「オムツはすぐに使うべき!?」両親が、なかなかオムツをはいてくれません。
普段、何気なく生活をしていると意識しませんが、本来「排泄」はとてもデリケートなものです。
そして生命を維持するための、必要な活動でもあります。
ではその活動に支障が出た場合、私たちは何に危惧をするでしょう。これは、いざ体験してみないとわからないものです。
高齢者は、人に迷惑をかけずに生活をしたいとの思いが強いため、介護を拒否する方も少なくありません。
また認知症を患っていると、その認識さえ乏しくなってしまいます。
特に排泄はデリケートものであり、支障が出ても隠そうとしたり、人に話そうとしません。
もし、両親がそのような状態になった場合、どういうアプローチが効果的なのでしょうか。
目次
オムツの種類
「オムツ」と一言でいっても、いろんなタイプがあります。履くものから、テープ止めるもの。インナー（尿取りパッド）と併用したり、単独で使えるものなど、色々と種類がありますので紹介します。
①軽失禁パンツ
こちらは少し厚めの吸水層が付いた履くタイプの下着です。主に少し尿漏れがある方などが使用に適しており、小さめの失禁パッドを組み合わせて使うことができます。
②パンツ型紙おむつ
リハビリパンツとも呼ばれているものです。主に立ったり歩いたりできる方が使うオムツです。尿取りパッドなしでも使用できますが、併用する事で、尿が漏れても、パッドだけを交換する事ができ、清潔も保つことができます。
③テープ止めタイプ
トイレに行くことが困難な方が使うオムツです。そのため、使用には介助が必要です。吸水性があり、尿取りパッドなしでも使用ができますが、併用する事で尿が漏れても、パッドだけを交換する事ができ、清潔を保つことができます。
このように、オムツと言っても、身体の状態や失禁の量によっても、適したものを使うことで失敗を防ぐことができます。
尿取りパッドにも、女性型の小さい物から、夜型用の大きい物まで、たくさんの種類がありますので、用途によって組み合わせて使用する事をお勧めします。費用も変わってきます。
失禁にも種類があります
失禁には「尿失禁」と「便失禁」があります。
いずれも、自分の意思とは関係なく、漏れてしまう事を言います。
「尿失禁」には、以下の種類があります。
①腹圧性尿失禁
咳やくしゃみをした時など、お腹に力が入り、腹圧がかかった時に尿が漏れてしまう事。女性に多くみられます。
②切迫性尿失禁
急に尿がしたくなり、我慢できずに尿が漏れてしまう事。
③溢流性尿失禁
尿を出したいのに出せず、少しずつ溢れてしまい尿が漏れてしまう事。前立腺肥大など、男性に多くみられる。
④機能性尿失禁
排尿機能は正常だが、運動機能の障害や認知症などで、トイレに間に合わない、あるいは排泄行為が認識できずに尿が漏れてしまう事。
尿失禁は病名ではありません。しかし、尿失禁の種類によっては治療や改善が見込まれますので、まずは泌尿器科へ受診し、専門医に相談する事をお勧めします。
オムツを拒否する理由
ではオムツの使用を拒否する理由を考えていきましょう。
その方の生活や環境、性格などを考えると、答えがあてはまるかどうかはわかりませんが、ここでは、拒否する方がよく話される例を紹介します。
・プライドが許さない
・おむつを使いだしたら、もうおしまいと思っている
・失禁している自覚がない
・おむつの感覚が苦手
・おむつはお金がかかる
などなど。
冒頭でもお伝えしたとおり、排泄はとてもデリケートな問題です。
本当に心を許した相手であればあるほど、羞恥心が先行してしまい、
「知られたくない」
「嫌われたくない」
といった感情が出てきてしまいます。
それが素直に言える方もいれば、頑なに本心を隠す方もいます。
特に両親へ勧めるとなると、自尊心も考慮しなければなりません。
本人も本当は「何とかしたい」と思っているかもしれません。
そう考えると、安易に「オムツを履いて」といった言葉は非常に心苦しくなってしまいます。
こちらの思いとしては、排泄の失敗をなくしてもらいたいと思っているのに、なかなかうまく伝えられず、感情が先立ってしまい、結果、両親を苦しめてしまう事にもなりかねません。
とても難しい問題です。
効果的なアプローチ
ここでは実際にうまくいった成功例を紹介します。
一概に誰にでも当てはまるものではありませんが、一つの例として知っておいてもらえればと思います。
① オムツと言わずにパンツと言う
「オムツ」というワードは、やはり、高齢者の方には「赤ちゃんや子供が使う物」といった認識が強くあります。あえて「オムツ」という言葉を使わず、便利な「使い捨てパンツ」があるからと、使用を勧めると、何の抵抗もなく、履いてくれたという例があります。
中には、「今、流行りのパンツ」や、「外出用パンツ」と言い方を変えるだけでも成功する場合があります。
② 女性用ナプキンから始める
尿取りパッドは小さい女性用の物から、夜間５回分の排尿を吸収する大きいサイズまで、種類がたくさんあります。
どうしてもかさばってしまい、あまり使用に気が進まない方でも、女性用の一番小さな物から使用する事で、違和感なく普通サイズの物を使えるようになったとの例があります。
③ ケアマネージャーや医師など、関係者から勧めてもらう
両親にオムツを勧めるには、やはり自尊心を傷つけたくないという方が多いと思います。
また、両親からすれば、子供に勧められると、素直に受け入れられないといった事も多くあります。
そこで、「第３者」に介入してもらう事をお勧めします。
多くの高齢者は、「お医者さんが言うなら仕方ない」と渋々我慢して、助言を受け入れる場合が多々あります。
かかりつけ医に受診をする際、事前に現在の排泄状況を説明し、助言という形で本人に伝えてもらいましょう。
そして一緒に病院に付き添って助言してもらうというアプローチはとても効果的です。
他にも、ケアマネージャーや、地域の民生委員の方と関係を作るなど、様々な関係者の方の力を借りましょう。
信頼関係を築くには時間がかかるかもしれませんが、その後も様々な場面で、助けになってくれます。
まとめ
高齢者は、今の生活をできるだけ変化させたくないという気持ちが強く、新しいことや違う事をすることに、抵抗を持つ方がほとんどです。
ましてや、デリケートなことに関しては誰にも知られたくないという気持ちが本心ではないでしょうか。
両親の一番恥ずかしい扉を開けようとするわけですから、抵抗があるのは、当たり前の事です。
おむつや紙パンツを嫌がる人が、ストレスなく使用できる方法は、人によって異なります。
最後まで使用しない方もいれば、排泄の失敗が改善する方もいます。
大事なことは、「排泄の失敗があるからといって、必ずオムツを使用しなくてはならない」と思わない事です。
絶対に使用しないといけないというわけではありません。
現在の生活環境を変えたり、福祉用具を使用する事で、排泄の失敗は改善する事ができます。
認知症の方でも、自尊心は最後まで残るといわれています。
家族が意地になって、「絶対に履いてもらわないと困る」となった分、両親も同じように、「絶対に履かない」と思ってしまうのではないでしょうか。
「オムツを使用する」というのは、一つの選択肢としてとらえ、まずは、両親の自尊心を尊重し、思いやる気持ちを先行させましょう。
両親を心配する気持ちは必ず伝わります。
意地を張っている両親も、きっと折れるところを探してくれるのではないでしょうか。
「今後の生活環境が変わる事への不安」や「介護を使って生活をどうデザインをしていったら良いか」など介護は協力体制で成り立っております。 ちょっとでも解決できる、ストレス軽減できる記事を目指し、一つの相談場所のメディアを目指しております。
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