ブックタイトル教育医学 J.Educ.Health Sci.　第63巻　第3号　通巻 第289号

概要

教育医学 J.Educ.Health Sci.　第63巻　第3号　通巻 第289号

Current Situation of and Problems with Elderly Patients with Dementia Home Recuperation in JapanIn Japan, as the Baby Boom generation becomesthe elderly population aged 75 years or moreby 2025, social security costs, including careprovision and medical costs, will rapidly increase.To cope with this problem, community-basedintegrated care systems have been proposed, anda shift has been promoted from medical treatmentin an“intra-hospital referral model”to that in a“regional inter-hospital referral model.”In theregional inter-hospital referral model, patients aresupported by the entire community.In the framework of community-based integratedcare systems, Hospitals for community-based careand sickbeds for community-based care wererequested to improve their functions to supportcommunity-based integrated care systems, suchas the acceptance of patients after the acutestage. Therefore, new standards to evaluatethese hospitals and sickbeds were established.For community-based integrated care systemsto function effectively, seamless care must beprovided in addition to conventional dischargesupport and planning, while considering thespecific characteristics of dementia. By providingseamless care, information on a patient withdementia collected before leaving hospital can beused after discharge, which decreases the stressexperienced by the patient and his/her family afterhe/she leaves hospital.A previous study 5) reported that the incidence ofbehavioral and psychological symptoms of dementia(BPSD) was 70?90% in elderly dementia patients,and BPSD was one of the factors disturbing homerecuperation. While paying attention to BPSD,seamless caring to elderly dementia patientswith a necessary medical treatment is obtained atcommunity-based integrated care systems in Japan 7) .Physicians admitted they had little knowledge ofthese services and had little interest in acquiringinformation about them. Government-run,community-based health and social service centreswere the "black boxes" to which they referredpatients and their caregivers for any form of help 16) .Therefore, when an elderly dementia patientundergoes a medical examination, nurses andother medical staff should provide comprehensivesupport for the patient and his/her family, so thatthe patient can remain living at home.The aim of the present study was to elucidatethe current situation of seamless care and itsrelated problems in home recuperation of elderlydementia patients in Japan.Ⅱ．Method1. Facilities and subjectsThe present study investigated three hospitalsthat consented to participate in the study, which hadbeen in operation for more than five years. Fromeach hospital, two outpatient nurses were selectedby the director of the nursing service department.Therefore, a total of six nurses participated in thestudy.2. PeriodThe study was conducted between June andAugust 2016.3. SurveyA survey was conducted in the form of anactive interview at each hospital after obtainingthe approval of the director of the nursing servicedepartment. Regarding the current situation ofseamless care and its related problems in homerecuperation of elderly dementia patients, eachnurse was asked about patients? behavior andmeasures currently taken by their hospital duringa semi-structured interview lasting for 30-40min. The interview was conducted in a privateroom and recorded using an integrated circuit(IC) recorder. The recorded interview was thentranscribed verbatim after obtaining the approvalof each nurse.4. AnalysisFirstly, the researchers read the transcribedinterviews several times to understand their contentin depth. Each answer provided in the interviewswas defined as a code and all answers were? 242 ?