高齢者のための食事指導 ―退院時になされた高齢者に対する食事指導と退院した患者の面接調査の結果についての研究―

高齢者を対象とした退院指導の評価を行う目的で、70歳以上の外来通院患者を対象として、患者が受けた退院指導の内容、理解度、実践状況の3つの要素について分析を行った。その中から、特に食事指導に焦点をあて在宅療養の視点から退院指導の問題点を考察した。食事指導を受けて退院した患者の約半数は更に指導を希望していた。指示された指導が実践できない患者の理由は、(1)指導不足、(2)意欲の喚起不足、(3)協力者の知識不足が上げられた。患者が希望している指導の内容は、食事療法の指導だけでなく、治療食や老人に適した食事についてであった。特に、栄養価の高い食事への関心が高く、具体的な指導を希望していた。また、看護婦による、社会資源を活用すべきかどうか、訪問看護を適応すべきかどうかの判断が、退院に向けてのアセスメントの内容として問題となった。

With the purpose of estimating the quality of care given to elderly patients who are about be discharged, we made an analysis of three main factors. The first is the details of discharge-care, secondly the degree to which the patient underdtands the type of care, and thirdly the care practice situation ; focusing on outpatients who are more than 70 years of age. Bringing meal treatment into focus, we examined the problems of discharge-care from the viewpoint of home treatment. About half of the discharged patients who were given meal treatment in the hospital hope to have further personal medical direction about their meals after being discharged. The reasons why the directed treatments couldn't be practiced by the patients were given as follows ; (a) deficiency of medical guidance, (b) insufficient encouragement of practice, (c) cooperator's having lack of knowledge about care of the aged. The details of medical treatments which the elderly patients want to be given are not only what is called meal treatment but also knowledge about food for patients and about appropriate meals for the aged. The patients seem to be highly interested in nutritious food and hope to have concrete advice for following a nutritious diet. Additionally, what is important in deciding the question of discharging is how to make good use of social resources by nurses and how to apply visiting nursing to be aged.