36 research outputs found
ロートを用いた客観的な簡易とろみ評価方法の開発
Some patients with dysphagia are prone to aspiration of low-viscosity liquids. Thickened liquids are often used in attempts to prevent aspiration. The patients should be given thickened liquids with suitable thickness, and the thickness should be constant at all time. While rotational and cone-and-plate viscometers are used for the evaluation of thickened liquids, they are high-precision and expensive equipment. To control the thickness of liquids, a simple and objective evaluation method is thus necessary. We developed a method to evaluate thickened liquids using funnels, and verified the appropriateness of this method. We measured the outflow times of five thickened liquids through funnels. One of the thickened liquids was a commercially available nutritional supplement, another was made with a thickening agent that contained guar gum, and all others were made with a thickening agent that contained xanthan gum. Four funnels with different stem sizes were tested. We found that the outflow time of thickened liquids through a funnel depended on their viscosities at a shear rate between 10 and 50 s–1, when the average inner diameter of the stem was in the range of 5.3–9.0 mm, and the volume of the liquid poured into the funnel was 30 mL. The correlation coefficient between the value of the sensory evaluation and the outflow time of the funnel with an average stem ID of 5.3 mm was 0.946. Therefore, this method may be useful in hospital and nursing home kitchens for evaluating thickened liquids
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Nav1.1 haploinsufficiency in excitatory neurons ameliorates seizure-associated sudden death in a mouse model of Dravet syndrome
Dravet syndrome is a severe epileptic encephalopathy mainly caused by heterozygous mutations in the SCN1A gene encoding a voltage-gated sodium channel Nav1.1. We previously reported dense localization of Nav1.1 in parvalbumin (PV)-positive inhibitory interneurons in mice and abnormal firing of those neurons in Nav1.1-deficient mice. In the present study, we investigated the physiologic consequence of selective Nav1.1 deletion in mouse global inhibitory neurons, forebrain excitatory neurons or PV cells, using vesicular GABA transporter (VGAT)-Cre, empty spiracles homolog 1 (Emx1)-Cre or PV-Cre recombinase drivers. We show that selective Nav1.1 deletion using VGAT-Cre causes epileptic seizures and premature death that are unexpectedly more severe than those observed in constitutive Nav1.1-deficient mice. Nav1.1 deletion using Emx1-Cre does not cause any noticeable abnormalities in mice; however, the severe lethality observed with VGAT-Cre-driven Nav1.1 deletion is rescued by additional Nav1.1 deletion using Emx1-Cre. In addition to predominant expression in PV interneurons, we detected Nav1.1 in subpopulations of excitatory neurons, including entorhino-hippocampal projection neurons, a subpopulation of neocortical layer V excitatory neurons, and thalamo-cortical projection neurons. We further show that even minimal selective Nav1.1 deletion, using PV-Cre, is sufficient to cause spontaneous epileptic seizures and ataxia in mice. Overall, our results indicate that functional impairment of PV inhibitory neurons with Nav1.1 haploinsufficiency contributes to the epileptic pathology of Dravet syndrome, and show for the first time that Nav1.1 haploinsufficiency in excitatory neurons has an ameliorating effect on the pathology
