布団とベット上における介護初心者と介護熟練者のおむつ交換時の腰部負担の差異

Objectives : To clarify the difference in low back load between novice and skilled caregivers in diaper changing on a futon and a bed. Methods : Agonist trunk and lower-limb muscle activity during diaper changing in 26 novice and 21 skilled caregivers was examined using a surface electromyograph attached to 8 agonist muscles, including the left and right lumbar erector spinae, rectus abdominis, vastus lateralis, and semitendinosus. 　The low back loads during diaper changes on the futon and bed were measured. 　The maximum voluntary contractions of the 8 muscles were normalized (%MVC) to compare their mean integrals between the novice and skilled caregivers on the futon and bed, and analyzed using t-tests, paired t-tests, and two-way analysis of variance. Using MyoResearch XP Software, diaper changing measurements were simultaneously videotaped to perform real-time analysis of movements and muscle activity. Results : For care time, novices took significantly longer to perform a diaper change on the futon and bed compared with skilled caregivers. The bilateral erector spinae in the novice caregivers was significantly greater on the bed than on the futon, but there was no significant difference in the rectus abdominis. In skilled caregivers, there was no significant difference in erector spinae and the rectus abdominis between the futon and bed. On the futon, no significant differences were observed in the left and right erector spinae and rectus abdominis between the novice and skilled caregivers. On the bed, the right erector spinae was significantly greater in novice compared with the skilled caregivers. For the bilateral vastus lateralis and semitendinosus, muscle activity in novice caregivers was significantly greater compared with skilled caregivers on the futon and bed. Skilled caregivers tended to maintain their posture by standing with their femora supported by the bed mattress throughout care activity on the bed. Discussion : It may be necessary for novice caregivers to acquire higher-level skills, such as creating a supporting point on the bed throughout caring activity. This will allow care activities to be performed efficiently with a reduced lumber load, while making full use of the convenience of beds and the lower height difference from caregiver to receiver.【目的】布団上とベッド上において、介護の初心者と熟練者間のおむつ交換時の介護動作 と腰部負荷の違いを明らかにする。 【方法】介護の初心者26名と熟練者21名を対象とし、表面筋電計を用いて布団上と在宅介 護ベッド上でのおむつ交換時の左右の体幹及び下肢の主動作筋活量 (腰部脊柱起立筋、腹 直筋、外側広筋、半腱様筋) を計測した。各筋の%MVC (Maximum voluntary contraction) の積分値を算出し、t 検定、対応のある t 検定、2 元配置分散分析を用いて、布団上とベッ ド上の初心者と熟練者を比較した。MyoResearch XP Softwareを用いて、筋活量と介護動 作をリアルタイムに画像分析した。 【結果】介護時間は、布団上とベッド上で、初心者の方が熟練者よりも有意に長かった。初 心者では、両側の脊柱起立筋はベッド上の方が布団上よりも有意に高かったが、腹直筋に は違いがなかった。熟練者では、脊柱起立筋と腹直筋と布団上とベッド上では違いがな かった。布団上では、左右の脊柱起立筋と腹直筋は、初心者と熟練者では違いがなかった。 ベッド上では、右の脊柱起立筋は初心者の方が熟練者よりも有意に高かった。両側の外側 広筋と半腱様筋は、布団上とベッド上で、初心者の方が有意に高かった。熟練者は、ベッ ド上での介護時は常に大腿部でマットレスに支点を作っておむつ交換をしていた。 【考察】布団上では、介護初心者は習得した介護を実践しやすかったと示唆される。ベッ ド上での介護時は、ベッドの利便性と要介護者との高低差が少ないことを活用して、常に ベッドに支点を作って介護する技術の習得が必要である。Thesis of Kyota Kaoru / 京田 薫 博士論文 金沢大学医薬保健学総合研究科（保健学専攻

