Intervention skills to facilitate productive occupational performance for persons with dementia : Interviews with expert occupational therapists

認知症者に対して小集団を形成し,生産的作業を実施する際に彼らに見られる作業上の問題および作業遂行を促進する支援技術を明らかにすることを目的に,熟練作業療法士5名に対して半構成的インタビューを行った.質的帰納的分析の結果,作業上の問題は19項目抽出され,支援技術は41項目抽出された.開始困難,作業中の停止など作業実行時にみられる問題だけでなく,仕上がりの悪さを卑下し,それが次の参加拒否に繋がるといった生産的作業特有の問題が抽出された.支援技術には,貢献欲を刺激するような目標設定や声かけによって動機づけすること,個人の性格特性だけでなく認知症タイプ特有の症状を考慮した小集団形成や作業選択をすることが含まれていた.黒子のように演じながら作業が淀みなく流れるように,言語的手がかりだけでなく視覚,触覚,聴覚,嗅覚といった様々な感覚モダリティーの手がかりをタイミング良く与えることが認知症者の作業遂行を促進するために重要である.The purpose was to identify problems in productive occupational performance of persons with dementia in small groups and to identify intervention skills. We interviewed five expert occupational therapists using a semi-structured interview. Using qualitative inductive analysis, we categorized the problems into 19 items and the skills into 41 items. As well as difficulties in initiating occupation steps, motion stop of occupation-in-action, problems in productive occupation whereby persons with dementia refuse participation in group activities when the quality of finished products is not good were also extracted. Setting up purpose and using phrases which enhanced clients' sense of contribution were included in the skills for inviting them to participate in activities. In addition, methods of selecting occupation and making groups with reference to personal character and dementia type were also included. It was found that experts give various sensory modality cues at appropriate timing, not only verbal cues but also visual, tactile, auditory and olfactory cues, acting as behind-the-scenes supporters