Oda Kazuaki
Dept of Internal Medicine, Nishioka Hospital.
Gan To Kagaku Ryoho. 2003 Dec;30(1 Suppl):158-60.
In the patients who were managed in the diabetes treatment department, 33 patients were chosen as the difficult cases for the home medical care, and the factors were reviewed. As for the man and woman ratio, 11 were men and 22 were women. The number of female patients was twice larger. The average age was 81.7 years old. As for the mode of the medical care, 11 patients were under the long-term hospitalization, 1 was under care of the health care facility, 12 were under care of the nursing home, 5 lived in private facilities for senior citizens, and 4 were treated under home medical care. The main reason to refuse the home medical care was the decline of the self-management ability. Of the 33 patients, dementia was observed in 21 patients, and the lack of recognition on their own disease was seen in 12 patients. So, without the support, the home medical care could not be provided. It is difficult to provide home medical care because of the complications (especially impaired visual sight, or cerebral vascular disease), the complexity of illness, the state of the family involved in home care, and the reform of the healthcare system. In order to promote the home the medical care of the elderly diabetics whose medical dependency became high, the management of the dementia patient, the support to the family involved in home care, the valid utilization of the care insurance system among other issues seems to be future challenges.
在糖尿病治疗科接受治疗的患者中，选取了33例作为家庭医疗护理的困难案例，并对相关因素进行了回顾。在男女比例方面，男性11例，女性22例。女性患者数量是男性的两倍。平均年龄为81.7岁。在医疗护理模式方面，11例患者长期住院，1例由医疗机构护理，12例由养老院护理，5例居住在私立老年设施中，4例接受家庭医疗护理。拒绝家庭医疗护理的主要原因是自我管理能力下降。在这33例患者中，21例存在痴呆，12例对自身疾病缺乏认知。因此，没有支持就无法提供家庭医疗护理。由于并发症（尤其是视力受损或脑血管疾病）、病情复杂程度、参与家庭护理的家庭状况以及医疗保健系统改革等原因，提供家庭医疗护理很困难。为了促进医疗依赖程度较高的老年糖尿病患者的家庭医疗护理，痴呆患者的管理、对参与家庭护理的家庭的支持、护理保险制度的有效利用等问题似乎是未来的挑战。
