A comparative study of ADL at home and at care facilities : differences between system of elderly daycare administration
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概要
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[Purpose] In elderly daycare facilities, services are provided according toindependence support, which is the basic philosophy of Long-Term Care Insurance,to maintain and improve the user s activities of daily living (ADL). However, theefforts aimed at independence support and methods of service vary from facility tofacility. In this study, we examined the relationship between the administrationssystem of the facilities and the user s independence of ADL, comparing two typesof elderly daycare that provide different methods of service. Facilities that allowedthe users to select the programs and time provided were classified into Group A,and those that provided predetermined sets of services were classified into Group B.[Methods] The subjects were elderly daycare facilities in three prefectures in theHokuriku region of Japan ; 46 users in two facilities in Group A, and 40 users inthree facilities in Group B. Evaluation of ADL at home and at a facility wasperformed using the Functional Independence Measure (FIM).[Results] There was no significant difference in the total FIM score at homebetween Groups A and B. In Group A, the total FIM score at the facility wassignificantly higher than that at home, while it was significantly lower in Group B.When the scores for each item in FIM at home and at the facility were compared,the scores for bladder control, bowel control, bed/chair/wheelchair transfer,bath/shower transfer, stairs, comprehension, and expression were significantlyhigher at the facility than those at home in Group A. In Group B, scores forgrooming, dressing upper body, dressing lower body, bed/chair/wheelchair transfer,comprehension, and expression at the facility were significantly lower than those athome, while score for bath/shower transfer was significantly higher at the facility.[Conclusion] When the users were allowed to select the contents of the programand when the program was offered at elderly daycare facilities, voluntary actionswere promoted, which may have increased users independence. The resultsindicated that when the program contents and the time provided werepredetermined, assistance for the users might reduce the independence of theelderly.【はじめに】通所サービスでは自立支援に沿って利用者へのサービスが行われ、利用者の日常生活能力の維持・向上を図っている。しかし自立支援の取り組みやサービス提供方法は施設によって異なる。本研究では提供されるプログラムや時間を利用者が選択する運営システムをグループＡ、サービスやその時間が規則的に決められている運営システムをグループＢとし、運営システムの違いと利用者のADL自立度の関連性を検討した。【方法】対象者はグループＡの２施設の利用者46名、グループBの３施設の利用者40名である。自宅と施設のADLの評価は機能的自立度評価法（以下、FIM）を用いた。【結果】自宅のFIM総点の比較では両グループ間に差は認めなかった。自宅と施設のFIM総点の比較では、グループＡでは施設の得点が高く、グループＢでは施設の得点が低かった。項目別の比較では、グループＡでは自宅より施設で排尿管理、排便管理、ベッド・椅子・車椅子の移乗、浴槽・シャワーの移乗、階段、理解、表出の得点が高かった。またグループＢでは自宅より施設の整容、更衣上半身、更衣下半身、ベッド・椅子・車椅子の移乗、理解、表出の得点が低く、浴槽・シャワーの移乗は施設の得点の方が高かった。【結論】通所サービスでのプログラム内容や遂行時間を利用者が自主的に選択できると自立度が高まり、プログラム内容や提供時間が規則的に決められていると自宅に比べ自立度が低くなることが示された。
- 2011-07-31
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