痴呆性高齢者の家族介護時間の特性—家族介護主担者の時間的様相

Lived-time among Family Caregivers of Elderly Persons with Dementia : The Temporal Dimension of Caregiving

　本研究の目的は，在宅痴呆性高齢者の家族介護時間の特性を介護主担者の介護時間の記録により明らかにすることである．調査は，原資料である社団法人呆け老人をかかえる家族の会が1999年10月に実施した「介護時間しらべ」（1週間の日々の記録）のうち，記載が詳細な23例を対象とした．分析はこの23例の人々が記載している延べ日数129日間と，記載内容から抽出された介護行為記録1,586件である．また，記録された介護行為は，「日常生活援助」「医学的管理」「交流」「行為の見守り・指示」「介護困難行動への対処」「家事」「外出・散歩」「その他の介護行為」の8項目に分類された．

　介護主担者の「1日の平均介護時間」は，351分±215分（mean±SD）であった．介護行為は，朝7〜8時台が全体の18.1％を占めていた．その中で，「日常生活援助」が「1日の平均介護時間」の71.5％を占めていた．行為の同時性の観点でみると，「日常生活援助」内における重複が多く，特に「身支度を整える行為」が「行為の見守り・指示」と重複していた．「行為の見守り・指示」は「交流」など介護主担者との関係性に影響する項目とも重複していた．以上のことから，家族介護主担者は同時並行的に時間をやりくりしている様相が明らかになった．今後は，介護サービスにおける介護主担者の精神的・身体的負担と同時に，時間的検討の余地が示唆された．

　The purpose of the present study was to investigate how caregiving tasks structure the lived-time experience of family caregivers of persons with dementia. Caregivers(n = 123)were recruited from the Alzheimer's Association Japan in October 1999. They were asked to keep a daily log of their caregiving activities for one week. From the total sample, 23 daily logs were selected and will be reported here. These logs comprise a total of 129 caregiving days and 1,586 total caregiving events. Content analysis identified 8 main categories of caregiving events : 1. ADL assistance ; 2. Medical management (medications and so on); 3. Social interaction and communication ; 4. Giving instructions and monitoring ; 5. Coping with problem behavior ; 6. Housekeeping ; 7. Going out for a walk or other activities ; 8. All others. The average daily caregiving time was 351 minutes(s.d. 215). Findings indicate that the highest frequency of caregiving occurred between the hours of 7 a.m. and 8 a.m. (18.1 % of all log entries). In a typical day, ADL assistance was the most frequent type of caregiving event(71.5%). In terms of simultaneity of tasks, dressing assistance often occurred with Giving instruction and monitoring. This also overlapped with Social interaction. Findings indicate that caregiving is a complex temporal event with caregivers typically performing multiple tasks at the same time. Better measures are needed to understand both the nature of caregiving time and its effect on caregiver's physical and mental health status.