腰部負担軽減を考慮した要介護高齢者のおむつ交換技術の開発

金沢大学医薬保健研究域医学系【目的】本研究は、腰部負担軽減を考慮した要介護高齢者のおむつ交換技術の開発を目的としている。最終年度は、ベッドの高さ調整と2種類の作業姿勢活用による腰部負担の軽減効果を検証した。【方法】1.対象:被験者は研究協力の得られた看護・介護職13名(平均年齢32.2±5.4歳,平均身長159.5±5cm,平均体重52.6±6.7kg)。要介護者モデルは寝たきり度C2を想定した看護大学院生1名(身長156cm,体重57.5kg)。2.測定方法:3次元動作解析、筋電図解析、主観的評価などの測定指標を用い、2種類のベッドの高さ(50cmと60cm)と作業姿勢(床面に両足を設置した姿勢とベッド上に片膝を乗せる姿勢)による腰部負担への軽減効果を検討した結果、以下の知見を得た。【結果】1.おむつ交換全工程では、ベッドの高さ50cmに比べ60cmで、上腕二頭筋%MVCが7.1%、体幹前傾角が19.5%、椎間板圧縮力が9.1%、腰部最大トルク比が3.8%と有意に減少し、腰部負担軽減が示された。2.おむつ交換各工程では、僧帽筋%MVC、上腕二頭筋%MVCに工程間の有意な差を認めた。上腕二頭筋%MVCは、「eズボンを上げる」が「bおむつを開く」、「cおむつを換える」、「dおむつを閉じる」に比べ有意に高く、腰部負担増加に影響した。3.おむつ交換全工程において、体幹前傾角は、身長差に関わらずベッドの高さ50cmに比べ60cmで腰部負担の有意な減少を認めた。一方、膝乗せ時の6動作において、体幹前傾角は、身長差に関わらずベッド50cm、膝乗せ姿勢、ベッド60cmの順に腰部負担の有意な軽減を認めた。以上より、腰部負担軽減を考慮したおむつ交換技術としてベッドの高さ調節や膝乗せ姿勢の活用が効果的であることが立証された。今後は繰り返しによる累積的負担を検証する研究の必要性が示唆された。研究課題/領域番号:17791673, 研究期間(年度):2005 – 2007出典：「腰部負担軽減を考慮した要介護高齢者のおむつ交換技術の開発」研究成果報告書　課題番号17791673（KAKEN：科学研究費助成事業データベース（国立情報学研究所））（https://kaken.nii.ac.jp/ja/grant/KAKENHI-PROJECT-17791673/)を加工して作

Foot problems and falls in elderly

Objective : We aimed to examine foot problems in community-dwelling elderly and assess the relationship between foot care and physical capacity/falls. Methods : The subjest were １０５ elderly （mean age ７４．６±６．３ years）who were self-sufficient in their daily lives. Participants completed a questionnaire survey regarding foot problems, foot care, and falls, and we measured primary risk factors for falling, which included walking capacity, muscle strength, and balance capacity. Results : １. We found that ６１．０％ of participants had foot problems including calluses （４３．８％）, hallux valgus （４０．６％）, trichhophytosis （３７．５％）, among others. Many subjects reported neglect of their problems or self-treatment. Approximately ８０％ of subjects, regardless of whether they had foot-related problems or not, reported that they washed their foot, and approximately half did foot exercises. The group with foot problems was more participants in this group reported a habit that was observed the foot （p＜０．０５）. ２. The group with foot problems demonstrated a slower walking speed （p＜０．０５） compared to the group without foot problems, but no significant difference was observed in balance capacity and muscle strength between groups. The group with foot problems was more likely to have experienced a fall, and more participants in this group reported stumbling tendencies （p＜０．０５）. The majority of participants in both groups reported “stumbling” as the reason for their falls, but the type of surface on which the fall occurred varied. Most participants with foot problems reported falls on level surfaces, while those without foot problems fell on uneven surfaces. Fall-induced injuries were common in the group with foot problems （p＜０．０５）. Discussion : Approximately ６０％ of community-dwelling elderly have foot problems. The association between foot problems and falls suggests that interventions for foot problems may prevent falls

