要支援高齢者のためのIADL向上プログラムの評価と開発

作業療法では脊髄損傷者や脳卒中後遺症者などの身体障害者にIADLのアプローチの報告はあるが、心身機能障害のない高齢者での文献はない。本研究の目的は、高齢に伴う廃用症候群でIADLが低下した要支援１、２の者を対象に、困難なIADLの共通因子を分析し、IADLの向上を図るプログラムを立案し、実施し、評価した。Ａ県、Ｓ市、Ｋ市で研究協力の得られた訪問介護サービス事業所を対象に、要支援１、２ の６０８名のIADLを訪問介護で主に援助している家事を家事実施チェック表により調査し、因子分析を行った結果、第１因子「協調性・巧緻性」、第２因子「移動・運搬」、第３因子「上肢の動き」、第４因子「握力やつまみ力」の４つの家事困難共通因子が読みとれた。それらの因子に対応したIADLエクササイズと基本的動作からなる基礎的運動プログラムの２つのIADL向上のためのプログラムを立案し、訪問介護利用者９名、通所介護８名を対象に３ヶ月、２０～３０ 分の介入を行った。訪問介護では、身体活動量と各因子に対応した家事実施チェック表によるIADL項目に有意な改善がみられた。通所介護では、階段昇降、屋外移動などの基本的ADLや身体計測値に特に変化がなかったが、IADL評価項目に改善があった。本プログラムの有効性を明らかにするために、対象者を増やし、対照群を設定し、介入を行う必要性があると考えられた。 Ȁ Instrumental Activity of Daily Living (IADL) has been reportedly performed as part of occupational therapy for patients with physical disabilities such as those with spinal cord injuries and stroke sequelae. However, there are still no reports in the literature regarding the application of IADL to the elderly without psychosomatic disorders. This study aimed to (1) analyze common difficult household work factors among elderly people certified as on support level 1 or 2 (the Japanese nursing-care insurance system at a previous stage) whose IADL decreased because of disuse syndrome, (2) prepare a program to improve IADLs, and (3) perform and (4) evaluate such a program. IADLs were studied using a household work checklist in 608 elderly people certified as on support level 1 or 2 who visited home-visit care centers in S city and K city, A prefecture, and then factor analysis was performed. The results demonstrated 4 common factors causing difficulty in household work, namely, “motor coordination/ skill movement”(first factor), “ambulation/ carrying”(second factor), “upper limb movement” (third factor), and “grip strength and pinch strength”(fourth factor). Therefore, two kinds of IADL improvement programs were prepared, including exercise specific for IADLs to address these factors and a basic exercise program containing basic actions. The intervention program was performed for 20 to 30 minutes per session over 3 months in 9 elderly people who visited the home-visit care centers and 8 elderly who had to commute for care. The IADL items in the checklist of household work regarding chairs stand and the above-mentioned factors were significantly improved in those who visited home-visit care centers. On the other hand, the IADL items were improved in those who had to commute for care ; however, there were no significant changes in basic ADLs such as stair climbing and walking outside, or body measurements. More subjects and a control group are needed in future studies to confirm the efficacy of this program