Dementia and Neurocognitive Disorders 2013; 12: 107-113 ORIGINAL ARTICLE 치매환자가족부양자의부양부담에영향을미치는요인 권오대 * 김태완 박미영 이상도 이현아 이호원 대구경북치매연구회 대구가톨릭대학교의과대학신경과학교실 * 대구파티마병원신경과 영남대학교의과대학신경과학교실 이상도신경과의원 계명대학교의과대학신경과학교실 경북대학교의과대학신경과학교실 Received: November 11, 2013 Revision received: December 26, 2013 Accepted: December 26, 2013 Address for correspondence Oh Dae Kwon, M.D. Department of Neurology, Daegu Catholic University Medical Center, School of Medicine, Catholic University of Daegu, 33 Duryugongwonro 17-gil, Nam-gu, Daegu 705-718, Korea Tel: +82-53-650-4298 Fax: +82-53-654-9786 E-mail: dolbaeke@cu.ac.kr This work was supported by the grant of Research Institute of Medical Science, Catholic University of Daegu (2012). Factors Affecting Caregiver Burden in Family Caregivers of Patients with Dementia Oh Dae Kwon, M.D.*,Tae Wan Kim, M.D., Mee Young Park, M.D., Sang-Doe Yi, M.D., Hyon-Ah Yi, M.D., Ho Won Lee, M.D., Daegu-Kyungpook Dementia Association Department of Neurology*, School of Medicine, Catholic University of Daegu, Daegu; Department of Neurology, Daegu Fatima Hospital, Daegu; Department of Neurology, College of Medicine, Yeungnam University, Daegu; Yi Sang-Doe Neurology Clinic, Daegu; Department of Neurology, School of Medicine, Keimyung University, Daegu; Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea Background: This study aimed to know the state of caregiver burden of family caregivers of patients with dementia and also to know factors associated with the severity of caregiver burden. Methods: Family caregivers of dementia patients were enrolled from five general hospitals in Daegu Metropolitan city, Korea. The participants analyzed in the present study were 199 subjects who were 24 to 86 years old, living in Daegu or Kyungsang Bukdo province. Demographic features, general characteristics, characteristics of caring patients were collected and Burden Interview was done by a psychologist. Factors affecting caregiver burden were assessed using statistical analyses. Results: The average severity of caregiver burden of family caregivers were between mild and moderate. Factors affecting the severity of caregiver burden were caregiving days per week among caregiver s characteristics and Neuropsychiatric Inventory and Geriatric Depression Scale among patient characteristics by multiple regression linear analysis. Caregiving cost shows marginal significance. Interestingly, cognitive scales like Mini-Mental State Examination, Clinical