Recognition of depression state in dementia by care workers and nurses and problems encountered

摘要

県内の介護保険３施設45施設の職員を対象に, 認知症における抑うつ状態に対する介護・看護職員の認識と課題を明らかにすることを目的に調査を実施した.Sunderland らの抑うつ症状に関する調査項目を参考に作成した調査用紙を用いて, ①抑うつ症状を示す認知症高齢者へのケア経験の有無, ②効果的と考える対応方法, ③経験したことのある抑うつ症状, ④抑うつ症状出現によって困ることについて質問した.355名に調査の協力を依頼し, 239名からの回答を得た. 回収率は67.7％, 有効回答率は87.0％ (215名) である.所属施設の内訳は, 介護老人福祉施設122名, 介護老人保健施設83名, 介護療養型医療施設10名. 介護・福祉職161名,看護職54名である. ｢②効果的対応方法｣は73.0％が『抗うつ薬をきちんと服薬する』, 86.0％が『家族介入も含めた十分なケアを提供する』, 10.2％は『十分なケアだけを提供する』であった. 『抗うつ薬をきちんと服薬する』については職種間および平均経験年数に関連を認めた. ｢④困ること｣は, 『行動・心理症状』や『症状・障害に対する理解』の他,《食事》《コミュニケーション》等の『日常生活への影響』に関するもの, ｢協力体制｣｢職員の疲労｣｢時間がかかる｣等の『支援体制』だった. 状態のとらえ方には経験によって影響されるものがあること, 抑うつ症状に対する正しい状態の理解, ケアの支援体制整備の必要性が示唆された.A survey intended to clarify the recognition of depression state in dementia by care workers and nurses and corresponding problems was carried out on 152 staff in 3 institutions in A prefecture.The question items were as follows : 1. Do you have experience of care of senior citizens with dementia showing depression symptoms? 2. What responses have you found effective? 3. Depression symptoms encountered. 4. What concerns do you have regarding occurrence of depression symptoms?The effective answer rate was 87.0％ : 122 special nursing home staff, 83 staff of health centers for the elderly, and 10 of medical facilities for elderly patients requiring long-term care. 161 were care workers and 54 nurses.For “effective response method”, 73％ answered “accurate use of anti-depressant drugs”, and 86％ “offer sufficient care including family intervention”. 10.2％ answered “Offer sufficient care only.”There was a significant difference in those who answered “accurate use of anti-depressant drugs based on job type and length of experience. Significant difference occurred by the experience.Concerns were, in addition to “Behavior and psychological symptoms” and “Understanding of symptoms and disability”, “influences on everyday life” such as “meals” and “communication”, and “support systems”including “cooperation systems” , “tiredness of staff” and “time-consuming” The study suggests that recognizing dementia is influenced by experience, and that regarding depression, which has a considerable influence on quality of life, it is important to have an understanding of dementia and to adjust the systems supporting care appropriately.