在宅医療の実際と創傷管理の現状

Current Status of Home Healthcare and Wound Management

はじめに

　本邦での急速な高齢化に備え，国は地域包括ケアシステム構築を進めている。そこで中心となるのは住民の日々の暮らしであり，その暮らしを支えるために要介護の予防と実際の介護，そして医療が提供される。その医療が在宅医療である。そのなかで褥瘡など難治性慢性創傷の予防や治療は，高齢化社会での大きな課題である。このため，病院などで慢性創傷の管理を担ってきた形成外科医に対し，今後は在宅領域での慢性創傷管理への取り組みが求められることになる。

　著者は，20年以上勤務した急性期病院から，地域での創傷管理への取り組みを念頭に，2021年春に在宅領域へと軸足を移した。まだ経験は短く浅いが，現場から見た在宅医療の実際と，それを踏まえた在宅領域での創傷管理について述べる。

　The construction of a comprehensive community care system is underway to help address the rapid aging of Japan's population. The central focus of this system is the daily lives of the elderly, and home healthcare is the medical care that supports these lives.

　The treatment and prevention of difficult-to-treat chronic wounds such as bedsores is a major issue in aging populations. For plastic surgeons who have been responsible for chronic wound management at hospitals, wound management in home settings will become a new mission in view of the increasing numbers of elderly people. Based on my own experience, I describe the reality and prospects of wound management in patients' homes.

　In home settings, the role of caregivers who are in close contact with the elderly patient is significant, and their wound management skills are important. However, caregivers usually have little time to focus on learning or conducting wound management because their priority is to maintain the life, activities, and mental health of the elderly patient. Understanding these issues, plastic surgeons should make efforts to improve wound management in home settings. The expansion of specialized care such as wound management in home settings will benefit both patients and sheltering acute care.