Exam 36 · 第36回 · 認知症の理解 (Understanding Dementia)
Question 47 問47
Ｍさん（80歳，女性，要介護1）は，アルツハイマー型認知症（dementia of the Alzheimer’s type）であり，3日前に認知症対応型共同生活介護（認知症高齢者グループホーム）に入居した。主治医から向精神薬が処方されている。居室では穏やかに過ごしていた。夕食後，表情が険しくなり，「こんなところにはいられません。私は家に帰ります」と大声を上げ，ほかの利用者にも，「あなたも一緒に帰りましょう」と声をかけて皆が落ち着かなくなることがあった。Ｍさんの介護を検討するときに優先することとして，最も適切なものを1つ選びなさい。
- Ｍさんが訴えている内容
- Ｍさんの日中の過ごし方
- ほかの利用者が落ち着かなくなったこと
- 対応に困ったこと
- 薬が効かなかったこと
Translation
Ms. M (80 years old, female, care level 1) has dementia of the Alzheimer's type, and moved into a group home for people with dementia (認知症対応型共同生活介護／認知症高齢者グループホーム) 3 days ago. Her primary doctor has prescribed a psychotropic medication. She had been spending time calmly in her room. After dinner, her expression became tense, and she shouted loudly, "I can't stay in a place like this. I'm going home," and also called out to other users (利用者), "Come home with me too," which made everyone unsettled. Among the following, choose the 1 option that is the most appropriate priority to consider when planning care for Ms. M.
- What Ms. M is saying (the content of her complaint)
- How Ms. M spends her daytime
- The fact that other users became unsettled
- The fact that staff had trouble responding
- The fact that the medication did not work
Show answer and explanation
Answer: 1
Why 1 is correct
The first thing to consider is what Ms. M is saying — "I'm going home" — and the feelings behind those words. Only 3 days after moving in, amid this change of environment, understanding what Ms. M is anxious about is the starting point for planning her care.
Why 2 is wrong
Arranging how she spends her daytime is also important, but that comes after understanding the meaning of what she is saying. Deciding on measures first, without this, leaves Ms. M's own feelings out of the picture.
Why 3 is wrong
The fact that other users became unsettled is a problem for the facility staff, and does not by itself help in understanding Ms. M herself. Accepting what Ms. M is saying comes first.
Why 4 is wrong
The fact that staff had trouble responding is the caregivers' point of view. Focusing on the caregivers' difficulty makes it harder to see Ms. M's own anxiety.
Why 5 is wrong
Since it is only the 3rd day after moving in, it is natural to think the change of environment is the cause. Concluding right away that the medication did not work is not appropriate — evaluating medication is the doctor's job.
Key point
Care starts by understanding what the person says and how she feels.
Key terms
- 認知症対応型共同生活介護
- A group home for older people with dementia. A service where a small number of residents live together and receive care.
- 向精神薬
- Medication that acts on mood or mental state. It is prescribed by a doctor.
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Exams 36–38, all 13 subjects, with furigana and an English explanation of every choice. The subject 「認知症の理解」 is free.