Dementia Japan 29 : 605-614, 2015 605 原著 要旨 1. はじめに 1 26 4.2 80 2 3 A survey of daycare facilities for dementia people in Japan Tohmi Osaki, Kiyoshi Maeda 1 650-0017 7-5 - 2 Medical Center for Dementia, Kobe University Hospital 7-5 - 2 Kusunoki - cho, Chuo - ku, Kobe 650-0017, Japan 2 651-2180 518 Kobegakuin University School of Comprehensive Rehabilitation 518 Arise, Ikawadani - cho, Nishi - ku, Kobe 651-2180, Japan BPSD Table 1 Table 2 3 5 2012
606 Dementia Japan Vol. 29 No. 4 October 2015 Table 1. The day care for people with severe dementia Outline Subjects Personal distribution Medical management is performed to each patient to improve the psychological symptoms and to recover the mental and physical function. Dementia patients with severe behavioral and psychological symptoms. Psychiatrists Occupational therapists Nurses Psychiatric nurses or psychiatric social workers or clinical psychologists Table 2. Day care and day service facilities in Japan Day care for people with dementia Day care for elderly Day service for elderly Day service for people with dementia Insurance Health insurance Long - term care insurance Subjects Dementia people with severe BPSD or physical illness People needed long - term care service D e m e n t i a p e o p l e needed long - term care service Personal distribution Psychiatrists Occupational therapists Nurses Psychiatric social workers Clinical psychologists Physicians Nurses Therapists OT, PT or ST Care workers Life counselors Nurses Care workers Life counselors Nurses Care workers Aims To improve the psychological symptoms and to recover the mental and physical function R e h a b i l i t a t i o n t o recover the mental and physical function Care of daily life and functional training Care of daily life and functional training Notes : BPSD=behavioral and psychological symptoms of dementia ; OT=occupational therapists ; PT=physical therapists ; ST=speech - language - hearing therapists. 23 239 2011 1 2009 ; 2006 ; 2011 ; 2008 2011 ; 2013 BPSD BPSD BPSD 2. 対象と方法 2 1 2 24 8
607 189 24 9 64 25 3 : HEB120613-6 3. 結果 189 67 : 35.4% 64 29 : 45.3% 3.1. 施設実態 71.7% 22.4% 6.0% 93.8% 25 1 1 67.2% 2 26.9% 3 6.0% 6 55.2% 5 34.3% 7 10.4% 5 6 9 1 25 1.4 2.0 1.0 3.2 19.4% 13 0.2 65 61.2% 29.9% 6.0% 92.8% 8 5 2 5 2 32.8% 8 23.9% 5 22.4% 9.0% 4.5% 7.5% 5 2/3 32.8% 41.8% 23.9% 24 6 2 1 100 3.2. 利用者実態 ± 34.5±17.7 51.4±32.6 26.2±16.1 6 10.7±7.6 6 9.4±8.5 25 102 36 66 80.4±7.8 60 96 30.3±25.1 1 138 70.0% 6.0% 5.0% 2.0% 17.0% 4.2 ±1.5 80.2% 16.8% 3 25.8% 2 21.6% 1 19.6% 4 13.4% 5 10.3% 2.1% 7.2% Figure 1 58.2% 37.8% 2.3±1.7 84.3%
608 Dementia Japan Vol. 29 No. 4 October 2015 Nursing care level 5 10.3 Nursing care level 4 13.4 Nursing care level 3 25.8 Unapplied 7.2 Support 2.1 Nursing care level 1 19.6 Nursing care level 2 21.6 Figure 1. Distribution of nursing care levels in the day care users.(%) Notes : N=102. 41.1 41.1 37.8 27.8 21.1 18.9 18.9 17.8 17.8 8.9 8.9 4.4 Figure 2. BPSD in the day care users.(%) Notes : N=102. BPSD=behavioral and psychological symptoms of dementia. 74.5% ADL 71.6% BPSD 65.7% 40.2% 26.5% Mini Mental State Examination MMSE 13.2±6.0 9.7±6.3 87.3% BPSD BPSD 41.1% 37.8% 27.8%
609 21.1% Figure 2 BPSD 32.4% 18.7% ADL 6.9% BPSD 50.5% 31.5% 18.0% ADL 33.7% 36.3% BPSD 28.4% BPSD 8.2% 36.4% 30.7% Figure 4 28.4% 4.5% 3.3. 従事する作業療法士の意識 50.0% 32.8% 21.6% 17.6% 10.8% 23.9% 49.5% 30.7% BPSD 22.4% QOL 14.9% 5.0% 14.9% ADL 6.0% 29.7% 28.7% 24.8% 16.8% 38.8% BPSD 47.5% 23.9% 28.3% 23.2% 1.0% 13.4% ADL 10.4% QOL 6.0% 6.0% 38.6% BPSD 75.5% 32.8% 56.9% 54.9% 25.4% 16.4% 51.0% 40.2% 10.4% 9.0% 4.5% 37.3% 33.3% ADL 1.5% 32.4% 6.9% BPSD Figure 3 6.9% BPSD BPSD 46.9% 51.7% 75.5 56.9 54.9 51.0 グラフタイトル 40.2 37.3 33.3 32.4 6.9 Figure 3. Non - pharmacological interventions performed in the day care. (%) Notes : N=102. ADL=activities of daily living.
