Japanese

Title	嚥下外来に関わる多職種の在宅療養高齢者と家族への支援の現状 - 本人と家族の納得を目指した支援のプロセス -
Subtitle	短報
Authors	前川一恵1), 藤野文代2), 飯田貴俊3)
Authors (kana)
Organization	1)姫路大学大学院看護学研究科博士後期課程, 2)姫路大学大学院看護学研究科, 3)北海道医療大学リハビリテーション科学部言語聴覚療法学科
Journal	日本摂食嚥下リハビリテーション学会雑誌
Volume	26
Number	1
Page	24-30
Year/Month	2022 / 4
Article	報告
Publisher	日本摂食嚥下リハビリテーション学会
Abstract	「要旨」【目的】嚥下外来に関わる多職種の, 在宅療養高齢者(以下, 高齢者)と家族への支援の現状を明らかにすることである. 【方法】A県内の嚥下外来のある21病院の中から, 本研究への協力の同意を得た4病院のいずれかに所属し, 嚥下外来に関わっている多職種8名を対象とし, 半構造化面接による質的帰納的研究を行った. 分析にはM-GTAの手法を用いた. 【結果】30の概念と7つのカテゴリー(以下, [ ]とする)が生成された. 高齢者と家族への多職種による初期の支援として, [本人および家族の食事への意向を聞く], [全体的な背景を踏まえた摂食嚥下機能の評価をする]支援を行っていた. 誤嚥のリスクはあるが経口摂取が可能な高齢者に対しては, [生活全体と介護力のバランスを踏まえた指導をする]支援を行い, 誤嚥のリスクが高く経口摂取が難しい高齢者に対しては, [本人の飲み込みが難しい現状を家族に説明する], [本人の味わう楽しみを支える], [本人と家族の安定した生活について話し合う]支援を行っていた. また, 人工的水分・栄養補給法を希望せずに看取りを決断する家族や, 嚥下調整食の指示があるにもかかわらず, 食べたい物を食べる選択をする高齢者に対しては, [多職種で支援の方向性を決める]支援を行っていた. これらの支援の最終目標としてコアカテゴリー(以下, 《 》とする), 《本人と家族と多職種で実現可能な目標をすり合わせる》支援を行っていた. 【結論】嚥下外来に関わる多職種らは, 高齢者と家族の食べることへの意向を尊重し, 納得を目指した支援を行っていた. 看取りを決断する家族や食べたい物を食べる選択をする高齢者もおり, 本人と家族と多職種で実現可能な目標をすり合わせていた.
Practice	医療技術
Keywords	嚥下外来, 多職種チーム, 在宅療養高齢者, 家族, M-GTA, dysphagia clinic, multidisciplinary medical personnel, frail elderly, caregiver

English

Title	Current Status of Support by Multidisciplinary Medical Personnel in Dysphagia Clinics for Frail Elderly with Dysphagia and Their Caregivers : A Support Process to Gain Their Understanding
Subtitle
Authors	Kazue MAEKAWA1), Fumiyo FUJINO2), Takatoshi IIDA3)
Authors (kana)
Organization	1)Doctor of Nursing Program, Graduate School of Nursing Science, Himeji University, 2)Graduate School of Nursing Science, Himeji University, 3)Department of Speech-Language-Hearing Therapy, School of Rehabilitation Sciences, Health Sciences University of Hokkaido
Journal	The Japanese Journal of Dysphagia Rehabilitation
Volume	26
Number	1
Page	24-30
Year/Month	2022 / 4
Article	Report
Publisher	The Japanese Society of Dysphagia Rehabilitation
Abstract	[Abstract] [Objective]: This study aimed to clarify the status of support provided by multidisciplinary medical personnel for frail elderly with dysphagia and their caregivers. [Methods]: Semi-structured interviews were conducted with 8 multidisciplinary medical professionals working in a dysphagia clinic at 4 hospitals that cooperated with this research from 21 hospitals located in prefecture A in Japan. Data were analyzed using the modified grounded theory approach. [Results]: The results generated 30 concepts and 7 categories. Multidisciplinary medical personnel working in dysphagia clinics provided the initial support by "listening to frail elderly and their caregivers talk about their hopes regarding eating" and "swallowing evaluation based on the overall background of the frail elderly and their caregivers." These personnel supported the frail elderly at risk of aspiration by "educating frail elderly and their caregivers to consider the balance between overall life and the state of care." They supported frail elderly who had difficulty in ingesting and a high risk of aspiration as follows: "They explained to their families the current situation wherein it is difficult for them to swallow," "They strived to help frail elderly to enjoy the taste of food," and "They discussed a stable life with the frail elderly and caregivers." Caregivers decide on end-of-life care without wishing for artificial hydration and nutrition; conversely, some frail elderly ate what they wanted despite having dysphagia. Multidisciplinary medical personnel supported these people "to determine the direction of support through a multidisciplinary approach." The personnel provided the ultimate goal of these support processes: "Frail elderly, their caregivers, and multidisciplinary medical personnel coordinate to achieve feasible goals." [Conclusions]: Multidisciplinary medical personnel working in dysphagia clinics aim to gain an understanding of the eating preferences of the elderly patients with dysphagia and their caregivers. Caregivers decide on end-of-life care and help treat the elderly patients so that they can eat their desired food despite the presence of dysphagia. For this reason, elderly patients with dysphagia, their caregivers, and multidisciplinary medical personnel coordinate to achieve feasible goals.
Practice	Medical technology
Keywords	dysphagia clinic, multidisciplinary medical personnel, frail elderly, caregiver, M-GTA

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