諏訪 さゆり

Abstract The implementation of home-care robots is sometimes unsuccessful. This study aimed to explore factors explaining people’s willingness to use home-care robots, particularly among care recipients and caregivers. Surveys were conducted in Japan, Ireland, and Finland. The survey questionnaire comprised four categories (familiarity with robots, important points about home-care robots, functions expected from home-care robots, and ethically acceptable uses), with 48 items assessing users’ willingness to use home-care robots. The responses from 525 Japanese, 163 Irish, and 170 Finnish respondents were analyzed to identify common and distinct factors influencing their willingness to use these robots. Common factors across the countries included “willingness to participate in research and development,” “interest in robot-related news,” and “having a positive impression of robots”. The distinct factors for each country were: “convenience” in Japan; “notifying family members and support personnel when an unexpected change occurs in an older person” in Ireland; and “design” in Finland. Therefore, developers should determine potential users’ willingness to participate in the research and development of home-care robots and consider a system that involves them in the development process.

Dementia with Lewy bodies (DLB) is the second most common cause of dementia and is associated with unique difficulties due to its characteristic symptoms. This study aimed to identify daily life changes experienced by people with DLB due to characteristic symptoms other than visual hallucinations. Semi-structured interviews and content analyses were conducted on 13 people with DLB and their 17 family members. Qualitative content analysis identified three categories of difficulties experienced by people with DLB in daily life: body discomfort, obstacles in daily life, and psychological pain. Participants experienced not only physical changes due to symptoms such as cognitive fluctuations, parkinsonism, and rapid eye movement sleep behavior disorder but also psychological pain related to daily life difficulties. This suggests the need for care that appreciates the unique experiences of people with DLB and includes psychological care to develop appropriate individual coping strategies, rather than focusing solely on alleviating physical symptoms.

本研究の目的は熟練訪問看護師の観察の特徴を訪問看護熟練者と訪問看護非熟練者である訪問看護初心者,看護学生の眼球運動の比較に基づき明らかにすることである.観察場面は高齢者への初めての訪問看護場面とした.訪問看護利用者のデータから作成した2事例8枚の写真を10秒ずつ提示し,写真を観察する対象者の眼球運動をTobii-ProX60にて計測し,Kruskal-Wallis検定にて熟練者,初心者,学生の3群間を比較した.熟練者は療養者の表情と立ち姿が中央にある退室場面の総移動距離は3群間で一番短く,学生より有意に短かった(p<.05).部屋で会話場面の注視領域「療養者の顔と服装」の熟練者の注視回数は3群間で一番多く,学生より有意に多かった(p<.05).本研究より自宅訪問時の写真の観察での眼球運動にも療養者を中心としたケア実践の特徴が表れると考えられた.熟練者の眼球運動の初心者と看護学生への提示は,限られた時間での療養者の観察を可能にすることが示唆された.(著者抄録)

BACKGROUND: As a type of welfare technology, care robotics is now widely seen as a potential aide to rehabilitation, increasing independence and enhancing the wellbeing of people with disabilities and older adults. Research into and development of care robots have both been vigorously promoted in North America, Europe and Asia, and the competition for technological advancement in robotics is becoming fierce. AI ethics and policy guidelines are being established. However, there are still differences in attitudes and perceptions, as well as national policies regarding this type of welfare technology. Moreover, despite the anticipated usefulness, it is believed that progress has been slow in the diffusion of care robots. PURPOSE: In order to explore how public discourses support technological innovation, such as care robots, while preparing society for potential risks and impact, we sought to ascertain whether public discourse on care robots varies from region to region. For example, what are the hopes and promises associated with care robots and what are the concerns? METHODS: To address these questions, this article explored how care robots have been portrayed in five major broadsheet newspapers in five jurisdictions in Asia and Europe (France, Great Britain, Hong Kong SAR, Ireland and Japan). We obtained 545 articles for the period between January 2001 and September 2020, more than half of which originated in Japan. A thematic analysis was conducted of these articles written in four languages (Chinese, English, French and Japanese). RESULTS: Positive and negative narratives were teased out, alongside other key prominent themes identified, such as Japan as the land of robots, the pandemic, and the impact of robots on the economy. As the number of robot-related articles grew from the year 2012 onwards, narratives became more nuanced in European newspapers, but not in Asian ones. Furthermore, recent articles began to address the social and relational impact of care robots, while providing concrete examples of improvements in the quality of life for users. Further careful examination will be necessary in the future in order to establish the impact of robotics use in rehabilitation for people with disabilities, older adults, their carers and society at large.

