認知症専門病院を受診・入院している認知症高齢者の家族介護者が行う行動・心理症状への対応：質的内容分析

Family Caregivers' Responses to Behavioral and Psychological Symptoms of Older People with Dementia Who are Outpatients or Hospitalized at Hospitals Specializing in Dementia: A Qualitative Content Analysis

要旨

　目的：認知症専門病院を受診・入院している認知症高齢者の家族介護者が行う行動・心理症状への対応を明らかにする．

　方法：認知症高齢者を介護する家族介護者16名に半構造化面接を実施し，Elo & Kyngäs（2008）の質的内容分析を行った．

　結果：【被介護者への抑えられない叱責】【被介護者に対する行動制限】などの16カテゴリーから構成される《BPSDへの対応の模索》《発展的対応》《抑圧的対応》《孤立をもたらす対応》の4つのテーマが得られた．家族介護者は周囲の人と効果的な対応を共有し，介護のコツを獲得するといった《発展的対応》と，叱責，制限といった《抑圧的対応》の両方を行っていた．【周囲に被介護者のことを隠秘】し，自己犠牲を払って《孤立をもたらす対応》に至る場合もあった．

　結論：被介護者の尊厳を傷つける可能性のある《抑圧的対応》に関して，適切なサポートを行うことで，虐待や孤立を予防できる可能性がある．

　Purpose: To clarify family caregivers' responses to behavioral and psychological symptoms of older people with dementia who are outpatients or hospitalized at hospitals specializing in dementia.

　Methods: We conducted semi-structured interviews with 16 family caregivers of older people with dementia. The method described by Elo and Kyngäs (2008) was used for qualitative content analysis of the data obtained via the interview.

　Results: The analysis identified four themes: «exploration for responses to BPSD», «developmental responses», «oppressive responses», and «responses leading to isolation». These themes were composed of 16 categories, including [uncontrollable reprimands to the caregiver] and [restraint on care recipient' activities]. Family caregivers' responses included both «developmental responses», such as [acquisition of tips on caregiving for the care recipient] by sharing effective responses with people around them, and «oppressive responses», such as rebuke, restraint. «responses leading to isolation» were observed in some cases in which [the care recipient was kept secret from people around the family] and caregiving involved self-sacrifice.

　Conclusion: Appropriate support for family caregivers with regard to «oppressive responses», which can violate care recipients' dignity, should prevent abuse and isolation.