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

为探讨老年人排便问题的护理方法，对养老院老年人排便问题的现状、原因及护理方法进行了调查。对因使用泻药而发生腹泻和大便失禁的老年人进行的护理，除了定期排便和使用尿布外，不包括排便欲望和保持坐姿的能力的评估。此外，根据对疗养院住客大便失禁状况的评估，对护理效果进行了评价。研究对象为习惯性服用泻药缓解便秘的老年疗养院居民，在前4周观察评估受试者排便困难的状况，并根据个体评估制定治疗方案。在接下来的4周内，我们引导受试者在餐后30分钟内上厕所，提供排便机会，监测并确认排便欲望，通过扶手和其他辅助设备帮助增加腹压并稳定坐姿。并鼓励患者多摄取膳食纤维，适时给予热垫、腹部按摩以促进排便。对5例重度痴呆患者（1男4女）进行护理。他们有能力在轮椅上保持坐姿，在日常生活中需要帮助。3名受试者从未在马桶座圈上排便。在护理过程中，大多数增加了在马桶座上排便的次数，大多数情况下都能顺利完成，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和从轮椅上起身和返回轮椅的能力方面也有所改善。

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.