활동제한환자 주 간병인의 간병부담과 삶의 질

도여정 영남대학교 대학원 2019 국내박사

Ph.D. Thesis Family Caregiver Burden and Quality of Life of Patients with Limited Activities Yeo-Jeong Doh Department of Public Health Graduate School Yeungnam University (Supervised by Professor Kyeong-Soo Lee) Abstract This study was carried out to compare caregiver burden, index of quality of life, subjective health level and anxiety and depression level among patients with limited IADL, or ADL, family caregiver in the family and non-caregiver in cohabiting family using 2015 Korea Health Panel data. Also, it compared and analyzed the index of quality of life and anxiety and depression level between family caregiver and control group without patients with limited activities selected by 1:1 individual matching based on gender, age and income quintile. 18,130 family members from 2015 Korea Health Panel 6,607 families were selected through 4 steps extraction process. Among patients with IADL and ADL, 324 patients with limited activities who answered that they require help of others for 3 months or more and 324 family caregivers among cohabiting families giving care to those patients with limited activities were selected as the final analysis targets. For non-caregiver, among the cohabiting families of the families with patients with limited activities, 272 families that are not family caregivers were selected for comparison and analysis. Among 15,260 people in 4,774 families without patients with limited activities, 9,970 people excluding family members of less than 30 year- old were selected as control group for comparison and analysis. Also, to increase comparability for index of quality of life and anxiety and depression level of the family caregivers who take care of patients with limited activities, control group pool was used and the comparison was made by 1:1 individual matching of compare family caregivers and target with the same characteristics of gender, age and income quintile. Ratio of female family caregivers for patients with limited activities was about 2 times higher than male, which had higher ratio of playing role of family caregiver. Also, among the family caregivers, ratio of performing economic activities was 50.9%, who play the roles of caregiver and economic activities, and they were found to be having double difficulties. The case of patient with limited activities and family caregiver living 1:1 had about 50% longer care time and significantly lower index of quality of life than family caregivers of the family with 3 or more living together including patients with limited activities. Among the limited activities, family caregivers taking care of patients with limited activities who have both the limitations of IADL and ADL at the same time had the lowest index of quality of life and had higher ratio of feeling anxiety and depression. But, among the cohabiting families, it was found that there is no difference between quality of life of non-caregivers and control group. This can be said to be the grounds showing there is significant difference of index of quality of life between family caregivers and non-caregivers also in cohabiting families, so it implies that action plans and programs such as customized consulting, etc. are very much necessary. Especially, female spouse family caregivers had lower quality of life and subjective health level and higher care time, caregiver burden and feeling of anxiety and depression than caregivers in the family other than spouse, so it can be said that the concern and action plans for female family caregivers are very urgent. Prevalence of chronic disease of family caregivers is 85.5%, which is higher than 44.1% of non-caregivers in cohabiting family members and 64.4% of the control group by individual matching with gender, age and income quintile. Considering the result of this study, it is necessary to provide customized services such as various policy for caregivers and consulting programs to reduce the caregiver burden and protect and improve health of the family caregivers living together with patients with limited activities.

조현병 환자 가족의 가족부담과 삶의 질에 영향을 미치는 요인

맹세리 인하대학교 대학원 2016 국내석사

Objective This study aimed to specifically identify patient's and primary caregiver's factors that may affect family burden of primary caregivers targeting patients with schizophrenia and their primary caregivers and furthermore to investigate the influence of primary caregiver's family burden and the quality of life. Methods Among patients with schizophrenia who were undergoing outpatient treatment at the psychiatric department of a university hospital, 72 patients without evidence of exacerbations of symptoms within the last one month and their 72 primary caregivers were investigated. From patients and primary caregivers, sociodemographic data were collected. Additionally, for patients, as clinical scales, patient's symptoms, drug attitude, internalized stigma, insight into disease, etc. were assessed, and for primary caregivers, family burden, quality of life, etc. were assessed. Patient's psychotic symptoms and insight into disease were measured using semi-structured interviews, and for all other questions, structured questionnaires were utilized. Results The subjective drug attitude of patients with schizophrenia (-10~10 points) appeared to be 3.56±5.21 points, which was generally positive. The internalized stigma (4~91 points) was 39.51±9.94 points, and the insight into disease (0~27 points) was 17.81±4.99 points. The total family burden of primary caregivers (0~144 points) was 42.00±26.07 points and the total mean quality of life score (QOL score) was 2.98±0.59 points. As a result of multiple regression analysis on primary caregiver's family burden using stepwise selection, primary caregiver's monthly income, primary caregiver's gender, and delusional symptom among patient's clinical symptoms significantly explained the total family burden of primary caregivers. In multiple regression analysis on quality of life, primary caregiver's monthly income, primary caregiver's education level, patient's gender, patient's treatment duration, the degree of disorganized speech among patient's clinical symptoms, patient's subjective negative drug attitude, and the degree of stigma resistance significantly explained the total mean quality of life score (QOL score). In the dimensions of quality of life, the physical health dimension was correlated with primary caregiver's education level, primary caregiver's gender, patient's gender, patient's treatment duration, patient's subjective negative drug attitude, and the degree of patient stigma resistance.The psychological dimension of quality of life was correlated only with primary caregiver's monthly income. The social dimension of quality of life was associated with patient's diagnosis duration, subjective negative drug attitude, and the degree of disorganized speech among patient's clinical symptoms. Lastly, the environmental dimension of quality of life was correlated with primary caregiver's education level, patient's treatment duration, and the degree of patient's insight into disease on positive symptoms. Conclusion Even primary caregivers of schizophrenia patients with stabilized symptoms were burdened by patient's delusion. Additionally, in various factors determining primary caregiver's level of quality of life, a clinical symptom such as patient's disorganized speech and clinically correctable factors such as subjective negative drug attitude, stigma resistance to their mental illness and insight into disease on positive symptoms were included. Therefore, provision of education regarding drug and disease for patients and primary caregivers will be helpful to effectively reduce family burden and improve the quality of life of primary caregivers.