介護老人保健施設における排便ケアシステムの構築を目指した介入

This study was conducted to evaluate the construction of a system for defecation care in long-term care health facilities. Two intervention programs were undertaken, one each for Facility A and Facility B. In both Programs A and B, fecal assessment using the Bristol Stool Scale (BSS) was introduced, and a defecation care leadership development workshop helped staff members to develop a defecation care improvement plan. In Program B, researchers also performed in-house education for 6 months after the workshop to support the defecation care improvement plan. The results were evaluated 1 year after the initiation of the programs. The feces changed from soft or hard to normal in 29.5% of residents in Facility A (Program A) and in 48.3% of residents in Facility B (Program B). The level of resident satisfaction increased significantly in both facilities. There was a significant increase in the number of residents not receiving stimulant cathartics, and the total amount of cathartics used decreased significantly in both facilities. In Program B, all the defecation care improvement plan goals were achieved, and there was a high rate of implementation of defecation assessment by staff. In Program A, some of the defecation care improvement plan goals were not achieved. It is suggested that the promotion of workshops for training defecation care leaders would improve the quality of defecation care. We also confirmed the efficacy of in-house training following the workshops, for the construction of a system for defecation care. 本研究の目的は、施設における排便ケアシステムの構築を目指した介入を行い、その効果を評価することである。施設内において排便ケアシステムを構築するため、２つのプログラムを作成した。２つのプログラムは、Ａ施設またはＢ施設のそれぞれで実施した。プログラムＡは、The Bristol Stool Scaleを用いて便の性状をアセスメントして便通コントロールをする能力、および排便ケアリーダーが排便ケア改善計画を立案して実施し、評価する能力の育成のため、６ケ月間の研修会を実施した。プログラムＢは、研修会後も引き続き６ケ月間、施設内における排便ケア改善計画の実施を支援するための組織内教育を加えた。Ａ施設はプログラムＡ、Ｂ施設はプログラムＢの対象とした。２つのプログラムの効果は１年後に評価した。入所者の便の性状は２つのプログラムとも１年後に有意に変化しており、軟便または硬便から普通便に改善した者の割合は、プログラムAが２９.５％、プログラムBが４８.３％だった。入所者の満足度は２つのプログラムとも有意に高くなった。２つのプログラムとも刺激性下剤を使用しない者の割合は有意に増加しており、施設全体の緩下剤の使用量は有意に減少した。プログラムＢは、以上の成果に加えて、スタッフの排便アセスメントの実施度は有意に高くなり、排便ケア改善計画の目標のすべてを達成した。しかし、Ａ施設では目標の一部が達成できなかった。以上の結果より、研修会により、スタッフの便の性状のコントロール能力の向上の効果が示唆された。さらに研修会後に組織内教育を行なうことで、施設内の排便ケアのシステムの構築における有効性が示唆された。Thesis of Sakakibara, Chiaki / 榊原 千秋 博士学位論文(金沢大学 / 大学院医薬保健学総合研究科

