치매노인 부양가족의 부적응에 관한 연구 : 가족탄력모델을 중심으로 = A Study on the Level of Family Adaptations to the Dementia : An Application of the Family Resiliency Model

다국어 초록 (Multilingual Abstract)

This paper’s aim was to research the maladaptation and difficulties in the adjustment process of family members of Alzheimer’s patients based on McCabbin’s “Resiliency Model of Family Stress, Adjustment and Adaptation”. The research was carried out under the premise that the maladjustment of family members due to the suffering of Alzheimer’s patients does not only greatly affect the family’s own welfare but also produces negative effects for the treatment and rehabilitation of the Alzheimer’s patient him- or herself. This research sought to find the factors that greatly influence the maladjustment of family members of Alzheimer’s patients. Another purpose was to analyze the amount of influence given by these factors and throw some light onto whether these factors can be applied to other Alzheimer’s patient families.
1. The subjects for the research were family members (mainly spouses and children) of patients officially diagnosed with Alzheimer’s disease who are 60 years old or older.
2. The establishments and facilities that were investigated were the Ulsan Metropolitan City Alzheimer’s Disease Support Center, the Ulsan City Senior Hospital, one general hospital, two oriental medicine hospitals, 11 Senior Day Care Centers, 3 Senior Citizen Short-Term Care Centers, Alzheimer’s Counseling Centers (Public Health Centers for the Junggu, Namgu, Donggu, Bukgu and Wuljugun Districts in Ulsan City), 11 Public Health Treatment Centers within the Wuljugun District and other Alzheimer’s support centers. This research also investigated Alzheimer’s patients who have been admitted and discharged from 10 Senior Citizen Nursing Homes, patients who have been temporarily admitted to nursing homes, patients who were monitored at Alzheimer’s Counseling Centers and a few Alzheimer’s patients who are treated at home. Medium- to small-sized hospitals and clinics were not cooperative in the research surveys, hence Alzheimer’s patients at these facilities were not readily accessible. As a result, the subjects of my research are limited to those within the Ulsan region. Therefore, the survey results hardly represent the family resiliency of family members of the entire population of Alzheimer’s patients in Korea.
Based on the results of my research I have come up with the following proposal to help families of Alzheimer patients using Social Work Intervention Methods.
Initially, in order to foresee, prevent and carry out therapeutic intervention methods to treat maladaptation of Alzheimer patients' families, it is necessary to perform a thorough review and examination of the family's capability in exercising emotional control, and communication methods as well as interaction and support obtained from the extended family. If Social Work Intervention Methods are considered to be imperative after the examination, the expert should help the family improve its emotional control, enhance interaction and the acquisition of support from the extended family members and plan social work intervention means in order to educate and instill more effective communication skills among the patients' family members.
First, in order to encourage efficient communication skills between the patient and the patient's family (in other words, enhance favorable communication methods that are not resentful to the counterpart), we can use either the Behavior Rehearsal Technique or the Role Exchange Technique. By using the Role Exchange Technique, which makes family members exchange roles, allowing them to get first-hand experience on how the use of bitter language and hostile communication methods can influence as well as help them gain clear insight into effective methods of communication. Through the Behavior Rehearsal Technique, family members can be expected to learn, practice and improve their communications skills and learn to communicate more congenially.
Second, to increase interaction and acquire more support from the patient's extended family, direct family members can induce their participation by organizing family meetings. Before a social worker initiates a family meeting, he should use a genogram to become aware of the source of support for an Alzheimer patient and his direct family. In addition, he should recognize the adverse effects and causes of stress in a particular family and also obtain active support and attention from the extended family for the direct family members of a patient suffering from Alzheimer's.
Third, emotional control is the most important factor that determines the level of family maladaptation. In order to improve emotional control, family members can use Family Hardiness Strengthening Skills (Maddi & Kobas, 1984 59In order to strengthen the family hardiness, private or group therapy can be considered for the family members. However, because there are fewer distractions, one-on-one private therapy is recommended and viewed to be far more effective for family members who are currently having difficulty adjusting their lives to those of Alzheimer's patients. Family Hardiness Strengthening Therapy uses the following techniques:
First, the "Focalization" Approach gives clients an opportunity to recall feelings of neglect and personal longings during childhood as well as encourages them to recognize and express their true feelings and thoughts.
Second, the "Situation Reenactment" Approach permits clients to first imagine a stressful situation that either becomes worse or better. Afterwards, the client is told to imagine what must change or happen for that situation to occur and what the client must do so that these situations do occur. The last stage of this approach is actually putting these trial situations into practice.
Third, the "Compensational Self-Improvement" Approach can be used in stressful situations where little or no improvement at all can be expected from the patient. Family members should be encouraged to accept the present situation and use their energy in a constructive way to improve themselves in other areas.
Fourth, the "Paradoxical Intention" Approach will allow clients suffering from severe depression and insomnia to regain self-control by allowing symptoms to become more severe -- in other words, making it worse to get rid of it.
Of the above mentioned approaches, the "Situation Reenactment," "Compensational Self-Improvement," and "Paradoxical Intention" approaches are considered to be the most effective ways to obtain and improve the family's emotional control.
Last of all, the following group of people require special and foremost attention because they experienced a relatively difficult time adjusting to the patient: people with low-income and little or no education, people with no background knowledge regarding Alzheimer's disease, people with a pessimistic view of the patient's recovery and people who lack an intimate and close relationship with the patient.
These groups of people can participate in the Family Education Program to gain a better understanding of the patients and Alzheimer's disease. These programs will allow family members to grasp and become more tolerant of the patients' pathological behavior as well as prevent maladjustments that could worsen the relationship between patient and family.

목차 (Table of Contents)

• 목차
• 제1장 서 론 = 1
• 제1절 연구의 필요성 및 목적 = 1
• 제2절 연구방법 = 4
• 제3절 연구의 한계 = 4
• 제2장 이론적 배경 = 5
• 제1절 치매의 특징과 유형 = 5
• 1. 치매의 개념 및 특징 = 5
• 2. 치매의 원인과 유형 = 7
• 제2절 가족탄력성의 이해 = 10
• 1. 가족탄력성의 개념 = 10
• 2. 가족탄력성 모델 = 13
• 3. 가족탄력성의 결정변인 = 19
• 제3절 치매노인 부양가족원의 적응에 대한 이해 = 30
• 1. 치매노인 부양가족원의 부양부담과 정신건강 = 30
• 2. 치매노인 부양가족원의 적응과정 = 32
• 제4절 선행연구 고찰 = 36
• 제3장 조사 설계 및 분석방법 = 37
• 제1절 조사대상 및 자료수집 = 37
• 제2절 조사도구 = 38
• 제3절 분석방법 = 44
• 제4절 연구 설계 및 연구 모형 = 44
• 제4장 조사결과 분석 = 45
• 제1절 치매노인과 부양가족원의 일반적 특성 = 45
• 1. 부양가족원의 일반적 특성 = 45
• 2. 치매노인의 일반적 특성 = 47
• 제2절 치매노인과 부양가족원의 일반적 특성에 따른 탄력요인 분석 = 49
• 제3절 가족탄력모델의 주요변인들과 가족 부적응과의 상관관계 = 108
• 제4절 가족 부적응 예측요인 분석 = 113
• 제5장 결 론 = 116
• 참고문헌 = 122
• 부 록 = 127
• Abstract = 138