在宅介護の役割獲得から役割不全を経て安定した生活の獲得に至る諸相—高齢者虐待経験のある養護者への面接結果

Aspects of the Transition From Acquiring the Caregiving Role to Role Dysfunction and Re-Establishing Stability: Results of Interviews With Caregivers Who Have Committed Elder Abuse

要旨

　目的：高齢者の虐待経験がある養護者を対象に，被虐待高齢者の介護を引き受け，役割不全の状況（虐待）から安定した生活を獲得する諸相を明らかにした．

　方法：高齢者虐待の経験がある養護者5名を対象に半構造化面接を実施し，Meleisの移行理論を基盤に作成した概念枠組みをDirected Content Analysisを用いて質的に分析した．

　結果：【養護者が自力で介護役割を担う】状況下で介護役割を獲得し，【追い詰められた状況と現状の苦しさからの解放】という役割不全の状況から役割支援を受け，安定した生活の獲得に至る諸相が得られた．

　結論：養護者の介護役割の獲得後，保健師等支援者やサービスなどの支援による介護と生活との調和により，介護役割の一時的移行がみられた．一方で，適切な支援が得られず，介護負担の軽減に至らない，負担の増大が役割不全（虐待）を招いた．しかし，適切な支援介入により，虐待や再燃を防ぎ，安定した生活を獲得につながることが明らかとなった．

　Purpose: The purpose of this study was to clarify the various phases of caregiving by caregivers experienced in elder abuse, from assuming the care of the abused to re-establishing a stable lifestyle after the role dysfunction (abuse) that hindered care.

　Methods: Semi-structured interviews were conducted with five caregivers from Prefecture A with experience in committing elder abuse. The interviews were qualitatively analyzed by directed content analysis based on a conceptual framework derived by the authors from Meleis' Transitions Theory.

　Results: Results: The results revealed that in situations where [caregivers assume the caregiver role on their own], they take on caretaking responsibilities and are relieved from role dysfunction situations in which [they feel trapped or are suffering under the current circumstances] by receiving caregiver support. Receiving support allowed the caregivers to re-establish stability in their day-to-day life.

　Conclusion: After taking on a caregiving role, a temporary shift in the caregiving role was observed due to the support of public health nurses, other health care workers, and support services. If appropriate support was not received by caregivers, the caregiver's burden was not relieved, leading to accumulation of burden and role dysfunction (or abuse). However, it was revealed that appropriate support interventions prevented abuse and relapses, which led to the caregiver being able to re-establish stability in their day-to-day life.