在宅における夜間介護が介護家族の心身に及ぼす影響

目的在宅における夜間介護が家族の血圧動態と疲労感に及ぼす影響を明らかにする。方法睡眠中断時の血圧動態の基礎研究を行った上で、了解を得た家族介護者80名の血圧と疲労感を分析した。方法は、24時間血圧日内変動測定(携帯用血圧モニタシステム:米国SpaceLabs社製ABP90217)、24時間活動量測定(Actigraph:米国A.M.I社製MicroMini型)より睡眠・覚醒判定、主婦用蓄積的疲労徴候インデックス調査、自記式行動調査、面接調査を行った。分析は、降圧剤内服の有無別に性と年齢を考慮して夜間介護者(夜間群)と日中介護者(日中群)間の血圧と疲労感を比較した。さらに睡眠状況と血圧の関係を分析した。結果1.非内服者の2群の比較:夜間群29名(女22名、62.0±10.0歳、就床7.4±1.2時間,覚醒2.2±1.5回、夜間実睡眠6.1±1.2時間、熟睡感無し55.2%)、日中群27名(女25名、63.3±11.1歳、就床6.5±1.6時間、覚醒0.6±0.7回、夜間実睡眠5.9±1.4時間、熟睡感無し18.5%)であり、夜間の就床時間、覚醒回教、熟睡感に差がみられた。収縮血圧の夜間降下値は、夜間群21.4±、12.9mmHg、日中群22.0±10.5mmHg、拡張血圧は夜間群14.9±8.1mmHg、日中群16.5±7.9mmHgであり、差はみられなかった。高血圧要治療者として夜間群8名と日中群9名を確認した。2.非内服女性の2群の比較:血圧に違いはみられなかった。3.内服者24名の2群の比較:血圧に違いはみられなかった。4.女性の疲労感の2群の比較:夜間群の方が訴え率は低かった。5.睡眠状況と血圧:夜間の実睡眠時間と覚醒回数に血圧との関係がみられた。結論夜間介護による血圧と疲労感への影響は明らかにならなかったが、睡眠状況による影響が示唆された。Objective : This study investigated effects of nighttime home-care on the blood pressure and sense of fatigue of care-providing family members.Methods : After a basic study of changes in the blood pressure with sleep interruptions, 80 care-providing family members were investigated using 24-hour ambulatory blood pressure, sleep-awake judgments by an Actigraph, the Cumulative Fatigue Symptoms Index-Housewife questionnaire, and a self-recording of activities. These were compared between nighttime care-providers(nighttime group) and daytime care-providers(daytime group) separately in those who were receiving depressor medication(medicated group) and those who were not(non-medicated group) according to the gender and age. The relationship between the state of sleep and blood pressure was also analyzed.Results : 1.Comparison in non-medicated subjects : The non-medicated subjects were 29 nighttime care-providers(22 females, age 62.0±10.0 years) and 27 daytime care-providers(25 females, age 63.3±11.1 years). Differences were observed in the time spent in bed, frequency of awakening, and percentage of subjects who complained of not having slept well. No difference was observed in the blood pressure. Hypertension that needed treatment was observed in 8 in the nighttime group and 9 in the daytime group. 2.Comparison in non-medicated females : No difference was observed in the blood pressure. 3.Comparison in 24 medicated subjects : No difference was observed in the blood pressure. 4.Comparison of the sense of fatigue in females : The sense of fatigue was weaker in the nighttime group. 5.State of sleep and blood pressure : The actual time of sleep and frequency of awakening were related to the blood pressure.Conclusions : No effect of nighttime care on the blood pressure or the sense of fatigue was found, but effects of the state of sleep were suggested.研究課題/領域番号:12672264, 研究期間(年度):2000-2003出典：「在宅における夜間介護が介護家族の心身に及ぼす影響」研究成果報告書　課題番号12672264(KAKEN：科学研究費助成事業データベース（国立情報学研究所）)　　　本文データは著者版報告書より作

地域在住の高齢者において介護の有無が避難行動の意向に及ぼす影響

本研究は、自身の意思で避難所または自宅待機を選択して避難することが可能な地域在住 の高齢者において、災害時の避難指示に対する避難行動の意向（自宅に居たい、避難所に移 動したい）とその影響要因を明らかにして、介護の有無がその意向に及ぼす影響について分 析することを目的とした。介護保険サービスを利用している24 人と利用していない61 人の 計85 人（平均年齢：77.7 歳、女性：81％）を対象として、避難行動の意向、防災意識、防災 行動に関して聞き取りによる質問紙調査を実施した。居住地域における災害の危険性を知っ ている者は79%、内服薬・お薬手帳を常備している者は51%、避難所・避難経路を確認した ことがある者は73%、発災時の家族との連絡方法を考えている者は69% だった。避難指示 が発令した際、自宅に居たいという意向の者は35%、避難所に移動したいという意向の者は 65％であった。介護保険サービスの利用者の方が利用していない者より、自宅に居たいとい う意向に影響していた。居住地域における災害の危険性を知らない者の方が知っている者よ りも自宅に居たいという意向に影響していた。また、介護保険サービスの利用者の方が利用 していない者よりも、地域の防災訓練への参加者の割合が低かった。以上のことから、介護 の有無が避難行動の意向の影響要因の一つであることが示されたが、それぞれの意向に影響 する要因は明らかにならなかった

