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認知症予防研究所

認知症終末期のケア・介護の方法

認知症の終末期とは
認知症の終末期とは、難しい言い方をすれば大脳皮質機能が広範に失われた状態のことを言います。わかりやすい言葉で言うと、表情がなくなり、排泄物を垂れ流す状態になり、物を食べることも困難になっている状態です。終末期では言葉を話すこともできなくなるため、意志の疎通は難しく常に寝たきりの状態です。
こうなってしまうともう長くないと思われがちですが、末期癌などの体内に病巣がある状態とは違うため、認知症の末期であっても、数か月から数年は生きていられる可能性もあります。

終末期のケアはターミナルケアに繋がる
認知症終末期には意志を伝えるというのが難しくなってくるため、自分では治療の判断などはできません。経口摂取が難しい状態になった場合、管を通して栄養を送るのか、それとも無理に延命治療をしないのか、家族による判断が求められます。
このままでは余命がわずか、という人をケアしていくことを「ターミナルケア」と呼び、初期の頃よりも家族にケアの方向性を求められる部分が大きいです。どういう方針でいくかというのを判断するのは家族としても心苦しい部分がありますが、できる限り安らかに最期を迎えてもらえるように、しっかりと決断しましょう。

最期を迎える場所
認知症終末期のケアで迷うのが、最期をどこで迎えるか。です。場所は大きく分けて2つあり、「自宅」か「病院を含めた施設」です。
本人の意思が確認出来ない認知症終末期であれば、家族が考える必要があります。そして、訪問看護師や介護施設などにその旨を伝え、家族や職員などが同じ気持ち、考えでターミナルケアが行えるようにしましょう。
自宅にしても、施設にしても、ターミナルケアには周りの人の協力が、必要不可欠です。医師や介護士と密に連絡をとってしっかりと最期について話しておくことが大切です。また、家族が傍にいることもとても大事で、たとえ意志の疎通が難しい状態であっても、家族の声は本人に届きます。一番不安なのは本人なので、声をかけて不安を取り除いてあげましょう。

認知症の終末期は意外に穏やか?
認知症の終末期は意外に穏やかだと言われています。痛みの認識が弱くなっていることが多く、意識レベルが低いので、苦しいという感覚も少なく、恐怖感も少なく最期を迎えることができます。意志の疎通ができないから痛みの感覚を伝えられないのか、それとも本当に痛みがわからないのか、という判断は難しいですが意識レベルが低い認知症の終末期では、癌の終末期患者などと比べて穏やかだと言えるでしょう。
無理に治療をしなくても、穏やかな最期を迎えられるというのはある意味幸せだと言えるのかもしれませんね。

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