Dementia Rating, Physical and Instrumental Activities of Daily Living did not affect caregiver burden of family caregivers. Conclusions: This study showed that caregiving days per week of caregivers and neuropsychiatric symptoms including depressive mood of patients are closely related with caregiver burden of family caregivers of patients with dementia in Korea. Key Words: Caregivers, Dementia, Burden interview 서론치매는노인인구에서발생빈도가높은대표적인노인성질환이다. 한국인의평균수명이연장되어 2000년에이미인구의 7% 이상이 65세를넘어선고령화사회가되었고인구의 14% 이상이노인인구인고령사회에근접하고있다 [1]. 이미한국사회의농촌지역은젊은이들이도시로이동하면서농촌지역의출산율이급격히떨어진결과로인구의 20% 이상이 65세이상인초고령사회가되었다 [2]. 노인인구의급속한증가로인하여치매의발병이많아지는것과동반되어 [3] 치매환자를부양하는부양자가증가되고있다. 부양부담은치매의원인질환과그중증도등의환자의특성과부양자의특성및부양여건에영향을받을수있기때문에정량화가어렵다 [4]. 또한부양부담에대한연구결과는특정한기준을세우기어렵기때문에연구자에따라결과가다를수있으며인종과문화에따라서도차이를보일수있다 [4, 5]. 우리나라는 2008년 7월부터노인장기요양보험을시행하여치매환자의부양을국가사업으로시행하고있으며이로인하여개인이가정에서부양하기어려운치매환자들이요양시설에입소하는것이쉽게되었다. 그렇지만경도의치매환자들은요양시설입소가제한적이며유교적전통에따른가족부양의선호가있으므로아직까지많은치매환자들이가족의부양을받고있는것으로생각된다. 치매환자의집이나가족보호자의집같은요양시설이외에서의치매환자부양에서부양을하는가족의역할은매우크다. 치매를진료하는의사들은진료실에서종종가족부양자들이받는부양부담을직간접적으로체감할수있다. 2013 Korean Dementia Association This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 107
108 권오대 김태완 박미영외 3 인 외국에서의선행연구에서는치매환자의부양부담이상당한것으로보고되어있고 [6, 7] 국내연구에서도부양부담이우울증상이나불안증상또는삶에대한만족도저하로나타나고있다 [8-11]. 국내연구중임상의사에의해수행된부양부담에영향을미치는요인에대한연구는제한되어있고 [10] 노인장기요양법의시행이전에된연구이며대상군의숫자도적으므로추가적인연구가필요하다. 저자들은본연구를통하여대구경북지역에거주하는치매환자를돌보는가족부양자들의특성을파악하고이들의사회경제학적인여건을조사하는동시에부양을받는치매환자들의의학적, 사회적특성을조사하고자하였다. 또한, 이를통하여가족부양자들의부양부담에영향을미치는요인들을찾고자하였다. 대상과방법대상대구의 5개종합병원에치매로등록되어진료를받고있는환자의가족부양자중에서대구나경상북도에거주하면서연구대상자의선별기준에부합하는가족부양자들중에서본연구에참여하기를동의하는환자 199명에대하여설문조사를하였으며, 이들이부양하는환자의인지기능에대한자료도동의를받아수집하였다. 본연구는대구가톨릭대학교병원연구윤리위원회의승인이후에진행되었다. 가족부양자의선별기준으로는종합병원신경과에서치매로진단을받은환자와적어도 6개월이상집에서동거한가족으로서한글을읽고쓸줄알며본연구에동의한사람으로하였다. 치매진단은 Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) [12] 의치매기준에만족하는것을원칙으로하였다. 알츠하이머형치매는 National Institute of Neurological and Communicative Disorders and Stroke-the Alzheimer s Disease and Related Disorders Association (NINCDS-ADRDA) [13] 의 probable 기준에부합하고, 혈관성치매는 National Institute of Neurological Disorders and Stroke and the Association International pour is recherché et l Enseignement en Neurosciences (NINCDS-AIREN) [14] 의 probable 또는 possible 에맞는환자를대상으로하였다. 파킨슨병치매는역시 DSM-IV 치매진단기준을만족하고 Emre 등 [15] 의 Parkinson s disease dementia의진단기준에부합한환자를대상으로하였다. 대상환자모집은 2012 년 9월부터 2013년 2월까지시행되었다. 한명의숙달된임상심리사가연구에참가한 5개병원을방문하여치매환자를부양하는가족부양자에대하여구조화된설문조사를시행하고심리검사항목을시행하였으며추가로피부양자인환자에대한정보를수집하였다. 