訪問リハビリテーションにおける高齢障害者の在宅介護継続因子の検討—在宅生活継続例と破綻例の介護者の心理的側面より

Case study-psychological factors involved in caring for the elderly at home

要旨：在宅高齢障害者の介護をする者にとって，その負担感は在宅介護の可否を決定する大きな要因である．この介護負担感は，主に介護者の置かれた状況を受け止める介護者の主観に大きく依存していることが多い．

　今回高齢障害者に対する訪問リハビリテーション(以下，訪問リハ)を実施した中で，在宅介護が継続した症例と破綻した症例の主たる介護者の心理的態度の変化の面から，在宅生活継続要因について検討を加えた．その結果，主たる介護者に対する他の家族の理解・協力が在宅介護継続のための大きな要因として考えられた．また，他の家族の理解・協力を得るためには，訪問リハ開始当初より主たる介護者と共に他の家族への対応が大切で，特に介護が表面上うまくいっている適応期の段階までに他の家族への対応を行う必要が考えられた．

　We did a comparative study two cases in which caregivers provided care for elderly, bedridden persons at home, with assistance from home health therapists.

　We compard the psychological factors of the caregivers who tended to their elderly mothers-in-law. One case was successful (continued care for five years), and one was not (continud care for two years only). In taking care of elderly bedridden mothers-in-law, the sense of burden was the key factor in whether the caregiving continued or not. We proposed that there are four types of psychological conditions, including confusion, adaptation, fatigue, and burn-out, that need to be dealt with when therapists go into the home. We found that the sense of burden is an important factor, and this factor depends on the environment of each caregiver. Support from the other members of the family for the caregiver was the key factor determining whether home care of elderly, bedridden persons continued or not. To provide a good support system, therapists should advise the other family members in the initial stage. As a result of comparing these two cases, we found that therapists should promote sufficient physical and psychological support from the other family members ever if the home care is well-done by the caregiver alone, without any other assistance.