Person-centred Careをめざした認知症ケアマッピング（DCM）の理論と海外の動向

Theory and Worldwide Trends of Dementia Care Mapping Aimed at Providing Person-Centred Care

　DCM（dementia care mapping；認知症ケアマッピング）は，Person-centred Careの価値基盤に基づいた観察技法であり，認知症高齢者ケアの現場の文化を変革することを目的としている。

　英国から端を発したDCMを導入している国は10数か国を数え，各国の責任者による国際DCM実施グループが構成されている。各国の代表者は，自国でPerson-centred Careの正しい理解を広めるために尽力している。Person-centred Careで私たちがめざしているのは，生産性や効率性を重視した社会から，認知症の有無にかかわらず，どんな人にも等しく存在価値があるという社会への変革である。過去10年の間に，RCTを用いた研究が各国で行なわれてきた。その活動により，デンマーク，ノルウェーなどでは，国の認知症施策にPerson-centred CareやDCMが取り上げられている。発祥国の英国では，さまざまな公的機関によるガイドラインで，Person-centred CareやDCMの推進が掲げられている。

　当初は，施設での利用を想定していたDCMであるが，現在は，在宅ケアの質の向上をめざした在宅用DCMも開発され，世界各国で導入が進んでいる。さらに，DCMは，認知症の人にとどまらず，学習障害や，高次脳機能障害をもつ人たちにも応用されようとしている。また，教育ツールとしての意義は，介護者，看護者にとどまらず，英国では，監査担当者への教育にも活用されている。

　Dementia Care Mapping（DCM） is an observational tool, whose fundamental value is based on person-centred care. It aims to reform culture in clinical settings. DCM, which was originally developed in England, has been used worldwide in more than 10 countries. The DCM international implementation group has been established by each country's respective representatives. These representatives from each country have been striving to spread correct understanding of person-centred care. Our goal in person-centred care is to change social values among people. Although productivity and efficiency has been valued in our society, we need to equally appreciate the existing value of each person, regardless of the presence or absence of dementia. In last ten years, Randomized Controlled Trial had been conducted in some countries. In Denmark and Norway, person-centred care and DCM have been incorporated into national measures for dementia care, as a result of various activities in different countries. In England, where these tools were originally developed, person-centred care and DCM have been promoted to be used in various official guidelines. When DCM was originally developed, it was primarily aimed at use in a health care facility, however, a modified version of DCM, which can be used in a home care setting, has been developed and was introduced in many countries in order to improve the quality of home care. In addition, DCM is about to be applied not only towards people with dementia, but also towards people with learning disabilities or higher brain dysfunctions. Moreover, in terms of the significance of DCM as an educational tool, it is not only used among nurses and care givers, but also for educating auditors in England.