種々の指標を用いた包括的評価による独居高齢女性の自立生活の特徴

Abstract

背景 高齢者は生活する地域の保健医療福祉サービスを利用して自立した生活を送ることが求められている.その自立した生活を維持するためには, その低下に応じた生活の自立を支える必要がある. 目的 都市部に居住する独居高齢者を訪問し, 身体, 精神状況を既成の評価尺度を用いて評価し, 自立した生活が継続できる特徴を明らかにすることを目的とした. 方法 対象:都市部に居住する70～84歳の女性28人.調査内容:基本情報として年齢・婚姻歴・職業・居住年数・独居年数・受診状況・介護保険利用有無および嗜好 (飲酒, 喫煙) .身体状況は, ① 身体計測② 機能的自立度評価 (以下:FIM) , 精神状況は, 主観的幸福感 (以下 : PGCMS) .分析方法:身体計測値からBMI, 上腕筋囲, 上腕筋面積を算出した.身体計測値は日本人の身体計測基準値 (JARD2001) を母平均としてZ検定をした. FIMは, 18問の7段階 (18-126) で採点した. PGCMSはLawton (1975) のPGCMSの11.4±3.8 (平均値±標準偏差) で検定した.また, PGCMSとBMIの相関の解析にはPearsonの積率相関係数を用いた.さらにPGCMSを11点以下と12点以上の2群に分け, その2群のBMI, FIM, 居住年数, 独居年数の平均値を比較した (Student's t検定) .解析にはSPSS forWindows ver.19jを用いた. 結果 身体計測値は, 基準値と同等, またはそれ以上の値を示し, 栄養状態は良好と評価した.FIMの平均値は121.1±6.5で自立範囲であった.PGCMSの平均値は13.0±3.3でLawtonの値より主観的幸福感が高かった (p<0.05) .PGCMSとBMIの間には負の相関が認められた (r=-0.532, p=0.004) . PGCMSの得点が11点以下のBMIは26.2±3.6, 12点以上は22.8±3.5 (p=0.02) , FIM, 居住年数, 独居年数は118.7±8.3vs.122.5±5.0 (p=0.21) , 51.8±18.Ovs.38.0±15.1 (p=0.04) , 9.9±11.1vs.15.2±12.6 (p=0.29) であった. 結論 訪問した独居高齢女性は, 栄養状態は良好で, 自立度, 主観的幸福感も高かった.本調査から得られた評価項目から高齢者を包括的に評価すると, 第一に機能的・主観的に自立していること, 第二に栄養状態が良好で適正体重に近いことがあげられる.自立度や栄養状態, 主観的幸福感をバランスよく維持できるような見守り等の支援体制が重要と考えられた.

Background Elderly persons are needed to live independently with the help of locally available social welfare and health services . In order to maintain their independent lives, various types of support should be afforded according to the conditions of their daily activities. Purpose By visiting solitude elderly people who reside in urban areas, a comprehensive assessment using established rate scales was done to extract the physical and mental factors contributing to continuation of the independent life. Methods Subjects were 28 females aged from 70 to 84 who reside in urban areas. For basic information, age, marital and occupational histories, residence and solitude years, medical conditions, conditions of care-insurance utilization, and habits (e. g. drinking and smoking) were examined. Some physical measurements and Functional Independence Measure (FIM) for physical information and Philadelphia Geriatric Center Morale Scale (PGCMS) for mental information were also examined. The Japanese somatometry standard values (JARD2001) were used as the standards of somatometry. FIM was evaluated in seven steps (18-126) consisting of 18 questions. For PGCMS, the value of 11. 4 ± 3. 8(mean ± S. D. ) of PGCMS by Lawton(1975) was used as the standard value. In addition, Pearson's product-moment correlation coefficient was used to analyze the correlation between PGCMS and BMI. Furthermore, the subjects were divided into two groups according to the PGCMS score, the low PGCMS group (the score less than 11 )and the high PGCMS group (the score more than 12 ) . Several indexes including BMI, FIM , residence years, and solitude years were compared between these 2 groups (Student's t test). Results The somatometry of subjects showed similar values to those of JARD2001. The FIM value was 121. 1-± 6. 5. The PGCMS score was 13. ± 3. 3 (p< 0. 05), which was higher than those of Lawton. The negative correlation was found between PGCMS and BMI(r= - 0. 532 , p=0. 004). Comparison between the low and high PGCMS group showed 26. 2 ± 3. 6/22. 8 ± 3. 5 for BMI, 118. 7±8. 3/122. 5±5. 0 for FIM(p=0. 21), 51. 8-± 18. 0/3 8. 0± 15. 1 for residence years (p=0. 04), and 9. 9± 11. 1/15. 2 ± 12. 6 for solitude years (p=0. 29) , respectively. Conclusion The present comprehensive assessmentdemonstrated some features of the solitude elderlywomen living in urban areas. Firstly, they live functionally and subjectively independent lives. Secondly, they are in proper nutritional status. To support independent lives of the elderly, appropriately adjusted supportive measures should be provided for maintenance of their nutritional states and subjective well-being feelings.