Yumoto Yoshie, Kernohan W George, Morioka Noriko, Ogata Yasuko
Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.
Faculty of Life and Health Sciences, Institute of Nursing and Health Research, University of Ulster, Antrim, UK.
Public Health Nurs. 2019 Mar;36(2):192-198. doi: 10.1111/phn.12572. Epub 2018 Dec 18.
Dementia is causing global concern with its massive impacts on affected individuals, families, society, and national economies. As the disease progresses, patients' needs increase in number, depth, and breadth, covering physical, psychological, social, and spiritual domains. Care varies from place to place, from country to country and from east to west. To learn from some of these variations, we explored advanced dementia care in United Kingdom and Japan. Informed by an overview of literature on care of people with advanced dementia, we reflected on direct nonparticipant observations of care in urban areas of Northern Ireland and Japan. While we identified a common purpose to address the complex needs of people living with dementia, there were differences in the approach to care. Broadly, dementia care in United Kingdom tends toward person-centered care with a strong interest in Advance Care Planning as part of a palliative care approach. In Japan, we found less evidence of early stage palliative care and more of family-based decision making to inform care of older people. In both countries, dementia care varies regionally, being more available in some areas than others. International knowledge exchange and further comparative studies will help to improve care for people with advanced dementia, everywhere.
痴呆症正引发全球关注，因其对患者个人、家庭、社会和国民经济产生巨大影响。随着病情进展，患者的需求在数量、深度和广度上都有所增加，涵盖身体、心理、社会和精神领域。护理方式因地区而异，因国家而异，也因东西方而异。为了了解其中的一些差异，我们探讨了英国和日本的晚期痴呆症护理情况。基于对晚期痴呆症患者护理文献的综述，我们对在北爱尔兰和日本城市地区的护理进行了直接非参与式观察并进行了反思。虽然我们确定了满足痴呆症患者复杂需求的共同目标，但护理方法存在差异。总体而言，英国的痴呆症护理倾向于以人为本的护理，对作为姑息治疗方法一部分的预先护理计划有浓厚兴趣。在日本，我们发现早期姑息治疗的证据较少，而更多的是基于家庭的决策来为老年人的护理提供信息。在这两个国家，痴呆症护理在地区上也存在差异，某些地区比其他地区更容易获得。国际知识交流和进一步的比较研究将有助于改善各地晚期痴呆症患者的护理。
