救急医療における高齢患者の課題と現状

Current Issues and the Status of Elderly Patients in Emergency Medicine

はじめに

　高齢者人口の増加に伴い，救急搬送者数は増加している。特に高齢者においては急病で搬送され，入院治療を要する割合が多い。なかでも敗血症は増加傾向であり，今後もこの傾向が継続すると想定されている。高齢者は加齢に伴い生体反応が変化することが判明しており，治療に際して留意する必要がある。

　高齢者は入院に伴う心身の障害を来しやすく，急性期治療を終えたとしても，入院前の生活を送ることが困難となることが少なくない。その結果，高齢者患者の転床・転院が停滞する “出口問題” が近年の救急医療における課題となっている。 “出口問題” の解決には，急性期医療から地域の医療・介護・生活支援サービスへの円滑な移行が必要であり，地域包括ケアシステムと呼ばれる体系的な地域社会におけるネットワークシステムの構築が重要であるとされている。

　As the elderly population in Japan continues to increase, the number of patients transported by emergency medical service is also increasing. A large proportion of elderly individuals are emergently transported because of illnesses that require hospitalization and treatment. Japan’s nationwide data indicate that the annual incidence of sepsis and death among inpatients with sepsis has significantly increased. It has also been observed that the biological responses of elderly patients can differ from those of non-elderly patients. Elderly patients are more likely to have physical and mental disabilities associated with hospitalization, and they often stay in acute-care hospitals longer after completing acute medical treatment, due to difficulty in returning to their pre-hospital lifestyle. As a result, it can be difficult to transfer elderly patients to other hospitals or facilities, and the accompanying social problems have recently become a challenge for emergency medicine. To address these issues, a smooth transition from acute medical care to community medical care, nursing care, and lifestyle support services is necessary, and the establishment of a systematic medical and nursing care network in each community is desired.