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高齢者ケアにおける臨床的意思決定：非老年医学専門医のための実践的知見

Isaac K S Ng1,2, Grace Rui Si Lim1,2, Yanling Xu1

  • 1Department of Medicine, National University Hospital, Singapore, Singapore.

Internal medicine journal
|November 28, 2025
PubMed

臨床推論は医療現場における実践および意思決定の根幹を成すものであり、患者に提供されるヘルスケアサービスの質を直接的に決定づけます。しかし、近年の診断ミスや医療エラーの蔓延を受け、教育的ペダゴジーを通じて臨床的意思決定プロセスを強化することにますます注目が集まっています。世界的な人口の急速な高齢化に伴い、さまざまな程度の併存疾患や機能状態、さらには異なるケア目標やニーズを持つ高齢者の医療における課題と複雑性は、間違いなく増大していくでしょう。老年医学は専門分野として長年にわたり発展し、高齢患者への最適なケアに向けた多職種連携が行われてきましたが、依然として多くの高齢患者は、老年医学の専門医ではない総合医や専門医によってケアされています。したがって本記事では、高齢患者をケアする際の臨床的意思決定に関する実践的な知見を提供することを目的とし、特に実際の診療におけるバイアスの形態をとる認知エラーや「ノイズ」を含む臨床判断に陥りやすい傾向について考察し、これらの課題を軽減してケアの質を向上させるための多層的な戦略について論じます。

キーワード:
臨床推論認知バイアスマルチモビディティ（多疾患併存）複合的ケア機能低下医学的意思決定

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