被在宅看護高齢者における排尿管理の実態調査

Abstract

訪問看護ステーション40施設とその利用在宅高齢者2322名(男1023名, 女1299名).尿道カテーテル留置者は225名(男97名, 女128名)で, 理由は尿排出障害62.5%, 尿失禁25.3%であった.おむつ使用者は1301名(男533名, 女768名)で, 使用開始時期は在宅看護開始前が79.9%, 理由は尿失禁11.6%, 寝たきり67.0%, 痴呆8.8%, 尿失禁予防12.3%であった.清潔間歇導尿施行者は36名(男23名, 女13名)で, 理由は尿閉・残尿が88.9%, 施行者は家族・介護者が63.9%であった.カテーテル留置の決定は医師84.7%, 看護婦・保健婦30.6%で, 清潔間歇導尿では医師86.9%, 看護婦・保健婦21.8%であった.おむつ使用の決定は医師11.4%, 看護婦・保健婦27.3%, 家族64.2%, 被看護者本人18.3%であった.専門家への受診は191名で, 排尿管理別の受診割合はカテーテル留置者39%, おむつ使用者5.8%, 清潔間歇導入施行者77.8%であった.専門医受診依頼は一般医よりなされるのが52%, ケースバイケースが36%であった

A fact-finding inquiry was made on elderly people in home care, in order to investigate urinary management. A questionnaire survey was performed on 2, 322 elderly people (1, 023 male and 1, 299 female) cared at home by 40 home nursing stations in Aichi prefecture. The survey focused on the urinary management and the practical problems at home. The number of the elderly managed by an indwelling catheter was 225 (9.7%) and 1, 301 (56.0%) of the elderly wore diapers. The rates of the people managed by an indwelling catheter or diapers widely varied among the home nursing stations. In 25.3% of the people managed by an indwelling catheter, the catheter was used because of urinary incontinence, which should not normally be indicated. Diapers were unnecessarily used in 23.9% of people mainly for a protective purpose. The majority of the people whose voiding dysfunction was managed either by an indwelling Foley catheter or diapers had had this treatment started before discharge from hospital. Only 5.8% of the elderly wearing diapers received consultation from medical specialists. Intermittent catheterization was performed in 36 people (1.6%), and in 23 (63.9%) the catheterization was carried out by the care givers. We conclude that the urinary management in the elderly cared at home is insufficient and that standardization of the urinary management and creation of a network of care givers, nurses, general physicians, medical specialists and government representatives should be urgently needed to improve the quality in urinary management in the elderly.