치매환자의부양자는치매증상발생후적어도 6개월이상동거한주부양자로서연구에동의한사람으로하였다. 문맹자나시각장애, 청각장애, 언어장애또는인지장애가심하여설문조사가힘든경우는제외하였다. 환자의인지기능에대한내용은 1년이내에시행된진료기록을기준으로하였다. 한국형간이정신상태평가 (K- MMSE, Korean version of mini-mental state examination) [16] 와 Global Deterioration Scale (GDS) [17] 이조사되었고 Clinical Dementia Rating (CDR) [18] 은 Clinical Dementia Rating Sum of boxes (CDR-SB) 점수를포함하여조사하였고, 우울증상에대하여는노인우울척도검사 (Geriatric Depression Scale) [19] 가, 기초적일상생활능력의척도로는 B-ADL (Barthel activities of daily living) 이, 복합적일상생활능력의척도로는 K-IADL (Korean version of instrumental activities of daily living) [20] 이나 S-IADL (Seoul instrumental activities of daily living) [21] 중한가지가병원의사정에따라시행되었다. 가족부양자의일반적인특성을조사하기위해부양자의거주지역, 성별, 연령, 종교, 교육수준, 결혼상태, 직업, 월소득을조사하였다. 환자와관련된특성으로서부양자와치매환자의관계, 1일부양시간, 주당환자를부양하는날짜, 보조부양자의유무, 부양을위해사용하는비용, 부양을위해하루운전하는시간등을측정하였다. 부양자의부양부담에대한조사로서한국판 ZBI (Korean version of Zarit Burden Interview, ZBI-K) [22, 23], 부양보상감척도 [24, 25], Life Satisfaction Index-Z [26, 27], Beck depression inventory [28, 29], Beck Anxiety Inventory [30, 31] 의다섯가지설문이시행되었다. 통계분석분석에포함된변수들의분포를검토하고환자와가족부양자의특성, 부양상황및일반적인상황은기술통계를사용하였다. 부양자의부양부담과다른변수와의연관성을알기위하여우선상관분석을시행하였다. 상관분석은변수의특성에따라 Pearson 방법과 Spearman 방법을선택하여적용하였다. 상관분석에서유의하게나온변수를대상으로단순회귀분석을시행하였으며다중공선성을고려하여다중회귀분석을추가로시행하였다. SPSS 19.0 version 의통계프로그램을사용하였고유의수준은양측검정에서 p< 0.05 인경우로가정하였다. 결과대상군의인구사회학적특성모집된가족부양자가부양하는치매환자의일반적특성으로여
치매부양자의부양부담 109 성이남성보다두배많았다. 여성의평균연령은 76 세였고평균학 력은 5 년이었다. 환자의인지기능은 K-MMSE 17 점, CDR-SB 7 점이었 다. S-IADL 은 20 점, 노인우울척도는 16 점이었다. 치매의유형별로는 알츠하이머병환자가삼분의이를차지하였고파킨슨병치매와혈 관성치매의순서였다 (Table 1). 가족부양자의인구사회학적특성 으로는여성이더많았고연령대별로는 50 대의가족부양자가가장 많았으며다음이 50 대이하, 70 대순서였다. 교육정도는고졸이가 장많았고대졸, 중졸순서였다. 일일환자부양시간은 20 시간이상 으로전일인경우가가장많았고그다음이 4 시간이하, 10-14 시간 의순서였다. 주당환자부양일수는같이살면서매일부양하는경 우가삼분의이를차지하였다. 부양을위해서운전을하는시간은 30 분이내가사분의삼정도를차지하였고다음으로 30 분에서 1 시 간운전하는경우였다. 부양자의대부분이광역시에살았으며시, 군, 읍면의순서였다. 보조부양자가있는경우가절반이었으며부양 자스스로평가한자신의건강상태는좋은경우와보통인경우, 그 리고나쁜경우가각각삼분의일로비슷하였다. 키는 160 cm 에서 169 cm 가가장많았고그다음이 150 cm 에서 159 cm 였다. 부양자의 체중은 50-59 kg 이가장많았으며다음이 60-69 kg 이었다. 가족부양 자의절반에서직업이없거나전업주부였다. 월가족수입은 200 만 원이하가가장많았고 201-400 만원이그다음이었으며환자부양 Table 1. Clinical characteristics of dementia in the patients Variable Category Patients (%) Type of dementia AD VD PDD Unknown K-MMSE 0-17 18-20 21-24 25-30 CDR 0.5 1 2 3 4 CDR-SB 0-2.5 3.0-5.5 6.0-8.5 9.0-24.0 K-NPI 0-5 6-11 12-23 24-106 GDepS 1-9 10-16 17-23 24-30 124 (62.3) 21 (10.6) 29 (14.6) 25 (12.6) 94 (47.2) 41 (21.0) 51 (26.2) 11 (5.6) 43 (21) 90 (45.2) 49 (24.6) 11 (5.5) 2 (1.0) 12 (6.2) 91 (46.6) 42 (21.6) 50 (25.6) 47 (25.1) 45 (24.1) 47 (25.1) 48 (25.7) 44 (25.0) 48 (26.7) 42 (22.2) 47 (26.1) AD, Alzheimer's disease; VD, vascular dementia; PDD, Parkinson disease dementia; K-MMSE, Korean version of mini-mental state examination; CDR, clinical dementia rating; CDR-SB, clinical dementia rating sum of boxes; K-NPI, Korean version of neuropsychiatric inventory; GDepS, geriatric depression scale. 