【認知症の高齢者】家族が病院へ行かないのですが…
認知症を持つ高齢者家族が、病院へ行きたがらず、拒否をされ困ってしまったご経験はありませんか。この記事では、病院でも特に「神経内科」や「物忘れ外来」へ行きたがらない、認知症の高齢者の心理と、その対応についてご紹介します。
目次
高齢者家族に対する、病院受診の「困った」場面を思い出してみましょう
ここでは、認知症を持つ患者さん2例を挙げてみます。
Aさん(80代女性)の例
最近物忘れが目立つAさんは、マイペースな性格。長男家族と同居している。長男の妻は、このところ、Aさんの様子が気がかりであった。長男の妻は、物忘れが目立って気になることをAさん本人に話し、近所の精神科の受診を勧めた。すると、「私はどこもおかしくない、病院へはいかない」とAさんは怒ってしまった。
Bさん（70代男性）の例
このところ、Bさんは年金が支給されると同時に、全ての年金を使い切ってしまうことが増えた。困ったBさんの妻が、息子に相談したところ、認知症ではないかと言われた。妻は、Bさんが病院の受診を拒否するだろうと思い、「健康診断へ行こう」とBさんに嘘の説明をし、神経内科へBさんを連れてきた。Bさんは何とか初回の受診は終えたものの、その日以降、全く会話をしなくなってしまった。
認知症を発症した場合、これまでできていた、さまざまな物事を行うことが、難しくなってしまいます。とは言っても、認知症の初期の段階では、本人がそのことを理解していると言われており、自身の変化に対し、次のような心理状態になると言われています。
□こんなことができなくなったなんて、言い出せない
□年をとればみんなこんなものだ、自分もそんなものだ
□家族に煩わしい思いをさせてしまうかもな
□認知症がひどくなって、醜態をさらすなんて、ごめんだ
親子や配偶者等であったとしても、自分の老いた姿や、弱みを他人に見せるのは、恥ずかしく、プライドが傷づくと感じる方もいらっしゃいます。また心のどこかで、「助けて欲しい」と感じ、小さな気遣いや、さりげない手助けを望んでいることが多いようです。認知症をもつ高齢者は「本当は助けて欲しい、しかし、うまく言い出せない」といったジレンマのを抱えているパターンが、少なくありません。そんな中で、身近の人に「物忘れがひどくなっている」「こんなこともできないんですか」等、失敗を指摘され、怒られるようなことが続けば、強いストレスになり、精神的に不安定になってしまうことがあります。
先にご紹介したAさんとBさんの例を考察してみます。
Aさん⇒物忘れがあることに対し、本人はそこまで気にしていなかったことが考えられます。年を取ればこんなものだ、と本人なりに、何とか自分の変化を受け入れようとしていたところ、長男の妻からの「物忘れが目立っている」と言う現実を突きつけられてしまいました。プライドが気づいたAさんは「自分はおかしくない」と自分を守るしかありませんでした。
Bさん⇒身近な家族である妻が、「健康診断」へ行こうと誘ったため、信じて妻について行ったBさん。病院へついてみると、思いもよらなかった診察をうけさせられた上に、認知症のためのテストや検査をされます。妻に騙されたと感じると同時に、自分がどんなテストをさせられるのだろうと言う恐怖を感じました。自分に自信がなくなり、「認知症」を疑われていると感じ、「診断されるのは、嫌だ」と強く思います。また、信頼していた家族に対し、騙されたと感じたことから、妻の発言にあらゆる疑念を持つようになりました。
認知症であることが疑わしい高齢者に対し、家族が病院を受診してほしい気持ちが先行することで、高齢者の気持ちに寄り添うことが難しくなってしまう場合があります。
スムーズに受診してもらう為のカギ
ご本人が、病院を拒否するのであれば、「無理して連れて行かなくてもよいだろう」とご家族はお思いになるかもしれません。しかし認知症は、さまざまな原因により発症しており、疾患であることは間違いありません。診察をし、必要な検査や治療をすることで、認知症の症状が軽くなったり、認知症の進行を抑えることができるケースがあります。次に挙げるポイントを押さえることで、スムーズに病院を受診してもらえるようになる場合があります。
□受診してもらいたい旨を、直接しっかりと話す。
本当に認知症であった場合のことを考えましょう。家族からすると、その状況が曖昧なままにしておくことで、不安があるはずです。この気持ちを、ご本人へ伝えましょう。「私のためだと思って、病院へ行ってくれない？」と話しかけてみます。
子どもからのお願いであれば「聞いてやろうじゃないか」という気持ちがうまれることもあります。
□かかりつけ医に説得してもらうようにする
高齢者ご家族が、普段から通っているクリニック等、かかりつけ医に、神経内科の受診をおすすめしてもらうのも、手です。家族に言われると、聞き入れづらくとも、信頼を置いている、かかりつけ医からの提言があれば、神経内科の受診に納得される場合があります。また、医療関係者の言葉であれば、聞き入れやすいという点もあることが考えられます。
まとめ
神経内科の受診をしたがらないことには、何らかの理由が存在します。また家族からの認知症を疑う声かけは、場合によって、高齢者本人のプライドを、傷付けてしまうことがあります。とは言っても、診察をしなくてよいと言えないのが認知症です。本人の気持ちによりそいながら、神経内科受診の必要性を理解してもらうことで、スムーズな受診ができるように働きかけるケースもあります。
弊社では、このような家族の「困った」に寄り添い、サービスを提供していきます。
「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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