Background: It is imperative that a team consisting of a physician, pharmacist, and nursing professional provides pharmacotherapy support to achieve the optimal effect of pharmacotherapy for older adults with dementia. This study reviewed Japanese publications on the process of pharmacotherapy support practised by various professionals for home-based older adults with dementia and investigated healthcare professionals' perceived importance and practice of pharmacotherapy support. Methods: This study aimed to shed light on basic pharmacotherapy support for behavioural and psychological symptoms among home-based older adults with dementia using multidisciplinary collaboration, through a literature review of Japanese publications. Based on the literature review, 13 items pertaining to basic pharmacotherapy support for home-based older adults with dementia were extracted. A mail-based, self-administered, anonymous questionnaire survey was conducted with professionals including physicians, pharmacists, and nursing professionals who provide pharmacotherapy support to home-based older adults with dementia. Participants rated 13 items on their perceived importance and practice of basic pharmacotherapy support using a four-point Likert scale. Results: The results indicated that participants recognised the importance of all 13 items. At least 80% of all professionals indicated that they practised seven out of 13 items. Less than 80% of all professionals indicated they practised the other six items that should be provided after the commencement of pharmacotherapy. A relatively high proportion of nursing professionals (70%) indicated they practised the remaining six items. The 13 items were indeed deemed important for characterising pharmacotherapy support. However, in Japan, suboptimal support is provided following the commencement of medication. This may be because appropriate modifications to dementia care are not made as the patient's condition progresses. Conclusions: It is suggested that multidisciplinary collaboration focusing on the progression of dementia and the process of pharmacotherapy, especially after the commencement of pharmacotherapy, may help provide effective, continuous pharmacotherapy.

Japan is facing a ‘care crisis’. There is an urgent need to ascertain the extent to which potential users are willing to use robotics-aided care before its roll-out as a formal policy. Based on our recent survey, we discuss home-care professionals’ real perceptions and their implications for the future development and implementation of home-care robots. While they showed some concerns about robotics-aided care, they perceived ‘physical support’, ‘communication’ and ‘monitoring’ functions positively. A small number of care professionals recommended assistive technologies listed in the insurance payment scheme. We conclude that both individual preferences and formal policy options are necessary for an effective implementation of robotics-aided care.

<sec> <title content-type="abstract-subheading">Purpose</title> This study aims to compare the level of needs for home-care robots amongst older adults, family caregivers and home-care staff and clarify the factors constituting these needs. </sec> <sec> <title content-type="abstract-subheading">Design/methodology/approach</title> A cross-sectional, anonymous questionnaire survey was administered. It included 52 items related to needs for home-care robots rated on a four-point Likert scale. Means and standard deviations were calculated, and the Kruskal-Wallis test was performed for each item. Factor analysis was conducted on the needs of home-care staff. </sec> <sec> <title content-type="abstract-subheading">Findings</title> Responses from 79 older adults, 54 family caregivers and 427 home-care staff were analysed. For all three groups, the level of agreement was high for the following needs: to inform family and support personnel immediately when older adults fall, about their location in case of natural disasters and about mismanagement of fire by older adults with dementia. For family caregivers and home-care staff, the level of need concerning monitoring was higher than for older adults. Extracted using factor analysis, the six factors representing the essential needs for home-care robots were risk minimisation, daily monitoring of the physical condition, supporting activities of daily living (ADL) and instrumental ADL, pre-empting problems, communication and miscellaneous support. </sec> <sec> <title content-type="abstract-subheading">Originality/value</title> The results showed that the education of caregivers and the co-design process of robot development should involve home-care staff, older adults and family caregivers, which are important for making decisions about the use of home-care robots for older adults. </sec>

