Problematic Behaviors in Elderly Dementia Patients Caused by the patients' Daily Surroundings and Relationship with Care-Providers

日本的痴呆症治疗始于1980年代，主要从医疗领域着手，然而，老年痴呆症患者的治疗是在1990年代的护理领域开始的。本研究的重点是老年痴呆患者的问题行为，这被认为是护理领域最困难的问题。很多时候，我们倾向于认为痴呆本身会引发老年患者的问题行为，在这项研究中，我们试图弄清楚这样一个事实，即老年患者的日常环境和护理提供者会使患者感到尴尬、困惑或不知所措。我们在本研究中考察了三个案例研究。I)通过对一位痴呆症患者的调查，对问题行为和应对方法的表现进行个案研究。这位痴呆症患者在家中度过了他的晚年，在此期间，据称患者的结构化护理系统尚未建立。2)精神科团体治疗的个案研究及精神科日间护理的家庭介入方式。3)居家护理的案例研究，在家庭成员外出工作时，邻居自愿为患者提供舒适的环境。通过这些案例研究，我们发现痴呆症患者认识到自己的疾病，并因此感到深深的痛苦和不安，这是问题障碍的直接原因。此外，如果我们为患者的日常环境做好准备，以补偿痴呆症特有的问题，同时提供对话式的沟通方式和充分的同情，那么患者的五种感官和情感都将受到刺激。因此，这些患者不仅在ADL上有改善，而且在生活质量上也有进步。因此，患者感到自我实现，并且活得和那些没有患痴呆症的人一样长。这项研究的结果即将发表。

Treatment if dementia in japan was started in the 1980s and was tackled chiefly from the medical field, however, treatment of elderly patients with dementia has been approached in the field of care-providing in the 1990S.This research focuses on the problematic behaviors of elderly dementia patients, which is considered to be the most difficult problem in the field of nursing care. Quite frequently, we tend to think dementia itself triggers problematic behavior in elderly patients, in this study we tried to muke clear the fact that the elderly patients' daily surroundings and care- providers can cause patients to feel embarrassed, confused or at a loss.We have examined three case studies in this study. I)A case study of the appearance of problematic behaviors and coping methods by examining a patient with dementia who spent his remaining years in his home during which time a structured care system for patients was purported not be well-established. 2)A case study in group psychiatric treatment and the approach toward family in psychiatric day care. 3)A case study in home care, in which neighbors volunteered to provide the patients with comfortable circumstances in daytime while family members were away at work.By examining these case studies, we disclose that patients with dementia recognize their own disorders and accordingly feel deep distress and uneasiness, which is a direct cause of problematic disorders. furthermore, if we prepare the patients' daily surroundings so as to compensate for the problems specific to dementia and, at the same time, provide a conversational communication style and ample sympathy, both the five senses and the emotions in the patient are stimulated. As a result, these patients show not only animprovement in ADL,but also progress in QOL.Consequently, the patients feels self-fulfilllment and live as long as those not afficted with dementia.Published results of this study are forthcoming.