Structure of Caring Experience : Exploring Factors Related to Maximing In Home-care Support System.

本研究旨在探讨社区老人照顾者与照顾者照顾经验的结构。2003年6月和2005年6月分别在东京葛饰和秋田大馆对1057名和522名符合长期护理保险条件的人进行了研究。在葛饰，老人往往独居，女儿或家庭佣工比大馆更经常担任照顾者的角色。在2年的随访研究中，分别有22.6%和33.1%的老年人死亡或入住长期护理机构。死亡病例的主要照顾者倾向于妻子或儿媳，生存分析显示，死亡与照顾者的士气状态较低或护理负担较高以及缺乏基本护理（如梳理或剃须）有关。在大馆，收容所化更为普遍。这可能是大馆县健康状况较好和营养不良发生率较低的原因。机构化的老人利用更多的短期停留服务，并揭示痴呆相关的行为更频繁。在日本，人们倾向于将家庭护理视为共同生活的护理。这种痴迷可能会促使家庭选择机构。个案研究显示，假装不关心的照顾行为有助于稳定的照顾关系。

The aim of this study was to explore the structure of care experience among elderly care recipients and their caregivers living in the community. One thousand and fifty-seven and 522 people who were eligible for long-term care insurance were studied in June 2003 and followed in June 2005 in Katsushika, Tokyo and in Odate, Akita, respectively. Elders tended to live alone and daughters or in-home helpers took roles of caregivers more often in Katsushika than in Odate. At the 2-year follow-up study, 22.6% and 33.1 %, respectively, of elders either died or admitted to the long-term care institutions. Main caregivers of deceased cases tended to be wives or daughters-in-law, and survival analysis showed that death was associated with caregivers' lower morale state or higher care burden and lack of basic care such as combing or shaving. Institutionalization was more common in Odate. This may explain better health status and lower malnutrition incidence in Odate. Institutionalized elders utilized more short-stay services and revealed dementia-related behaviors more often. In Japan, people are apt to regard in-home care giving as care giving living together. This obsession may urge families to choose institutionalization. Case studies suggest that care giving under pretending no concern contributes to stable care-relationship.