Development of care programs based on assessment of functional bowel disorders for geriatric residents in health service facilities

为探讨适宜的排便问题护理方法，对养老院老年人排便问题的实际情况进行调查，并对排便问题产生的原因及护理方法进行调查。由于使用泻药而导致腹泻和尿失禁的老年人的护理包括定期如厕和使用尿布，但不包括评估排便的愿望或保持坐姿的能力。此外，我们在评估养老院居民大便失禁状况的基础上提供护理，并评估护理效果。研究对象是老年养老院的居民，他们习惯服用泻药来缓解便秘。在前4周，我们观察并评估受试者排便困难的状态，并根据个体评估制定治疗方案。在接下来的4周内，我们引导受试者到厕所，在饭后30分钟内提供排便机会，监测并确认排便意愿，通过扶手等辅助设备帮助增加腹部压力并稳定坐姿。我们还鼓励他们摄入更多的膳食纤维，给予热垫，并在适当的时候进行腹部按摩，以方便大便的运输。我们对5例重度痴呆患者（男1例，女4例）进行护理。他们有能力坐在轮椅上保持坐姿，在日常生活中需要辅助。其中三名受试者从未在马桶座圈上排便。在护理过程中，大多数患者增加了在马桶盖上排便的次数，大多数患者都能成功地做到这一点，避免了大便失禁。都增加了排便欲望的次数。他们在保持姿势的能力上也有了一些改善，从轮椅上起身和回到轮椅上也更容易了。

In order to investigate an appropriate care method for defecation problems, an actual condition survey on defecation problems as well as the causes and care methods of these problems were conducted for elderly residents in nursing homes. Nursing care for elderly individuals suffering from diarrhea and incontinence due to laxative use involved scheduled toileting and use of diapers, and did not include assessment of desire to defecate or the ability to maintain a sitting position.Moreover, we provided nursing care based on the assessment of the state of fecal incontinence among nursing home residents and evaluated the effects of the nursing care. The subjects were aged nursing home residents who habitually took laxatives to ease constipation.For the first 4 weeks, we observed to assess the states of subjects' defecation troubles and formulated treatment plans based on the individual assessment. For the next 4 weeks, we guided the subjects to a toilet to provide opportunity of defecation within 30 minutes after meals, monitored and confirmed the desire to defecate, helped increase abdominal pressure and stabilize sitting position by handrails and other aid equipment. We also encouraged to take more dietary fiber, gave hot-pad, and conducted abdomen massage to facilitate transit of stools whenever appropriate.We provided the nursing care to 5 subjects with severe dementia (1man, 4 women). They had ability to maintain sitting position with wheelchair, and they needed aides in daily life. Three subjects had never passed stools on a toilet seat. During the nursing care, most increased the number of defecation on a toilet seat, and one could do most cases successfully, avoiding incontinence of feces. All increased the number of defecation desire. They also showed some improvement over the ability of maintaining their posture and easier transfer in arising from and returning to wheelchair.