介護老人保健施設における実践―言語聴覚士の専門性と多職種間連携

The specialty of the speech-language-hearing therapist and interprofessional collaboration in a geriatric health services facility

　認知症支援における多職種間連携について，老人保健施設における実践を通して述べた．認知症ケアの基本はパーソンセンタードケアであり，その人らしさを中心とした介護である．パーソンセンタードケアは多職種での包括的アプローチで実践され，認知症の人の生活全般における言動・行動の観察が必要である．老人保健施設で暮らす認知症の人へ多職種でかかわる意義は，その人が穏やかに安心して，よりその人らしく生活ができるよう支援することであり，多職種連携の実践では，情報収集・情報共有・コーディネートが重要となる．認知症支援では，認知機能の改善のためにエラーレス学習や間隔伸張法などを活用したより専門的なリハビリテーションアプローチの展開が求められているのではないだろうか．しかしながらその一方で，多職種連携での包括的なアプローチを実践する際には，言語聴覚士としての専門性を強調し過ぎない姿勢も大切と考えられた．

　In this article, we describe the practice of a speech-language-hearing therapist (SLHT) working at a geriatric health facility focusing on interdisciplinary dementia care. We believe that the basic approach to dementia care should incorporate the principles of person-centered care, set forth by the British geropsychologist Tom Kitwood. Person-centered dementia care is based on a deep appreciation of human nature and the value of each person. Careful observation of persons with dementia in daily activities is necessary to practice person-centered care by the multidisciplinary care team. Such an approach empowers persons with dementia living in a geriatric health facility, allowing them to stay calm and comfortable. Collecting and sharing information along with work coordination among different disciplines is important to meet the needs of persons with dementia. As SLHTs, we can and should actively contribute to the interdisciplinary team to realize the expressed needs of persons with dementia utilizing our specialties such as cognitive treatment techniques. Errorless learning and spaced retrieval treatments have been shown to be effective in helping people with dementia to acquire new information and/or motor skills necessary to support their lives. It is also emphasized that in the interdisciplinary approach, SLHTs should share information and collaborate with other disciplines in the evaluation and treatment of the areas that traditionally come under their specialties.