老人保健施設における入所者の貧血の検討
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概要
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高齢者における貧血は高齢者のQOLや予後に関係していることが知られている。介護老人保健施設入所者における貧血の有病率を明らかにするため，背景の異なる２つの介護老人保健施設の入所者を対象にして，末梢血液検査の調査を行った。２つの介護老人保健施設の対象者はそれぞれ129名（平均年齢82.1歳，男女比0.4）と155名（平均年齢84.8歳，男女比0.34）で，平均Hb濃度はそれれぞれ12.2 g/dLと11.8 g/dLであった。これらは対照として調査した人間ドックにおける，65歳以上の1,019名の利用者（平均年齢70.5歳，男女比2.1）の平均Hb濃度14.4 g/dLに比較して有意に低下していた。この低下は男女別に検討した場合も同じ結果であった。貧血の原因を調べるため，入所者の赤血球指数や基礎疾患を検討したが，特定の疾患群とHb濃度との間に相関は認められなかった。貧血の診断基準を男性は12g/dL未満，女性は11 g/dL未満とすると，２つの介護老人保健施設でそれぞれ約1/4と1/3の入所者が貧血であった。多彩な老年症候群でみられる貧血の診断と治療は，高齢者総合機能評価の基礎となる身体機能評価の一部として重要であると考えられた。今後さらなる介護老人保健施設の貧血調査の報告が待たれる。The present Japanese long-term health care insurance payment system, initiated in April 2000, now occupies a central position in the health care of the aged. Anemia is common among the aged and has been shown to affect older persons’ physical function, yet as a result of this care system’s payment structure, laboratory examinations are seldom performed, and hematological data of elderly nursing home residents is not documented. In order to contribute to the care of the elderly in intermediate welfare facilities, a study of the prevalence of anemia was carried out with 284 residents. When compared to 1019 people aged 65 and above visiting outpatient clinics for complete medical checkups, the residents of the intermediate welfare facilities were found to be significantly anemic. When anemia is defined as a hemoglobin concentration below 11 g/dL in women and below 12 g/dL in men, about one-third to one-fourth of the residents was anemic. This study was unable to uncover the causal disease of anemia, mainly because of the existence of a variety of underlying diseases in each person. Further investigation is needed in such facilities in order to ascertain the prevalence and underlying causes of anemia. Furthermore, the definition of anemia for elderly people is still controversial in Japan, and new criteria should be established in order to facilitate therapeutic approaches to geriatric syndrome. In conclusion, the study of anemia among intermediate welfare facility residents would serve to assess underlying diseases and nutritional.
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関連論文
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