THE DEVELOPMENT OF INFANT-CAREGIVER RELATIONSHIPS IN A CHILD CARE SETTING

이승연 Columbia University 2005 해외박사

Although the infant-caregiver relationship has been emphasized as a vital component for high quality infant educare and caregiver education, it has been under-explored in theory and research. This qualitative study sought to explore the infant-caregiver development process in a natural and holistic way and taking the infant, the caregiver, and the context into consideration. This study also aimed at identifying some potential factors that contribute to this relationship development. Three infant-caregiver dyads in an infant room at a university-affiliated child care center were selected and followed for a semester, constituting three case studies. The infant participants were new or relatively new to the setting and 6.5-10.5 months of age at the beginning of the data collection, while the caregiver participants were student caregivers, taking a practicum course and assigned to the infants as key caregivers. Data were collected through multiple methods: observations (natural observations, video recordings), caregiver interviews, documents, and a researcher journal. The individual cases illustrated how each dyad developed a relationship in its unique way and pace; the time and opportunity that they had together, what they brought with them (e.g., personalities, relationship histories, experiences), and their match brought about differences. In addition, a synthesis of the findings across the three cases showed general patterns of relationship development: As a process, it took about 6 to 11 weeks to build firm (close, secure, synchronous) relationships in the relationship-based and supportive context, when the infants and the caregivers spent limited time (9 to 11 hours per week) together. The infant-caregiver relationship was two-way and reciprocal in that each learned from the other and each sought out the other, and the leading role of the infants and the observant, responsive, and reflective role of the caregivers brought about mutually pleasurable and engagind experiences. Also, the context had a significant impact on the infant-caregiver relationship development, and various kinds of systematic and human support were vital. This study supports the significanse of the infant-caregiver relationship for high quality infant educare and caregiver education and sheds light on the necessity of a process-oriented and holistic perpective on infant-caregiver relationship development.

THE MAIN AND BUFFERING EFFECTS OF PSYCHOSOCIAL RESOURCES ON ELDERLY CAREGIVER DEPRESSIVE SYMPTOMS

오윤진 University of Pittsburgh 2004 해외박사

본 연구는 거동이 불편한 노인을 돌보는 배우자에게 있어서 사회심리적 자원들이 어떤 역할을 하는지를 밝히려는데 그 목적을 둔다. 구체적으로 첫째, 사회심리적 자원이 caregiver의 정신건강(depression)에 직접적인 영향을 미치는지 혹은 완충효과를 주는지를 조사한다. 둘째로는 caregiver의 정신 건강을 설명하는데 있어 stress를 일으키는 요인들과 사회심리적 자원들 중에서 어느 요소가 더 영향력이 큰지를 조사하는 것이다. 또한 본 연구는 연구 변수들 간의 관계에서 성별에 따른 차이가 있는지를 비교한다. 본 연구의 표본은 Caregiver Health Effects Study (CHES)의 전체 5,588명의 연구 대상자 중에서 동거하는 배우자 153쌍을 선별하여 연구 가설을 검증하였다. 개념적 틀로서 Pearlin (1990)의 Caregiving Stress Model을 적용하여 일련의 고급통계기법인 위계서열적 회귀분석을 시도하였다. 그 결과로 contextual variables(나이, 인종, 성별, 교육수준, 건강, 소득)이 caregiver의 정신건강 변량의 11%를 설명하였고, 그 중에서 신체적 건강 상태가 그 자신의 정신 건강을 유의미하게 예측했다. 또한 주로 care recipient의 문제 행동과 같은 일차적 stressors가 caregiver의 정신 건강중 11%의 변량을 설명했다. 제정적 부담과 같은 이차적 stressors가 추가로 4% 설명해냈다. Caregiver의 사회심리적 자원이 19%를 설명해 주었고 그 중에서 노인의 신앙심과 자기 극복 능력(Self-Mastery)이 아주 큰 역할을 했다. Caregiving 수행과정에서 성별에 따른 특이한 차이도 발견되었다. 즉 제정적 부담과 신앙심은 여성 caregiver에서만 유의한 예측 변수로 작용하였다. 남성 caregiver의 정신건강을 예측하는데 있어서 자기극복능력은 뜻 밖의 설명력을 갖는 것으로 나타났다. 신앙심은 3가지 타입의 stressors와 상호 작용하여 직접 영향을 미치는 자원으로 역할을 할 뿐 아니라 완충효과로 나타냈다. 자기 극복 능력은 대체로 caregiver의 정신건강에 뚜렷한 직접적인 영향을 미쳤고, 일차적 stressors와 상호 작용할 때만 완충효가를 나타냈다. 반면 공적 서비스의 이용은 직접 혹은 완충효과가 없는 것으로 밝혀졌다. 자세한 세부 분석에 따르면 강한 신앙심을 가진 caregiver에게는 중간정도와 약한 신앙심을 지닌 노인들에 비해 stressor와 정신건강 사이에 약한 상관성이 있는 것으로 나타났다. 자기 극복 능력은 의외의 불규칙한 양상을 보였다. 이 모든 결과를 종합해 볼 때 caregiver들이 자신의 자기극복능력과 신앙심을 유도해낼 수 있도록 도와주는 지지적이고 교육적인 서비스가 요구 되었다. 또한 구체적으로 신앙심 가운데 어느 요소가 의미있게 작용하였는지를 밝힐 수 있는 더 과학적인 연구 기법의 필요성을 강조하였다. 자기극복능력의 측정에 있어 일반적인 측정 도구뿐 만 아니라 구체적 행동 또는 사례에 따른 자기극복능력을 측정할 수 있는 도구의 필요성이 요구 되었다. This study investigates how caregiver psychosocial resources would function as a protective resource for spouse caregivers of frail elders. Specifically, the present study examines the main or buffering effects of psychosocial resources on caregiver depression and explores the relative importance of stressors and resources in accounting for depression. In addition, it compares gender differences in the relationships among study variables. From a sub-sample of the Caregiver Health Effects Study data, 153 spouse caregivers of frail elders were selected to investigate research questions. A series of hierarchical multiple regressions were run based on part of the Pearlin et al.'s (1990) caregiving stress model as a conceptual framework. The results showed that contextual variables accounted for 11% of the explained variance, with perceived poorer health significantly predicting depression. Primary stressors also explained 11% of the variance, primarily due to problematic behaviors. Secondary stressors explained an additional 4%, with financial burden significantly contributing to the variance. Caregiver psychosocial resources contributed 19% to the variance, with both religiosity and self-mastery playing a particularly strong role in predicting depression. Some gender differences were found. Financial burden and religiosity were significant predictors of depression only for wives. Self-mastery had a strange explanatory efficacy in predicting depression for husbands. Caregiver religiosity was both a direct and buffering resource interacting with three types of stressors. General sense of mastery had a strong direct association with caregiver depression, and a buffering effect for primary stressors. Formal service use, on the other hand, had no significant buffering and direct effects. The sub-analyses indicated that, for caregivers with higher levels of religiosity, the positive association between stressors and depression was less strong than those for the low and medium groups. Self-mastery showed an unanticipated quadratic pattern. The results suggest the need for supportive and educational services to help caregivers draw on their self-mastery and religiosity. The findings also underscore the need for further scientific research study that examines which specific factors of religiosity are operating. It suggests a need of using both general and caregiving-specific mastery scales in caregiving research.

