Minimal requirements and the present circumstances in terminal care of aged person at home - Application of qualitative study -

（目的）本研究的目的是调查成功进行家中老年人临终关怀的最低要求，并了解日本长崎市这一领域的现状。（对象和方法）在招募了一直在家为老年人提供临终关怀的人员后，对每个招聘人员进行了半结构化访谈。访谈的基本问题包括临终关怀接受者的平均日常活动、认知能力、情绪、沟通能力、症状和社会环境。所有的采访都被录下来，然后进行分析。（结果与结论）护理人员以老年女性居多，护理开始时年龄在46 ~ 80岁之间，护理时间3 ~ 8年。临终关怀的接受者由几乎相同数量的男性和女性组成，他们在护理开始时的年龄从75岁到92岁不等。大多数受助人都是逐渐而不是突然失去独立生活的。此外，他们的上臂、吞咽功能和交流能力直到晚期才相对完好地保存下来。提供者和接受者的特点是乐观和忍耐。他们的经济状况处于中等偏上的水平，能够负担得起方便护理人员使用的护理仪器，甚至能够负担得起为受助人改造房屋的费用。在社会方面，能够很好地进入附近的医院和来访的护理机构是至关重要的。受助人获得了各种社会服务，包括由来访的护士在家中提供洗澡服务，重要的是，他们可以在需要的时候轻松进出医院。然而，在护理的最后阶段，提供者对继续在家护理的焦虑一直在增长。

(Objective) The aim of this study was to investigate the minimal requirements for successfully conducting the terminal care of aged person at home and also to recognize the present circumstances of this field in Nagasaki-city, Japan.(Subjects and Methods) After recruitment of persons who had been providing the terminal care to aged person at home, semi-structured interviews were conducted in each recruiter. The basic questions of the interview include average daily activities, cognitive abilities, mood, communicating abilities, symptoms and social circumstances of the terminal care recipient. All interviews were taped and then analyzed.(Results and Conclusion) Most of the care providers were old females whose age at the start of the care were ranged from 46 to 80 years old and had provided the care for 3 to 8 years. Terminal care recipients were consisted of almost equal numbers of males and females whose age at the start of the care were ranged from 75 to 92 years old. Most of the recipients had been gradually, not suddenly, losing their independence. Further, their upper arm and swallowing functions and communication abilities were relatively well preserved until the later stage. Characteristically, the providers and recipients were both optimistic and endurant. Their economical situations were in over the average and could afford the care instruments for providers' convenience and even the remodeling of the house for the recipient. Socially, it is fundamental to have a good access to a neighbor hospital and a visiting nursing care institute. The recipients were provided various social services including a bathing service at home by visiting nurses and, importantly, could be in and out of hospital easily whenever they were needed. Nevertheless, anxiety of the providers on continuation of the care at home had been growing toward the end stage of this care.