치매노인가족의 보호형태와 비용분석에 따른 부양가족 지원방안 = Analysing the types and costs of family caregiving for the demented elderly : strategies to support families with the demented elderly

다국어 초록 (Multilingual Abstract)

The purpose of this study is to analyse the types and costs of family caregiving for the demented elderly empirically, and then to suggest practical and policy measures to support families with the dependent elderly using the results of analysis.
For this research, primary caregivers that provide caregiving to demented elderly were drawn and surveyed(N=380). Among collected data, data for 339 primary caregivers were used for this study. The subjects used in this study consisted of family caregivers from various settings that give care to the demented elderly. The 108 subjects were caregivers from home care that family provide most care, the 136 subjects were caregivers utilizing day care programs for the demented elderly, the 71 subjects were caregivers utilizing hospital care, the 71 subjects were caregivers utilizing short term care, and the 7 subjects were caregivers utilizing group home.
To accomplish the purpose of this study, various analytic and statistical procedures have been conducted. First of all, previous literature review and analysis have been used to describe theoretical background and establish research methods of this study. Second, derived-demand equations were estimated for hours of family care, care costs per month, and the use of formal services. An economic model of household production was used as the theoretical framework to test the study hypothesis, and 17 hypotheses from the model were tested. The study was cross-sectional and caregivers to the elderly with dementia were the units of analysis. Third, various statistical techniques were conducted. Determinants of the number of hours of family care provided, the costs of family care per month were estimated using ordinary least squares regression. The caregiver's formal care choices were estimated using a binary probit model. The use of formal care services was modeled using three separate probit equations for elderly day care, hospital care, institution care.
The results of this study can be summarized as follows.
First, age of care recipient is a significant determinant for several analytic models. Age of care recipient is positively associated with the direct cost of total sample. Age of care recipient have weakly negative effect on the use of the elderly day care.
Second, household income of primary caregiver is positively associated with direct cost. The coefficient of this household income is statistically significant in direct cost model of total sample.
Third, while the care recipient's degree of limitations in ADLs is positively and statistically significantly associated with direct cost, the care recipient's degree of limitations in IADLs is positively and statistically significantly associated with total cost(summing direct cost, indirect cost, derived cost).
Fourth, while the care recipient's degree of limitations in ADLs is negatively and statistically significantly associated with the use of the elderly day care service, the care recipient's degree of limitations in IADLs is positively and statistically significantly associated with the use of the elderly day care service.
Fifth, the presence of substitute caregiver is positively and statistically significantly associated with total cost.
Sixth, while the use of day care services or institution care programs is positively and statistically significantly associated with direct cost, it is negatively and statistically significantly associated with indirect cost, and then is negatively and statistically significantly associated with total cost.
Seventh, while the caregiver's education level is positively associated with direct cost and the choice of formal services(day care or institution care), it is negatively associated with hours of informal care provided. It reach statistical significance in these models.
Eighth, the caregiver's marital status being married is positively associated with the choice of hospital care and has statistically weak significance.
Ninth, the caregiver's daughter in law relation with care recipient is negatively associated with the use of elderly day cares or hospital care. Particularly, it is strong, negative, and statistically significant in the use of hospital care.
Tenth, the caregiver's age has second equation relation with hours of informal care provided. That is, an increase in caregiver's age would be expected to increase hours of informal care provided, but decrease hours of informal care provided from the specific level of age.
Eleventh, the caregiver's health status being healthy is negatively associated with hours of informal care provided and is statistically significant.
Twelfth, the caregiver's negative mental health is negatively associated with hours of informal care provided and is statistically significant in home care sample. It is positively associated with the use of day care.
Thirteenth, the caregiver's labor forces participation is negatively associated with hours of informal care provided and is statistically significant.
Fourteenth, the caregiver's labor forces participation is negatively and statistically significantly associated with direct cost and total cost. Particularly, it is strong statistically significant in total cost.
Fifteenth, the caregiver's labor forces participation is positively and statistically significantly associated with the use of institution care.
Based on these results, I suggested several strategies to support families with the demented elderly.
Strategies to support families with the demented elderly could be proposed the two major parts through this study. The one part is the aspect of practical support measures, and the other part is the aspect of policy measures.
The practical support strategies can be compose of two types of interventions across the caregiving career.
First, practical intervention at the period of role acquisition should be preventive in function, focusing on the avoidance of problems that commonly emerge later in the course of dementia.
Second, practical intervention at the period of role enactment should be stress management. Caregiving can be enormously stressful, especially over the protracted course of most dementia care and the transition to institutional placement in caregivers' lives is often very difficult.
The policy measures to support families with the demented elderly can be proposed based on results of this analysis.
First, family caregiving for the demented elderly should be incentive by social policies. That is, it need to be encouraged by social policy programs and legal obligation.
Second, it need to establish a policy balancing among demented elderlies, caregivers, society for costs and benefits of caregiving for the demented elderly. Balancing costs are the satisfaction of motivational imperatives and other intrinsic rewards associated with caring for the demented elderly.
Third, support services should have a partnership with families with the demented elderly. This approach is to formalize the involvement of the family, developing care plans that include contributions from both informal and formal providers.
Fourth, the timing of institution placement should be optimal and the optimal institution should be provided optimally by patient condition.
Fifth, the strengthening of public home care service and institution care are required.

