Danivas Vijay, Bharmal Mufaddal, Keenan Paul, Jones Steven, Karat Samuel Christaprasad, Kalyanaraman Kumaran, Prince Martin, Fall Caroline H D, Krishna Murali
Foundation for Research Advocacy in Mental Health (FRAMe), Mysore, India.
Northwestern Mental Health, Melbourne, Australia.
Soc Psychiatry Psychiatr Epidemiol. 2016 Dec;51(12):1659-1664. doi: 10.1007/s00127-016-1286-4. Epub 2016 Sep 29.
Limited availability of specialist services places a considerable burden on caregivers of Persons with Dementia (PwD) in Low- and Middle-Income Countries (LMICs). There are limited qualitative data on coercive behavior towards PwD in an LMIC setting.
The aim of this study was to find relevant themes of the lived experience of relatives as caregivers for PwD in view of their use of coercive measures in community setting in South India.
Primary caregivers (n = 13) of PwDs from the Mysore study of Natal effects on Ageing and Health (MYNAH) in South India were interviewed to explore the nature and impact of coercion towards community dwelling older adults with dementia. The narrative data were coded using an Interpretative Phenomenological Analysis (IPA) approach for thematic analysis and theory formation.
Caregivers reported feeling physical and emotional burn-out, a lack of respite care, an absence of shared caregiving arrangements, limited knowledge of dementia, and a complete lack of community support services. They reported restrictions on their lives through not being able take employment, a poor social life, reduced income and job opportunities, and restricted movement that impacted on their physical and emotional well-being. Inappropriate use of sedatives, seclusion and environmental restraint, and restricted dietary intake, access to finances and participation in social events, was commonly reported methods of coercion used by caregivers towards PwD. Reasons given by caregivers for employing these coercive measures included safeguarding of the PwD and for the management of behavioral problems and physical health.
There is an urgent need for training health and social care professionals to better understand the use of coercive measures and their impact on persons with dementia in India. It is feasible to conduct qualitative research using IPA in South India.
在低收入和中等收入国家（LMICs），专科服务的有限可及性给痴呆症患者（PwD）的照护者带来了相当大的负担。在LMICs环境中，关于对PwD的强制行为的定性数据有限。
本研究的目的是，鉴于印度南部社区环境中亲属作为PwD照护者使用强制手段的情况，找出他们生活经历的相关主题。
对来自印度南部迈索尔衰老与健康纳塔尔效应研究（MYNAH）的PwD的主要照护者（n = 13）进行访谈，以探讨对社区居住的老年痴呆症患者实施强制手段的性质和影响。使用解释性现象学分析（IPA）方法对叙事数据进行编码，以进行主题分析和理论构建。
照护者报告感到身心疲惫、缺乏喘息护理、没有共享照护安排、对痴呆症的了解有限，以及完全缺乏社区支持服务。他们报告说，由于无法就业、社交生活不佳、收入和就业机会减少以及行动受限，他们的生活受到了限制，这影响了他们的身心健康。照护者对PwD常用的强制手段包括不恰当地使用镇静剂、隔离和环境约束，以及限制饮食摄入、获取资金和参与社交活动。照护者采用这些强制手段的原因包括保护PwD以及管理行为问题和身体健康。
迫切需要培训卫生和社会护理专业人员，以便更好地理解印度强制手段的使用及其对痴呆症患者的影响。在印度南部使用IPA进行定性研究是可行的。