おむつ交換作業におけるケアスタッフの腰部負担に関する生体力学的評価

取得学位 : 博士（保健学）, 学位授与番号 : 医博甲第1943号 , 学位授与年月日 : 平成20年3月22日, 学位授与大学 : 金沢大学, 審査結果の報告日 : 平成20年2月18日, 主査 :泉 キヨ子 , 副査 :長谷川 雅美, 城戸 照

高齢者施設におけるケアスタッフの夜勤帯の連続する排泄介助に伴う腰痛に関する研究

金沢大学医薬保健研究域医学系昨年度は,高齢者モデル4人を連続しておむつ交換した結果,人数を重ねるごとに腰部前傾角度が減少し,所要時間が増加する変化が腰痛歴のある1名にみられた.今年度は,夜勤帯の連続したおむつ交換として10人を想定し,4人連続との違いについて検討した.1.対象:被験者は,研究協力の得られた高齢者のおむつ交換に熟練し,腰痛歴のある看護師.高齢者モデルは,研究に同意し寝たきりランクC2を想定した看護学生.2.方法:被験者は,通常用いる作業姿勢で高齢者モデルを10回連続しておむつ交換した.腰部前傾角度は,光ベルコム製関節角度測定センサー(DIANGLE)を用いて測定した.体幹前傾・膝屈曲角度は,デジタルビデオカメラを用いて撮影し,動作解析ソフト(Bless Pro)で解析した.主観的な反応として,1回ごとに負担の有無・部位・内容などを確認した.1.腰部前傾角度は,67.6度から62.5度と4人目までは平均角度が減少した.しかし徐々に増加して6人目68.4度をピークに再び減少し,8-10人目に約65度を維持した.2.体幹前傾角度は,53度から64.9度へとゆるやかに増加した.同様に膝屈曲角度も148度から168.2度へとゆるやかに増加した.3.主観的な反応として,1人目から腰部の痛み,4・5人目から背中に広がる痛み,8人目以降には下肢後面の痛みがみられた.その反面,「背中を伸ばせば楽になる」とし,終了後には,「腰は痛いけどまだやれる.座ったら楽になる」と述べた.今回を通じて,連続4人目以降10人目までのおむつ交換は,回数を重ねるごとに身体を起こし再び前傾姿勢を保つこと,また,膝関節や下腿の筋群に力を入れて腰部負担を軽減していると考えた.そのため,角度だけでなく,筋電図等の指標と一緒に捉える必要性が示唆された.研究課題/領域番号:15791341, 研究期間(年度):2003 – 2004出典：「高齢者施設におけるケアスタッフの夜勤帯の連続する排泄介助に伴う腰痛に関する研究」研究成果報告書　課題番号15791341（KAKEN：科学研究費助成事業データベース（国立情報学研究所））（https://kaken.nii.ac.jp/ja/grant/KAKENHI-PROJECT-15791341/)を加工して作

Development of the salt-reduction and efficacy-maintenance program in Indonesia

We conducted a randomized, controlled trial to examine the effects of a salt-reduction and efficacy-maintenance program on the improvement and maintenance of self-care and self-efficacy in reducing the salt intake of older people with high blood pressure. A total of 51 participants with hypertension/prehypertension in Indonesia were randomly assigned to a control group or one of two intervention groups: salt-reduction training or salt-reduction and efficacy-maintenance. The salt-reduction and efficacy-maintenance group received educational training and a maintenance meeting; the participants\u27 knowledge, attitudes, self-care practices, and self-efficacy significantly improved after training and were maintained after the maintenance meeting. Participants in the salt-reduction training group showed significant effects for the same variables; however, their food salt concentrations rebounded after the maintenance meeting. No significant improvement was found in the control group. The salt-reduction and efficacy-maintenance group participants reported positive effects of salt reduction and different practices based on who prepared their meals. The salt-reduction and efficacy-maintenance group program was effective in improving and maintaining knowledge, attitudes, and self-efficacy of salt-reduction practices and could be applied with community-dwelling older people with high blood pressure. © 2016 John Wiley & Sons Australia, Ltd.Embargor Period 12 month