在宅における夜間介護と家族の血圧動態と疲労に関する多角的および縦断的研究

本研究は,夜間介護が家族介護者の血圧動態と疲労に及ぼす影響を明らかにすることを目的として,100名の家族介護者の24時間睡眠状況,24時間血圧日内変動,および疲労感の実態を明らかにして,これらの関係性を分析した。また,影響要因を明らかにするため,要介護者の24時間睡眠状況と同一者の追跡調査を行った。その結果,高齢の家族介護者は,降圧剤内服の有無にかかわらず血圧管理が重要であることが明らかになった。特に,女性介護者の降圧剤の非内服者で血圧値が高い者と降圧剤の内服者において,睡眠状況と血圧動態・疲労感との関係性が示唆され,適切な睡眠の確保が必要であると考える。家族介護者と要介護者の24時間の睡眠状況を同時に測定した結果,家族介護者の睡眠は要介護者の睡眠の影響が大きいことが示唆された。したがって,要介護者が適切な睡眠を確保できるように睡眠環境を整えていくことが大切であると考える。家族介護者の3年後は,日中の仮眠時間と24時間の睡眠時間が長くなっていた。特に,3年後に介護していなかった者においては疲労感が軽減していた。これらのことから,疲労感の軽減は,加齢のため睡眠時間を長くとるようにしたことに加え,介護役割がなくなったことによる影響が考えられる。夜間介護で最も多いおむつ交換の介護動作時の身体負荷を明らかにする方法を確立するため,筋電計を用いたパイロットスタディを行った。本研究方法により,介護動作と動作時の血圧動態を測定することが可能であることが示唆された。今後,さらに各事例の詳細な分析と縦断調査を継続するとともに,介護動作時の身体への負荷と介護環境から受ける影響について調査し,要介護者だけでなく,家族介護者の心身の健康を維持できる在宅での介護方法を明らかにしていきたい。To clarify the influences of nighttime care on blood pressure and fatigue in family caregivers, we evaluated the 24-hour sleep status, diurnal changes in blood pressure, and chronic fatigue in 100 family caregivers, and analyzed their association. To clarify influential factors, the 24-hour sleep status in caregivers was evaluated, and a follow-up survey was performed.The results of our study showed the importance of blood pressure control in aged family caregivers irrespective of the use of antihypertensive drugs. In particular, in female caregivers with high blood pressure either using or not using antihypertensive drugs, there were associations between the sleep status and changes in blood pressure/ fatigue, suggesting the necessity for adequate sleep.The sleep status of family caregivers and that of people with care needs were evaluated by simultaneous measurement. The sleep status in the family caregivers was markedly affected by that of people with care needs. Therefore, the slee p environment should be improved so that people with care needs can get adequate sleep.After 3 years, the sleep time during the daytime and that during the 24-hour period increased in the family caregivers. In particular, fatigue decreased in the family caregivers no longer giving care after 3 years. These results suggest that the decrease in fatigue in the caregivers is due to their efforts to sleep more because of aging and the disappearance of their care role.To establish a method of clarifying the load of care motion on the body during a change of diapers, a pilot study using an electromyography was performed. The results suggested that the measurement of changes in blood pressure during care motions is possible by the method used in this study.In the future, we will continue to perform detailed analysis of each case and a longitudinal survey, investigate the load of care motions on the body and the influences of the care environment, and clarify care methods at home that allow the maintenance of the physical and psychological health of not only people with care needs but also their caregivers.研究課題/領域番号:16592197, 研究期間(年度):2004-2006出典：「在宅における夜間介護と家族の血圧動態と疲労に関する多角的および縦断的研究」研究成果報告書　課題番号16592197 (KAKEN：科学研究費助成事業データベース（国立情報学研究所）)　　　本文データは著者版報告書より作

The impact of sleep on ambulatory blood pressure of female caregivers providing home care in Japan: An observational study

金沢大学医薬保健研究域保健学系Background: Elderly family caregivers are presumed to be susceptible to having various health problems. However, biomedical indicators of health in these caregivers are rarely examined. Objective: To examine the effect of sleep quality, measured by hours of sleep and the number of times leaving bed, on various blood pressure parameters in elderly caregivers. Design: Observational study. Setting: Northern Japan. Participants: Seventy-eight female family caregivers. Methods: Ambulatory blood pressure was monitored at 30-60-min intervals for a 24-h period. An actigraph was used to determine sleep/wake status. Face-to-face interviews were conducted to obtain home care and demographic information, and self-administered questionnaires were used to collect information on activities in a 24-h period. Results: The mean age of the caregivers was 62.5 ± 9.6 years, and the mean hours of sleep were 7.3. Out of 78 caregivers, 19 were on antihypertensive medication. Of the remaining 59, this study found 45.8% to be hypertensive, with the mean maximum systolic pressure exceeding 180 mmHg. The hours of sleep at night and for the 24-h period were inversely associated with the mean systolic blood pressure. The majority of caregivers on antihypertensive medication also had high blood pressure. Conclusions: This study suggests the importance of 24-h ambulatory blood pressure monitoring for elderly caregivers, so as to screen for hypertension as well as to monitor the effectiveness of antihypertensive medication. © 2008 Elsevier Ltd. All rights reserved.This article has not been published yet

