Arthur Labatt Family School of Nursing, The University of Western Ontario, London, ON.
Can J Aging. 2012 Dec;31(4):423-34. doi: 10.1017/S0714980812000396. Epub 2012 Dec 7.
The hours of unpaid elder care by family members are projected to triple by 2038. Because living with dementia can inhibit decision-making abilities, family members are often besought to assist in this process. In this ethnographic study, relationships within home-based dementia care were critically examined through face-to-face interviews and participant observations with clients, family caregivers, and home care providers (n = 51). The findings revealed how the formalized home care system contextually imposes decisions, and revealed three themes: (1) accommodating clinically defined competence/incompetence, (2) making untimely decisions, and (3) reinforcing exclusion in decision making. These themes shed light on how cultural values (competency), beliefs (immutability of the system), and practices (timing of decisions) of the home care system are ultimately deterministic in decision making for persons with dementia and caregivers. Additional attention to the collaborative and inclusive practices of all family members in dementia home care is imperative in order to optimize health.
预计到 2038 年，家庭成员无偿的老年护理时间将增加两倍。由于痴呆症患者的决策能力会受到影响，因此经常需要家庭成员来协助完成这些决策。在这项民族志研究中，通过与客户、家庭护理人员和家庭护理提供者（n=51）进行面对面的访谈和参与观察，对家庭痴呆护理中的关系进行了批判性地审查。研究结果揭示了正式的家庭护理系统如何根据具体情况做出决策，并揭示了三个主题：（1）适应临床定义的能力/无能力，（2）做出不合时宜的决策，（3）在决策中强化排斥。这些主题揭示了家庭护理系统的文化价值观（能力）、信念（系统的不可变性）和实践（决策的时间）如何最终决定痴呆症患者及其护理人员的决策。为了优化健康，必须更加关注痴呆症家庭护理中所有家庭成员的协作和包容性做法。
