スキップしてメイン コンテンツに移動

Let’s Think About Life with Dementia #3　 “I live alone, but I’m not alone”―A Critical Role of Visiting Nurses

 

Many older people like to continue their own way of living even when they live alone with dementia. The key to making it happen, I have always felt, is how supporters can value these older people’s wisdom, which they have built over the years, and their wishes to remain who they are. In March 2025, the Tokyo Metropolitan Geriatric Medical Center published the guidebook titled “Supporting Independence of Older People Living Alone with Dementia: Practice Guide fo
r Visiting Nurses.” This guidebook provides a useful checklist and practical tips for visiting nurses who support older people living alone with dementia. I had an opportunity to be part of this research as a committee member.

 

The checklist was developed based on detailed interviews with visiting nurses, who had extensive experience in supporting older people living alone with dementia, as well as opinions of experts in this area. It summarizes attitudes, perspectives, and support methods emphasized on the frontline in the following steps:

·         Step 1: Getting into the user’s life and building relationships through a series of dialogues (4 items)

·         Step 2: Assessing the user’s physical and mental state and daily living, with a holistic understanding of the person (6 items)

·         Step 3: Providing personalized support in collaboration with multiple professionals (5 items)

·         Step 4: Making judgements and supporting decision-making, foreseeing future changes (3 items)

 

Let me share with you an example in the guidebook.

Ms. D (age 80) was in the middle stage of dementia, continuing to live alone with the support of visiting nurses. She would always welcome visiting staff members with a big smile. She was also able to enjoy conversation with jokes. But since a certain point, her smile had disappeared and her rooms had been left messy. She didn’t seem like her usual self. On another day, a home care worker happened to find Ms. D far from her home, getting lost and standing still. Suspecting that something must be going on, her visiting nurse contacted Ms. D’s family and found that her older sister had passed away about a month earlier.

As this example shows, we sometimes notice changes in the person’s physical and mental health, as well as daily living, from small differences in their expressions and behavior. But the person may not be able to effectively put their worry and sorrow into words. We certainly should listen to the person’s voice; in many cases, however, their words alone are insufficient for understanding the situation.

 

Although I’m not a visiting nurse, involvement in this research has reminded me how important it is for visiting nurses to share the attitude focusing on detecting even the smallest changes, while collaborating with other professionals. Even if they cannot immediately find out what has happened, like Ms. D’s case, they can notice small signs in the person’s expressions, words, behavior, disorganized living space, and other changes. It is essential that supporters share these signs as they carefully and attentively engage with the person. This process requires a multifaceted understanding, including not only medical but also psychological and social aspects, as well as seamless support.

 

The point is that the person can feel connected to others even if they live alone. I strongly feel this possibility from the stories of people with dementia and supporters featured in the guidebook. Older people can continue to live in their own way with peace of mind, even if they live alone with dementia. To achieve this, visiting nurses and other various professionals need to work more collaboratively and foster connections with the local community as the foundation of the person’s living. And most of all, we need to remind ourselves that support starts with empathy, walking together with the person here and now.

You can download the guidebook from the following URL (in Japanese):

“Supporting Independence of Older People Living Alone with Dementia: Practice Guide for Visiting Nurses”

https://www.tmghig.jp/research/cms_upload/1b79188a1fdd5d515251f5756bf9fb40.pdf

 

Published by: Tokyo Metropolitan Geriatric Medical Center

Supported by: The National Association for Visiting Nurse Service

Edited by: Shuji Tsuda, Tomoko Nakajima, Emi Kaneda

 

Taeko Nakashima

Faculty of Health Management　Department of Social Health and Business Management

Nihon Fukushi University

https://www.nfu.ne.jp/ (in Japanese)

