失智症家庭照顧者之照顧經驗：照顧衝突抑或老人虐待

Caregiving Experiences of Families of Individuals with Dementia: Caregiving or Elder Abuse?

失智症所產生的困擾行為，使得照顧工作備受挑戰。本研究聚焦於照顧高齡失智症的家庭照顧者，探索失智症家庭照顧情境中衝突與暴力家庭關係的發生脈絡，揭露照顧情境中可能隱含的虐待因素，以及正式支持系統之體制面，與失智症家庭照顧者實際照顧的斷裂經驗。本研究運用深度訪談法，訪談五位照顧失智症者之家庭照顧者，探究其歷經的照顧衝突經驗，採「主題分析法」分析，歸納與整理家庭照顧者對於照顧失智老人的經驗感受與情境脈絡。研究發現如下：其一，相較於失能長者，照顧失智長者須面對不同的困擾行為與每況愈下的病狀，加速照顧量能內耗使照顧衝突不斷發生；其二，失智者與照顧者間存在著雙向暴力，相對人也可能同時是被害人；其三，照顧衝突演變為暴力行為非單一因素引發，當失智症之困擾行為照顧、家庭衝突關係及缺乏家庭支持等多重危險因素的超載，交互影響照顧情境壓力，進而形成潛在照顧暴力脈絡；其四，家庭照顧者制止困擾行為的照顧方式，與情緒失控的不當行為僅一線之隔，取決於照顧者對於照顧衝突情境之調節與因應；其五，期待被理解的家庭照顧者、看見個別照顧情境的問題與需求：家庭照顧暴力情境下公權力的介入並無助於協助家庭後續照顧失智老人，甚至可能標籤化為違逆常倫的家庭照顧者。根據上述研究發現，提出相關實務工作上的建議，並評估現階段對失智症家庭照顧的支持性服務可以進一步改進之處。

The disruptive behaviors caused by dementia render caregiving particularly challenging. This study focuses on family caregivers of elderly individuals with dementia, exploring the context in which conflicts and violent family dynamics arise within caregiving situations, and uncovering potential factors of abuse that may be implicitly present in these settings. This study considers the formal support system and the disconnection between this system and the actual experiences of family caregivers of dementia patients. Comprehensive interviews were conducted with five family caregivers of individuals with dementia to investigate their experiences of conflicts in caregiving. Through thematic analysis, the caregivers’ perceptions of their experiences and the contextual dynamics of caregiving are organized and synthesized. The findings are as follows: First, compared with caring for physically disabled elders, caregiving for elderly individuals with dementia involves managing different disruptive behaviors and the progressive worsening of the condition, which accelerates caregiver burnout and may cause frequent conflicts in caregiving. Second, a bidirectional dynamic of violence exists between dementia patients and their caregivers, where the caregiver may be a victim in the relationship. Third, the escalation of conflicts in caregiving into violent behaviors is not triggered by a single factor. An observation of the convergence of dementia-related disruptive behaviors, family conflicts, and insufficient family support shows that these multiple risk factors intensify the stress within caregiving situations, creating potential contexts for abusive caregiving. Fourth, a thin boundary exists between the appropriate caregiving methods for managing disruptive behaviors and inappropriate actions caused by loss of emotional self-control. This boundary depends primarily on the caregiver’s ability to manage and respond to conflicts in caregiving situations. Fifth, family caregivers typically seek understanding and recognition for specific challenges and demands within their caregiving situations. The intervention of public authorities in cases of abusive caregiving does not necessarily support the continued care of elderly dementia patients and may stigmatize the caregiver as behaving contrary to social norms. Through these findings, this study offers practical recommendations and assesses potential improvements to the current support services available to family caregivers of persons with dementia.