Department of Urban Science and Policy, Faculty of Urban Environmental Sciences, Tokyo Metropolitan University, 1-1 Minami-Osawa, Hachioji-shi, Tokyo, 192-0397, Japan.
Gerontology Program, J. F. Oberlin University Graduate School of International Studies, 1-1- 12 Sendagaya, Shibuya-ku, Tokyo, 151-0051, Japan.
BMC Geriatr. 2023 Oct 6;23(1):628. doi: 10.1186/s12877-023-04348-5.
The number of caregivers performing medical care tasks at home for older adults is expected to increase. Family caregivers, who are not healthcare professionals, are likely to find these activities difficult and burdensome. However, appropriate support may decrease the negative and increase the positive aspects of caregiving. This study investigated direct associations between caregivers providing medical care at home and their negative and positive appraisals of caregiving (burden and gain), indirect associations through healthcare professional support and informal support, and whether the associations between medical care tasks and caregivers' appraisals of caregiving differed based on the support received.
Interview surveys were conducted in 2013, 2016, and 2019 in a Tokyo Metropolitan Area city with family caregivers of community-dwelling older adults who were certified as requiring care in Japan's long-term care insurance system. This study analyzed the combined data from each survey (n = 983). Structural equation modeling (SEM) analysis was utilized to examine direct associations between providing medical care and caregiver appraisals and indirect relationships through healthcare professional support and informal support. The modulating effects of these forms of support on the relationship between medical care and caregiver appraisals were assessed using multigroup SEM analyses.
Approximately 9% of family caregivers provided medical care at home. The results of SEM analyses, controlled for care recipients' physical and cognitive difficulties; caregivers' age, sex, and economic condition; and survey year, revealed no direct associations between providing medical care and caregivers' sense of burden and gain. They also did not reveal any indirect effects through either healthcare professional support or informal support. However, the results of multigroup SEM analyses indicated that caregivers providing medical care who used home-visit services by physicians and/or nurses, compared to those who did not, tended to exhibit a greater sense of gain.
These results suggest that family caregivers providing medical care at home can positively change their appraisals of caregiving if they receive appropriate support. Home medical care services provided by healthcare professionals can effectively support caregivers. Developing strategies and policies to make medical care services at home more accessible to caregivers is crucial.
预计在家中为老年人提供医疗护理任务的护理人员数量将会增加。非医疗专业人员的家庭护理人员可能会发现这些活动既困难又繁重。然而，适当的支持可能会减少护理的负面方面，增加积极方面。本研究调查了家庭护理人员在家中提供医疗护理与他们对护理的负面和正面评价（负担和收益）之间的直接关联，通过医疗专业人员支持和非正式支持的间接关联，以及医疗护理任务与护理人员对护理的评价之间的关联是否因所获得的支持而不同。
2013 年、2016 年和 2019 年，在日本东京都的一个城市，对需要接受日本长期护理保险系统认证的社区居住的老年人的家庭护理人员进行了访谈调查。本研究分析了每次调查的综合数据（n=983）。结构方程模型（SEM）分析用于检验提供医疗护理与护理人员评估之间的直接关联，以及通过医疗专业人员支持和非正式支持的间接关系。使用多组 SEM 分析评估了这些支持形式对医疗护理与护理人员评估之间关系的调节作用。
大约 9%的家庭护理人员在家中提供医疗护理。在控制了护理对象的身体和认知困难、护理人员的年龄、性别和经济状况以及调查年份的情况下，SEM 分析的结果显示，提供医疗护理与护理人员的负担感和收益感之间没有直接关联。它们也没有通过医疗专业人员支持或非正式支持显示任何间接影响。然而，多组 SEM 分析的结果表明，与未使用的护理人员相比，使用医师和/或护士家访服务的提供医疗护理的护理人员往往更能感受到收益。
这些结果表明，如果家庭护理人员在家中提供医疗护理时得到适当的支持，他们可以积极改变对护理的看法。医疗专业人员提供的家庭医疗护理服务可以有效地支持护理人员。制定使家庭医疗护理服务更容易为护理人员获得的策略和政策至关重要。
