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

Kanako OGISO, Sayuri TOIDA and Miyuki WATANABEto link with the necessary patient treatment. Byobserving the cognitive capacity of a patient, anoutpatient nurse can obtain information on thepatient, so as to assess normative needs. In thisstudy, in the case of consultation with a physicianalone,“a nurse obtains information on a patient?sclinical record and calls the patient?s home byphone when necessary”and“there is a patient whoforgets that he/she has already consulted with aphysician and gets consultation again and again.”Sometimes, the patient and his/her family do notrecognize the necessity of support for the former?scognitive deterioration. Demented elderly oftenhave decline in their cognitive functions andbehavioral symptoms increase over many years.For caregivers, cognitive decline in the elderlycan lead to increased stress, frustration, anxiety,depression and health problems 14) . Dementiarelatedworries experienced by caregivers, whoare relatives of dementia patients, are as follows:the caregivers (a) experience memory deficitsand this reminds them that they are aging, (b) areafraid of possibly losing their self-identity as aresult of dementia because they have seen whatis happening to their family member and knowthat dementia has a genetic component, (c) havedifficulty seeing their family member change inphysical appearance and suffer decreased mentalacuity, (d) have increased anxiety about losingtheir self-identity because they do not know howthe disease process will end, (e) want to escapefrom the likelihood of dementia in order to keeptheir self-identity, and (f) try to change theirlifestyle behaviors and life attitudes in a positivemanner to improve their chances of avoidingdementia 4) . As professionals, nurses are requestedto ascertain these worries. It is elucidated that malecaregivers experience care problems 9) . Therefore,it is necessary to support caregivers according totheir characteristics. It is considered necessary toapproach a patient?s family while considering thefamily?s caring ability.These results suggest that in order to reducethe burden of family caregivers, it is importantto preserve and improve ADL of the homeboundelderly disabled, and to prevent dementiadecline 8) . Caregiver burden was not stronglycorrelated with the degree of cognitive impairmentof patients, but rather with behavioral andpsychological symptoms of dementia and malepatient gender 13) . Educational support for thefamily is also important. Onichi et al 12) suggestedthat among BPSD, inability of finding the wayhome, inability of managing money and fecalincontinence were the most difficult symptoms tocope with.“The practice of seamless care throughmulti-occupational description cooperation inthe community”is required for continuing homerecuperation. It was suggested that healthcarestaff should perform nursing care while providinga humane environment for elderly dementiapatients that values personhood 10) . However, thetime available for professionals to provide nursingcare at home is limited. For nursing care at home,a patient?s family members and volunteers arerequested to provide a comfortable space. Inaddition, nursing care provision by a patient?sfamily members is limited, and so are nursingservices covered by long-term care insurance.Cooperation with people in a community isimportant, for patients to live in that particularcommunity. According to Charlesworth et al 2) ,“asthe number of people with dementia increases, sotoo will the number of experienced carers willingto volunteer to support others. It is importantto develop and apply support systems that canadequately reduce daily difficulties caused byproblematic behaviors in order to effectivelysupport the elderly with dementia 11) . Therefore,“the people in a neighborhood”and“local welfarecommissioners”are also necessary.Ⅴ．AcknowledgmentsThe authors would like to thank the researchcooperator and all staff members at each hospital? 249 ?