- 桃山学院大学総合研究所紀要 (ISSN:1346048X)
- vol.42, no.2, pp.41-72, 2016-12-05
"A Field Study on the Actual Conditions of Senior Citizens with Dementia in Izumi City," a joint study conducted by Izumi City and St. Andrew's University, was presented in March, 2014. The purpose of the study was to collect basic data on measures taken for persons with dementia in the municipal area of Izumi City, to identify any underlying issues, and to analyze what the next steps should be. The data was collected by investigating the understanding of dementia, and the everyday lives of persons with dementia and their family members, the support being provided to patients by medical institutions and designated in-home long-term care support providers, the beliefs and principles dementia supporters were guiding themselves by, and the ways that communities could be aided. Our aim was to grasp the current situation and issues of senior citizens with dementia and find ways to provide them with in-home care so that they can lead their lives with their wishes respected, concern-free and, most importantly, in their communities. Therefore, since the focus of the aforementioned field study was on the municipal area of Izumi City, we decided to adopt the items presented in the study and look further into them. In order to acquire a logical understanding of the actual conditions of senior citizens with dementia, we researched a number of items, such as nursing care services covered by insurance, the present state of family caregiving, and the provision of social resources to caregiving and medical services, and examined how strongly these items were interrelated. The data obtained from investigating the actual conditions of senior citizens with dementia in Izumi City were sorted according to certain conditions, subjected to statistical processing, and analyzed. In this study, we dealt with primary insured persons. From our analyses, we found that the amount of the burden felt by caregivers varied depending on the length of time they were undertaking caregiving. Caregiver burden, or stress, was found to be lower in caregivers with experience of under a year but to increase considerably as the length of time exceeded a year and continue to be felt strongly into the third year ; the burden was found to then gradually lighten. In order to maintain enough strength to continue caregiving, caregivers must not become isolated from society. Consulting experts in one's community is known to be an effective way to stay in touch with society. In our study, care managers were found to be the most consulted. This fact most likely reflects the current need caregivers have for care managers to serve as consultants when applying for nursing care services. Family members and relatives were the next most often consulted, which suggests that caregiving is not something that can be performed by a single caregiver but requires a team of family members and relatives. The next most often consulted were care facility operators and care service providers, indicating that caregivers seek advice when experts from home-visit nursing care facilities or senior citizen day care centers pay daily visits. One of the most difficult cases of caregiving is when the receiver is suffering from dementia. In our study, nearly 70% of caregivers who responded that their receiver was either "diagnosed with dementia, or was not but is highly likely to have dementia," said they were feeling stressed from caregiving. When caregivers sought consultation, especially in the hope of relieving their stress, those who caregivers found particularly helpful were again experts from home-visit nursing care facilities and senior citizen day care centers, as well as their care receivers' doctors. Of these three sources, the one that caregivers responded they felt relieved the most after consulting were home-visit nursing care providers. This is most likely because "home-visit nursing care providers" have more opportunities to interact with caregivers as well as care receivers than do care providers at "senior citizen day care centers" or "their care receivers' doctors." Such opportunities must be enabling home-visit nursing care providers to build interpersonal relationships with caregivers, through which caregivers are finding care providers helpful in relieving stress. In addition, a cross-sectional analysis examining the struggles and problems encountered during caregiving revealed that caregivers did not know who they could contact for consultation on dementia or knew much about this disease. Dementia's status as a lesser known disease among the general public could be the cause of this situation. Another cross-sectional analysis, which examined the responses from caregivers feeling stressed and the symptoms care receivers were showing, found that a great number of these caregivers reported symptoms such as "memory loss" and "repeated questions or statements." This shows that caregivers are finding it difficult to communicate with their care receivers. In addition, a concern shared by these caregivers was expressed over the decreasing levels of independence that their care receivers were showing each day and how much further they may decrease. This concern indicates that some amount of these caregivers' stress is coming from the unpredictable ways in which the symptoms of this disease develop. For the reasons above, rather than simply advising caregivers "not to leave persons with dementia alone (but to watch over them closely)," discussions must consider the diversity of symptoms by which this disease deprives sufferers of the self-reliance necessary for daily life, as well as the fact that the unpredictability of this disease is causing caregiver burden, and move towards reviewing the support services currently offered and revising the current support system where necessary, such as the application procedures for receiving nursing care services. Since an analysis covering all circumstances related to support measures for persons with dementia and their caregivers would be beyond the scope of this paper, we focus our analysis on the amount of caregiver burden, whether care receivers were diagnosed with dementia, and the receivers' level of care. From our analysis, we argue that the support that caregivers and care receivers require changes as the course of caregiving proceeds, and that they need support accordingly.