高齢者夫婦二人暮らしの介護継続の意思を支える要素と妨げる要素―介護する配偶者の内的心情を中心に

Supportive and Hindering Factors Affecting the Will to Continue Home Care in the Case of Elderly Couples: With a Focus on the Mindset of the Care-giving Spouse

要旨

　本研究は，高齢者夫婦二人暮らしの介護がどのように継続されているかについて示唆を得るため，介護継続の意思を支える要素と妨げる要素の二つの側面から介護する配偶者の内的心情を探求した．その結果，介護継続の意思を支える要素は，『やりがい』，『被介護者への愛着』，『慈愛の気持ち』，『献身的な思い』，『被介護者への恩義』，『安心感』，『気晴らしがあること』，『負担に思わないこと』の8つのカテゴリーが抽出された．『被介護者への愛着』は『慈愛の気持ち』とともに『献身的な思い』という自己犠牲の感情を支えていると考えられ，『やりがい』は介護継続の意思を直接的に支えていると考えられた．一方，介護継続の意思を妨げる要素は，『いらだたしさ』，『閉塞感』，『不安感』，『諦めの気持ち』，『孤独感』，『周囲への気兼ね』の6つのカテゴリーが抽出された．『いらだたしさ』は直接的に介護継続の意思を妨げる要素だと考えられた．介護者は，夫婦二人暮らしの中で，『諦めの気持ち』から生じたやらざるを得ない気持ちと『献身的な思い』とのせめぎあいの中で介護を行っていることが推察された．看護職は，介護者自身が介護の効果を確認できるように関わり，自己犠牲の思いにつながる負担を軽減することの必要性が示唆された．

Abstract

　In this study, the mindset of care-giving spouse was investigated via a qualitative approach to determine supportive and hindering factors affecting their will to continue home care in order to throw light on situations where care of one elderly spouse by another is carried out at home. Eight factors supporting this will to continue were established, being a“feeling that the care is worthwhile”, “attachment to the cared for spouse”, a “feeling of affection”, a “feeling of devotion”, “obligation to the cared for spouse”, “peace of mind”, a“means of diversion”, and “lack of a feeling of burden”. “Attachment to the cared for spouse”and the“feeling of affection” were both considered to support the feeling of self-sacrifice, or the“feeling of devotion”. The “feeling that the care is worthwhile”was considered to directly support the will to continue home care of the spouse.

　On the other hand, six factors that hindered the will to continue home care were established, being a“feeling of irritation”, a “sense of despair”, a “sense of hopelessness”, “anxiety”, “loneliness”, and a“hemmed-in feeling”. The“feeling of irritation”was considered to be a factor directly hindering the will to continue spousal home care. It was conjectured that caregivers conduct home care with conflicting feelings of obligation born of a reaction to the“sense of hopelessness”, and the“feeling of devotion”. This study indicated the necessity of having nursing staff involved in the home care in such a manner that the care-giving spouse him/herself can confirm the effects of his/her care, thus reducing the burden on that spouse caused by feelings of self-sacrifice.