{"id":290,"date":"2013-05-14T14:21:00","date_gmt":"2013-05-14T05:21:00","guid":{"rendered":"http:\/\/www.hcfm.jp\/journal\/?p=290"},"modified":"2015-08-06T14:21:27","modified_gmt":"2015-08-06T05:21:27","slug":"%e8%aa%8d%e7%9f%a5%e7%97%87%e6%82%a3%e8%80%85%e3%81%ae%e4%ba%88%e5%be%8c","status":"publish","type":"post","link":"https:\/\/www.hcfm.jp\/journal\/?p=290","title":{"rendered":"\u8a8d\u77e5\u75c7\u60a3\u8005\u306e\u4e88\u5f8c"},"content":{"rendered":"<p>\uff0d\u6587\u732e\u540d\uff0d\u2028\u00a0\u5e73\u539f\u4f50\u6597\u53f8\uff08\u8457\uff09\uff0e\u7b2c\uff13\u7ae0 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\/>\n\uff087-a:\u6700\u5927\u9650\u7d046\u8a9e\u306b\u9650\u5b9a\u3055\u308c\u305f\u8a00\u8a9e\u6a5f\u80fd\u306e\u4f4e\u4e0b\u30017-b\uff1a\u7406\u89e3\u3057\u3046\u308b\u8a9e\u5f59\u306f\u305f\u3060\u4e00\u3064\u306e\u5358\u3000<br \/>\n\u3000\u8a9e\u30017-c\uff1a\u6b69\u884c\u80fd\u529b\u306e\u55aa\u5931\u30017-d\uff1a\u7740\u5ea7\u80fd\u529b\u306e\u55aa\u5931\u30017-e:\u7b11\u3046\u80fd\u529b\u306e\u55aa\u5931\u30017-f\uff1a\u6df7\u8ff7\u304a\u3000<br \/>\n\u3000\u3088\u3073\u660f\u7761\u306e\u5404\u6bb5\u968e\uff09 \u3000<br \/>\n\u00a0<br \/>\n\uff12\u8a8d\u77e5\u75c7\u60a3\u8005\u306e\u4e88\u5f8c\u3068\u6b7b\u56e0<br \/>\n\u00a0\u30fb\u82f1\u56fd\u306e\uff15\u3064\u306e\u5730\u57df\u306714\u5e74\u9593\u306b\u6e21\u3063\u3066\u884c\u308f\u308c\u305f\u524d\u5411\u304d\u8abf\u67fb\u3067\u3001\u8a8d\u77e5\u75c7\u60a3\u8005\u306f\u8a3a\u65ad\u5f8c\u5e73\u57474.5\u3000<br \/>\n\u5e74\u3067\u6b7b\u4ea1\u3057\u3066\u3044\u308b\u3053\u3068\u304c\u308f\u304b\u3063\u3066\u3044\u308b\uff08\uff11\uff09\u3002\u7c73\u56fd\u306e\u30a2\u30eb\u30c4\u30cf\u30a4\u30de\u30fc\u578b\u8a8d\u77e5\u75c7521\u4f8b\u306e\u8ffd\u8de1\u8abf\u67fb\u3067\u306f\u8a3a\u65ad\u5f8c\u306e\u751f\u5b58\u5e73\u5747\u671f\u9593\u306f\u7537\u60274.2\u5e74\u3001\u5973\u60275.7\u5e74\u3067\u3001\u4e88\u5f8c\u306b\u4e0e\u3048\u308b\u56e0\u5b50\u3068\u3057\u3066\u306f\u5e74\u9f62\u3001\u6027\u5225\u3001\u8a3a\u65ad\u6642\u306e\u91cd\u75c7\u5ea6\u3001\u8eab\u4f53\u6a5f\u80fd\u3001\u5408\u4f75\u75c7\u304c\u6307\u6458\u3055\u308c\u3066\u3044\u308b\uff08\uff12\uff09\u3002<br \/>\n\u00a0\u30fb\u8a8d\u77e5\u6a5f\u80fd\u304c\u91cd\u5ea6\u306e\u30a2\u30eb\u30c4\u30cf\u30a4\u30de\u30fc\u578b\u8a8d\u77e5\u75c7\u3067\u306f\u80ba\u708e\u3067\u306e\u6b7b\u4ea1\u304c\u591a\u304f\u3001\u8a8d\u77e5\u6a5f\u80fd\u304c\u8efd\u5ea6\u306e\u30a2\u30eb\u30c4\u30cf\u30a4\u30de\u30fc\u578b\u8a8d\u77e5\u75c7\u3067\u306f\u5fc3\u75be\u60a3\u3084\u8133\u5352\u4e2d\u3067\u306e\u6b7b\u4ea1\u304c\u591a\u3044\u3053\u3068\u304c\u6307\u6458\u3055\u308c\u3066\u3044\u308b\u3002\uff08\uff13\uff09<br \/>\n\u00a0\u30fb\u30a2\u30eb\u30c4\u30cf\u30a4\u30de\u30fc\u578b\u8a8d\u77e5\u75c7\u4ee5\u5916\u306e\u8a8d\u77e5\u75c7\uff08\u8133\u8840\u7ba1\u6027\u3001\u30ec\u30d3\u30fc\u5c0f\u4f53\u578b\u3001\u524d\u982d\u5074\u982d\u8449\u578b\u8a8d\u77e5\u75c7\uff09\u306e\u4e88\u5f8c\u306b\u95a2\u3059\u308b\u5831\u544a\u306f\u5c11\u306a\u3044\u304c\u3001\u30a2\u30eb\u30c4\u30cf\u30a4\u30de\u30fc\u578b\u8a8d\u77e5\u75c7\u3068\u6bd4\u8f03\u3059\u308b\u3068\u3084\u3084\u77ed\u3044\u3002<br \/>\n\u00a0<br \/>\n\uff13\u8a8d\u77e5\u75c7\u306e\u5ef6\u547d\u6cbb\u7642\u306e\u52b9\u679c<br \/>\n\u00a0\u30fb\u91cd\u5ea6\u8a8d\u77e5\u75c7\u306e\u7d4c\u7ba1\u6804\u990a\u306e\u6709\u7528\u6027\u306b\u3064\u3044\u3066\u306f\u3001\u502b\u7406\u7684\u306a\u7406\u7531\u304b\u3089\u3001RCT\u306f\u5b9f\u65bd\u51fa\u6765\u305a\u3001\u80c3\u763b\u3000<br \/>\n\u5897\u8a2d\u5f8c\u306e\u751f\u5b58\u671f\u9593\u3092\u5f8c\u308d\u5411\u304d\u306b\u307f\u305f\u7269\u304c\u4e3b\u3067\u3042\u308a\u3001\u672c\u66f8\u3067\u306f\u9032\u884c\u8a8d\u77e5\u75c7\u306b\u306f\u7d4c\u7ba1\u6804\u990a\u3092\u5b9f\u65bd\u3059\u3079\u304d\u3067\u306f\u306a\u3044\u3068\u3044\u3046\u6b27\u7c73\u306e\u30b3\u30f3\u30bb\u30f3\u30b5\u30b9\u304c\u5f62\u6210\u3055\u308c\u308b\u3088\u3046\u306b\u306a\u3063\u305f\u5831\u544a\u304c\u7d39\u4ecb\u3055\u308c\u3066\u3044\u308b\u3002<br \/>\n\u00a0\u30fbFinucane\u3089\u304c\u91cd\u5ea6\u8a8d\u77e5\u75c7\u306e\u7d4c\u7ba1\u6804\u990a\u306b\u95a2\u3059\u308b\u7dcf\u8aac\u306e\u4e2d\u3067\u3001PEG\u9020\u8a2d\u5f8c\u306e\u4e2d\u592e\u751f\u5b58\u671f\u9593\u306f7.5\u30f6\u6708\u3067\u3042\u308b\u3053\u3068\u300163\uff05\u306f1\u5e74\u4ee5\u5185\u306b\u300181\uff05\u306f\uff13\u5e74\u4ee5\u5185\u306b\u6b7b\u4ea1\u3057\u3066\u3044\u308b\u3068\u3044\u3046\u898f\u6a21\u306e\u5927\u304d\u306a2\u3064\u306e\u7814\u7a76\u30c7\u30fc\u30bf\u3092\u7d39\u4ecb\u3057\u3001\u8457\u540d\u306a\u5ef6\u547d\u52b9\u679c\u306f\u8a3c\u660e\u3055\u308c\u306a\u3044\u3068\u89e3\u8aac\u3057\u3066\u3044\u308b\u3002\uff08\uff14\uff09\u3000<br \/>\n\u00a0<br \/>\n\uff14\u8a8d\u77e5\u75c7\u306e\u4e88\u5f8c\u4e88\u6e2c<br \/>\n\u00a0\u30fb\uff12\u3064\u306e\u4e88\u5f8c\u4e88\u6e2c\u30b9\u30b1\u30fc\u30eb\u304c\u7d39\u4ecb\u3055\u308c\u3066\u3044\u308b\u3002<br \/>\n\u00a0\u30fbMortality<br \/>\nRisk Index(MRI)\uff08\uff15\uff09:\u7c73\u56fd\u306eNursing Home(NH)\u306b\u5165\u5c45\u3057\u3066\u3044\u308b\u91cd\u5ea6\u8a8d\u77e5\u75c7\u60a3\u8005\u3092\u5bfe\u8c61\u3068\u3057\u305f\u7814\u7a76\u304b\u3089\u958b\u767a\u3055\u308c\u305f\u8a8d\u77e5\u75c7\u60a3\u8005\u306e\u534a\u5e74\u4e88\u5f8c\u306b\u3064\u3044\u3066\u8a55\u4fa1\u3059\u308b\u30b9\u30b1\u30fc\u30eb\u300212\u306e\u30ea\u30b9\u30af\u30d5\u30a1\u30af\u30bf\u30fc\u3092\u8a55\u4fa1\u3057\u52a0\u7b97\u3059\u308b\u3053\u3068\u3067\u534a\u5e74\u4ee5\u5185\u306e\u6b7b\u4ea1\u7387\u3092\u4e88\u6e2c\u3067\u304d\u308b\u3002<br \/>\n\u00a0\u30fbAdvanced<br \/>\nDementia Prognostic