コメント

コメントを投稿

このブログの人気の投稿

Cutting-edge Daily Life of Elderly #10 Joining Hands to Exchange Energy

We can now enjoy longevity as we live in the 100-year-life era. People first worked to extend the average life expectancy, and then aimed for longer healthy life expectancy. I would say Japan has now entered the era aiming for longer “engage life expectancy.” What is engage life expectancy? It is the period in which a person can contribute to society and others. Going beyond healthy life expectancy, it refers to how long we can be useful to society throughout our lives.   “We are offering free hand massages today. You’re welcome to try it.” A receptionist told me when I visited a car dealership the other day. Lucky me! I instantly replied, “Yes, please!”   The massage space was set up in a corner of the showroom, with two massage therapists waiting for guests. The one on the right was a young, innocent-looking woman, carefully checking the cosmetic items she’d use for massaging. The one on the left was an older women, looking fully ready to serve and smiling at m...
コメントを投稿
続きを読む

< Series: What is “normal” in Japan, what is “normal” in other countries #1>　Where do people want to spend their final days? Where do they actually spend their final days?

 From 2010 to 2011, the International Longevity Center Japan carried out an international comparative research project on end-of-life care. As part of this project, we conducted the International Comparative Study on Ideal Terminal Care and Death. In this study, we asked medical doctors, nurses, direct care workers, and social workers about what they thought was ideal terminal care and what would actually happen.   The International Comparative Study on Ideal Terminal Care and Death : English summary. https://www.ilcjapan.org/studyE/doc/End-of-life_Care.pdf List of research activities since 2010 (in English) https://www.ilcjapan.org/studyE/index.html   In this study, we presented these professionals in different countries with hypothetical cases, including Mrs. A with terminal cancer as shown below. We asked them where they thought would be the best place for Mrs. A to spend her final days. Additionally, we asked them where they thought she would actually ...
コメントを投稿
続きを読む

推し活とプロダクティブ＃１５ 社会的処方とプロダクティブ

夏休み、いつもより 80 代の両親と過ごす時間の長い毎日。 慌ただしすぎて気づかなかったこと、一部分しか知らずに深刻さを理解していなかったことを突きつけられる毎日。   ため息ばかりではあるけれど、研究者としては、毎日を追いかけることで新たな発見もあったりする。 その一つが、母が不安定になるとはじまる二つの行動の実態が見えたこと。   母の不安や焦りのサインとも言えるのだけれど、一つ目の行動が、同じ家にいる夫に、ひどい日は 100 回以上も電話をかけ続けること。 留守電にしてる父のスマホには、実家や昔の住まいに「迎えに来てください」のメッセージがたくさん。   これが増えるときに連動しているのが、認知症外来への通院日と一番身近な家族である夫が外出したり zoom などで自分の知らない世界と楽しそうに話した後。 不安だよね … 、漠然とした事実を突きつけられるって、支えだと思っていた人が知らない世界にいるって … 。   もう一つの行動が、何時間も何回も、食器棚や冷蔵庫の整理をすること。 お皿の位置がしょっちゅう変わり、買ったばかりの新玉ねぎが丸ごと冷凍庫に入っていたり、ワタシもイライラしてしまうことも多々だったのだけれど … 。   夏休み、チラチラ観察をした結果、わかったのが、この引き金となるトリガーがあること。 それは、忘れちゃう、無くしちゃう、作りすぎちゃう母に先回りして家族が役割を奪ってしまうこと。   できないでしょ、座っててと部屋の片隅に押しやるのは一番やっちゃいけないこと。 わかってはいるけれど、やっぱり一緒にいる時間が多いほどに難しい … 。   そんな日常で驚くのは、冬の個展に向けて作品の準備をしたり、認知症になったご近所さんを心配をしている時はかっての母に戻ること。 発注済みの額縁屋さんに何度も電話したり、ご近所さんが既に亡くなっていることを忘れていたりというオチはあるのだけれど … 。   元気な時よりも、弱ってきた時ほどに、役割を持っていると感じられることって大事。 それを家族だってわかっちゃいるけれど、余裕もないし、ストレスで自分が助けてもらいたい位の状況だったりも...
コメントを投稿
続きを読む