에드는비용은월 50 만원이하가대부분이었다 (Table 2). 치매환자 를부양하는데대한부양부담 (Burden Interview) 은평균 37.6 ± 19.1 점이었다. 부양부담자의부양부담에영향을미치는요인 부양부담 (ZBI-K) 에영향을주는요인을찾기위하여상관분석을 시행하였다 (Table 3). 유의한상관관계가있는것으로나온요인으 로는 S-IADL 이가장뚜렷한양적선형관계가있는것으로나왔으 며주당환자부양일수, CDR, K-NPI, CDR-SB, 부양비용, 주총부양 시간의순서였다. 그외에유의한상관관계를보인요인들은 GDS, Table 2. Characteristics of family caregivers and caregiving situation Variable Category Caregivers (%) Religion Protestant Catholic Buddhism None Employment status None Housewife Retired Employed Caregiving cost (10,000 won) 0-50 51-100 101-150 151-200 Relation to patient Spouse Parent Child Child-in-law Etc. Caregiving hours per day 0-4 5-9 10-14 15-19 20-24 Caregiving days per week 1-2 3-4 5-6 7 Caregiving hours per week 0-21 22-70 71-168 Driving hours for patients per day (minutes) < 30 30-60 61-90 91-120 > 120 Height (centimeters) <150 150-159 160-169 > 170 Body weight (kilogram) <50 50-59 60-69 70-79 > 80 19 (9.5) 28 (14.1) 83 (41.7) 67 (33.7) 7 (3.5) 73 (36.7) 32 (16.1) 85 (42.7) 162 (81.4) 28 (14.1) 5 (2.5) 2 (1.0) 60 (30.2) 93 (46.7) 7 (3.5) 36 (18.1) 3 (1.5) 49 (24.6) 24 (12.1) 27 (13.6) 12 (6.0) 87 (43.7) 44 (22.1) 10 (5.0) 9 (4.5) 136 (68.3) 52 (26.1) 48 (24.1) 99 (49.7) 150 (75.4) 17 (8.5) 16 (8.0) 4 (2.0) 12 (6.0) 6 (3.0) 73 (36.7) 81 (40.7) 37 (18.6) 20 (10.1) 81 (40.7) 59 (29.6) 26 (13.1) 11 (5.5)
110 권오대 김태완 박미영외 3 인 Table 3. Correlations between Burden Interview and other variables Variable Pearson coefficient (Spearman) 여성, 하루부양시간, 종교가있는경우, 적은키, B-ADL, 대도시거 주였다. 상관분석에서유의한상관관계가있는것으로나타난요인 들을단순회귀분석으로분석하였다 (Table 4). 상관분석과동일하게 가장유의한관계가있는것으로나타난요인은 S-IADL 이었고주 당환자부양일수, K-NPI, CDR-SB 의순서였다. 그외에유의한관계 를보인요인으로는부양비용, 주총부양시간, B-ADL, 적은키, 일일 부양시간등이었다. 입력방식과단계선택의다중회귀분석을실시 하였으며 R 2 값이더큰입력방식을채택하였다. 상관분석과단순회 귀분석과는다르게주당환자부양일수 (p = 0.010) 가가장유의한요 인으로나왔으며 K-NPI (p = 0.021) 와 GDS (p= 0.023) 가그다음으로 유의한관계가있는것으로나타났다 (Table 5). 