재가치매노인 행동심리증상에 대한 가족의 정서대처강화 프로그램 효과

Abstract

The present study aimed to examine the effects of applied family emotion coping reinforcement program on the behavioral and psychological symptoms of community-dwelling elderly with dementia. Using a nonequivalent control group pretest and posttest design, the study was conducted at two centers for dementia located in N-gu, S City and I-gu, G City, South Korea for about 5 months from November 1, 2016 to March 24, 2017. The subjects were a total of 42 family members of community-dwelling elderly with dementia, of which 20 family members participated in the family emotion coping reinforcement program and 22 family members did not participate in the program. Data analysis was performed using descriptive statistics, pre-test for homogeneity, and independent t-test. The results of the study were as follows: The caregiver stress score of family members of community-dwelling elderly with dementia who participated in the emotion coping reinforcement program was significantly lower (1.27 points) than those who did not participate in the program (2.14 points) (t=-3.44, p=.001), and thus, the first hypothesis was supported. The active coping behavior score of those who participated in the emotion coping reinforcement program was significantly higher (2.85 points) after the program than those who did not participate (2.48 points) (t=2.15, p=.037), and thus the 2-1 sub-hypothesis was supported. The passive coping behavior score of those who participated in the emotion coping program was higher (2.71 points) than those who did not participate (2.42 points) (t=1.87, p=.068), but there was no significant difference, and thus the 2-2 sub-hypothesis was rejected. The self-efficacy score of those who participated in the emotion coping reinforcement program was higher (64.87 points, SD 12.35) than those who did not participate (57.70 points, SD 13.50) (t=1.81, p=.078), but there was no significant difference, and thus the third hypothesis was rejected. The aggressive behavior score of the elderly with dementia whose family members participated in the emotion coping reinforcement program was significantly lower (1.26 points) than the elderly whose family members did not participate (1.68 points) (t=-2.67, p=.011), and the 4-1 sub-hypothesis was supported. The agitation behavior score of the community-dwelling elderly with dementia whose family members participated in the emotion coping reinforcement program was lower (1.50 points) than those whose family members did not participate (1.74 points) (t=-1.56, p=.125), but there was no significant difference, and thus the 4-2 sub-hypothesis was rejected. The resistance to nursing score of the community-dwelling elderly with dementia whose family members participated in the emotion coping reinforcement program was lower (1.31 points) than those whose family members did not participate (1.45 points) (t=-0.89, p=.371), but there was no significant difference, and thus the 4-3 sub-hypothesis was rejected. The physical behavior score in the community-dwelling elderly with dementia whose family members participated in the emotion coping reinforcement program was lower (1.15 points) than those whose family members did not participate (1.21 points) (t=-0.67, p=.504), but there was no significant difference, and thus the 4-4 sub-hypothesis was rejected. The neuropsychiatric behavior score of the community-dwelling elderly with dementia whose family members participated in the emotion coping reinforcement program was significantly lower (1.45 points) than those whose family members did not participate (1.80 points) (t=-2.45, p=.019), and thus the 4-5 sub-hypothesis was supported. In conclusion, the family emotion coping reinforcement program for community-dwelling elderly with dementia, which was based on a stress-coping-adaptation model, was found to reduce caregiving stress and improve coping behavior of the family members of community-dwelling elderly with dementia and improve behavioral and psychological symptoms of the community-dwelling elderly with dementia when emotion coping was reinforced. Therefore, the present study suggests that specific emotion coping may help the elderly with dementia and their family members in daily life and may be helpful to family members of the elderly with dementia living together over a long time.

본 연구는 재가치매노인 행동심리증상에 대한 가족의 정서대처강화 프로그램을 적용하여 그 효과를 검증하기 위한 목적으로 실시되었다. 연구설계는 비동등성 대조군 전후설계이며, 2016년 11월 1일 부터 2017년 3월 24일까지 약 5개월 동안 S시 N구와 G시 I구 치매지원센터 2곳에서 수행되었고, 참여 한 재가치매노인 가족 20명, 참여하지 않는 재가치매노인 가족 22명으로 총 42명을 최종분석대상으로 하였다. 자료분석은 서술통계와 사전 동질성 검증, independent t-test를 이용하였다. 본 연구에 대한 결과는 다음과 같다. 정서대처강화 프로그램에 참여 후 재가치매노인 가족의 부양스트레스 점수는 1.27점으로 참여하지 않는 재가치매노인 가족 2.14점보다 유의하게 낮아서(t=-3.44, p=.001) 제 1가설은 지지되었다. 정서대처강화 프로그램에 참여 후 재가치매노인 가족의 적극적 대처행동 점수는 2.85점으로 참여하지 않는 재가치매노인 가족 2.48점보다 유의하게 높아서(t=2.15, p=.037) 부가설 2-1은 지지되었다. 정서대처강화 프로그램에 참여 후 재가치매노인 가족의 소극적 대처행동점수는 2.71점으로 참여하지 않는 재가치매노인 가족 2.42점보다 높았으나(t=1.87, p=.068) 유의한 차이가 없어 부가설 2-2는 기각되었다. 정서대처강화 프로그램에 참여 후 재가치매노인 가족의 자기효능감 점수는 64.87점, 표준편차는 12.35로 나타났고 참여하지 않는 재가치매노인 가족 57.70점, 표준편차는 13.50보다 높았으나(t=1.81, p=.078) 유의한 차이가 없어 제 3가설은 기각되었다. 대처행동 강화프로그램에 참여 후 재가치매노인의 공격적 행동 점수는 1.26점으로 참여하지 않는 재가치매노인 1.68점보다 유의하게 낮아서(t=-2.67, p=.011) 부가설 4-1은 지지되었다. 정서대처강화 프로그램에 참여 후 재가치매노인의 초조행동 점수는 1.50점으로 참여하지 않는 재가치매노인 1.74점보다 낮았으나(t=-1.56, p=.125) 유의한 차이가 없어 부가설 4-2는 기각되었다. 정서대처강화 프로그램에 참여 후 재가치매노인의 간호에 대한 저항 점수는 1.31점으로 참여하지 않는 재가치매노인 1.45점보다 낮았으나(t=-0.89, p=.371) 유의한 차이가 없어 부가설 4-3은 기각되었다. 정서대처강화 프로그램에 참여 후 재가치매노인의 신체적 행동 점수는 1.15점으로 참여하지 않는 재가치매노인 1.21점보다 낮았으나(t=-0.67, p=.504) 유의한 차이가 없어 부가설 4-4는 기각되었다. 정서대처강화 프로그램에 참여 후 재가치매노인의 신경, 정신행동 점수는 1.45점으로 참여하지 않는 재가치매노인 1.80점 보다 유의하게 낮아서(t=-2.45, p=.019) 부가설 4-5는 지지되었다. 결론적으로, 스트레스-대처-적응모델에 기반을 둔 재가치매노인 행동심리증상에 대한 가족의 정서대처강화 프로그램은 정서대처를 강화한 후 재가치매노인 가족 부양스트레스, 대처행동, 치매노인의 행동심리증상을 향상시키는 것으로 검증되었다. 따라서 본 연구에서 재가치매노인과 오랜 시간 생활하는 가족들에게 치매노인 행동심리증상에 대한 구체적인 정서대처를 적용함으로써 가족과 치매노인의 일상생활에 도움을 줄 수 있고, 다른 치매노인 가족과 지역사회에서의 연계에도 도움이 될 수 있을 것으로 본다.