退院後老人福祉施設を利用している大腿骨近位部骨折後の後期高齢者の背景因子が生活機能に及ぼす影響 <原著論文>

本研究の目的は,大腿骨近位部骨折後の後期高齢者の背景因子が退院後の生活機能に及ぼす影響を明らかにすることである.研究協力に同意が得られた老人福祉施設利用者7名(78～96歳)に対し半構成的面接を行い,質的記述的研究を行った.分析の結果,背景因子が骨折後の生活機能に及ぼす影響として【生活機能の低下による生活の困難感】【老いを考慮し,回復状況を見極める】【生活動作を調整し,自身の生活を取り戻す】【取り巻く人々とのつながりを支えに相互関係の中で自分なりに生活を楽しむ】の4つを見出すことができた.これら4つの因子の分析を通して[困難][コントロール][自律]の特徴が見出され,それらの3つの位相を行きつ戻りつしながら,現状を受け入れ,自分なりに生活を調整していることが分かった.3つの位相の背景には,過去の体験の肯定的な受け入れ,生活スタイルの維持,日常生活における自律の願望や自ら楽しみを見出そうとする積極姿勢,対象者を支え,励ましとなる取り巻く人々との相互関係等の背景因子が正の要因として骨折後の生活機能の維持[コントロール]・向上[自律]に影響を及ぼしていることが示唆された.

The purpose of this study was to identify contextual factors that affect functioning in daily life in elderly individuals, 75 years and over, following discharge after proximal femoral fracture treatment. Seven elderly subjects, aged 78 to 96, who utilized the elderly welfare facility, agreed to participate in the study. We conducted semi-structured interviews with them and produced a qualitative description of the data. We identified four categories which represent the effects of contextual factors on functioning in daily life: experiencing difficulties in daily living due to decreased functioning; assessing recovery status in the context of one's aging; adjusting movements used for daily activities to regain one's lifestyle, and enjoying life through interaction with others by finding support from friends and family. "Difficulty", "control", and "autonomy" were three characteristic phases extracted from the analysis of these four factors. Participants oscillated between these phases as they came to accept their current state, found ways to adjust their lives, and worked toward autonomy. These three phases suggest that factors such as a positive acceptance of past experiences, lifestyle maintenance, a desire for autonomy, a positive attitude to finding joy in daily life, and relationships between the participants and their friends and family affect how each participant maintained and improved his/her functioning in daily life.