또한, 부양비용은유 의성에근접한 p 수치를보였다 (p = 0.057). p value (Spearman) Residence of caregivers -0.270 (-0.244) 0 (0.001) 199 B-ADL -0.214 0.003 188 Height -0.159 0.026 199 Religion -0.153 (-0.152) 0.032 (0.033) 197 Caregiving hours per day 0.154 0.029 199 Gender 0.176 (0.166) 0.013 (0.019) 199 GDS 0.225 (0.236) 0.002 (0.001) 195 Caregiving hours per week 0.228 0.001 199 Caregiving cost 0.234 0.001 197 CDR-SB 0.267 0.000 195 K-NPI 0.286 0.000 187 CDR 0.298 (0.341) 0 (0.000) 195 Caregiving days per week 0.325 0.000 199 S-IADL 0.343 0.000 109 p values are by correlation coefficient analysis. N, number of patients; B-ADL, barthel activities of daily living; GDS, geriatric deterioration scale; CDR-SB, clinical dementia rating sum of boxes; K-NPI, Korean version of neuropsychiatric inventory; CDR, clinical dementia rating; S-IADL, Seoul instrumental activities of daily living. Table 4. Correlations between Burden Interview and other variables Variable R 2 B t p Caregiving days per week 0.106 2.582 4.829 0.000 K-NPI 0.082 0.294 4.058 0.000 CDR-SB 0.071 1.243 3.854 0.000 S-IADL 0.118 0.538 3.779 0.000 Caregiving cost 0.055 0.125 3.363 0.001 Caregiving hours per week 0.052 0.064 3.290 0.001 B-ADL 0.046-1.077-2.993 0.003 Height 0.025-0.393-2.242 0.026 Caregiving hours per day 0.024 0.319 2.193 0.029 p values are by simple linear regression analysis. K-NPI, Korean version of neuropsychiatric inventory; CDR-SB, clinical dementia rating sum of boxes; S-IADL, Seoul instrumental activities of daily living; B-ADL, barthel activities of daily living. N Table 5. Correlations between Burden Interview and other variables Variable R 2 B t p 0.414 Caregiving days per week 2.690 2.630 0.010* K-NPI 0.227 2.346 0.021* GDS 7.265 2.313 0.023* Caregiving cost 0.103 1.931 0.057 Religion -1.414-1.226 0.223 Gender 3.950 0.893 0.374 CDR -2.909-0.455 0.650 Height -1.204-0.445 0.657 B-ADL 0.211 0.303 0.762 Caregiving hours per week -0.020-0.285 0.776 CDR-SB -0.201-0.154 0.878 Caregiving hours per day 0.024 0.061 0.952 S-IADL 0.017 0.056 0.956 p values are by multiple linear regression analysis. *p< 0.05. B-ADL, barthel activities of daily living; GDS, geriatric deterioration scale; CDR-SB, clinical dementia rating sum of boxes; K-NPI, Korean version of neuropsychiatric inventory; CDR, clinical dementia rating; S-IADL, Seoul instrumental activities of daily living. 고찰 본연구는치매환자를돌보는가족부양자들의부양부담을평 가하고가족부양자들의인구사회학적인특성과부양을받고있는 환자들의인지적, 인구사회학적인특성을파악하여부양부담에영 향을미치는요인을평가하고자하였다. 주당환자부양일수가가족 부양자의부양부담에영향을미치는가장중요한요인으로나타났 으며 K-NPI 로측정된환자의신경행동증상과 GDS 로측정된환자 의우울증상도영향을미치는것으로나타났다. 기존의한국내연 구에서는 79 명을대상으로부양부담에미치는인자를조사하였으 며환자의우울증상과부양자의낮은자발성등이부양부담에영 향을미치는요인으로나타났으며환자의우울증상은본연구의 결과와일치하고있다 [10]. 우리나라에서국가시책으로 2008 년부터노인장기요양보험이시 행되고있지만가족중에서치매환자를부양하고있는가족부양 자들의부양부담은아직까지상당히크다. 부양부담을정량화하는 것은어려운일이지만다양한설문도구가계발되어보호자들의부 양부담을정량적으로측정하려는시도에도움을주고있다 [23, 25]. 본연구에서사용된부양부담척도인 ZBI-K 는 0-20 점인경우에는 부담없음으로평가하며 21-40 점은보통부담, 41-60 점은심한부담, 61-88 점은극심한부담으로평가한다 [22, 23]. 치매환자의부양부담 은본연구에서평균 37.6 ± 19.1 점으로나타났으며보통부담과심한 부담에분포되어있어부양자대부분이적지않은부담을느끼고 있는것으로나타났다. 가족부양자에의해부양받는환자들은 CDR 1-2 사이의경도에