PURPOSE: To clarify potential users' perceptions toward the development and social implementation of home-care robots in Japan, Ireland, and Finland. METHODS: Unsigned, self-administered questionnaires were distributed to adults aged 65 or older, family caregivers, and home-care/health and social care professionals (HSCPs). A total of 1004 responses were collected. RESULTS: In Japan, many people were already familiar with robots in their daily lives. The most notable finding about their perspectives on home-care robots was related to safety. Moreover, 93.7 % of the Japanese respondents said, "If the user cannot decide whether to use a home-care robot, family members who know the user well should decide," followed by 76.4 % in Ireland and 83.1 % in Finland (p < .001). In Ireland, 81.8 % of the respondents said, "I want to help other people and society by participating in the research and development of home-care robots" (Japan: 69.9 %; Finland: 67.5 %) (p = .006). In Finland, many people had a negative impression of robots compared to the other two countries. Finland had the highest percentage (75.4 %) of respondents who said, "Health care professionals should be allowed to use secondary information collected by a home-care robot" (Japan and Ireland: 64 %) (p = .024). Moreover, Ireland and Finland emphasized the need to guarantee the entitlement to receive human care. CONCLUSIONS: Devising optimal strategies for the development and social implementation of home-care robots by incorporating various perspectives while valuing human dignity will require examination of each country's characteristics with respect to history, culture, policies, and values related to robots.

<title>Abstract</title> <sec> <title>Background</title> Home-care robots have been developed as one of the assistive technologies, and benefits and challenges of their use have been debated in many countries. Research teams in Japan, Finland and Ireland carried out a questionnaire to explore perceptions of potential users (older people, family caregivers, and health and social care professionals (HSCPs)) towards the use of home-care robots. As part of a larger tri-country comparative study, this paper reports preliminary findings from the data collected from the online survey of HSCPs in Ireland. </sec> <sec> <title>Methods</title> Questionnaire was developed iteratively among the research teams in three countries. Questions related to the use of advocates in deciding whether to use home-care robots, desirable functions in such robots, and perceptions of privacy protection. Based on networks of professional and advocacy groups, HSCPs were contacted and 123 respondents took part in the questionnaire, and 46 fully completed the questionnaire. </sec> <sec> <title>Results</title> Out of 46 respondents (44 female, 1 male and 1 did not wish to specify), 80% answered that they are open to the use of home-care robots. Safety monitoring and alert functions were considered to be most desirable in home-care robots. 76% of the respondents placed importance on the guarantee of entitlement to receiving human care, irrespective of the use of home-care robots. 30% answered that they have a negative impression of robots, to some extent. The overall majority (N=39, 85%) felt strongly that a decision as to whether to use home-care robots should be made by the user, and that the access to data collected in any form by robots requires extra care. </sec> <sec> <title>Conclusion</title> While there was generally a positive perception of the use of home-care robots among Irish HSCPs, cautious attitudes were evident in the areas of decision-making and privacy. This study was funded by the Pfizer Health Research Foundation. </sec>

