我们能否超越负担和倦怠,支持痴呆症患者的家庭照顾者的健康和幸福?来自加拿大不列颠哥伦比亚省的证据。
Can we move beyond burden and burnout to support the health and wellness of family caregivers to persons with dementia? Evidence from British Columbia, Canada.
机构信息
Department of Economics and Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada.
出版信息
Health Soc Care Community. 2012 Jan;20(1):103-12. doi: 10.1111/j.1365-2524.2011.01025.x. Epub 2011 Aug 18.
After more than a decade of concerted effort by policy-makers in Canada and elsewhere to encourage older adults to age at home, there is recognition that the ageing-in-place movement has had unintended negative consequences for family members who care for seniors. This paper outlines findings of a qualitative descriptive study to investigate the health and wellness and support needs of family caregivers to persons with dementia in the Canadian policy environment. Focus groups were conducted in 2010 with 23 caregivers and the health professionals who support them in three communities in the Southern Interior of British Columbia. Thematic analysis guided by the constant comparison technique revealed two overarching themes: (1) forgotten: abandoned to care alone and indefinitely captures the perceived consequences of caregivers' failed efforts to receive recognition and adequate services to support their care-giving and (2) unrealistic expectations for caregiver self-care relates to the burden of expectations for caregivers to look after themselves. Although understanding about the concepts of caregiver burden and burnout is now quite developed, the broader sociopolitical context giving rise to these negative consequences for caregivers to individuals with dementia has not improved. If anything, the Canadian homecare policy environment has placed caregivers in more desperate circumstances. A fundamental re-orientation towards caregivers and caregiver supports is necessary, beginning with viewing caregivers as a critical health human resource in a system that depends on their contributions in order to function. This re-orientation can create a space for providing caregivers with preventive supports, rather than resorting to costly patient care for caregivers who have reached the point of burnout and care recipients who have been institutionalised.
在加拿大和其他地方的政策制定者经过十多年的努力,鼓励老年人在家中安度晚年之后,人们认识到,就地老龄化运动对照顾老年人的家庭成员产生了意想不到的负面影响。本文概述了一项定性描述性研究的结果,该研究旨在调查加拿大政策环境下痴呆症患者家庭照顾者的健康和福利以及支持需求。2010 年,在不列颠哥伦比亚省南部内陆的三个社区,与 23 名照顾者和支持他们的卫生专业人员进行了焦点小组讨论。以不断比较技术为指导的主题分析揭示了两个总体主题:(1)被遗忘:被独自和无限期地抛弃来照顾,捕捉到照顾者试图获得认可和足够的服务来支持他们的照顾但却失败的后果;(2)对照顾者自我保健的不切实际的期望与照顾者照顾自己的期望负担有关。尽管现在对照顾者负担和倦怠的概念有了相当的了解,但导致痴呆症患者的照顾者产生这些负面影响的更广泛的社会政治背景并没有得到改善。如果有的话,加拿大的家庭护理政策环境使照顾者处于更加绝望的境地。有必要从将照顾者视为一个依赖他们的贡献才能运作的系统中的关键健康人力资源的角度出发,对照顾者和照顾者支持进行根本性的重新定位。这种重新定位可以为照顾者提供预防性支持创造空间,而不是为已经达到倦怠和被收容的照顾者和护理接受者寻求昂贵的患者护理。