高見 美保

【目的】健やかな地域生活を促進するためのプログラムへの参加高齢者に対する,COVID-19の感染拡大防止対策の影響と,それによって生じた身体状況及び生活状況の変化を明らかにすることである。【方法】プログラム開始前,プログラム実施6ヵ月後,再開時の3回分の評価が揃っている参加高齢者13名(全員女性,平均年齢80.5歳)を対象とし,身体状況の計測値と生活状況の変化について分析した。【結果】プログラム開始前,プログラム実施6ヵ月後,再開時の比較で,体重,骨密度,2ステップテスト値に有意な変化が確認された。体重は51.4kg,49.1kg,51.2kgと変化し(p=.013),介入前と再開時の比較に減少が認められた。また,骨密度は66.0g/cm2,76.0g/cm2,73.2g/cm2と変化し(p=.013),介入前と介入6ヵ月後の比較で上昇が認められ,2ステップテスト値も0.9,1.1,1.0と変化し(p=.018),介入前と介入6ヵ月後の比較で上昇が認められた。また,生活上の変化として「体調に問題ない」と「外出を控えた/頻度が減少した」の回答者数は同数だったが,その半数に「足腰の弱りを自覚する」状況があり,転倒や骨折による入院に至ったケースもあった。【結論】本研究の結果より,COVID-19の感染拡大による半年以上の健やかな地域生活を促進するためのプログラム休止は,参加高齢者の外出頻度を低下させ,運動機能に影響を与えたことが分かった。高齢者にとって低下した運動機能を引き上げることは容易ではなく,骨折など受傷に伴う入院は廃用性症候群を引き起こす可能性もある。今後は感染対策下であっても,高齢者の活動の場を確保できるような新たな交流方法を整備するとともに,地域で生活する高齢者に持続的にアプローチできる支援活動が必要である。(著者抄録)

This study evaluated the effectiveness of a life-enhancement program designed to focus on dining conditions in welfare facilities for seniors living in Japan. Effectiveness was specifically evaluated based on whether improvements were achieved in (1) nutritional status, (2) oral health, (3) frequency of fever, and (4) vitality of appetite across three sites. As part of a comprehensive-care initiative that began with dining support, the program consisted of two main components: (1) a 3-month intensive program comprised of (a) collective experiential learning for residents and staff (including nutritionists, nurses, and physiotherapists) and (b) a tailor-made individual program for residents followed by (2) a 3-month continuation program. Participants included 168 individuals (31 males and 137 females) from a total of three facilities (average age was 85.9 [60-104] years). Results showed that the intensive program significantly improved nutritional status (e.g., BMI, caloric intake, and water intake; P < 0.000-0.005) and tongue movement (P < 0.000) while significantly reducing dental-plaque and tongue-coating indices (P < 0.000). Significant improvements were also achieved for degree of appetite and vitality indices (P < 0.000-0.001). However, incidences of fever were not reduced. These findings indicate that the program effectively improved nutritional status, oral health, vitality, and appetite. However, these effects did not sufficiently remain once the program was finished, thus suggesting the need for a continuous intervention.

Objectives: A program fostering self-management for the elderly was implemented and the effects of the program and their continuities were assessed. Methods: Subjects consisted of 19 males and 131 females (average age, 73.1 +/- 7.4; range, 60-94years). The intervention program consisted of the collective experience learning and private consultation. The collective experience learnings included; (1) monitoring the oral condition and practicing oral self-care, (2) monitoring the oral function and practicing oral exercises, and (3) group discussion on continuing oral self-care. Outcomes were evaluated at the beginning and the end of the intervention program, and three months after the investigation by the scores in; (1) oral self-care (2) oral condition, i.e., decayed teeth, community periodontal index (CPI), deposits of plaque and dental calculus, (3) oral function such as RSST, oral diadochokinesis, (4) QOL (SF-8 v2, and GOHAI), and (5) cognitive function (MMSE-J). Informed consent was obtained from all subjects, and this study was approved by the Research Ethics Committee of the University of Hyogo. Results and Discussion: At three months after intervention, 124 subjects continued participating and 88 subjects (71%) completed all data. On the oral self-care, subjects cleaned their teeth more often and longer than before (P < 0.001). The use of dental floss and interdental brushing significantly increased in number (P < 0.001), and 67 participants (54%) visited the dentist during the program. CPI and deposits of plaque were significantly reduced after intervention (P < 0.001). The scores of oral function also significantly improved (P < 0.001-0.05). The scores of QOL (physical health), oral QOL and cognitive function significantly improved (P < 0.001-0.05). These results suggest that this program not only promotes oral self-care, resulting in good oral health conditions, but also improves cognitive functions of the elderly.

© 2015, Springer Japan. All rights reserved. Aspiration pneumonia is the leading cause of death among the elderly. Modified-texture foods, i.e., foods with altered consistency, are recommended in order to maintain both normal swallowing and adequate nutrition, which is also expected to reduce aspiration pneumonia, when elderly people are suspected to suffer from disorders of eating and/or swallowing. However, it is reported that overly-restrictive diets have been provided to most residents given modified-texture diets. Furthermore, there is scant empirical evidence of the medical effectiveness of food texture-modification. Little attention has been paid to the effect of the consistency of food substances, as well as the ability of mastication, on general health. Our cross-sectional studies showed that eaters of regular foods have lower incidences of pneumonia and fever, while those eating modified-texture, i.e., softer and finer, foods have higher incidences of pneumonia and fever. In this review, the effects of interventions for prevention of aspiration pneumonia were overviewed then the impact of the consistency of food substances on the health of the elderly and the direction of further research was discussed.

The effect of the consistency of food substances on health has not been assessed. The ingestion of food substances which require mastication promotes salivary secretion and oral function, which may in turn lead to a lower incidence of aspiration pneumonia. Thus, this study aims to reveal the importance of ingesting regular solid food and inquires into the condition associated with ingesting regular food.The subjects were 225 Japanese residents (47 males and 178 females; age, mean 87.9years) in welfare facilities for seniors. The following data were obtained from the facility's records: 1. consistency of food substances and their caloric intake, 2. their general health status 1) BMI, 2) medical record, 3) cognitive function. Their oral health status was checked by dentists.Eaters of regular food had a lower incidence of pneumonia (16.7%) than chopped food (28.6%), paste food (58.3%) and gastric-tube fed residents (57.1%). This may be because of the higher calorific intake of eaters of regular food (mean+/-SD; 1378.0 +/- 206.9 kcal) compared to chopped food (1282.7 +/- 193.5), paste food (1189.6 +/- 324.4kcal) and those gastrostomy tube fed residents (812.5 +/- 150.7kcal) (ANOVA, p<0.001). Eaters of regular food had better dental occlusion, better oral function and better cognitive function.Since this was a cross-sectional study, it was not possible to ascertain causal relationships. However, the results suggest that the consistency of food substances which require mastication has some influence in lowering the incidence of aspiration pneumonia of the elderly.