運動不足と全身衰弱を伴う101歳女性の栄養管理：症例報告

Nutritional Management in a 101-Year-Old Woman with Physical Inactivity and General Weakness: A Case Report.

抄録

日本は世界一の長寿国であり、百寿者はもはや珍しい存在ではない。しかし、百寿者に関する十分な情報は得られていない。ここでは、百寿者における栄養管理の事例を把握するために、自宅での栄養管理を中心に極度の運動不足と全身の衰弱から回復した101歳の百寿者の症例を報告する。患者は無気力状態になり、活動レベルと食事摂取量が急速に低下した。主治医により老衰と診断された。摂食・嚥下に問題はないと判断し、食べる意欲が低下していると予測した。私たちは3ヶ月間の介入を計画した。誤嚥のリスクを減らすため、食事中の姿勢に注意した。食欲を刺激するために、食品の種類と色を増やした。食感や安全性を考慮し、ペースト状（IDDSIレベル4）のものから、なるべく普通の大きさの固形食に変更した。また、食事と食事の間に好きなお菓子を摂取することで、食事を楽しむことを勧めた。初回介入から2ヵ月半後、患者の運動不足と全身の衰弱は劇的に改善し、はっきりと話すことはできないが、食べること、大きな声で笑うこと、鼻歌を歌うことに意欲的であることが認められた。患者はようやく家族と夕食をとることができるようになった。

Japan has the world's highest life longevity, and centenarian patients are no longer rare. However, sufficient information related to centenarians is not available. Herein, we report the case of a 101-year-old centenarian woman who recovered from extreme inactivity and general weakness, mainly through nutritional management at home, to understand instances of nutritional management in centenarians. The patient developed lethargy, with a rapid decline in activity levels and food intake. She was diagnosed with senility by a primary doctor. We concluded that she had no problems with feeding and swallowing and predicted that her motivation to eat had decreased. We planned an intervention that lasted three months. To reduce the risk of aspiration, we paid attention to her posture while eating. To stimulate her appetite, we increased the variety and color of food items. To consider both the texture of food and safety, we changed the form of foods from paste (IDDSI Level 4)-like to solid food of regular size as much as possible. We recommended that the patient consume her favorite sweet between meals to enjoy eating. Two and half months after the initial intervention, the patient's inactivity and general weakness improved dramatically, which was recognized by her willingness to eat, laugh loudly, and hum, although she could not speak clearly. The patient finally was able to have dinner with her family.