外来化学療法を受ける高齢がん患者が訪問看護を導入する意義を明らかにするため、外来看護師13人、訪問看護師10人へ個別に半構造化面接を行い、得られた逐語録の質的内容分析を行った。高齢がん患者が訪問看護を導入する意義は、「初回の外来化学療法を開始するまでの時期」では【病院だけでなく地域でも支援を受ける体制ができる】、「外来化学療法を継続する時期」では【症状悪化の予防や対処行動の相談が自宅でも可能になり、治療と生活を継続しやすくなる】【家族が困難に対処しながら生活を継続していけるような支援を受けることができる】など、「外来化学療法の継続が困難になる時期」では【自身が決断した最期のすごし方に向けた準備ができる】【自身を看取る家族への支援を受けることができる】などであった。高齢がん患者の訪問看護導入は、高齢がん患者が自ら治療や療養場所を決断できることや家族に対するグリーフケアに資する。(著者抄録)

[要旨] 本研究の目的は，独居の認知症高齢者の在宅生活継続に影響する要因のうち認知症高齢者本人の要因を明らかにすることである。在宅生活を継続している独居認知症高齢者の担当ケアマネジャー11名に半構造化面接を行い，得られたデータは国際生活機能分類（ICF）を分析枠組みとして質的帰納的に分析した。ただし，認知症高齢者本人の要因を明らかにすることが目的のため，環境因子は除外した。結果，独居の認知症高齢者の在宅生活継続に影響する要因として，健康状態は【認知症の診断が確認されている】等２テーマ，心身機能・身体構造は【介護用品の利用によって保たれている心身機能がある】等４テーマ，活動は【意思の伝達とコミュニケーションが出来る】等５テーマ，参加は【地域のひとや家族に対する関わり方が継続している】等３テーマ，個人因子は【趣味や嗜好，対人関係から分かる変化していない本人の価値観がある】等３テーマが抽出された。認知症高齢者は，日常生活の中で促進要因にある自らの力の発揮によって独居の在宅生活継続が可能となっていた。また，入院や一時的な体調の変化によって，機能低下が生じた場合でも，住み慣れた自宅という環境に戻ることや福祉用具の利用を含めた適切な支援を受けることで機能の維持や回復につながっていた。独居の認知症高齢者の在宅生活継続には，様々な要因が相互に影響しあっており，ICFの視点を用いてこれらの情報を整理することは有効であると示唆された。

本研究の目的は、認知症の人を対象とした看護、介護、リハビリテーション領域の介入研究においておこなわれている倫理的配慮について、論文から読み取ることのできる現状を明らかにし、今後の課題を検討することである。文献検索に使用したデータベースは医中誌Web版およびPubMedで、過去5年間の文献の中からキーワードを用いて検索し43件を抽出した。43件の文献から、ベルモントレポートで示された倫理原則との対応を参考に、倫理的配慮に関する記述を抜き出して分析した。インフォームド・コンセントについて、本人が関与していたものが27件、本人が関与しなかった可能性があったものも13件あった。対象者の脱落があったことが記述されていた文献は12件で、その中には、実施した介入や評価測定に関連した脱落も含まれていた。また、介入に付随して生じうるリスクに関する記述があったものが7件あった。研究対象者となることは社会貢献の側面があることから、通常の診療以上にインフォームド・コンセントは重要である。できる限り多くの研究で認知症の人本人のインフォームド・コンセントへの関与を可能にするためには、意思決定能力が発揮できるような支援とともに、インフォームド・アセントやディセントの確認も重要になると考えられる。また、インフォームド・コンセントだけでなくリスク・ベネフィット評価の視点も取り入れ、認知症の人を対象とした介入研究を倫理的に進めていくための具体的な方法について検討していく必要がある。(著者抄録)

