치매 행동심리증상(BPSD)에 따른 데이케어센터 종사자의 케어부담에 대한 연구

Abstract

본 연구는 데이케어센터의 종사자들을 대상으로 케어서비스를 제공하고 있는 치매노인의 행동심리증상의 발생빈도와 유형에 따른 종사자의 케어부담감을 파악하여 기초자료를 제공하는 데 목적을 두었다. 연구의 목적을 달성하기 위하여 서울특별시에 소재한 데이케어센터에서 근무하는 종사자(사회복지사, 간호사, 물리치료사, 요양보호사, 간호조무사) 97명을 대상으로 자료를 수집하였다. 본 연구의 주요결과를 요약하면 다음과 같다. 첫째, 치매노인의 행동심리증상 실태를 파악한 결과 데이케어센터에서 주야간보호서비스를 이용하는 치매노인들은 배회, 반복행동, 반복요구, 소음발생, 불평, 의심 등의 초조행동 행동심리증상을 가장 빈번하게 나타내고 있으며 수면방해, 음식집착, 부적절한 성표현 등의 신체증상이 가장 낮게 나타내고 있는 특성이라는 것을 알 수 있었다. 둘째, 종사자들이 느끼는 치매 행동심리증상에 대한 케어부담은 초조행동 유형에 대한 부담감 가장 높았으며 다음으로는 공격행동, 케어저항, 정신증상, 신경증상, 신체증상 유형 순이었다. 영역 하위문항별로 종사자들이 느끼는 케어부담에서는‘고함’이었고, 가장 낮은 부담을 나타낸 것은 부적절한 성 표현 이었다. 셋째, 치매노인의 행동심리증상 빈도가 종사자의 케어부담감에 미치는 영향에 대해 파악한 결과, 공격행동과 신체증상을 제외한 대부분의 영역에서 어느 정도의 상관이 나타나고 있음을 확인하였다. 특히 케어저항과 정신증상 간의 상관은 상당히 높게 나타났다. 또한 다중회귀분석 결과, 신체증상을 제외한 나머지 변수들이 상당한 영향력을 미친다는 것을 알 수 있다. 공격행동, 초조행동, 케어저항, 신경증상, 정신증상 순으로 영향력이 나타났다. 이러한 점으로 미루어 보아, 치매노인의 행동심리증상의 빈도가 증가하면 데이케어센터 종사자의 케어부담이 상승한다고 볼 수 있다. 반면에 종사자의 인구통계학적 변수들의 영향력은 통계학적 유의도 수준을 충족하지 못하고 있다. 이상의 본 연구 결과를 통하여 데이케어센터 종사자들의 케어부담이 치매노인의 행동심리증상의 특성에 따라 영향을 받고 있음을 확인 되었으며, 이는 치매노인에게 케어서비스를 제공함에 있어서 학대와 방임으로까지도 영향을 미칠 수도 있다. 따라서 종사자의 케어부담을 감소시키기 위하여 치매 행동심리증상의 특성에 따른 심층적이고 차별화된 교육프로그램 및 케어서비스 매뉴얼 개발이 필요하다고 판단된다. 아직까지 우리나라는 치매노인에게 케어서비스를 제공하는 시설 종사자에 대한 연구는 근무시의 불만족, 소진의 원인, 처우개선, 스트레스 요인 등과 관련된 내용의 연구가 대부분이었기 때문에 본 연구는 양질의 치매노인 케어서비스 도모에 있어서 중요한 기여를 하였다고 판단된다.| The purpose of this study was to explore daycare center employees’ care burden according to the type of and the occurrence frequency of behavioral and psychological symptoms of the elderly with dementia for whom daycare center employees provide care service, and to provide basic materials. To carry out this purpose, this study collected data on the subjects of 97 daycare center employees (social workers, nurses, physical therapists, care workers, nursing assistants) working at daycare centers located in Seoul. The primary results of this study can be summarized as follows. First, from the results of exploring the status of behavioral and psychological symptoms of the elderly with dementia, it is found that the elderly with dementia most frequently showed agitation behavioral and psychological symptoms such as wandering, repeated behavior, repeated request, noise creation, complaint, and suspicion, etc., and that the most infrequently showed characteristics were physical symptoms such as sleep disturbance, food attachment, improper sexual expression, etc. Second, as for care burden that daycare employees felt about psychological symptoms of dementia, the burden on the type of agitation behavior was found to be the highest, and then aggressive behavior, care resistance, mental symptom, neural symptom, physical symptom in that order. As for care burden that daycare employees felt according to the subcategorized items, the highest was found to be ‘shouting’ and the lowest was improper sexual expression. Third, from the results of exploring the effects of the frequency of behavioral and psychological symptoms of the elderly with dementia upon daycare employees’ care burden, most areas other than aggressive behavior and physical symptom were found to have correlation to a degree. In particular, the correlation between care resistance and mental symptom was found to be significantly high. Also, from the results of multi‐regression analysis, the other variables excluding physical symptom were found to be significantly influential. As for the power of influence, the more influential were aggressive behavior, agitation behavior, care resistance, neural symptom, and mental symptom in that order. Inferring from the above, it is said that daycare employees’ care burden ascends as much as the frequency of behavioral and psychological symptoms of the elderly with dementia increases. On the other hand, the influence of daycare employees’ demographic variables was not found to meet the level for the statistical significance. Through the results of this study above, it is confirmed that daycare employees’ care burden was influenced by the characteristics of behavioral and psychological