치매부양자의부양부담 111 서중등도의치매환자로나타났다. 학력은초등학교졸업정도의수준을가지고있는데이는지역적특성으로인해서수도권지역의환자들이중졸학력에가까운것에비하여상대적으로낮은것으로보인다 [32]. 중증의치매환자가거의없는이유로는중증도의환자들이노인장기요양보험으로인하여대부분요양시설에입소하였기때문으로보인다. 또한환자들의 NPI 점수와노인우울척도도그리높지않았는데행동심리증상이나우울증상이심한치매환자들도역시요양시설에입소하였을것으로생각된다. 예상과달리종교를가지고있는사람들과없는사람들의부양부담의차이가나타나지않았다. 이러한결과는종교를가지고있는사람들에서환자를적극적으로부양해야하고인내심을가지고환자의행동증상을대해야된다는의무감이종교를통해얻는지지를상쇄하기때문일가능성이있으며한선행연구에서는치매환자를부양하는것이부양자의잘못된행실로인해서받는처벌이라고생각하기때문에종교를가지고있는사람의부양부담이증가될수있다고하였다 [33]. 부양자의취업여부와관련하여 2004년에국내에서시행된한선행연구에따르면부양자중직장에다니는사람은 27% 로서직장인보다전업주부들이더많은것으로보고하였다 [34]. 본연구에서는직장에다니는부양자의비율이 43.1% 에달하여위의연구에비하여높게나왔으며최근여성의취업률이높아진것과연관이있는것으로보인다. 부양자중에서배우자가 30% 이고나머지는자녀들이나며느리또는사위였다. 환자들의평균연령이 76세라는것을고려하면배우자가살아있고간병할정도로건강하다면대부분배우자가환자를부양하는것으로보이며배우자가사망하였거나간병할정도로건강하지못할때자녀들이나며느리또는사위가부양을맡는것으로보인다. 본연구에서선행연구보다배우자의비율이낮은것은본연구에등록된환자들의평균연령이 3세정도높기때문인것으로보인다 [11, 34]. 하루부양시간을볼때 10시간이상을부양에사용하는경우가거의삼분의이를차지하고있어한집에같이살든지가까운곳에살면서하루종일부양하는경우에해당하는것으로보인다. 또한, 주부양일수를볼때매일부양을위해서환자를방문하는경우가거의 70% 에달한다. 나머지 30% 는함께살면서부양하는환자의배우자일것이며부양을담당하는자녀들의절반이상이매일환자를만나는경우이며동거하거나가까운곳에거주하는것으로보인다. 상관분석과단순회귀분석에서는주당환자부양일수가 S-IADL 다음으로부양부담에영향을미치는것으로나왔으나다중회귀분석에서는그유의성이사라졌다. 다중회귀분석에서는주당환자부양일수가부양부담에가장큰영향을미치는것으로나타났다. 그외에부양부담에영향을미치는요인으로서환자의 K-NPI와 GDS 의순서였고이는선행연구들과일치하는결과이다 [35, 36]. 부양비용은유의성에거의근접한관계를보였다. 본연구에서주당환자부양일수가부양부담에가장큰영향을미치는요소로나타났다. 상대적으로하루에부양하는시간과주당환자부양일수를곱한주총부양시간과하루동안의부양시간은유의성이없었다. 비록주당환자부양일수가주총부양시간과밀접한관계가있지만주총부양시간이길더라도주중에환자를방문하지않는날이있을수있다. 또한방문하는날에부양하는시간이길더라도보조부양자에게맡기고쉬는것이부양부담을덜어줄수있다. 일본에서시행된한선행연구에서낮시간의일부라도요양보호사가방문해서부양을할때부양부담이줄어들었고가족부양자가느끼는부양부담이클수록요양보호사의방문이주는부양부담의감소는컸다 [37]. 이러한선행연구의결과와본연구의결과는일치하기때문에부양부담을줄이려면부양시간도줄여야하지만부양방문일수를줄이는것도중요하게보인다. 환자의신경행동증상을보여주는 NPI에는망상, 환각, 초조 / 공격성, 우울 / 낙담, 불안, 다행감 / 들뜬기분, 무감동 / 무관심, 탈억제, 과민 / 불안정, 이상운동증상, 수면 / 야간행동, 식욕 / 식습관의변화등의요소가있다. 이러한증상들이심할때부양자의부양부담이늘어나는것은자명하다 [35]. 또한 GDS로측정된환자의우울증상에의하여부양자의부양부담이늘어나는것은환자의우울증상이부양자에게협조하는정도를낮출뿐만아니라부양자에게도우울한기분이전파되어부양자의부담을늘이는것으로보인다 [34]. 최근국내에자동차가많이보급되어운전을하는성인이과거에비해많이늘어남에따라운전시간에따른부양부담의차이를살펴보았다. 환자부양을위한하루운전시간은 30분이내가대부분이었으며이는같은집에사는배우자나같은집에사는자녀또는자녀들의배우자가많기때문에방문을위해운전하는경우가많지않음을시사한다. 하루 30분이상운전하는경우가많지않았기때문에부양부담과의유의성이잘나타나지않은것으로생각된다. 치매환자의가족부양자의부양부담이나생활의질에대한연구는국내에서많이시행되어있다 [11, 22, 25, 34]. 본연구는대학병원이나종합병원에서치매를전문으로하는신경과의사에의하여심리검사를포함한치매의원인조사를충분히하고정확한진단기준에따라서진단한경우이기때문에간단한선별검사만으로치매로진단한경우보다신뢰할수있는결과를보여준다고생각된다. 또한, 숙달된임상심리사가모든자료를수집하고부양자들에대한설문을시행했기때문에설문조사의자료도기존의연구들에비하여더신뢰할수있을것이다. 한가지아쉬운점은알츠하이머형치매의빈도가매우높고상대적으로혈관성치매나파킨슨병치매의빈도가낮았기때문에치매의유형에따른부양부담의비교가어려웠던점이다.
