ブックタイトル教育医学 J.Educ.Health Sci.　第63巻　第3号　通巻 第289号

概要

教育医学 J.Educ.Health Sci.　第63巻　第3号　通巻 第289号

Current Situation of and Problems with Elderly Patients with Dementia Home Recuperation in Japanundergoes a medical examination at a medicalinstitution alone.“Old patients who live aloneor whose care is performed by the elderly oftenconsult with a physician alone.”Due to a decline incognitive capacity,“there is a patient who forgetsthat he/she has already consulted with a physicianand gets consultation again and again.”There isalso a case in which“a nurse obtains informationon a patient?s clinical record and calls the patient?shome by phone when necessary.”(4) Ambulance transportationIt is true that“ambulance transportation is away of consultation”in addition to its use whenthere is a rapid worsening of symptoms. Due to thesymptoms of dementia,“there is a case in which apatient changes his/her speech, so how to contactwith the patient?s family is unknown.”“When apatient?s family cannot be contacted, the patient?sresident card is obtained in order to cope with thepatient”in some cases.(5) Advocacy from nursesDue to the symptoms of dementia, it issometimes difficult for the patient to express his/her wishes to others. Therefore, it is important that“after a patient consults with a physician, a nurseshould talk to the patient and additionally explainthe situation according to the patient?s degree ofunderstanding,”and that“when a patient is notsatisfied with a doctor?s explanation, the doctorshould reexamine the patient and explain thesituation until the patient understands it.”(6) Detecting cognitive declineSometimes, dementia cannot be diagnosedon the basis of the information written on apatient?s clinical records.“A nurse should detecta patient?s cognitive decline as soon as possibleand make sure the patient obtains the necessarymedical treatment and nursing services.”In dailyobservations,“a nurse should confirm whether theanswer to the question is correct. When a patienttalks about the same thing again and again andrepeats the same action, a nurse should questionwhether the patient has dementia. When a patientcontinuously mistakes the consultation day, thepatient should undergo dementia tests.”(7) Examination by a doctorIt is also necessary to perform outpatientconsultations smoothly.“When waiting time forconsultation is too long, a patient may complainand be anxious about the consultation. Therefore,consultation must be performed efficiently.”Moreover,“a nurse should inform the doctor thatthe patient has dementia before consultation.”(8) Correspondence with a mentally unstablepatient“There is a person who does not havedementia but experience a decreased degree ofunderstanding. This decrease sometimes makesthe person mentally unstable.”Therefore, thedoctor in charge of the person needs to alwaysobserve the person?s appearance.(9) How to spend waiting timeLong waiting times at an outpatient clinic canmake anybody uneasy. Therefore,“when waitingtime for consultation is too long, a patient shouldbe able to experience some change, such asentering a treatment room.”(10) Finding reasons for not wanting to behospitalizedEach individual has his or her own values.Therefore, it is important to realize that“a patientdoes not want to be hospitalized because the fee ofa private room is too high or because other peoplemay be disturbed if the patient is in a large room.”2) The practice of seamless care through multioccupationaldescription cooperation in thecommunityFor an elderly dementia patient to be ableto live permanently in the community, variousprofessionals must strengthen their cooperationand provide care toward the same goal in order tosupport the patient and his/her family. Here, threesubcategories were extracted.(1) Cooperation in a hospitalWhen an elderly dementia patient needsmedical treatment, it is important to stabilize? 246 ?