【看護師解説】介護における歯磨きのケアと肺炎
介護において「口腔ケア(歯磨き)」がどれだけ大切なものかご存じですか？何気なくご自身の歯磨きをされている方はほとんどかと思いますが、もしこのケアが自身でできなくなったらどうなるのでしょう。
ここでは介護と口腔ケアについてまとめています。
目次
口腔ケアの意義や意味についておさらい
”口腔ケア（歯磨き）”とは口の中を清潔に保つことです。介護の場面であれば、ご自身で歯磨きのケアができない方に対し介護者が歯磨き等のケアを行うこと、または部分的に歯磨きや口をすすぐなどのケアの介助が必要な場合にケアすることをいいます。
さらに広い意味では入れ歯のケアや食べ物を食べること飲み物を飲み込む動作についても口腔ケアに該当します。口の中は清潔な場所だとお思いの方もたくさんいらっしゃることでしょう。しかし実際はおよそ500-700種類の細菌が1000億以上住み着いて口腔内にいることがわかっています。なんとも清潔とは言い難い部分であることがわかります。
人間は唾液は1日に1Lから1.5L分泌されています。
食事を摂取するとき、またそれ以外でも常に唾液で口腔内の湿潤を持っており、口腔内を潤わせることでウィルスや細菌からの防御機能を働かせています。それに加え私たちが口腔ケアをすることで、少しでも口の中をきれいに保つことができ、爽快感を得ることもできます。
そういった点でも呼吸ケアは非常に大切な日常のケアであることがわかります。
誤嚥性肺炎聞いたことはありますか？
肺は口と鼻、気管支を介して外界と繋がっています。
一般的に肺や気管支の中はウィルスや細菌はおらず、無菌状態であると言われています。 その肺にウィルスや細菌が肺に達することで感染が起こります。それにより高熱や咳、痰、呼吸困難などの症状が見られるようであれば肺炎の可能性が高くなります。
健康で若く元気な方は多少の細菌やウィルスが体内に入っても、ある程度は身体の防御機能で追い出すことができます。
しかし口腔ケアが充分にできないような介護を要する方や高齢方は免疫力とが低下していたり、身体の防御機能が低下している場合がほとんどです。そのため肺炎に非常になりやすく危険であることがわかります。ここ数年の日本人の死因のベスト5には肺炎が入っています。
コロナになる前の平成29年の結果（*1）より肺炎は日本人の死因の第3位となっていました。この肺炎で亡くなる方の多くは後期高齢者であると言われています。あなたも、高齢の方が咳き込んでいる（つまり、むせてしまっている）場面を見た事はありませんか？
口の中の細菌が入った唾液が気道に入って肺炎を起こすことを「誤嚥性肺炎（ごえんせいはいえん）」と呼んでいます。
それは食べ物でむせこむだけでなく、唾液を飲み込むことで起きることもあります。食べ物を食べたり、飲み物を飲み込む動作を「嚥下（えんげ）」と呼んでいます。この嚥下がうまくいかないことで誤嚥性肺炎になる場合が多くあります。よく誤嚥性肺炎見られる高齢の方は、加齢によりこの嚥下の機能が低下してしまうことが挙げられます。
他には脳梗塞といった嚥下の機能が障害される病気の後遺症で、嚥下の機能が低下するといった場合もあります。
▼肺炎の入院のうち高齢者の多くは誤嚥性肺炎だと言われている(*2)
肺炎予防につながる歯磨きのポイント
1,口腔内全体と磨いているところが直視できるように極力明るく居場所でケアを行いましょう。
2,口腔内全体の状態を観察し、歯磨きを始めます。食べかす等の食物残渣が多い場合は、歯磨きの前にうがいをするか拭き取りをし、歯ブラシで磨きます。
3,寝る前の歯磨きは特に丁寧に行いうようにしましょう。
4,歯の状態や歯並びで歯磨きの方法や歯磨きの道具が変わることもあります。ケアを要する方に合った磨き方を歯科医師や歯科衛生士に教えてもらい、練習しましょう。
まとめ
口腔ケアは病気を予防するためにも、欠かせないケアであることがお分かりいただけましたか？特に介護をされている方は多くのケアをされ忙しいなかで、「歯磨きははおろそかになっているかも…」と話される患者ご家族様にお会いすることがあります。
今は便利な口腔ケアグッツも多く販売しています。一度介護の専門窓口までご相談してみるのはいかがでしょうか。
「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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