코로나19 상황에서 가족돌봄자의 스트레스와 관련 요인 : 비돌봄자와 비교하여

양진영 서울대학교 대학원 2021 국내석사

코로나19 확산으로 인하여 전 세계적으로 감염 확산 예방정책을 시행하였고 한국에서도 감염 확산을 막기 위하여 재택근무 권고, 등교 금지, 사회복지시설 서비스 중단 등의 정책이 시행되었다. 이 과정에서 양육과 돌봄을 담당하는 기관들이 휴관, 축소되어 가족들의 돌봄 부담이 심화되었다. 재난 상황에서 사회구성원들에 대한 건강 영향은 차별적으로 발생한다는 점에서 돌봄 여부에 따른 스트레스 수준이 다를 것으로 예상하나 실증연구가 제한적이다. 따라서 본 연구에서는 코로나19 상황에서 가족돌봄자와 비돌봄자의 특성과 돌봄 여부에 따른 스트레스 수준과 관련 요인에 대하여 알아보았다. 가족돌봄자를 코로나19 상황에서 가족 내 돌봄 필요한 구성원이 있는 자로 정의하였다. 본 연구는 서울대학교 코로나19 기획 연구단 연구진이 시행한 『코로나19와 사회적 건강』 1차 설문조사를 활용하여 2차 분석을 실시하였다. 종속변수로는 스트레스와 외상직후 스트레스를 선정하였고, 독립변수로는 인구사회학적 특성, 코로나19 삶의 변화, 코로나19 대응 전략, 사회적 자원을 설정하였다. 돌봄 여부에 따른 변인의 특성을 알아보기 위해 빈도분석과 기술통계를 시행하였고, 돌봄으로 인한 차이가 발생하는지 로지스틱 회귀분석과 다중선형회귀분석을 통해 확인하였다. 스트레스 영향요인을 파악하기 위하여 다중회귀분석을 추가로 진행하였다. 연구 결과, 전체 2,000명 대상자 중 가족돌봄자는 276(13.8%)명이었다. 연구대상자의 평균 스트레스, 외상직후 스트레스 점수는 각각 27.34점, 26.13점이었고, 가족돌봄자의 스트레스와 외상직후 스트레스는 비돌봄자보다 통계적으로 유의하게 높았다. 가족돌봄자는 비돌봄자에 비하여 기혼상태인 경우가 많았고, 만성질환과 정신질환을 보고한 경우가 많았다. 스트레스 인한 삶의 변화로는 가구소득의 변화가 많았다. 가족돌봄자는 비돌봄자에 비해 감염 대처 효능감과 정책 신뢰도가 낮았고, 코로나19 관련 정보를 많이 탐색 하는 것으로 나타났다. 돌봄은 연구대상자의 스트레스 수준과 유의미한 연관성을 보였다. 연령, 정신질환에서도 차이가 나타났으며 코로나19로 인한 일상 위축, 소득감소, 생활 변화가 많을수록 스트레스가 증가하였다. 정책 신뢰도는 사회구성원들의 스트레스 수준을 유의미하게 감소시켰다. 특히, 가족돌봄자의 스트레스 증가요인으로는 자가 보고된 만성적 신체질환, 코로나19 생활 변화, 감소요인으로는 도움을 요청할 수 있는 사람의 수가 있었다. 즉, 가족돌봄자가 신체적 건강 상태가 좋지 않을수록, 코로나19로 인한 생활 변화가 많을수록 스트레스가 증가하였고, 도움을 요청할 수 있는 사람이 많을수록 감소하였다. 연령이 감소할수록 가족돌봄자의 외상직후 스트레스는 증가하였다. 반면 비돌봄자의 스트레스 수준 영향요인은 다면적 스트레스 관련 요인이 가족돌봄자에 비해 다양하게 나타났으며, 이는 평소 제한 없이 일상생활을 누리던 일반 사람들이 코로나19로 인한 다양한 규제로 인하여 스트레스를 받은 것으로 보인다. 상기 연구 결과를 통하여 코로나19 상황에서 가족돌봄자는 비돌봄자에 비하여 더 높은 스트레스를 경험하였다. 코로나19와 같은 재난 상황에서 가족돌봄자들의 스트레스 수준을 완화하기 위하여 대안적 긴급돌봄 서비스 체계 마련과 정신건강 관리 시스템을 구축이 필요하다. 특히 신체적 건강 상태가 좋지 않을수록 가족돌봄자의 스트레스가 증가했다는 점에서 이들의 건강관리를 위한 정책 개입의 필요성을 시사한다. 또한 주변에 도움을 요청할 사람의 수가 가족돌봄자의 스트레스 감소요인으로 작용하였기 때문에 코로나19 상황에서 방역 수칙을 준수하며 가족돌봄 지원 서비스가 지속 또는 확대하는 것이 필요하겠다. 반면 비돌봄자의 경우 코로나19로 인한 일상의 변화가 크고 이로 인해 다양한 요인이 복합적으로 스트레스를 증가시킨 점에서 최대한 방역과 일상이 공존 가능한 건강재난 대응 보건 정책 개발이 필요하며, 방역 정책으로 인한 일상생활 제한이 높은 수준으로 지속되는 경우 사회구성원을 위한 맞춤형 심리지원이 필요하겠다. 이상 본 연구는 코로나19 하에 대표성 있는 자료로 가족돌봄자의 특성과 스트레스 수준 및 관련 요인을 분석했다는 점에 의의가 있고, 돌봄 내용 및 강도에 대한 상세 분석 부족한 제한점이 있다. With the widespread of COVID-19, all the countries around the world are bringing policies into effect for infection control based on quarantine, and likewise, South Korea has implemented restriction regulations. In this process, as organizations related to parenting and caregiving have been closed down or cut off, family members are under greater pressure. Whereas health effects discriminatively occur on people and it is expected during a crisis people experience different levels of stress, there is no precedent experimental study. Therefore in this study, during the pandemic, characteristic comparisons of family caregiver and non-caregiver are going over stress exposure associated with COVID-19 and stress level. This study has conducted a second analysis based on the survey [COVID-19 and Social Health] by Seoul National University COVID-19 research team. Dependent variables include stress and PDI. Independent variables include caregiving, sociodemographic characteristics, life changes associated with COVID-19, coping strategy for COVID-19, and social resources. Frequency analysis and descriptive statistics were used to analyze the characteristics of each variable contingent upon the presence of caregiving. To identify the difference between caregiving status, logistic regression analysis was utilized. Multiple linear regression analysis was used to figure out the influence factors of variables and stress levels. Out of a total 2,000 study subjects, family caregivers were 276 and non-caregivers were 1,724. The average level of stress and PDI were 27.34, 26.13 each. There was a significantly higher average stress and PDI level –27.34(SD+-8.11), 26.13(SD+-9.94) respective- in the family caregiver group than in the non-caregiver group. There was a significant difference in the stress level depending on family caregiving. Differences were also seen in age and mental illness. Stress increased as daily contraction, income reduction, and lifestyle changes increased due to COVID-19. Policy reliability significantly reduced the stress level of the population. Major differences between the family caregivers and non-caregivers were that family caregivers reported more likely to suffer from chronic physical and mental illness than non-caregivers. It showed that the health status of family caregivers is significantly low. Family caregivers experienced more changes in the employment environment and domestic income. Also, family caregivers had low efficacy and policy confidence in coping with infection and searched for information about COVID-19. The stress risk factor for family caregivers was a chronic physical illness, and the protective factor was the number of people who could ask for help. In other words, the worse the physical health of family caregivers, the less the number of people who could ask for help, the more stress they had. Age was the risk factor for trauma stress. As age decreased, the trauma stress of family caregivers increased. From the result, the family caregiver group had a notable difference in the stress level compared to the non-caregiver group and COVID-19 had an effect on stress levels. To relieve the stress level of family caregivers in disaster situations such as the COVID-19 pandemic, it is necessary to prepare alternative emergency care service systems and mental health management systems. Moreover, it also showed that as the number of people to ask for help increases, the degree of stress decreases. Therefore, it poses the importance of countermeasures such as building up trustful relationships between local communities following the quarantine policy. On the other hand, factors influencing the stress level of non-caregivers in the COVID-19 situation were more diverse, especially for COVID-19 related stress exposure. The findings of this study have significance in analyzing the overall features of family caregivers and stress levels in addition to clarifying the associated factors during the COVID-19 pandemic. It is limited in that there was a lack of detailed descriptions of the primary caregiver because the concept of the family caregiver has been expanded to the case where there are members in the family who need care.

