Department of Psychiatry of the Elderly, Altrecht Mental Health Care, Oude Arnhemseweg 260, Zeist 3705 BK, The Netherlands.
BMC Psychiatry. 2013 Mar 27;13:103. doi: 10.1186/1471-244X-13-103.
Owing to the policy of extramuralization of care in most Western countries older people with severe mental illness have to rely more and more on informal caregivers for daily care. Caregivers themselves are often aged, and although caregiving implies an impact on daily life that exceeds the boundaries of usual informal care, the impact differs across caregivers. Some caregivers seem to suffer more than others, and the differences cannot be fully understood by factors currently known to exacerbate the burden of caregiving. In order to help caregivers reduce the impact of caregiving it is important to gain a deeper understanding of factors influencing the burden and its impact on the caregiver's life. With this in mind, the aim of the study is to explore and understand differences in the impact of long-term caregiving on the quality of life of caregivers who look after older adults with severe mental illness.
A qualitative, associative, inductive strategy and continuous simultaneous coding were used to interpret the data of 19 semi-structured interviews.
We identified an underlying psychological factor "perceived freedom of choice" which explains the gross differences in impact, leading to a definition of two main types of caregivers. Depending on how people perceive freedom of choice to provide care, the consequences of caregiving can be characterized as a process of gain (type 1) or loss (type 2). Four influential factors deepen the impact of caregiving for the type 2 caregivers, and two subtypes are identified for this category. Consequences of caregiving are most readily seen in a deteriorating quality of the relationship with the care recipient and in the psychosocial well-being of the caregiver.
The concept of freedom of choice adds to our understanding of the differences and explains the variation in impact on the caregivers' life. The type 1 caregiver generally experiences gain whereas type 2 generally experiences loss, which puts the latter group typically at risk of becoming overloaded. Whether people perceive that they have freedom of choice in caregiving is an important consideration in evaluating the type of intervention needed to support caregivers.
在大多数西方国家，由于护理的院外化政策，患有严重精神疾病的老年人越来越依赖非正式护理者提供日常护理。护理者本身往往年龄较大，尽管护理对日常生活的影响超出了通常的非正式护理的范围，但这种影响因护理者而异。一些护理者似乎比其他人遭受更多的痛苦，而这些差异不能完全用目前已知的加重护理负担的因素来解释。为了帮助护理者减轻护理的影响，深入了解影响护理负担及其对护理者生活影响的因素非常重要。考虑到这一点，本研究的目的是探索和理解照顾患有严重精神疾病的老年人的长期护理对护理者生活质量的影响差异。
采用定性、关联、归纳策略和连续同步编码对 19 次半结构化访谈的数据进行解释。
我们确定了一个潜在的心理因素“感知的自由选择”，它解释了影响的巨大差异，从而定义了两种主要类型的护理者。根据人们对提供护理的自由选择的感知，护理的后果可以被描述为一个获得（1 型）或损失（2 型）的过程。四个影响因素加深了对 2 型护理者的护理影响，并为这一类别确定了两个亚型。护理的后果最容易体现在与护理接受者的关系恶化和护理者的心理社会幸福感下降上。
自由选择的概念增加了我们对差异的理解，并解释了对护理者生活影响的变化。1 型护理者通常会获得收益，而 2 型护理者通常会遭受损失，这使后者群体通常面临过载的风险。人们是否认为他们在护理中有自由选择是评估支持护理者所需干预类型的重要考虑因素。
