臨牀透析 Vol.32 No.12(2-6)


特集名 リハビリ・運動療法を活用した高齢腎不全患者の栄養管理
題名 高齢腎不全・透析患者への栄養指導の実際 (6) 認知症患者
発刊年月 2016年 11月
著者 徳丸 季聡 金沢大学附属病院栄養管理部・管理栄養士
【 要旨 】 症例は70歳代,女性.30歳代に糖尿病を指摘され治療が開始された.60歳代より認知機能の低下を認めた.70歳代に腎機能低下のため当院に紹介となり,BMI(body mass index)30以上の肥満のため食事内容の評価および教育目的に栄養指導が開始となった.栄養管理上の問題点は,食事摂取状況の把握が困難,果物の摂取過剰,漬物の摂取過剰であった.背景に認知機能の低下があるため,指導内容は簡潔を心がけた.果物は手のひらを用いて適量を指導し,漬物は即席のピクルスに置き替える指導を行った.指導開始時と4カ月後を比較すると,BMIは30.1から29.6に低下した.高齢者は容易に食事摂取量が低下するため,減量をはかる場合は,栄養状態をモニタリングしながら行うことが重要である.
Theme Nutritional care for elderly chronic kidney disease patients utilizing rehabilitation and kinestology
Title Nutritional education for weight loss from chronic renal failure -- decline in cognitive function in elderly patients
Author Toshiaki Tokumaru Department of Nutrition, The University Kanazawa Hospital
[ Summary ] A 70 year old woman was referred to our hospital for treatment of chronic renal failure. She had been treated for diabetes mellitus from her thirties and had been suffering a decline in cognitive function for the past ten years. Nutritional education was started for treatment of obesity. Evaluation of dietary intake indicated she had some nutrition related problems. She had difficulty grasping tools in meal situations. She had an excessive intake of fruit and Japanese pickles. Because of her cognitive decline, basic guidance was considered. For example, proper fruit intake was prescribed specifi cally in reference to the amount which could be placed in her hand and Japanese pickles were exchanged for Western pickles. Her body mass index decreased to 29.6 from 30.1 in four months. Dietary intake for the elderly can easily be reduced. Therefore, it is important to monitor patient nutrition to produce safe diets.
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