치매 환자 가족 돌봄자의 돌봄 평가 연구

조윤영 연세대학교 대학원 2008 국내석사

The purpose of this study was to measure the caregiving appraisal(burden, satisfaction, mastery, demand, impact) of family caregivers of patients with dementia by identifying the their potential stressors and the efficacy of their coping efforts related to caregiving experiences.The sample consisted of 103 primary family caregivers recruited from two outpatient clinics at general hospital in Gyeonggi-province, Korea. The data was collected by the researcher between May and June in 2008. The Korean version of the Revised Caregiving Appraisal Scale(K-RCAS) was used in this study and Cronbach's alpha, t-test, ANOVA, Duncan test, and correlation analysis, with the SPSS Win 12.0 program, were used for data analysis.The results of this study are as follows:1. The mean score for K-RCAS for family caregivers was 72.43(±9.21), and the mean scores of 5 subscale were 'burden' (2.91±0.61), satisfaction (3.00±0.77), mastery (3.21±0.44), demand (2.40±0.80), and impact (2.70±0.84).2. The level of the burden of the 70-79 year-old family caregivers had the most score and the 20-29 year-old had the least score(F=3.272, P=0.006). The score of the satisfaction of the daughter who cared for the patient with dementia was the highest, the satisfaction of the son, the spouse, the son-in-law, the grand children were followed. The daughter-in-law's satisfaction had the least score(F=2.472, P=0.037). The scale of the satisfaction was the significantly higher in the family caregiver of university graduates than in the family caregiver of high school or middle school graduates(F=3.177. P=0.027). The score of the burden(F=6.047, P=0.000) and the impact(F=3.265, P=0.015) of the family caregiver in bad health were the significantly higher than in good health. The level of the satisfaction(F=3.669, P=0.008) and the mastery(F=5.800, P=0.000) were higher in the family caregiver having good health condition than having a bad health condition.3. The burden(F=0.001, P=0.008) and the impact(F=2.318, P=0.026) of the family caregiver who residing with patient was significantly higher than residing apart from patient. The caregiver's demand was significantly higher in 7-12 month, the duration of caregiving, than over 13 month or under 6 month. The burden scale of the caregiver with assistance from other family member or society was the higher score than without any assistance from others.4. The level of the burden had negative correlation with the level of the mastery and correlation with the score of impact. The satisfaction score had significant correlation with mastery score.This study shows that the demand of family caregiver who caring for a male patient for 7-12 month, and the satisfaction of the daughter who caring for a female patient were significantly high. In addition, the burden of the caregiver who living with 70-79 year-old patient with assistance from other source was high. Therefore there is a need for nursing intervention strategies to decrease the burden from potential stressors and to strengthen the mastery and the satisfaction. 본 연구는 DSM-IV Criteria에 의해 치매로 진단받은 치매 환자를 가정에서 돌보는 가족 돌봄자의 돌봄 평가(부담감, 만족감, 숙련감, 요구감, 영향감)를 파악하여 그들의 상태에 필요한 간호중재의 기초 자료를 제공하기 위한 서술적 조사연구이다. 연구 대상자는 G도에 소재한 노인 전문병원과 대학부속병원에서 치매로 진단받고 외래치료를 받으며 집에서 돌봄을 받고 있는 환자의 가족 돌봄자 103명이며, 2008년 5월부터 2008년 6월까지를 자료수집기간으로 하여 설문조사하였다. 돌봄 평가를 측정하기 위해 Lawton et al.(2000)가 개발하고 개정한 Revised Caregiver Appraisal Scale(RCAS)를 Lee et al.(2007)이 번안한 Korean Version of the Revised Caregiving Appraisal Scale(K-RCAS)을 사용하였다. 자료 분석은 SPSS Win 12.0 program을 이용하여 서술 통계, t-test, ANOVA, correlation analysis를 통해 분석하였다.본 연구의 결과는 다음과 같다.1) 치매 환자를 돌보는 가족 돌봄자의 돌봄 평가는 총점 135점 만점에 평균 72.43(±9.21)으로 나타났으며, 돌봄 평가의 하부항목은 가능한 점수 범위 1-5점 사이에서 부담감은 평균 2.91(±0.61)점, 만족감은 평균 3.00(±0.77)점, 숙련감은 평균 3.21(±0.44)점, 요구감은 2.40(±0.80)점, 영향감은 2.70(±0.84)점 이었다.2) 가족 돌봄자의 일반적인 특성에 따른 가족 돌봄자의 돌봄 평가를 살펴보면, 부담감은 가족 돌봄자의 연령이 70-79세인 경우(F=3.272, P=0.006), 건강상태가 나쁜 경우(매우 나쁘다, 나쁜 편이다)(F=6.047, P=0.000)에 높았으며, 통계적으로 유의한 차이가 있었다. 만족감은 가족 돌봄자가 돌보는 치매 환자가 여자일 경우(F=2.532, P=0.024), 환자와의 관계가 딸일 경우(F=2.472, P=0.037), 학력이 대졸 이상(F=3.177, P=0.027), 건강상태가 좋은 경우(F=3.669, P=0.008)에 높았고, 통계적으로 유의한 차이가 있었다. 숙련감은 가족 돌봄자가 돌보는 치매 환자의 연령이 낮을수록(F=2.996, P=0.034), 건강상태가 좋은 경우(F=5.800, P=0.000)에 높았고, 요구감은 가족 돌봄자가 돌보는 치매 환자가 남자일 경우(F=1.787, P=0.031), 돌본 기간이 7-12개월인 경우(F=2.870, P=0.040)에 높았으며 통계적으로 유의한 차이가 있었다. 영향감은 가족 돌봄자의 건강상태가 나쁠수록(F=3.265, P=0.015), 환자와 현재 동거하는 경우(F=2.318, P=0.026)에 높았으며, 통계적으로 유의한 차이가 있었다.3) 치매 환자와 가족 돌봄자의 돌봄 환경에 따른 가족 돌봄자의 돌봄 평가의 차이를 살펴보면, 부담감은 현재 동거하는 경우(F=0.001, P=0.008), 정기적으로 도움을 받고 있는 경우(F=0.140, P=0.008)에 높았으며, 통계적으로 유의한 차이가 있었다. 영향감은 가족 돌봄자의 건강상태가 나쁠수록(F=3.265, P=0.015), 환자와 현재 동거하는 경우(F=2.318, P=0.026)에 높았으며, 통계적으로 유의한 차이가 있었다.4)가족 돌봄자의 돌봄 평가에 항목 중에서, 부담감은 영향감(γ=0.661, P<.01)과, 숙련감은 만족감(γ=0.571, P<.01)과 유의한 상관관계를 보였으며, 부담감은 숙련감(γ=-0.246, P<.05)과는 통계적으로 유의한 역 상관관계를 보였다.본 연구는 치매 환자를 돌보는 가족 돌봄자의 일반적 특성과 돌봄 환경에 따른 가족 돌봄자의 부담감, 만족감, 숙련감, 요구감, 영향감의 차이를 확인함으로써 치매 환자를 돌보는 가족 돌봄자의 스트레스원과 적응력의 효능을 확인할 수 있었다. 이는 가족 돌봄자의 잠재적인 스트레스원인 부담감은 완화시켜줄 수 있고, 적응노력인 만족감과 숙련감은 강화시켜줄 수 있는 간호중재 개발을 모색하는데 기초자료로 제공할 수 있을 것이다. 또한 가족 돌봄자의 특성에 따라 가족 돌봄자가 느끼는 부담감, 만족감, 숙련감, 요구감, 영향감에 차이가 있음을 확인하였다. 따라서 남자환자를 돌보며 돌본 기간이 7-12개월인 가족 돌봄자의 요구감이 가장 높고, 여성 환자를 돌보며 관계가 딸인 가족 돌봄자의 만족감이 가장 높으며, 연령이 70-79세이고 현재 동거하고 있으며 정기적인 도움을 받는 가족 돌봄자의 부담감이 높으므로 그들의 요구를 충족시키기 위한 간호중재방안을 개발할 것을 제언한다.

Digital literacy, mutuality, and self-care in patients with heart failure and their caregivers : a dyadic approach