610 Dementia Japan Vol. 29 No. 4 October 2015 Markedly improvement Unchanged Markedly worsened Improvement Worsened BPSD 2.0 44.9 44.9 8.2 0 Caregiver burden 2.0 30.4 39.2 28.4 0 Cognitive function 2.0 16.7 45.1 30.4 5.9 ADL 06.9 59.4 30.7 3.0 Figure 4. Changes that were compared to the time of day care start. (%) Notes : N=102. BPSD=behavioral and psychological symptoms of dementia ; ADL=activities of daily living. 41.4% 6 58.6% 4 34.5% 8 24.1% 25 ± 1.5±0.6 2.3±1.2 1.1±0.5 3.3±1.4 0.6±0.5 10.3% 72.4% 17.2% 75.9% 48.3% 44.8% 37.9% 55.2% 44.8% 41.4% 20.7% 3.4% 93.1% 72.4% 37.9% 3.4. 自由記載 66 5 4. 考察 2/3
611 1 25 6 1 7 8 2 1 2 1 3 1 51 26 10 2/3 80 4 2 8 GH 2 GH GH 1 3 70% 2013 6 4 MMSE MMSE 16.0 2009 BPSD BPSD BPSD Neuropsyatric Inventory Cummings et al., 1994 BPSD BPSD ADL ADL BPSD ADL ADL ADL 2011 BPSD 3 7 8 2013 BPSD BPSD
612 Dementia Japan Vol. 29 No. 4 October 2015 BPSD Fujii et al., 2010 5 BPSD 1 2 2008 2011 M 文献 203 2011 homepage on the Internet http:// www.mhlw.go.jp/stf/shingi/2r9852000001trya - att/2r98520
613 00001ts1s.pdf Cummings JL, Mega M, Gray K, Rosenberg - Thompson S, Carusi DA, Gornbein J 1994 The Neuropsychiatric Inventory : comprehensive assessment of psychopathology in dementia. Neurology 44 : 2308-2314 Fujii M, Ishizuka S, Azumi M, Sasaki H 2010 Hypothesis of behavioral and psychological symptoms of dementia. Psychogeriatrics 10 : 113-116 2009 24 : 609-616 2012 5 homepage on the Internet. http://www.mhlw.go.jp/stf/houdou/2r9852000002 j8dh.html 2011 22 : 245-254 2013 24 2006 35 : 333-341 2011 10 40 : 869-876 2008 19 : 35-41
614 Dementia Japan Vol. 29 No. 4 October 2015 A survey of daycare facilities for dementia people in Japan Tohmi Osaki 1 2, Kiyoshi Maeda 2 1 Medical Center for Dementia, Kobe University Hospital 2 Kobegakuin University School of Comprehensive Rehabilitation Over 50 thousands of demented people stay in mental hospitals in Japan. The average period of stay in the mental hospitals of these elderly is about 2 years. Daycare facilities are considered to be used to facilitate early discharge from mental hospitals. We conducted a survey to clarify demographics of demented elderly using daycare facilities for dementia people in Japan. The questionnaire was sent to 189 daycare facilities for dementia people in Japan, and 67 questionnaires 35.4% were sent back. Seventy % of the facilities were attached to mental hospitals. The average age of the users was 80.4 y.o. and 2/3 of the users were females. The average day to use was 4.2/week. The levels of care needed were that 25.8% was level 3, 21.6% was level 2, 19.6% was level 1 and 13.4% was level 4. Seventy % of the users were with Alzheimer s disease. The average score of Mini Mental State Examination was 13.2 and 87.3% of these people had at least one behavioral and psychotic symptoms of dementia BPSD. One third of the people were administered with at least one of various antipsychotics to manage BPSD. OTR considered that OT was beneficial to manage BPSD. Address correspondence to Dr. Kiyoshi Maeda, Department of Kobegakuin University School of Comprehensive Rehabilitation 518 Arise, Ikawadani - cho, Nishi - ku, Kobe 651-2180, Japan