SLIDE 1 Organised by:
Malaysian Healthy Ageing Society
Co-Sponsored:
SLIDE 2 MEDICAL SOCIAL WORKERS’ SU SUPP PPORTS TS OF F HO HOME E CA CARE RE FO FOR TE TERMINAL AL DEM EMEN ENTI TIA A PA PATI TIEN ENTS TS AN AND FA FAMILIES ES
Hospital, National Center for Geriatrics and Gerontology
The Center for Comprehensive Care and Research on Memory Disorders
Aya Seike Akimasa Takeda, Takashi Sakurai, Yukihiko Washimi, Hidetoshi Endo, Kenji Toba
Hospital, National Center for Geriatrics and Gerontology, JAPAN
絆 kizuna, JAPAN
1th WORLD CONGRESS ON HEALTHY AGEING 2012, 19th-22nd March, Kuala Lumpur
SLIDE 3 Out line
- Today’s presentation has ５ parts-
1: Background & Objects 2: Methods 3: Results ４: Summary ５: Conclusion
SLIDE 4
Operational definition
Terminal Dementia Patients -The tentative plan(Aida,Shimizu,2010)- 【State】 ・ Dementia advances. Communication, Ingestion, Swallowing are difficult. Bedridden state. ・The doctors can’t expect the uptrend of disease condition, prevention of advance. (If they provide with the possible best medical treatment) ・Performing clinical decision. (With the consideration of the dying process)
SLIDE 5 Operational definition
※Medical Social Worker (Suzurikawa,2002; Seike,2011)
(※an abbreviation: MSW) ・They solve bio-psycho-social problems of patients with physical disease and mental disorder by using their knowledge and skills in social welfare. ・They coordinate teams which support patients and their families so that other medical ,health-care, and welfare staffs can cooperate smoothly.
SLIDE 6
Background
National Government policies in JAPAN Supports for Japanese terminal dementia patients Research on Japanese terminal dementia patients
Dementia refugees with no place for recuperation
No systems support patients who don’t know their rights and the means to apply for formal supports. Few research on how welfare staff can support patients and families. Various problems of terminal dementia patients and their families
SLIDE 7 Objects
How can MSWS support home care and life styles
- f terminal dementia patients and their families？
SLIDE 8
Research methods
A home health provider’s two MSWs took charge of pts& families
【period】 May2009 – May 2011 【come from】 discharged from the critical care & mental hospitals, the long-term care health facilities 【total number】 450 patients From among
Subjects: Terminal dementia patients at home (N=45) and Their families(N=55)
Main data: 1: Pts’ mental & physical states, the kinds of medical treatments & care supports 2:Their families’ needs 3:MSWs’ supports
Extraction of data: From their case records, clinical records Analysis: Statistical analysis
SLIDE 9 Results1
- Patients’ attributes of the point that MSW began intervention-
(N=45)
Items of assessments Score, The number of people(%)
The average age(SD)
80.5±4.25(years)
Mental : Mini-Mental-State【MMSE】(SD)
7.5±3.2 ※full marks=30
Physical(ADL): Barthel Index【BI】(SD)
15.2±5.3 ※full marks=100
Major diseases(Except for dementia)
Cerebro vascular disease 18(40.0%) Cardiac disease 12(26.6%) Cancer 8(17.7%)
The style of receiving medical support
The doctor’s home visiting 42(93.3%)
The condition of house hold
Elderly couple 27(60.0%) With one child 13(28.9%)
Non-utilization (though application of formal supports are necessary)
19(42.2%)
※Only family care 12 Using a daily help 3 Friend’s support 2 Volunteer’s support 2
SLIDE 10 Results 2
- The total number of families’ primary needs-
(The number of families=55 people)
10 20 30 40
Explanation of pts' conditions and prognosises Requests of some informations and advices about social services utilization Listening of their thought
(the number of people)
33(60.0%) 28(51.0%) 15(27.3%)
SLIDE 11 Results 3
- Details of supports to their families-
(The total number of the supports, n=368 cases)
(The total number of families , N=55 people)
50 100 150 200 250
Companionship (when their doctors will tell pts' prognosis to their families) Reports on the progress of their supports Explanation of social support system Advice on how to utilize social support Checking of their intentions (life design, plan of care) Understanding of their emotions and efforts
(the number of case) 201(54.6%) 183(49.7%) 162(44.0%) 130(35.3%) 102(27.7%) 83(22.6%)
SLIDE 12 Results 4
- Details of supports to patients-
(The total number of patients , N=45 people)
The patients’ supports = The indirect supports
Two supports to their families ・Understanding of their emotions and efforts
・Checking of their intentions
at the same time
MSWs’ hearings of patients’ life history and thinking, memories with patients. The creations of the base for the best choices to patients
SLIDE 13
Summary
1: Patients’ attribute of MSWs’ first intervention They had high risk factors of life difficulties. ・The patients’ disabilities of judgment ⇒The necessity for the substitute determination
by their families for patients’ life style, medical and care supports ・House hold (elderly couple)
・Non-utilization of formal supports 2: The families’ primary needs ・Listening of their thoughts ・”The patients’ life in the future” (e.g.; Advices about social services utilization
Explanation of patients’ prognosisses)
SLIDE 14 Summary
- 3. MSWs’ support for their families
・Understanding and checking of their thoughts, emotional. ・Explanation and advice to utilize social supports Predominated by “Encouragement” and “ Education”.
- 4. MSWs’ support for the patients
・The indirect supports MSWs’ hearings of patients’ life history and thinking, memories with patients.
At the same time
The creations of the base for the best choices to patients and families
SLIDE 15 autonomy Self- determination Patients, Families Autonomy
Conclusions
The practices of MSWs’ supports
“Education” “Encouragement”
The prevention
abuse & neglect
- What are the creations of the base
for the best choices to patients?-
SLIDE 16 Hospital, National Center for Geriatrics and Gerontology, JAPAN
To everyone attending
絆 kizuna, JAPAN
We will do our best. We never give up, even if what happens.
Please share with me your research and practice in supporting patients and their families.
Thank you very much. I’m looking forward to seeing you!
- Arigato, Xie Xie, Danke, Merci, Gracias, اًرْكُش., ขอบคุณ, Salamat po, Terima Kashi,-