김호곤 Graduate School, Yonsei University 2024 국내박사

치매환자 보호자의 삶의 질에 영향을 미치는 요인에 대한 경로분석

김소연 연세대학교 대학원 2018 국내석사

This study aimed to suggest a path analysis model of Quality of Life for caregiver of person with dementia. The participants were 110 caregiver of person with dementia living in the local community. This study surveyed caregiver’s quality of life as World Health Organization Quality of Life assessment instrument-bref(K-WHOQOL-BREF), caregiver’s burden of care as Burden of Interview(BI), cognitive function of person with dementia as Global clinical Dementia Rating(GDS), degree of depression for caregiver as Center for Epidemiologic Studies Depression Scale(CES-D), social support for caregiver as Medical Outcomes Study social support scale, caregiver’s physical health as Physical Health Questionnaire(PHQ). Socio-demographic information including social service satisfaction was collected with questionnaire made by researcher. The collected data was analyzed by SPSS Version of 23.0, AMOS Version 23.0. On the result, path model suggested in this study showed that a burden of care variable, caregiver’s depression variable were affect for caregiver’s quality of life in directly. The cognitive function of person with dementia variable have an indirect path to caregiver’s quality of life. Its indirect pathway revealed a statistically significant result. Independence level of activity daily living for person with dementia did not directly affect caregiver’s quality of life, but were shown to be mediated by burden of care and caregiver’s depression. The results of this study show the direct and indirect relationship between various variables and quality of life in caregiver of dementia living in community and identified multidimensional effect of variables affecting quality of life. This study provides way to improve the caregiver’s quality of life and it could be the meaningful information in associated area of dementia. 본 연구의 목적은 치매환자의 보호자를 대상으로 하여 보호자의 삶의 질에 영향을 미치는 변인들간의 경로모형을 제시하고 적합성을 검증하는 것이다. 연구 대상자는 지역사회에 거주하고 있는 치매환자 보호자 총 110명이었다. 치매노인 보호자의 삶의 질을 보기 위하여 한국판 세계보건기구 삶의 질 척도 단축형(K-WHOQOL-BREF)을 사용하였고, 부양부담을 측정하기 위하여 간병 부담감 척도(BI)를, 환자인지능력에는 전반적 치매 임상평가척도(GDS)를, 우울증상에는 우울증상 척도(CES-D)를, 보호자의 사회적지지에는 사회적 지지 척도(Medical Outcomes Study social support scale)를, 보호자의 신체증상에는 (PHQ)를 사용하였다. 사회서비스만족도를 포함한 인구사회학적 정보는 연구자가 작성한 설문지를 활용하여 자료를 수집하였다. 수집된 정보는 SPSS Version 23.0 및 AMOS Version 23.0을 사용하여 분석하였다. 연구 결과, 치매환자 보호자의 삶의 질에 영향을 미치는 변인들로 구성된 경로모형에서 삶의 질에 직접적으로 영향을 미치는 변인으로는 부양부담과 보호자 우울증상이 있었다. 환자인지능력은 보호자의 삶의 질과 직간접 경로를 모두 형성하였는데 직접경로는 유의하지 않았으나 부양부담을 매개로 형성된 간접경로는 유의한 것으로 나타났다. 환자일상생활독립정도는 부양부담과 보호자 우울증상을 매개로 하여 보호자의 삶의 질에 영향을 미치는 것으로 나타났다. 본 연구는 치매환자 보호자의 삶의 질에 영향을 미치는 변인들로 경로모형을 검증하여 직, 간접적인 관계를 규명하여 삶의 질에 영향을 미치는 변인들간의 관계를 파악하였다는 것에 의의가 있다. 본 연구는 치매환자의 보호자와 환자의 삶의 질을 향상시키기 위하여 어떤 방향으로 접근하여야 할 지 제시하였으며 치매관련 분야에서 기초자료로 활용될 수 있을 것으로 사료된다.