家族介護者の睡眠と血圧日内変動と疲労感の追跡調査

: We prospectively followed family caregivers to examine changes in sleeping patterns, ambulatory blood pressure, and fatigue status three years after the initial survey. : 67 family caregivers who enrolled in the first survey conducted between 2001 and 2004. : We asked the participants to enroll in the follow-up survey by mail. We interviewed care condition and asked to write self-reported activity recording for those who gave the written informed consent. An actigraph was used to determine sleep status and ambulatory blood pressure was monitored for 24-hour period. The Cumulative Fatigue Symptoms Index-Housewife was used. The research proposal was approved by the ethics committee of the faculty of Medicine, Kanazawa University. : The changes in the first and second survey results were tested by the Wilcoxon matched-pairs signed-ranks test according to presence of continuation of home care. : Of 67 eligible participants, 66 were alive. Of those, two were hospitalized, and 24 remained as primary caregivers. Thirty-three participants agreed to enroll in the second investigation. Fourteen participants continued home care and 19 ceased to provide care because of the death or hospitalization of care receivers. Of 14 caregiving participants, no significant changes were found for sleep status, blood pressure measurements, and fatigue status although the number of participants with hypertensive treatment increased by two. In 19 non-caregivers group, nap time in the daytime became significantly longer and the mean duration of nap increased by 54 minutes, and chronic fatigue was relieved significantly. No significant changes in the blood pressure measurements were detected although additional two people were under hypertension medication. : This study did not show any clear difference of health condition between those continuously engaged in home care and those who had discontinued giving care. In the 19 former caregivers, the daytime nap time was significantly increased with a reduction in the feeling of fatigue. These results may be attributable to the cessation of home care. : The cessation of caregiving activities led to increased nap time and contributed to the reduction of chronic fatigue. The increasing number of participants with hypertensive treatment suggests additional care is necessary for aging participants, especially for those continue to provide care.【目的】介護を長期間続けることによる心身への影響を明らかにするため、家族介護者の３ 年後の転帰と、同一者の３年後の睡眠、血圧日内変動、および疲労感の追跡調査を行った。 【対象】2001年から2004年に行った初回調査から３年経過した家族介護者67名。 【方法】対象者の転帰を郵送で調査し、再調査を依頼した。書面での同意を得た者に対し介 護状況に関する面接調査と24時間自記式行動調査を行った。Actigraphにより24時間の睡 眠時間を測定した。携帯型無拘束間接型血圧装置により24時間の血圧変動を測定した。疲 労感は The Cumulative Fatigue Symptoms Index-Housewifeより調査した。 【分析】初回調査と追跡調査の比較は、在宅介護の継続の有無別に、事例ごとに対応した Wilcoxon符号付き順位検定を行った。 【結果】家族介護者67名の３年後の状況は、66名が生存しており、そのうち２名は入院、在 宅介護を継続していた者は24名だった。64名中、追跡調査に同意した者は33名だった。そ のうち在宅介護を継続していた者が14名、要介護者の死亡や入院により介護していなかっ た者が19名だった。在宅介護を継続していた14名の初回調査と追跡調査の結果を比較した 結果、睡眠時間、血圧、疲労感には有意差がみられなかった。３年後の降圧剤内服者は２ 名増えて８名だった。介護していなかった19名は、３年後の方が日中の仮眠時間が有意に 長く平均54分増えており、疲労感が有意に軽減していた。血圧には有意差がみられず、内 服者は２名増えて８名だった。 【考察】本研究では、在宅介護継続者と介護を継続していなかった者との間に健康状態の有 意な差は認められなかった。介護を中断していた19名は、日中の仮眠時間が有意に長く疲 労感が軽減していた。このことは在宅介護を継続していなかったことに起因すると考えら れる。 【結論】介護の中断は、仮眠時間が増えて疲労感の軽減に貢献することが示唆された。高血 圧の治療者数の増加は、加齢、とくに在宅介護を継続していくためには、高血圧の治療の 追加が必要であることを示していると考える。[原著:Originals