Echo intensity obtained from ultrasonography images reflecting muscle strength in elderly men
認知症の人の意思決定における介護支援専門員の支援に関する文献レビュー
目的:本報告は,認知症の人と家族の円滑な意思決定を支援する方法を探求するために,認知症の人の意思決定における介護支援専門員(以下,専門員)の支援状況と課題を文献から検討した。 方法:文献選定には医学中央雑誌Web版およびCiNii Artclesを用い,キーワードを「介護支援専門員」「認知症」「意思(意志)決定」「居宅介護支援」とした。該当した文献から会議録,総説・解説,重複したものを除き,その中から専門員が行う認知症の人の意思決定支援に関する文献8 件を選定し,ハンドサーチした3 件と合わせ,合計11 件を分析対象とした。 結果:11 件の文献を類似性に従って分類すると,認知症の人に対する説明・同意とその影響を検討した文献,認知症の人への支援から意思決定に言及した文献,高齢者の意思決定支援に関する文献,困難事例の検討から意思決定について言及した文献の4 つに分類された。これらの文献から,認知症の人の意思決定における専門員の支援状況として,意思決定の前提である情報の適切な提供が,認知症の人に対して充分行われているとは言えず,意思決定には家族の意向が優先されやすい現状にあることが明らかになった。また,専門員が行う居宅介護支援を困難にする要因として,家族間での意向の不一致や本人のサービス拒否に関する記述が多く,支援が困難になる状況には意思決定に関する問題が複雑に絡んでいることが示唆された。 考察:認知症の人に対する意思決定支援に焦点を絞った調査は少なく,居宅介護支援の中での困難事例を検討している文献が多くみられた。意向の不一致や,その調整の困難などの意思決定に関する問題には,認知能力・判断力の低下の問題が潜んでいるが,そこに限局した調査がほとんどみられない。今後は認知症の人とその家族の意思決定に関して,専門員がどのように調整を行い介入しているかの詳細な検討を行っていく必要がある。資
地域在住自立高齢者を対象にした体力測定会への参加希望者における閉じこもりリスクと孤独感との関連
Purpose:This study was conducted for the purpose of examining the risk of becoming homebound and the correlation of loneliness in the community-dwelling older adults volunteering to participate in a physical f itness measurement program. Method:The subjects of this study consisted of 638 older adults dwelling in Kameoka City who volunteered to participate in a physical fitness measurement program in 2012 and desired also to participate in a similar program held roughly one year and a half years later.A survey was conducted in the form of a questionnaire survey that was mailed to the subjects.The contents of the survey consisted of questions relating to gender,age,household composition,frequency of meetings with separately dwelling family members,number of neighbors they can rely on,tasks within the home,presence of a hobby,participation in group activities,subjective view of health,subjective physical strength,risk of depression,risk of becoming homebound,assessment using the Japanese language version of the UCLA loneliness scale( 3rd edition)( to be simply referred to as ""loneliness"") and assessment using the Life Satisfaction Index K( to be abbreviated as LSIK).Analyses consisted of an intergroup comparison of loneliness scores for each parameter.This was followed by an analysis of covariance using those parameters for which there was a correlation with loneliness as covariates in order to examine the correlation between risk of becoming homebound and loneliness. Results:539 of the subjects submitted valid responses to the survey (response rate:84.5%).The analysis of the risk of becoming homebound indicated that 20 subjects were homebound( 3.7%),90 subjects were at risk of becoming homebound (16.7%) and 429 subjects were not homebound (79.6%). According to the results of an intergroup comparison of loneliness scores for each survey parameter,signif icant differences( p <0.001) were observed