Characteristics of Care among Resistiveness to ADL Care towards Patients with Moderate Dementia of the Alzheimer's Type

Abstract

　Resistance to ADL care and relationships with medical staff or care providers are important factors for patients with moderate Alzheimer type dementia. In this study, by observing the in volvement of staff during patient resistance to ADL care, we aimed to examine what "desirable care" would be. The study observed 7 patients with moderate Alzheimer's type dementia hospitalized in a geriatric dementia ward, and the 20 care-providers with whom they interacted. We used a paticipant observation method involving direct observation and recorded findings. Each patient was observed for a total of 40 hours. When a patient expressed a smile at the end of the care, after resistance had been seen in the beginning, it was considered to be satisfied care. On the other hand, if a smile was not expressed, it was considered to be unsatisfied care. When care was unable to be completed, and if a smile was not expressed, it was considered to be interrupted care. Data was analyzed by comparing each care type. Care patterns were observed in the care-providers for patients. The length of time they spent on each aspect of care was noted. For ADL care of toileting, dressing, and eating, satisfied care showed statistically significant differences with longest time spent. In each aspect of care, the existence of "Daily conversation" and "Explanation of the care (reasoning with the patient)" was examined in respect to the care-provider's voice. In toileting, dressing and bathing, satisfied care was significantly related to the existence of "Daily conversation". When care was resisted, it was thought that overcoming the resistance related to the achievement of the care by satisfying the patient through spending time and engaging in daily conversation.