| 特集名 | 高齢透析患者に対する在宅支援のあり方 ― 看護と介護 | |
|---|---|---|
| 題名 | 高齢患者の在宅腹膜透析における支援の現状と課題 | |
| 発刊年月 | 2013年 03月 | |
| 著者 | 前園 道子 | 所沢腎クリニック看護部・看護師 |
| 著者 | 関 智恵子 | 所沢腎クリニック看護部・看護師 |
| 著者 | 小林 威仁 | 埼玉医科大学総合診療内科 |
| 著者 | 中元 秀友 | 埼玉医科大学総合診療内科 |
| 【 要旨 】 | 本邦では高齢者や合併症を有する透析患者の増加に伴い，自己管理や通院が困難な透析患者が増加しており，そのような患者において在宅医療である腹膜透析（PD）はもっとも適した透析療法であることが報告されている． 2012年の診療報酬の改訂では，PDの診療報酬の引き上げと同時に，在宅介護支援の充実が行われた．しかしながら，高齢腎不全患者のPD導入に際しては，在宅患者ならびに家族の支援が必要である． 在宅PD患者支援は，患者家族と医療施設の対応だけでは負担が大きく困難な場合が多い．とくに患者家族への身体的，心理・社会的な支援も考える必要がある．理想的には地域医療システム（介護支援施設やデイケア，さらに身体障害者などの支援制度）を利用した患者および家族支援が望まれる．個々の患者の背景によって可能な支援は限定されるため，状況に応じた最善の支援システムを考えていくことが重要である． |
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| Theme | Role of home support for elderly dialysis patients -- nursing and care giving | |
|---|---|---|
| Title | Present condition and subject of support in elderly patient's home peritoneal dialysis | |
| Author | Michiko Maezono | Nursing Department, Tokorozawa Kidney Clinic |
| Author | Chieko Seki | Nursing Department, Tokorozawa Kidney Clinic |
| Author | Takehito Kobayashi | Department of General Internal Medicine, Saitama Medical University |
| Author | Hidetomo Nakamoto | Department of General Internal Medicine, Saitama Medical University |
| [ Summary ] | In recent years, elderly patients with end stage renal failure (ESRD) have been successfully treated with peritoneal dialysis (PD). PD is a suitable medical therapy because it enables us to maintain good residual renal function (RRF) and prevent severe heart failure. In Japan, PD remains the principal modality for in home dialysis for the elderly although PD patients account for only 3.2 % (n=9,626) of the overall dialysis patient population. However elderly ESRD patients, sometimes experience difficulties in the continuation of PD therapy. Problems may arise due to the development of dementia as well as declines in muscular strength, vigor, and overall physical strength of patients. In spite of these difficulties, some local dialysis centers have tried to maintain and manage elderly PD patients at home by utilizing diverse social resources, in addition to obtaining the cooperation of caregivers such as family members. In Japan, in home support for elderly PD patients is available in several special forms. These consist of utilization of visiting nurse care or home-visit nursing care services. Information concerning renal failure and education on home-care support providers and welfare service facility staff members is also provided. In addition, patient support is given through use of social community support systems, such as a care support institutions and day care centers. Modification of PD therapy through such means as use of automated PD and hemodialysis, as well as PD combination therapy must also be properly implemented. The organization of treatment teams, including physicians, nurses, social workers and dietitians, as well as the construction of centralized patient information management systems are all important for treatment of elderly patients who require dialysis therapy. It is important to consider the best support system in relation to individual patient's situations and needs. |
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