symptoms of the elderly with dementia, which may possibly extends to abuse and noninterference in performing care service for the elderly with dementia. Thus, to decrease daycare employees’ care burden, it is said that it is necessary to develop in‐depth and differentiated education program and care service manual depending on characteristics of behavioral and psychological symptoms of dementia. As there have been facility employee related studies available mostly for dissatisfaction at work, reasons of burnout, labor condition improvement, and stress causes, this study may significantly contribute to the attempt of providing good quality care service for the elderly with dementia.; The purpose of this study was to explore daycare center employees’ care burden according to the type of and the occurrence frequency of behavioral and psychological symptoms of the elderly with dementia for whom daycare center employees provide care service, and to provide basic materials. To carry out this purpose, this study collected data on the subjects of 97 daycare center employees (social workers, nurses, physical therapists, care workers, nursing assistants) working at daycare centers located in Seoul. The primary results of this study can be summarized as follows. First, from the results of exploring the status of behavioral and psychological symptoms of the elderly with dementia, it is found that the elderly with dementia most frequently showed agitation behavioral and psychological symptoms such as wandering, repeated behavior, repeated request, noise creation, complaint, and suspicion, etc., and that the most infrequently showed characteristics were physical symptoms such as sleep disturbance, food attachment, improper sexual expression, etc. Second, as for care burden that daycare employees felt about psychological symptoms of dementia, the burden on the type of agitation behavior was found to be the highest, and then aggressive behavior, care resistance, mental symptom, neural symptom, physical symptom in that order. As for care burden that daycare employees felt according to the subcategorized items, the highest was found to be ‘shouting’ and the lowest was improper sexual expression. Third, from the results of exploring the effects of the frequency of behavioral and psychological symptoms of the elderly with dementia upon daycare employees’ care burden, most areas other than aggressive behavior and physical symptom were found to have correlation to a degree. In particular, the correlation between care resistance and mental symptom was found to be significantly high. Also, from the results of multi‐regression analysis, the other variables excluding physical symptom were found to be significantly influential. As for the power of influence, the more influential were aggressive behavior, agitation behavior, care resistance, neural symptom, and mental symptom in that order. Inferring from the above, it is said that daycare employees’ care burden ascends as much as the frequency of behavioral and psychological symptoms of the elderly with dementia increases. On the other hand, the influence of daycare employees’ demographic variables was not found to meet the level for the statistical significance. Through the results of this study above, it is confirmed that daycare employees’ care burden was influenced by the characteristics of behavioral and psychological symptoms of the elderly with dementia, which may possibly extends to abuse and noninterference in performing care service for the elderly with dementia. Thus, to decrease daycare employees’ care burden, it is said that it is necessary to develop in‐depth and differentiated education program and care service manual depending on characteristics of behavioral and psychological symptoms of dementia. As there have been facility employee related studies available mostly for dissatisfaction at work, reasons of burnout, labor condition improvement, and stress causes, this study may significantly contribute to the attempt of providing good quality care service for the elderly with dementia.