本研究の目的は、看護基礎教育課程における認知症看護実践能力修得に向けたカリキュラムの開発に向けて、フィンランドのセイナヨキ応用科学大学の看護師とゲロノミの基礎教育課程における認知症看護・ケアの教育の特徴を具体的に明らかにすることであった。セイナヨキ応用科学大学において看護師とゲロノミの基礎教育課程の教育に関わっている教員と実習指導者、合計5名に対し、教育の特徴についてインタビューを実施した。得られた語りから看護師およびゲロノミの基礎教育課程における基本的考え方、講義、演習、実習における主な教育手法、工夫点などについて抽出し、簡潔に記述した。両課程は成人学習理論に基づき、認知症高齢者の尊厳を尊重することを重要視する教育が行われていた。看護基礎教育課程では認知症看護に特化した科目は開講されていないが、老年看護学に関する科目の中で認知症看護についても学習内容に含まれ、インターネットを活用した学習も展開されていた。実習ではメモリー協会などが作成しているパンフレットを利用して認知症高齢者をケアすることも行われていた。ゲロノミ基礎教育課程では、認知症高齢者のケアという科目があり、認知症の進行予防によって自宅で長く生活できることを目指すものであった。認知症ケアについての管理や開発などの科目も設定され、自宅で生活する認知症高齢者を含む高齢者を訪問して、生活をより良いものにするために検討したり、プロジェクトに参加したりしながら学べるようにしていた。以上より、日本の大学の看護基礎教育課程においても、成人学習理論と認知症高齢者の立場に立つことを基盤とし、学生自身が地域の社会資源を活用・参画しながら認知症看護・ケアを学習できる可能性が示唆された。(著者抄録)

本研究の目的は、都市部に住むがんを罹患した妻との死別後の男性高齢者の生活の再構築がどのようなプロセスを辿るのか世代の異なる男性高齢者2名の語りから時間経過に沿って明らかにすることである。対象へ約60分の半構造化面接を行い、分析は修正版グラウンデッド・セオリー・アプローチを用いた。男性高齢者2名の語りから《良くなることを願って食にこだわりを持って介護する》《そばで見ていても苦痛をどうしてやることもできず辛くなる》《生きてきた時代背景に影響を受けた死生観がある》《予想とは違う臨終のときが突然訪れたような気がする》《自分の生活を取り戻すための体力づくりを始める》《死別後も自分の意思を持って前に進んでいく人生を送りたいと思う》というA・Bに共通する6概念が導き出された。A・Bに異なる概念として導き出されたのは&lt;死別後の生活を意識した生活をおくる&gt;&lt;家事は分担していたので苦にならない&gt;&lt;妻の生前から自ら近所付き合いを行う&gt;&lt;別居の家族や親族の訪問を時々受け、身の回りの世話をしてもらう&gt;&lt;生前の妻の人付き合いの良さに助けられる&gt;&lt;買い物や知人と会う時間をつくり出かける&gt;&lt;死別後、自分の健康面を気にかけてくれる存在がいると安心できる&gt;であった。個々の余生時間や生きてきた時代背景に影響を受けた死生観の違いから、死別後の生活の支えとなるものや人生の終え方に対する考えに違いがあることが示唆された。(著者抄録)

本研究の目的は、介護付有料老人ホームに勤務する看護職者が入居者および家族とかかわる上で重要だと認識していることを明らかにし、介護付有料老人ホームにおける看護支援の特徴を検討することである。データ収集は、研究協力について同意の得られた看護職8名へのフォーカスグループインタビューによって行った。インタビューデータから、意味内容の類似性に従い分類した結果、介護付有料老人ホーム(以下、有料老人ホーム)における看護支援に関して以下8のカテゴリーに集約された。【有料老人ホームの自由さや裁量をいかして、入居者自身が生きたい人生を実現できるようにすること】【入居者・家族との信頼関係を構築するために積極的に交流すること】【入居者・家族が納得のいく医療に関する意思決定ができるように支えること】【入居者とその家族が、最期まで安心して過ごせるよう対応すること】【配偶者との死別を体験した入居者のグリーフケアを行うこと】【入居者の異変を早期に発見して対処することにより、重症化を防ぐこと】【有料老人ホームの看取りを含めたケアの質を担保するために看護職と介護職を育てること】【他職種と柔軟に業務分担を行うこと】であった。以上より、有料老人ホームの自由さや裁量をいかして様々なニーズを持つ高齢者を受け入れ、入居者が生きたい人生を実現できるよう支援する看護が行われていたことが明らかになった。また、入居者を亡くした後も有料老人ホームで暮らし続ける家族へのグリーフケアにも取り組んでいるという特徴が見出された。(著者抄録)