for gender,number of neighbors the subjects can rely on,subjective view of health,subjective physical strength,risk of depression, tasks within the home,presence of a hobby,participation in group activities and LSIK score. The average loneliness scores of each risk of becoming homebound were 36.2 ± 8.9 in the nonhomebound group,41.9 ± 9.8 in the group at risk of becoming homebound,and 45.8 ± 8.7 in the homebound group,with scores becoming higher as the tendency to become homebound worsened. The correlation between the two was such that significant differences ( p =0.007) were observed when the above parameters were used as covariates,and loneliness was greater in the group at risk of becoming homebound than in the non-homebound group( p =0.047). Discussion:This study demonstrated that persons at risk of becoming homebound are present even among relatively healthy older adults expressing a strong desire to continue to participate in physical f itness measurement programs like the subjects of this study,and that there is already a strong sense of loneliness among subjects of the group at risk of becoming homebound. Efforts to eliminate this sense of loneliness targeted at older adults at risk of becoming homebound who are already demonstrating a decrease in frequency of leaving their homes are expected to lead to effective countermeasures for preventing these persons from becoming homebound. 目 的:地域在住自立高齢者を対象とした体力測定会への参加希望者における閉じこもりリスクの程度と孤独感との関連を明らかにすることを目的とした。 方 法:亀岡市在住高齢者で2012 年の体力測定会に参加し,その約1 年半後の体力測定会に参加を希望した638 名を対象とした。調査は郵送法による質問紙調査を行った。質問項目は性別,年齢,世帯構成,別居家族と会う頻度,近所に頼れる人の人数,家庭内の仕事,趣味の有無,グループ活動への参加,主観的健康感,主観的体力,うつのリスク,閉じこもりリスク,日本語版UCLA 孤独感尺度(第3 版)(以下,孤独感),生活満足度尺度K(以下,LSIK)である。分析は各調査項目において孤独感得点の群間比較を行った。次に,孤独感と関連のあった項目を共変量とした共変量分散分析を行い,閉じこもりリスクと孤独感の関連を明らかにした。 結 果:有効回答者539 名(有効回答率84.5%)であった。閉じこもりリスクの分布は,閉じこもり群20 名(3.7%),閉じこもり予備群90 名(16.7%),非閉じこもり群429 名(79.6%)であった。調査項目ごとの孤独感得点の群間比較では性別,近所に頼れる人の人数,主観的健康感,主観的体力,うつのリスク,家庭内の仕事,趣味の有無,グループ活動への参加,LSIK に有意差が認められた( p < 0.001)。閉じこもりリスク別の孤独感得点の平均は,非閉じこもり群36.2 ± 8.9 点,閉じこもり予備群41.9 ± 9.8点,閉じこもり群45.8 ± 8.7 点と閉じこもり傾向に伴い高まった。両者の関連では先の項目を共変量としても有意差があり( p =0.007),閉じこもり予備群の孤独感が非閉じこもり群に比べて有意に高かった( p =0.047)。 考 察:体力測定会に継続参加可能な意欲の高い比較的健康な高齢者においても,閉じこもりリスク保有者が存在し閉じこもり予備群で孤独感が高いことが示された。閉じこもり予備群のうちから,孤独感を解消させるような働きかけを行うことが閉じこもり予防対策につながると期待される。原
認知症の人の睡眠障害への看護支援に関する文献検討
目 的:本報告の目的は,在宅療養する認知症の人の睡眠障害に対する看護支援プログラムの作成にむけて,国内外における先行研究から,睡眠の測定や看護支援の方法を明らかにすることである。 方 法 : 国内文献の検索は,医学中央雑誌Web版およびCiNii Articlesを用いて,「認知症(痴呆症)」「高齢者」「睡眠障害」「ケア」「看護」「在宅」をキーワードに設定した。海外文献は,PubMedを用い,キーワードを「dementia」「elderly」「insomnia」「care」「home-care」「nursing」とした。該当文献から会議録や商業誌を除き,認知症の人の睡眠障害に関するものを国内8 件,ハンドサーチ2 件を加え,海外10 件,合計20 件を選定した。 結 果:国内外の先行研究のフィールドは高齢者施設が多く在宅療養はわずかであった。介入研究は少なく大半は実態調査であった。対象者の平均年齢は国内の方が高い傾向で,睡眠測定は客観的測定指標と主観的評価指標を併用するかいずれかを採用する方法であった。調査で使用する睡眠測定機器は年々変化し,対象者の負担や精度を考慮して選定されていた。 認知症の人への睡眠障害の看護支援は,対象者の既往歴や性差,ADL や認知機能障害の程度等を配慮し,日中の活動性や社会的接触等の同調因子を意識した個別的な働きかけに効果が認められた。高齢者のみならず介護者にも睡眠障害を認め,介護負担が大きい介護者への支援も必要であった。 考 察:睡眠測定の方法は,最近10 年の間に簡易で負担が考慮され,精度の高い機器が使用さるようになった。睡眠障害への看護支援プログラムでは,対象者の選定基準を明確にし,日中の活動性や社会的同調因子への働きかけが実施されていた。プログラムの作成に際し日常生活行動や生活習慣,生活環境等の個別的な配慮をしつつ根拠に基づく同調因子への働きかけが有効であることが示唆された。高齢者とともに介護負担の大きい家族への予防的な睡眠健康教育の実施が必要であった。資
