認知症高齢者が内面を表出するうえでの生活環境の意味づけ—日本家屋の施設での生活を文化的側面から捉えて—

概要

本研究の目的は，認知症高齢者が内面を表出するうえで，日本家屋の施設の生活環境をどのように意味づけているのかを文化的側面から記述することである．研究デザインは，焦点を絞ったエスノグラフィーを用い，香川県内のK施設で，認知症高齢者A氏とA氏に関わる利用者・職員に参加観察を実施した．また，ヘルパーと職員にインタビューを実施した．分析は，生活環境を意味づけている場面について文脈を重視して抽出し，5つの領域に分類，コード化し，カテゴリーを見出し，関連性を記述した．本研究は，香川大学医学部倫理委員会の承認を得て行った．
A氏が内面を表出するうえでの生活環境の意味づけは，【家庭を感じ，安らげる場】【仕事の感覚を，持ち続ける場】【幾度も挑戦し，一喜一憂する場】の3つのカテゴリーと8つのコードで構成されていた．K施設は，利用者が自宅にいるような環境を創り,家族のように関わるといった考えをもつ職員達と日本家屋の物的環境が重なり合うことで【家庭を感じ，安らげる場】となっていた．また職員達は，認知症高齢者の行動には理由があると考え，A氏の言動を妨げずに見守っていた．そのなかで，A氏は【仕事の感覚を，持ち続ける場】や【幾度も挑戦し，一喜一憂する場】と意味づけていた．
A氏は，家庭を感じ安らぎながら，これまでの経験を幾度も再経験し，過去を振り返ることで，過去の後悔に折り合いをつけていた．これらの背景には，過去を何度も想起することができる生活環境とA氏の言動を見守り，家族のように関わる職員の考えがあった．また，A氏自身が，表現していることに寄り添う，聴き手の存在が重要であることが示唆された．
Our purpose was to clarify the significance of the living environment in a nursing facility designed with Japanese-style architecture for demented elderly in helping them express themselves from the cultural aspect. Participant observation was conducted for A, a demented elderly person, and staff who interacted with A at facility K in Kagawa Prefecture. Staff were also interviewed. Scenes reflecting the living environment were extracted focusing on the contexts, coded, and categorized, and then, relevance with A was described. This study was approved by the Ethics Committee of Kagawa University School of Medicine.
There were three categories of the meanings of the living environment for A that helped him express his feelings (“a place to feel at home and at ease”; “a place to maintain the feeling of being at work”; “a place to repeatedly take challenges and react to the outcomes”), and 8 codes. The staff’s efforts to create an environment where clients can feel at home and are involved like family members and the physical environment of the Japanese-style facility provided “a place to feel at home and at ease”.
The staff observed A’s behaviors without disturbing him since they believed that there are reasons behind the behaviors of demented elderly. It was assumed that A considered this facility as “a place to maintain the feeling of being at work” and “a place to repeatedly take challenges and react to the outcomes”. A dealt with his past regrets by repeatedly re-experiencing and looking back over the past while feeling at ease. This was supported by the living environment that allowed A to repeatedly recall his past, and by the staff who involved A as their family member. The results suggested the importance of people who closely listened to and embraced what A expressed.