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20世纪80年代，主要从医疗领域着手，而老年痴呆症患者的治疗在20世纪90年代开始进入护理领域。本研究关注老年痴呆症患者的问题行为，这被认为是护理领域最困难的问题。老年痴呆症是老年患者行为问题的诱因，本研究试图揭示老年患者的日常生活环境和护理人员会使患者感到尴尬、困惑或不知所措的事实。I）通过检查在家中度过余生的痴呆症患者，对问题行为和应对方法的出现进行案例研究，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照顾的家庭取向。（3）在居家照顾的个案研究中，当患者的家人外出工作时，邻居们自愿在白天为患者提供舒适的环境。通过对这些个案的分析，我们发现痴呆患者认识到自己的疾病，并因此感到深深的痛苦和不安，这是问题性疾病的直接原因。此外，如果我们为病人准备好日常环境，以弥补痴呆症特有的问题，同时提供一种对话式的沟通方式和充分的同情，病人的五官和情感都会受到刺激。结果，这些患者不仅在ADL方面有所改善，而且在QOL方面也有所进步。因此，患者感到自我实现，并且与未患有痴呆症的人一样长寿。

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.