노인주간보호서비스 이용의 결정요인 - 장기요양보호 노인의 가족부양자 중심으로-

이현희 전북대학교 대학원 2004 국내석사

The purpose of this study is to find out the characteristics of long-term care elderly and their family caregiver targeted on the utilizer group and the non-utilizer group of the day care services for the elderly, to examine family caregiver's determining factors which influences on use of day care service for the elderly applying Bass and Noelker's model. The survey of the questionnaire was accomplished by 200 cases whose the family caregiver of the long-term care elderly over sixty years old and being in hospital or going to a hospital regularly in Jeollabuk-Do which has day care service for the elderly especially focused on Jeonju, Gunsan and Iksan area. At the predisposing factor, enabling factor, need factor which are personal factors determine the use of the service, predisposing factors are awareness of the service, relation with family caregivers and personal value of the elderly caregiving. Enabling factors are family income, recognition of the service and presence of assistant caregiver. Need factors are classified into health condition of the elderly including IADL(Instrumental Activities of Daily Living), ADL(Activities of Daily Living), Cognitive disorder, problem behavior and family caregiver's burden including physical, economic, emotional and social burden. Based on these factors, the main results of this study is as follows. First, there is no sex, age and educational background differences in the feature of population sociology between the service using group and non-using group's family but difference exits in habitation area and presence of occupation. On relationship between the elderly and their caregivers, daughterin-law comes first then comes daughter, spouse in orders. The form of habitation Supported the elderly and their family caregiver if they live together, using group is almost twice time as much as higher than non-using group. Less than five years is most likely period of caregiving for both groups but using group is higher in more than ten years caregiving. Priorities of responsibility among government, social caregiving and their children caregiving, government or social caregiving take precedence than the caregiving of children for both groups. On the other hands, for the subject of caregiver, son preference was demonstrated about two times in using group than non-using group. Using group has higher recognition of the service than non-using group and both groups consider day care affirmatively. Second, going through both groups for the characteristics and differences of more than eighty years old aged people's. As for marital status, non-using group has higher rate of having spouse than using group and there is no significant differences in educational background and incomes. The chronic disease is most frequent for both groups and using group has more the elderly with one of senile dementia or paralysis than non-using group. The non-using group has more numbers of the elderly with more than two diseases including senile dementia and paralysis. Third, considering supported the elderly's health condition and their family caregiver's burden, the non-using group has more the elderly with high dependence in ADL. As for caregiving burden of family, emotional and social burden is higher in using group than non-using group. However, there is no difference in physical, economic burden between two groups. Fourth, logistic regression analysis was performed to investigate the factors which has influence on use of day care service for the elderly including predisposing factors, enabling factors, need factors. As a result, all variables in predisposing factors which are relation with caregiver, value of caregiving and awareness of the service affect to use of day care service. Family income, recognition of service and presence of assistant caregiver were considered as enabling factors but none of them has influence