Psychological nursing of senile hemodialysis patients:Factors in suicidal despair and countermeasures

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概要

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• In recent years, regular hemodialysis has been adapted to senile patients who have troublesome complications. Some of these senile patients lose their zest for living and complain of "suicidal despair." We report the results of an analysis of factors involved in suicidal despair and an attempt to counteract this condition. Thirty patients (ages 18-78 years) who had been on dialysis for at least one year were studied. Five of 10 patients older than 65 years were found to have suicidal despair. Their physical condition was estimated from the hemodialysis score, number of complications, frequency of blood access operation and senile dementia. Their psychological condition was determined by manifest, anxiety score (MAS) and egogram. Sociopsychological, economical and religious problems were investigated by a questionnaire on their social adjustment and specific consciousness as an inhabitant of Toyama Prefecture. Results were as follows: Some of the 10 patients older than 65 years showed deterioration of dementia. Complications and frequency of blood access operation were apt to increase. Further more all of them showed a social consciousness specific to Toyama Prefecture. That is, they tended to esteem productivity and labor, suppress self-expression to a great extent and judge themselves as social stragglers who could not take part in production. In addition, 3 of 5 patients with suicidal despair showed strong anxiety and borderline dementia. We attempted increase their comfort and reduce their suicidal despair by taking account of the specific consciousness. As a result, the hemodialysis score and anxiety improved in 4 of 5 patients and borderline dementia improved in 3 of 3 about 10 monthes later. Suicidal despair diminshed gradually.In summary, we analyzed factors involved in suicidal despair, a common but serious complication in senile hemodialysis patients. To improve the condition, we took account of their specific consciousness as local inhabitants of Toyama Prefecture. It is suggested that nursing senile hemodialysis patients by taking note of their specific consciousness may be beneficial in improving senile dementia and suicidal despair.

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