認知症高齢者の自己効力感が高まる過程の分析とその支援

Abstract

背景 高齢社会の進展に伴い、認知症の高齢者の数も増加し、2020年には291万人に上ると推計されている。認知症とは、獲得された知能が何らかの器質的障害によって持続的に低下し、日常生活や社会生活等に支障をきたした状態である。従って認知症高齢者の本質的な問題は、それまで生きる拠り所としていた知的能力や生活史を失い、人間関係も失うことによって、生きる不安が起こることである。不安を軽減する支援方法について看護や介護する立場からの研究は多いが、当事者の立場からの研究は少ない。目的 認知症高齢者が環境変化の中でどのように自己尊重を低下させ、不安をどのように受け止め、不安に対処しているのかを明らかにする。そこに自己効力感がどのように関連し、どのように高まっているかそのプロセスを明らかにし、それを高める支援の方法について分析する。結果 面接回数は11回で、目的から4段階に分けられた。自己認知に関する表出は334項目あった。その内容を分類すると、自己否定の意識につながるもの14カテゴリーと、自己肯定の意識につながるもの10カテゴリーとなった。自己意識と面接の段階との関連では、どの段階においても自己肯定・自己否定の意識が表出された。面接の回を重ねる毎に自己肯定の意識の表出が多くなった。趣味などの当事者の強みに働きかけた時に自己肯定の意識が多く表出された。結論 当事者の具体的な強みに働きかける事で自己効力感は高まる。高まる過程は、行きつ戻りつして螺旋状に高まっていく。自己効力感が高まっていると、納得できない環境変化等に遭遇しても自分の気持ちを表出する方法で対処することができる。

Background In Japan's progressively aging society, the number of elderly individuals suffering from dementia has been increasing, and is projected to reach 2.91 million by the year 20202). Dementia is a condition in which a patient's personal and social lives are hindered by a sustained decline in acquired knowledge caused by some form of organic lesion. Therefore, the essential problem in elderly dementia patients is the anxiety over their lives arising from the loss of cognitive functioning and life history, which were the foundation upon which their lives were based, as well as the subsequent loss of personal connections. While many studies have focused on support methods for reducing such anxiety from a nursing perspective, few have examined the issue from the patients' perspective. Objective To identify the ways in which elderly dementia patients experience a decline in self-esteem and accept and manage their anxiety during a change in their environment, determine how self-efficacy relates to these elements, and to find and analyze a support method that can increase self-efficacy. Results Patients participated in 11 interviews that were divided into 4 stages according to the objective. Interviews included 334 items related to expressions of self-concept, which were classified into 14 categories associated with the sense of self-denial and 10 categories associated with the sense of self-affirmation. Regarding the relationship between self-consciousness and the stage of the interview, the sense of self-affirmation or the sense of self-denial were expressed at each stage. The sense of self-affirmation was expressed more frequently in each interview, and was often observed when stimulating a patient's strengths, such as his or her hobbies. Conclusion By stimulating specific strengths in patients, their self-efficacy can be increased. While this process may initially have alternating results, it eventually results in increased self-efficacy. Elevated self-efficacy allows patients to better express their feelings, and thus enables them to manage challenges such as undesirable changes in their environment.