on use of the service. There was statistical significient that only economic burden among the family care giver's burden and ADL, IADL, problem behavior into health condition of the Elderly. In conclusion, the value of the Elderly caregiving, the relationship between the elderly and caregiver, attitude of social service, health condition of the elderly and burden of family caregiver influence the use of day care service for the elderly. This result, practical implications can be indicated to activate the day care service for the elderly. The first, enforcement in medical treatment and rehabilitation program regarding disease and functional level is necessary as well as assure of professional man power. Also the strategies for connecting system with medical institutions must be considered to satisfy the elderly's health need. Second, social supportive program which targeted family caregivers should be developed and managed. Third, the number of day care center should be largely increased that can reach out Gun area for long-term care the elderly and their family caregiver to use more easily as well as adjustment is needed regarding service hours and the number of time. Fourth, government's aggressive supports and expansion of system are required for every long-term care the elderly to get benefits. With this, in later research, if the investigation is made not only supported the elderly and their family caregivers but also the situations for service centers the most suited model will be presented. 본 연구는 노인주간보호서비스 이용 집단과 비이용 집단을 중심으로 장기요양보호노인과 가족부양자의 특성을 밝혀내고, Bass와 Noelker의 모델을 활용하여 노인주간보호서비스 이용에 영향을 미치는 가족부양자 결정요인들을 파악하고자 하는 연구이다. 이를 위해 노인주간보호 기관이 있는 전라북도 내 전주, 군산, 익산지역을 중심으로 병원에서 입원 또는 통원치료를 받고 있는 60세 이상 장기요양보호노인의 가족부양자 200명을 대상으로 설문조사를 실시하였다. 서비스 이용여부에 영향을 미치는 개인적 요인인 선행요인, 가능성요인, 욕구요인을 살펴보면 선행요인은 서비스의 인식도, 가족부양자와의 관계, 부양에 대한 가치관이며, 가능성요인은 가구소득, 서비스인지도, 부(副)부양자 유무이다. 욕구요인은 일상생활수행능력(ADL), 도구적 일상생활수행능력(IADL), 인지장애, 문제행동 정도를 포함한 노인의 건강상태와 신체적부담, 경제적부담, 정서적부담, 사회적부담을 포함한 가족부양자의 부양부담감으로 분류하였다. 이를 중심으로 분석한 결과를 요약하면 다음과 같다. 첫째, 서비스 이용집단과 비이용집단간의 가족부양자들의 인구사회학적 특성과 차이점에서 성별, 연령, 학력, 월 소득 등은 차이가 없었으나 거주지역과 직업유무에서는 두 집단간에 차이가 있었다. 노인과 부양자와의 관계는 두 집단 모두 주부양자로 며느리가 가장 높았으며, 딸, 배우자의 순이었다. 피부양노인과 부양자와의 거주형태는 함께 살고 있는 경우 이용 집단이 비이용 집단보다 두 배 가까이 높게 나타났다. 부양기간은 두 집단 모두 5년 미만이 가장 높았으나, 10년 이상에서는 이용집단이 높게 나타났다. 부양가치관중 국가나 사회부양, 자녀부양 가운데 어느 것이 우선인지에 관한 부양책임에서는 두 집단 모두 자녀부양보다 국가나 사회부양 우선이 높았다. 반면에 아들과 딸 선호에 관한 부양주체에서는 아들 선호의식이 비이용자보다 이용자에서 두 배 정도 높게 나타났다. 두 집단간 서비스의 인지도는 이용집단이 비이용집단보다 더 높았으며, 주간보호에 대한 인식은 두 집단 모두 긍정적인 것으로 나타났다. 둘째, 서비스 이용 집단과 비이용 집단간의 피부양 노인의 특성과 차이점을 살펴보면 연령은 두 집단 모두 80세 이상이 가장 높았다. 결혼상태는 비이용자가 이용자보다 배우자가 있는 비중이 높았으며, 학력과 수입은 두 집단간에 유의미한 차이가 없었다. 노인의 진단병명은 두 집단 모두 기타 만성질환이 가장 높았으며, 치매나 중풍 한 가지 질환만 갖고 있는 것은 이용집단에서, 치매나 중풍을 포함한 두 가지 이상 질환을 갖고 있는 경우는 비이용 집단이 많았다. 셋째, 서비스 이용집단과 비이용집단간 피부양노인의 건강상태 및 가족부양자의 부양부담을 살펴보면 노인의 건강상태는 일상생활수행능력(ADL)에서 의존성이 높은 노인이 비이용 집단에 높게 나타났다. 가족의 부양부담은 서비스 비이용 집단에 비해 이용 집단에서 정서적, 사회적 부담감이 더 높은 것으로 나타났으며, 신체적, 경제적 부담감은 두 집단간에 차이가 없었다. 넷째, 주간보호서비스 이용여부에 영향을 미치는 요인들을 알아보기 위해 선행요인, 가능성요인, 욕구요인 모두를 포함한 로지스틱 회귀분석을 실시하였다. 그 결과 선행요인에서는 부양자와의 관계, 부양가치관, 서비스의 인식도 등 모든 변인이 유의미한 영향을 미치는 것으로 나타났다. 가능성 요인은 가구소득, 서비스 인지여부, 부(副)부양자 유무가 변인으로 포함되었으나 모두 서비스 이용에 영향을 미치지 않는 것으로 나타났다. 욕구요인은 노인의 건강상태는 일상생활수행능력(ADL)과 도구적 일상생활수행능력(IADL), 문제행동정도에서, 가족부양자의 부양부담은 경제적 부양부담이 유의미한 영향을 미쳤다. 결론적으로 노인주간보호서비스를 이용하는데 영향을 미치는 요인은 노인부양에 대한 가치관과 노인과 부양자와의 관계, 사회적서비스에 대한 태도, 노인의 건강상태와 가족부양자의 부양부담 정도로 나타났다. 이와 같은 결과를 통해 노인주간보호서비스 활성화에 기여할 수 있는 실천적 함의를 제시할 수 있다. 첫째, 노인들의 건강에 관한 욕구를 충족시킬 수 있도록 질환유형과 기능수준에 따른 의료, 재활 등 전문적 프로그램을 강화하고 전문 인력을 확보하며 의료기관과의 연계 시스템 구축 전략을 모색해야 할 것이다. 둘째, 가족부양자들을 대상으로 사회적 지지체계 프로그램을 개발, 운영할 필요가 있다. 셋째, 장기요양보호노인들과 가족부양자들이 쉽게 이용할 수 있도록 군 지역까지 주간보호센터의 수를 대폭 확충하는 방안이 필요하며, 서비스의 이용 시간과 횟수를 조정하는 것도 필요하다. 넷째, 모든 장기요양보호대상자가 혜택을 받을 수 있도록 노인주간보호서비스에 대한 정부의 적극적인 지원과 제도의 확대가 필요하다. 이와 함께 후속 연구에서는 이용여부를 유료, 실비, 무료, 비이용 등 유형별로 나누고 조사대상을 피부양노인과 가족부양자 뿐만 아니라 서비스 기관의 상황까지 분석한다면 노인주간보호서비스 이용 형태에 관한 최적의 모형을 제시할 수 있을 것이다.

