我が国の高齢者医療・介護の行方を決めるものは医療環境の動向である(Pro)(高齢者医療の立場から) : チーム医療推進について The role of a multidisciplinary approach in geriatric care and rehabilitation from the acute to the chronic stage
高齢者医療の医療環境が長期予後や介護の行方を定める鍵となりうる例として, 急性期から回復期にかけて多職種連携によるチーム医療について検討した. 藤田保健衛生大学病院における褥瘡対策チーム, 胃瘻外来および七栗サナトリウムにおける回復期リハビリテーションの成果は以下のようである. 1) 褥瘡対策チーム: 褥瘡発生率の低下が見られた 2) 胃瘻外来: 転院症例に比べて退院後の生存期間の延長が認められた 3) 回復期リハビリテーション: 従来型リハビリテーションに比べて, 退院時と退院18ヵ月後のADLの有意の上昇と自宅復帰率の増加が見られた. 以上より, 介護負担の軽減, 長期予後の改善のためにはこの時期におけるチーム医療の実施が重要であると考えられる.
A multidisciplinary team for bed sores consisted of 10 members including 3 dermatologists, 3 nurses, 1 physical therapist (PT), 1 pharmacist, 1 dietician, and 1 medical clerk. The incidence of new bed sores after admission was significantly decreased from 3.31% in 2003 to 1.04% in 2005 (P<0.01). A total of 324 percutaneous endoscopic gastrostomy (PEG) procedures were performed from 2001 to January 2006. Among those, the survival of 172 elderly patient (aged 65 years or older at the time of PEG) was calculated by the Kaplan-Meier method. The 30-day mortality rates was 11%, and the 1-year, and 5-year survival rates were 61.2%, and 34.4% respectively. After discharge, 40 patients were followed up at the PEG clinic in our hospital whose staff consisted of 1 expert surgeon, 5 nurses and 1 dietician. When compared with 67 patients transferred to other hospitals or nursing homes, the patients in the PEG clinic showed a significantly longer survival (P<0.01, 44 versus 29 months). A full-time integrated treatment (FIT) program for stroke rehabilitation was developed in the Nanakuri-Sanatorium of our university in 2000. Eighty-one stroke patients were on the FIT program during their hospital stay and achieved significantly higher activities of daily living (ADL) scores (P<0.01) at discharge assessed by functional independence measure (FIM) compared to 41 patients on previous rehabilitation program. In addition, their ADL scores were maintained significantly higher (P<0.05) even at 18 month after discharge, which might help them to stay home independently or with less care burden.These results suggest the important role of multidisciplinary approach for geriatric care and rehabilitation.
日本老年医学会雑誌 43(6), 726-729, 2006-11-25