A 2-year follow-up study on falls and related factors among community-dwelling elderly individuals
Purpose:We conducted a 2-year follow-up study on falls and related causes experienced by localregion, independent elderly citizens. Method:We analyzed a total of 533 subjects, all independent elderly citizens living in Kameoka City in Kyoto Prefecture who participated in both the 2011 Everyday Life Sphere Needs Assessment and the 2013 Physical Strength Measurements studies. Our study focused on the 25 items included as basic attributes in the 2011 Everyday Life Sphere Needs Assessment.After performing an analysis of the relationships between gender, age, and fall experience, we employed the existence of falls as a subordinate variable, age as a covariant, and each of the 25 basic-attribute items as independent variables in a multivariate logistic regression analysis to grasp the causes related to falls. Furthermore, we used 7 determinate items and a batch-input logistic regression analysis method to analyze the effect of an independent life style on falls. Results:In the 2-year follow-up study, 35.5% of the subjects experienced at least one fall.The age of the subjects experiencing falls was slightly higher in the female group, compared with the males, but no significant difference was demonstrated.A significant difference was demonstrated in the ratio of falls in the highly-aged elderly group, compared with the lower-aged elderly group. In regard to the relationship between falls and each of the determinate items, in the male group, significant differences were demonstrated for motility, oral functions, memory lapses, and the tendency for depression, and especially the motility function showed a strong causal relationship, even with suppression of the other causes. In the female group, a significant relationship was demonstrated between subjects with a tendency for depression and subjects with a high instrumental activities of daily living index, and with suppression of the other causes in the analysis, a significant relationship was demonstrated between subjects with a low oral function index and a high instrumental activities of daily living index. Conclusion:It was suggested that even the independent elderly citizens were predisposed to fall down by aging. In addition, sex deference of factor related to falls was observed, and thus sexspecific support policy for fall prevention that considered a characteristic and a background by sex is necessary. 目的:地域在住の自立高齢者を対象に2 年間の追跡調査を行い,転倒経験の有無とその関連要因を分析した。 方法:京都府亀岡市在住の自立高齢者で,2011 年の日常生活圏域ニーズ調査と2013 年の体力測定の両方に参加した533 人について分析した。調査内容は,基本属性の他,日常生活圏域ニーズ調査25項目を用いて,①運動機能,②低栄養,③口腔機能,④閉じこもり,⑤物忘れ,⑥うつ傾向,⑦手段的日常生活動作(IADL)の7 つの判定項目を設定した。分析は,性,年齢と転倒経験との関連を分析した後,転倒有無を従属変数,年齢を共変量,各判定項目それぞれを独立変数とするロジスティック回帰分析により転倒に関連する要因を把握した。また,7 つの判定項目を一括投入するロジスティック回帰分析により転倒への独立した影響を分析した。 結果:追跡2年間において,少なくとも1回以上転倒のあった者は35.5%であった。女性は男性より転倒した者がやや高率であったが有意差はなく,後期高齢者は前期高齢者より有意に高率であった。転倒と各判定項目との関連は,男性では,運動機能,口腔機能,物忘れ,うつ傾向において有意差がみられ,とくに運動機能は,他の要因の影響を調整しても強い関連を示した。女性では,うつ傾向とIADLの高い者に有意な関連がみられ,他の要因の影響を調整した分析では口腔機能の低い者,IADL の高い者に有意な関連がみられた。 考察:地域在住の自立した高齢者であっても,加齢により転倒しやすくなることが示唆された。また,転倒に関連する要因において,男性と女性とで異なった様相を呈し,性による特性や背景を考慮した転倒予防対策が必要であると推察された。原