Supply of goods from hospitals to outpatients practicing intermittent self-catheterization in Japan

Hospitals supply goods to patients practicing intermittent self-catheterization (ISC), yet procedures for distribution have yet to be standardized, making it difficult to track the types of goods that are shipped and their amounts. The aim of this study was to standardize the types and amounts of goods provided by medical facilities on the basis of the survey results. We conducted a survey of medical facilities and patients regarding the status of goods supplied for ISC. Data were collected from January to May 2010 from 5 outpatient urology clinics and 26 patients practicing ISC. The first finding of this research is that the amount of supplied goods was insufficient and part of the supply method was incorrect. The second is that the status of goods supplied changed not only with ISC, but also with hospital characteristics. The third is that hospital costs averaged $63·10; the supplied catheter number affected hospital costs. Patient costs per month averaged$26·50, clearly showing that patients experience an economic burden. Patient costs were high in cases in which the percentage of types of goods supplied was low. A researcher analysed survey data to determine issues and procedures relevant to the supply of goods. The study showed a need to develop an optimal supply system for ISC patients and identified issues in the current system in Japan that require resolution. © 2012 The Authors. International Journal of Urological Nursing © 2012 BAUN & Blackwell Publishing Ltd

日本のケアマネジャーにおける認知症の行動・心理症状のケアマネジメントに影響を与える要因

Aim: The aim of this study was to clarify the actual status of management of triggers ofbehavioral and psychological symptoms of dementia (BPSD) among care managers andthe factors that affect the implementation of management.Methods: An anonymous self-administered questionnaire was conducted for care managersfrom 4000 in-home long-term care support providers throughout Japan. The followingitems were surveyed: gender, basic qualifications, years of work experience with basicqualifications and care manager, cognitive symptoms, underlying illness and physical andmental conditions, living ability, living environment, social participation and life history,precautions when creating care plans, and difficulties in support. Univariate analysis wasconducted according to whether the management of BPSD triggers was implemented.Binary logistic regression analysis was conducted with the items that showed significantdifferences as independent variables, and the implementation of trigger management as thedependent variable.Results: An analysis was conducted on 832 care managers with the basic qualifications ofa certified care worker and nurse. Of these, 430 (53.6%) managed triggers, while 402 (46.4%)did not. Compared to those who didn’t manage triggers, a significantly higher percentageof those who did manage triggers assessed their cognitive symptoms, physical and mentalstatus, living ability, living environment and social participation, and adopted precautionswhen creating care plans. Factors affecting the implementation of trigger managementincluded the patient’s strengths, connection with local residents, promotion of familymembers’ understanding of dementia, consideration of abuse prevention, cooperation withdoctors, and basic qualifications.Conclusions: Half of the respondents implemented trigger management, which wasaffected by the list of precautions when creating care plans, and basic qualifications.Promoting care plans that include support, which increases the self-efficacy of peoplewith dementia, building stable relationships with local residents and family members,and cooperation with doctors, may lead to the implementation of trigger management. Inparticular, the necessity of promoting trigger management among certified care workerswas suggested

A foot-care program to facilitate self-care by the elderly: A non-randomized intervention study UMIN000029632 UMIN

金沢大学医薬保健研究域保健学系Objective: We aimed to evaluate a foot-care awareness program designed to improve foot morphology, physical functioning, and fall prevention among the community-dwelling elderly. Eleven independent community-dwelling elderly women (aged 61-83 years) were provided with foot-care advice and shown effective foot-care techniques to perform regularly for 6 months, and compared with a control group of 10 elderly women who did not receive any intervention. Measurements of foot form, functional capacity, subjective foot movement, and physical function were taken at baseline and 6-month follow-up. Results: At follow-up, improvements were seen in the intervention group in foot morphology, subjective foot movement, foot pressure, and balance. In the intervention group, 90% of women had maintained or improved foot form and none of them had fallen during the post-intervention period, compared to the control group where 30% improved foot form (p = 0.0075) and four (40%) of them had fallen. Therefore, a foot-care program may have the potential to prevent falls and improve mobility among the elderly. Trial Registration UMIN-CTR No. UMIN000029632. Date of Registration: October 19, 2017 © 2017 The Author(s)