance facility was reduced from twice to once per night and the resulting changes in sleep variables were considered along with the characteristics of the elderly residents, with the goal of acquiring hints for diaper-changing methods that could improve sleep quality. The baseline and intervention durations were set at 2 weeks each, and Actigraph devices were used for 24-hour continuous measurement of sleep variables and environmental factors such as temperature. The participants were 13 elderly female residents aged 92.3±7.3 years, and Nishimura's mental (NM) and activity of daily living (N-ADL) scale scores of 9.9±7.1 and 9.8±3.5 points, respectively. There were no differences in health status or environmental factors observed between the two periods. No differences in median sleep values were observed, but the range from minimum to maximum values within the sample was large. Based on the participants' average age, duration of the standard estimated nocturnal awakening time was set as 80 minutes, and the participants' characteristics were considered based on the number of days with decreases from this standard value during the intervention period. Of the reduction group, 7 participants had a significantly higher NM scale (p=.026), and had a higher tendency of N-ADL (p=.050). The intervention effect of reducing the number of night-time diaper changes was estimated to be related to cognitive functions or ADL levels. The results of this study suggest that cognitive function and ADL need to be considered in the examination of excretion assistance for sleep improvements among the elderly in institutionalized facilities.