Aim: This study aimed to explore the experiences and thoughts of a nonagenarian-centenarian woman with dementia living alone, through detailed analysis of her unsolicited diary. Data Source: After receiving consent from Aki (a pseudonym), her family and caregivers, copies of her diaries, hand-written in Japanese, were provided for analysis. Methods: The content of the diaries was broadly organized into themes and qualitative content analysis carried out for each theme along a sequential timeline. Changes in perspective, expression, quality of script, and frequency of notations were noted over time are compared with clinical assessments of dementia and activities of daily living recorded by health care providers. Demographic history was obtained from family members. Results: On recommendation by her nursing care manager, Aki began keeping a diary. By age 99, Aki was widowed and noted: “I'm lonely by myself.” but still expressed hope: “I won't give up on myself.” Concerning memory loss, she wrote: “I've already forgotten what happened this afternoon,” and “I'll do things for myself.” Regarding dependence, she said: “I get help from my children and others outside the family.” And commented on the home care staff: “I don't know if they've come to help.” “Is it someone I know well?” Although she thought that they took her belongings, she wrote: “I'll try not to forget to be grateful to them.”. Discussion: The diaries show that even as the dementia progressed, Aki was aware of her cognitive decline compounded by family losses. She used the diary as a coping method and to address relationships with family and caregivers.

本研究の目的は、せん妄を発症した在宅高齢者に対する訪問看護師の困難を明らかにすることである。A県内全ての訪問看護ステーション293ヶ所に質問紙を発送し、せん妄を発症した在宅高齢者(65歳以上)の支援をおこなった経験がある訪問看護師に対して、自記式無記名の質問紙調査への回答を依頼し、得られたデータの記述統計処理および質的内容分析を実施した。回収された質問紙は42部であり、回収率は14.3%であった。所属する訪問看護ステーションを利用する在宅高齢者で過去1年間にせん妄を発症した者は、1〜3人と回答した訪問看護師が最も多く、22名であった。そのうち最も困難を感じた1事例について、高齢者の年齢は80〜84歳と回答した訪問看護師が最も多く、14名であった。せん妄の発症場所は自宅が最も多く、37名であった。せん妄の症状として最も多かったものは、不穏31名であった。せん妄を発症した原因として最も多かったのは認知症21名であった。看護支援において感じた困難は、&lt;高齢者に対するせん妄の予防と改善のための支援&gt;、&lt;家族介護者に関する支援&gt;、&lt;せん妄の的確な判別&gt;の3カテゴリーに集約された。自宅においても、様々な要因によってせん妄を発症する高齢者が存在することが明らかとなり、在宅療養の特性を反映した、せん妄ケアに関する訪問看護支援を検討する必要性が示唆された。(著者抄録)

Mobile robotics is a potential solution to home behavior monitoring for the elderly. For a mobile robot in the real world, there are several types of uncertainties for its perceptions, such as the ambiguity between a target object and the surrounding objects and occlusions by furniture. The problem could be more serious for a home behavior-monitoring system, which aims to accurately recognize the activity of a target person, in spite of these uncertainties. It detects irregularities and categorizes situations requiring further explorations, which strategically maximize the information needed for activity recognition while minimizing the costs. Two schemes of active sensing, based on two irregularity detections, namely, heuristic-based and template-matching-based irregularity detections, were implemented and examined for body contour-based activity recognition. Their time cost and accuracy in activity recognition were evaluated through experiments in both a controlled scenario and a home living scenario. Experiment results showed that the categorized further explorations guided the robot system to sense the target person actively. As a result, with the proposed approach, the robot system has achieved higher accuracy of activity recognition.