목차 (Table of Contents)

• 목차 = i
• Ⅰ. 서론 = 1
• 1. 연구 필요성 및 목적 = 1
• 2. 연구방법 = 5
• 3. 연구 범위와 한계 = 5
• 4. 용어의 정의 = 7
• Ⅱ. 이론적 배경 = 8
• 1. 노인과 치매 = 8
• 2. 치매노인에 대한 부양부담과 스트레스 = 9
• 1) 부양부담 = 9
• 2) 부양 스트레스 = 11
• 3. 비공식 보호와 공식 보호 = 16
• 4. 가족보호환경의 변화와 휴식보호 = 18
• 1) 가족보호환경의 변화와 휴식보호의 필요성 = 18
• 2) 휴식보호의 정의 = 20
• 3) 휴식보호서비스의 분류 = 22
• 4) 휴식보호의 효과 = 27
• 5. 가족의 치매노인 보호활동의 이행단계 = 28
• 6. 치매노인 보호비용의 계산 = 32
• 7. 선행연구동향 = 38
• 1) 부양가족의 노인보호 형태 = 43
• 2) 치매노인 보호비용 = 56
• 3) 문헌 및 연구논리의 한계와 보완 = 67
• Ⅲ. 조사설계 = 69
• 1. 조사대상 및 조사방법 = 69
• 2. 조사도구의 구성 및 내용 = 70
• 3. 척도의 신뢰도 분석 = 72
• 4. 부양행동 분석모형의 구성 = 73
• 5. 분석 방법 = 78
• 6. 연구가설 = 78
• Ⅳ. 조사결과 분석 및 논의 = 84
• 1. 치매노인의 특성과 치매양상 = 84
• 1) 치매노인의 일반적 특성 = 84
• 2) 치매양상과 일상생활동작기능 = 84
• 2. 주부양자의 특성과 자원 = 87
• 1) 주부양자의 일반적 특성 = 87
• 2) 주부양자의 자원 = 89
• 3. 치매노인의 보호비용 = 90
• 1) 치매노인 보호비용의 빈도분석 = 90
• 2) 치매노인 보호비용의 분산분석 = 92
• 4. 부양자의 스트레스 정도 = 96
• 5. 보호의 형태와 비용의 결정요인 분석 = 99
• 1) 가족의 보호시수와 비용에 미치는 요인 = 101
• 2) 가족의 공식 보호선택에 미치는 요인 = 106
• 6. 연구결과와 연구가설에 대한 논의 = 109
• 1) 빈도분석과 분산분석결과에 대한 논의 = 109
• 2) 연구가설에 대한 논의 = 117
• Ⅴ. 치매노인가족의 지원방안 = 127
• 1. 실천적 측면 = 127
• 1) 역할습득단계의 지원방안 = 128
• 2) 역할실행단계의 지원방안 = 130
• 2. 정책적 측면 = 131
• 1) 가족의 노인부양 인센티브 강화 = 132
• 2) 합리적인 부양분담체계 확립 = 134
• 3) 가족과의 파트너십 구축 = 139
• 4) 시설입소의 적기결정체계 확립과 적정시설의 보급 = 141
• 5) 공적 재가보호서비스 및 시설보호서비스의 강화 = 144
• Ⅵ. 결론 = 146
• <참고문헌> = 151
• 부록 1 설문지 = 166
• 부록 2 우리나라의 자녀의 노인부양 장려 정책 = 176
• Abstract = 178

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