在宅で高齢者を介護する主介護者の介護負担感 : 排尿介護に焦点を当てて <原著論文>

本研究の目的は,65歳以上の高齢者(以下,被介護者)の介護を在宅で主に担う家族介護者(以下,主介護者)の介護負担感に,被介護者の排尿状況や主介護者・被介護者各々の各属性がどのように関連しているかを明らかにすることである。介護負担感の把握にZarit介護負担尺度日本語版(以下,J-ZBI),尿失禁の分別判定に排尿チェック表を各々用いて作成した質問紙を,協力施設の対象者162名に配付した。その結果,101名(62.3%)から有効回答を得,内94名(93.1%)の被介護者に尿失禁を認めた。J-ZBI得点は,被介護者に尿失禁「有」群(38.6±19.2点)が「無」群(29.3±22.6点)よりも高かった。主介護者の介護負担感を示すJ-ZBI得点は,被介護者の排尿時に「介助不要」より「半・少し介助」を要す方が高い傾向を示した(p < 0.1)。また,尿とりパッド「着用」群を介護する主介護者の方が「非着用」群を介護する者よりJ-ZBI得点が高い傾向を示した(p < 0.1)。一方,介護支援者「有」群は「無」群よりJ-ZBI得点が低かった(p < 0.05)。これらの結果から,排尿介護による介護負担感を低減するためには,尿とりパッド「着用」や排尿時に「半・少し介助」が必要な被介護者に,トイレ移動や排尿時の下着の上げ下げ・尿とりパッド交換のためのリハビリテーションを実施し,被介護者の排尿行動能力の向上に努めることが必要であると考えられた。

The purpose of this study was to investigate the impact on their caregiver of urinary incontinence in frail elderly persons cared for at home. The study also aimed to explore the relationships between the characteristics of the elderly and their caregivers, and the degree of burden experienced by the caregivers. Questionnaires were distributed to 162 caregivers. The questionnaire consisted of demographic questions, the Japanese version of the Zarit Burden Inventory (J-ZBI), and a voiding check sheet used to identify the types of urinary incontinence. Of 162 caregivers, 101 returned completed questionnaires (a 62.3% response rate). The results showed that 94 out of 101 elderly persons (93.1 %) had urinary incontinence. The degree of care burden experienced by caregivers was higher when they had to care for elderly with urinary incontinence than those without it. Moreover, the J-ZBI scores of the caregivers were moderately higher when the elderly required a moderate degree of voiding assistance than when they required no assistance (p < 0.1). Similarly, the J-ZBI scores were moderately higher when the caregivers had to care for elderly who used incontinence pads, compared with those who did not use them (p < 0.1). On the other hand, the J-ZBI scores of caregivers who received support from others were significantly lower compared with those without support (p < 0.05). It is important to improve the toileting ability of elderly persons who need incontinence pads and/ or a moderate level of voiding assistance by providing adequate rehabilitation training. Such training includes exercise in transferring to a toilet, exercise in pulling underwear up and down and exercise in wearing incontinence pads.