特別養護老人ホームの入所高齢者への音楽提供の現状:全国横断調査

Background: Music activities enhance residents’ enjoyment and adaptation to nursinghomes. Community music therapy promotes human relationships and a pleasant livingenvironment. However, there have been few comprehensive studies focusing on theconditions of music provision. The aim of this study was to identify the conditions,problems, and staff recognition of the effects of music provision to improve its use innursing homes through music therapy, music activities, and the concept of communitymusic therapy based on a nationwide cross-sectional survey. Method: An anonymousquestionnaire was mailed to a total of 517 randomly selected nursing homes. Questionscollected data on demographic characteristics; the planners and providers of music;objectives/ways/evaluation of music provision; respondents’ recognition of the effects ofmusic; and conditions of music activity training. We divided the respondents into musictherapy, music activity, and no music groups. Pearson’s chi-square test, Fisher’s exact test,and the Kruskal-Wallis test were used to identify differences in demographics and staffrecognition among the three groups. Among the results with significant differences, theitems of continuous variables were analyzed using the Steel-Dwass test, and the items ofthe chi-square test were further analyzed using residual analysis. Results: We collecteda total of 96 completed questionnaires. Music therapy or music activity was provided by80.2% of nursing homes. Around 50% of the nursing homes that provided music therapyhad a music therapist as a planner and provider. Care workers were most often theplanners and providers. The rate of evaluation of music provision was approximately 10%-30%. The recognition of “increased staff intimacy with residents” was significantly lowerin the no music group among the three groups in residual analysis (p<0.05), and wasapproximately 30% less than in the music activity group. Only 6.3% of the nursing homesprovided music activity training. Conclusions: The findings of the present study suggestedthat while promoting the cultivation of music therapists, education of staff in musicactivities should be developed

特別養護老人ホームの介護職員を対象とした音楽活動教育プログラムの開発 －音楽療法士と介護職員からの評価－

Background: The provision of music in nursing homes is related to the quality oflife of residents. Care workers should provide appropriate music for residents even ifmusic therapist is not available. In addition, music provision assimilating the conceptof community music therapy is important to provide well-being by improving humanrelations. This study was performed to develop a music activity training program for careworkers adopting the concept of community music therapy, based on prior research, suchas learning theory, and to evaluate its reliability, validity, and feasibility.Method: The reliability and validity of the program were investigated using an anonymousquestionnaire by five music therapists for senior adults. Music activity training was givento 17 care workers, and the effects of the program were investigated using the anonymousquestionnaires.Results: In the evaluation by music therapists, all most intraclass correlation coefficientswere ≥ 0.8. Without music experience, the feasibility was consistently considered low. Aftermusic activity training, there was a significant reduction in number of care workers whothought that “the number of people who can provide musical activities is limited,” and thedegree of understanding of the concept of community music therapy increased significantly(p < 0.05).Discussion: The evaluation results of the care workers and music therapists indicated thatthe content of the program was valid and it was deemed feasible. While care workers’knowledge and confidence regarding music activity increased slightly, it will be necessaryto adjust the content of the program and add music activity practices

開発モデルにおける糖尿病高齢患者の家族介護者の介護負担要因の検討

The present study aimed to examine the factors contributing to burden among family caregivers of older adults with diabetes mellitus (DM), with regard to the characteristics of older adults as well as those of caregivers, caregiving self-efficacy and caregiver behavior toward diabetes support and social supports based on a conceptual development model. In total, １5１ family caregivers who were children or spouses responded (9３.8%). In this cross-sectional study, primary family caregivers were personally interviewed using a set of anonymous structured questionnaires for data collection from one hospital in Northern Vietnam. We examined the factors contributing to caregiver burden via linear regression analysis and pathway analysis. Most family caregivers were under 60 years old (66.9%) and female (７４.２%). Linear regression analysis indicated that family caregivers with chronic illness status (β = .２0), the number of hours of caring for older adults (β = .１5), self-efficacy (β =－.１6), and caregiver behavior toward DM care support (β =－.３9) were all significant factors contributing to caregiver burden (F = １0.３95, p < .00１, AdjR２ = .４１). Pathway analysis showed that chronic illness status was a significant direct predictor of caregiver burden, whereas the number of hours of caring for older adults both directly and indirectly predicted caregiver burden via mediators including self-efficacy and caregiver behavior toward DM care support (χ２ = １.0２１, df=１, p = .３１２, CFI = １.000, GFI = .99７, SRMR =.000, and RMSEA = .000). The characteristics of caregivers and their responsibility for older adults should be considered to decrease the burden of caregivers. Nursing intervention, social support, increased self-care and the acquisition of caregiving knowledge and skills might help in reducing family caregiver burden