在宅における老人虐待事例の援助の分析—援助過程の質，および援助結果に影響を与える要因の検討

The Analysis of Supports for Elder-Abuse-Case in Home : Study of Factors Influencing Quality of Support Process and Outcome

　本研究の目的は，1）老人虐待事例の援助過程の質が援助結果に及ぼす影響を明らかにすること，2）援助結果に影響するその他の要因を明らかにすること，である．埼玉，福岡，山形3県の地域看護職を対象とした平成7年の実態調査で把握された171の老人虐待事例のうち，当時継続中の事例について郵送質問紙法によるフォローアップ調査を行い，28の有効回答（回収率67.0％）を得た．援助過程の評価として特定の利用者に対する援助活動を5段階評価の45項目で問うQCM-P尺度，援助結果の評価には，目標達成度と虐待状況の変化を採用した．これらの結果の分析から，①施設入所で改善群，②在宅での質の高い援助で改善群，③在宅での質の高い援助で改善せず群，④在宅での質の高い援助が行えず改善せず群の4タイプに事例を分類した．タイプごとに援助経過を分析した結果，以下のことが明らかになった．1．老人虐待事例の援助においては，援助過程の質が保たれていれば，結果の改善を導いたり，さらに深刻な事態を回避することができる．2．サービス資源の不足や連携体制の不備といったケア構造に関連する条件を改善することにより，援助過程の質を高め，良い結果に繋げることができるが，経済的な問題が存在したり，主虐待者が孤立している場合，援助の効果は低くなる．

　The purpose of this study is 1) to identify the influences quality of support process gives to outcome and 2) to clarify the other factors influencing to outcome. We performed follow-up study by mailing the questionnaire on cases which were part of 171 cases grasped by the research toward community health nurses working in Saitama, Fukuoka, and Yamagata in 1995 and being supported continuously in 1995. Twenty-eight valid cases were gained (respondent rate were 67.0%). We chose Quality of Care Management-Process Measurement (QCM-P) asked with five steps measurement and 45 questions to a specific user as assessment tool of support process, and degree of accomplishment to the goal and mutation of abused state as assessment tool of outcome. From the analyses of those results, following four types of cases were identified; 1) the cases improved by institutionalize, 2) the cases improved by supports of good quality, 3) the cases not to improved by supports of good quality, and 4) the cases not to improved because supports of good quality were not performed. Following things became to make clear through the analyses of each courses of supports ; 1) In support of elder-abuse-case, the improve of outcome is induced and further serious situation is able to avoided if support process of good quality is kept. 2) The quality of support process is improved and good outcome is able to come by improvement of conditions connecting to care structure such as shortage of services resources or lack of cooperation system. However, effectiveness of supports is low under the conditions there is financial problem or main abuser is isolated in.