시설거주노인의 연구참여 동의능력 유무에 영향을 미치는 요인에 대한 연구 = Factors affecting the capacity to consent to research among nursing home residents

다국어 초록 (Multilingual Abstract)

The purpose of this study is to identify nursing home residents' characteristics who are at high risk of impaired decision-making capacity to consent for research. The sample included 202 nursing home residents in Busan Metropolitan City. In order to minimize ethical problems, the signed consent-to-research participation process form was obtained from both the older adults in nursing homes and authorized surrogates.
The results revealed that 145 residents(71.8%) had the capacity to consent to research and 57 residents(28.2%) did not pass. In order to examine the relationship between older adults' capacity to consent, and gender, age, education, ADLs, IADLs, cognitive impairment(SPMSQ) and depress symptoms(GDS), Pearson correlation coefficients were computed. The results revealed that gender(women), education(lower), age(higher), ADLs(more severe), IADLs(more severe), cognitive impairments(more severe) and depressive symptoms(more severe) were significantly related with the older adults' incapacity to consent to research. However, the results of logistic regression analysis identified that older adults’ capacity to consent to research was statistically associated with only cognitive impairments(SPMSQ) among the considered independent variables(Odds=.606, p< .001).
The findings of this study could provide several information for researchers and practitioners who address or work for older adults in long-term care settings. First, gerontological researchers should obtain informed consent from older residents in institutional settings. Second, the signed consent to research participation for older adults with cognitive impairments should obtain from both older residents in nursing homes and authorized surrogates. Third, the professionals for older adults in long care settings should check thoroughly the surrogate consent process for the older adults' research or program participation.

국문 초록 (Abstract)

본 연구의 목적은 시설에 거주하는 노인을 대상으로 연구참여 동의능력에 영향을 미치는 요인을 분석하는 것이다. 본 연구를 위해 부산지역에 위치한 요양원에 거주하고 있는 202명의 노인을 설문조사하였다. 연구참여를 위한 고지된 동의서를 작성하기 어려운 대상자를 위해 시설책임자나 서비스 제공자를 통해 이중동의를 받아 윤리적 문제를 최소화하였다.
연구결과 본 연구에 참여한 202명의 시설거주노인 중에서 145명(71.8%)이 연구참여 동의능력이 있었고, 57명(28.2%)은 동의능력이 없는 것으로 판정되었다. 시설거주노인의 특성에 따라 개별적으로 동의능력 유무와의 상관관계분석에서 성별, 연령대, 학력, 요양등급, 일상생활능력(ADL), 도구적 일상생활능력(IADL), 인지기능(SPMSQ), 우울증상(GDS) 등이 모두 통계적으로 유의미한 관계가 있었다. 여성일수록, 학력이 낮을수록, 연령이 높을수록, 신체기능이 낮을수록, 인지기능이 낮을수록, 우울증상이 높을수록 노인의 연구참여 동의능력이 없는 것으로 조사되었다. 하지만, 노인의 특성을 동시에 독립변수로 고려하여 로지스틱 회귀분석을 한 결과, 시설거주노인의 인지기능(SPMSQ)만이 동의능력에 통계적으로 유의미한 영향을 가져오는 변수로 나타났다(Odds=.606, p< .001).
본 연구결과를 토대로 시설거주노인을 대상으로 조사를 수행할 연구자와 서비스를 제공하는 실천가를 위한 몇 가지 함의를 제시할 수 있다. 첫째, 시설에 거주하는 노인을 대상으로 조사하는 연구자는 연구참여를 위한 고지된 동의과정을 반드시 거쳐야 한다. 둘째, 인지기능의 저하가 의심되는 시설거주노인을 대상으로 조사를 수행할 때는 고지된 동의와 대리동의 과정을 함께 거쳐야 한다. 셋째, 시설에서 장애노인을 돌보고 있는 시설관계자는 시설거주노인을 대상으로 수행되는 연구조사와 프로그램 평가에 대해 수락여부에 신중해야 할 것이다.

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