Tool(ADEPT)\uff086\uff09:MRI\u304c\u7c73\u56fd\u306e2\u3064\u306e\u5dde\u306eNH\u5165\u5c45\u8005\u306e\u30c7\u30fc\u30bf\u306b\u57fa\u3065\u3044\u3066\u3044\u308b\u306a\u3069\u306e\u9650\u754c\u3092\u4fee\u6b63\u3057\u305f\u30b9\u30b3\u30a2\u3067\u3001\u5168\u7c73\u306eNH\u306e\u91cd\u5ea6\u8a8d\u77e5\u75c7\u60a3\u8005222,405\u4eba\u306e\u5bfe\u8c61\u306b\u5927\u898f\u6a21\u306a\u5f8c\u308d\u5411\u304d\u30b3\u30db\u30fc\u30c8\u7814\u7a76\u3092\u884c\u3044\u4f5c\u6210\u3057\u305f\u3002<br \/>\n\u00a0<br \/>\n\uff081\uff09\u00a0 Survival time in people with dementia:analysis from population based cohort\u00a0<br \/>\nStudy with 14 year follow up BMJ,336:258-262,2008<br \/>\n\uff082\uff09\u00a0\u00a0Survival after Initial Diagnosis of Alzheimer Disease.Annals of Internal\u00a0<br \/>\nMedicine,140(7):501-509,2004<br \/>\n\uff083\uff09\u00a0 Causes of death associated with Alzheimer disease:variation by level of cognitive impairment before death.J Am Geriatr Soc,42(7):723-6,1994<br \/>\n\uff084\uff09\u00a0 Tube feeding in patients with advanced dementia A review of evidence.JAMA,282(14):1365-1370,1999<br \/>\n\uff085\uff09\u00a0 Estimating Prognosis for Nursing Home Resident with dementia,JAMA 291(22)<br \/>\n:2734-2740,2004<br \/>\n\uff086\uff09\u00a0 \u00a0The advanced Dementia Prognostc Tool:A risk score to Estimate Survival in\u00a0<br \/>\n\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nursing Home Residents with Advanced Dementia.JPSM,40(5):639-651,2010\u00a0<br \/>\n\u00a0<br \/>\n\u00a0<br \/>\n\uff0d\u8003\u5bdf\u3068\u30c7\u30a3\u30b9\u30ab\u30c3\u30b7\u30e7\u30f3\uff0d<br \/>\n\u00a0<br \/>\n\u00a0\u30a2\u30eb\u30c4\u30cf\u30a4\u30de\u30fc\u578b\u8a8d\u77e5\u75c7\u60a3\u8005\u306e\u4e88\u5f8c\u4e88\u6e2c\u30b9\u30b1\u30fc\u30eb\u304c\u3042\u308b\u3053\u3068\u3092\u521d\u3081\u3066\u77e5\u3063\u305f\u3002\u307e\u305f\u91cd\u5ea6\u8a8d\u77e5\u75c7\u60a3\u8005\u306b\u5bfe\u3059\u308b\u80c3\u763b\u9020\u8a2d\u306e\u6b27\u7c73\u306e\u30b3\u30f3\u30bb\u30f3\u30b5\u30b9\u3084\u305d\u306e\u3082\u3068\u3068\u306a\u3063\u305f\u5831\u544a\u306b\u3064\u3044\u3066\u3082\u52c9\u5f37\u306b\u306a\u3063\u305f\u3002\u8a8d\u77e5\u75c7\u60a3\u8005\u306e\u5bb6\u65cf\u306b\u98df\u3079\u3089\u308c\u306a\u304f\u306a\u3063\u305f\u969b\u306b\u3069\u3046\u3059\u308b\u304b\u65b9\u91dd\u3092\u6c7a\u5b9a\u3059\u308b\u6a5f\u4f1a\u304c\u3042\u308b\u304c,Shared decision making\u3092\u884c\u3046\u4e0a\u3067\u3053\u308c\u3089\u306e\u4e88\u5f8c\u30b9\u30b1\u30fc\u30eb\u3084\u80c3\u763b\u9020\u8a2d\u4e88\u5f8c\u306e\u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u63d0\u793a\u306f\u6709\u7528\u306b\u306a\u308a\u5f97\u308b\u3068\u611f\u3058\u305f\u3002<\/p>\n<p>\u00a0<br \/>\n\u958b\u50ac\u65e5\uff1a2013\u5e745\u67081\u65e5<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\uff0d\u6587\u732e\u540d\uff0d\u2028\u00a0\u5e73\u539f\u4f50\u6597\u53f8\uff08\u8457\uff09\uff0e\u7b2c\uff13\u7ae0 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