Health Habits in Caregivers of Young Children with ASD: Key Factors, Facilitators, and Barriers

Hamo, Amarelle Columbia University ProQuest Dissertations & These 2022 해외박사(DDOD)

Background. Caregivers of individuals with Autism Spectrum Disorder (ASD) are a highly stressed group and their parenting stress has been linked to increased depression, anxiety, and reduced parenting self-efficacy (Osborne & Reed, 2008; Rezendes & Scarpa, 2011; Weiss & Lunsky, 2011). Given these areas of concern that parents of children with autism experience, there is a need to look more closely at modifiable factors that improve parental well-being. As such, health habit behaviors, including sleep, diet, exercise, and substance use are modifiable factors demonstrated to be causally related to well-being in adults.The present dissertation consists of two studies that explored how parents’ engagement in health habits (sleep, diet, exercise, and substance use) related to their well-being (stress and depression) and explored the possible determinants of health habit engagement. Specifically, how parental characteristics (both psychological and demographic), social support (both relationship-based and resource-related), and child factors (child behavior and demographic variables), relate to parents’ engagement in these habits. And, in study two, these exploratory analyses went further by examining how parent’s engagement in healthy habits relates to the observed parenting quality.Methods and Results: Study 1. Study one was a needs assessment completed by mothers and fathers (n=68) of children in an Applied Behavior Analysis (ABA) early intervention program in the northeastern United States, all at-risk for a developmental disability, many of whom were at risk for developing ASD. Parents completed questionnaires that included questions about their healthy habit engagement adapted from the Promise Neighborhoods RFA Indicators and the Promise Neighborhoods Research Consortium [PNRC] Measurement System (Promise Neighborhoods Research Consortium: Measures, 2001) as well as those related to parent, social support, and child characteristics. Parental characteristics included demographic characteristics of caregiver age and education level along with questionnaires on the parent’s psychological functioning; a measure of well-being (WHO-5; Topp, Ostergaard, Sondergaard, & Bech, 2015), parental stress (PSI-4; Abidin, 2012), and caregiver depressive symptoms (PHQ-9; Kroenke, Spitzer, & Williams, 2001). Questionnaires covering the second domain of social support included a measure of perceived social support (Interpersonal Support Evaluation List (ISEL-12); Cohen & Hoberman, 1983), marital satisfaction (Kansas Marital Satisfaction Scale; Schumm et al., 1986a), household income, and caregiver nativity. Questionnaires covering the third domain of child factors included a measure of child sleep problems (Children’s Sleep Habits Questionnaire; Owens, Spirito, & McGuinn, 2000), the ratio of children to adults in the home, child age, and child gender.Overall, about half of the caregivers reported an insufficient amount of sleep (less than 7 hours on average). A third of caregivers reported they did not exercise at all. Only a third reported eating breakfast every day, half ate only one serving of fruit most days and one serving of vegetables a day, half ate family meals prepared at home almost every day, a third ate fast food regularly, about half were told to lose weight. Most did not smoke or drink alcohol regularly. Additionally, about 30% reported elevated levels of depressive symptoms and elevated levels of parental stress. Significant relationships were found between parental characteristics, social support, child factors, and healthy habit engagement. Of note, caregiver stress, depression, and well-being were related adversely to mother’s sleep, diet, and substance use. Perceived social support was positively related to sleep, marital satisfaction negatively to smoking, household income negatively to diet and alcohol consumption, and nativity positively to sleep, diet, and alcohol consumption. No correlations were found with child factors and healthy habits. Examining a regression model of the facilitators and barriers to healthy habit engagement, caregiver well-being positively related (t=4.015, p<.001) while child sleep disruptions negatively related to healthy habit engagement (t=-2.344, p=.026). Additionally, depression was found to mediate the relationship between healthy habit engagement and parental stress using PROCESS (CI= (-1.811, -.324), R2=.274).Methods and Results: Study 2. Study two aimed to narrow in on a specific population of mothers of preschool-aged children with autism. Participants were 46 mother-child dyads, with children ages 2-6 to 5-6 recruited from a preschool utilizing an Applied Behavior Analysis (ABA) approach to schooling. Children had a classification of ASD, verified by the Autism Diagnostic Observation System – Two (ADOS-2) (Lord, Rutter, DiLavore, Risi, Gotham, & Bishop, 2012). Parenting behaviors, categorized as positive and harsh parenting, were observed across three tasks and coded using the Psychological Multifactor Care Scale — ASD Adapted Preschool Version (Brassard, Donnelly, Hart, & Johnson, 2016). Mothers completed the same questionnaires as study one for measures of healthy habit engagement, parental characteristics (excluding the WHO-5), and social support, There were additional child factor measures; however, including the child sleep problems and child externalizing behavior subscales from the CBCL (Achenbach & Rescorla, 2000), child language functioning (Vineland-III Communication subscale; Sparrow, Cicchetti, & Saulnier, 2016), ASD severity (ADOS-2), along with ratio of children to adults in the home, child age, and child gender.Overall, more than half of the mothers reported an insufficient amount of sleep (less than 7 hours on average). Almost half of mothers reported they did not exercise at all. Almost half reported eating breakfast every day, a third ate only one serving of fruit most days, and half ate one serving of vegetables a day, a third ate family meals prepared at home almost every day, a third ate fast food regularly, and a third were told to lose weight. Most did not smoke. Additionally, 11% of the sample had elevated depressives symptoms and 20% had elevated levels of parental stress. Similar significant relationships were found between parental characteristics, social support, child factors, and healthy habit engagement in study two. Of note, caregiver stress and depression were related negatively to caregiver’s sleep, diet, exercise, and being overweight. More perceived social support was related to better diet, household income to not being overweight, and nativity to smoking. Correlations were also found with child factors and healthy habits; child sleep with mother’s sleep, externalizing behavior problems with smoking, and high child to adult ratio with mother’s sleep. Examining a regression model of the facilitators and barriers to healthy habit engagement, caregiver depressive symptoms related negatively to healthy habit engagement (t=-.380, p=.049). ASD severity (t=-.511, p=.045) and child age (t=-.523, p=.014) came out as negatively related to mother’s diet in a similar model analysis. Additionally, mothers sleep directly related to both positive (R2=.213) and harsh (R2=.165) observed parenting quality.Conclusion. The results from study one and study two suggest that sleep, diet, exercise and substance use are important for parent’s well-being in both parents of children in early intervention and mothers of preschool-aged children with autism. Furthermore, parental wellbeing was the most predictive of engagement in healthy habits when examining possible facilitators and barriers. Child sleep was an important potential barrier in parents of children in early intervention and autism severity and child age were important potential barriers to mother’s diet in mothers of preschool-aged children with ASD. Furthermore, in study two, mothers sleep was an important factor not only for well-being but also for an objective measure of parenting quality, further strengthening the importance and value of sleep for a highly stressed population.