112 권오대 김태완 박미영외 3 인 결론으로서, 본연구를통해대구경북지역의치매환자를돌보는가족부양자의부양부담이어느정도인지알수있었고, 부양부담에영향을미치는치매환자의요소와부양자의사회경제적인요소들을알수있었다. 본연구의결과를두고볼때전통적으로배우자나한명의자녀가치매환자부양을책임지는모습은부양자간에교대로부양을해서부양방문일수를줄이는노력이필요하다고생각된다. 실제로외래진료실에서만나는가족부양자중에서수년간치매환자를부양한경우에부양부담이심하여우울증증상을보이는경우가드물지않기때문이다. 또한치매를진료하는임상의사들은환자의신경행동증상과우울증의치료에더관심을가지고적극적으로치료해야할필요가있을것으로생각된다. 참고문헌 1. Statistics Korea. Population Prospects of Korea and World. 2009. 2. Kwon O, Kwak J. Illiteracy effect on cognitive decline in a rural elderly population: a 3-year follow up study. Dementia and Neurocognitive Disorders 2011; 10: 52-7. 3. Kim KW, Park JH, Kim MH, Kim MD, Kim BJ, Kim SK, et al. A nationwide survey on the prevalence of dementia and mild cognitive impairment in South Korea. J Alzheimers Dis 2011; 23: 281-91. 4. Torti FM Jr, Gwyther LP, Reed SD, Friedman JY, Schulman KA. A multinational review of recent trends and reports in dementia caregiver burden. Alzheimer Dis Assoc Disord 2004; 18: 99-109. 5. Vetter PH, Krauss S, Steiner O, Kropp P, Moller WD, Moises HW, et al. Vascular dementia versus dementia of Alzheimer s type: do they have differential effects on caregivers burden? The Journals of Gerontology Series B, Psychological Sciences and Social Sciences 1999; 54: S93-8. 6. Souetre E, Thwaites RM, Yeardley HL. Economic impact of Alzheimer s disease in the United Kingdom. Cost of care and disease severity for noninstitutionalised patients with Alzheimer s disease. Br J Psychiatry 1999; 174: 51-5. 7. Sadik K, Wilcock G. The increasing burden of Alzheimer disease. Alzheimer Dis Assoc Disord 2003; 17 Suppl 3: S75-9. 8. Youn G, Knight BG, Jeong HS, Benton D. Differences in familism values and caregiving outcomes among Korean, Korean American, and White American dementia caregivers. Psychol Aging 1999; 14: 355-64. 9. Kim S, Yoon H, Kim J, Haley W. Factors affecting life satisfaction and depression of caregivers of the elderly with dementia: a comparative study of Korean and American caregivers. Journal of the Korea Gerontological Society 2003; 23: 193-221. 10. Kim J, Shin I, Yoon J. Determinants of care burden of caregiver in patients with dementia. J Korean Neuropsychiatr Assoc 2001; 40: 1106-13. 11. Kim T, Kim S, Kim J, Kim E, Park K, Sung S, et al. The difference of caregiver burden in patients with alzheimer s disease and vascular dementia. J Korean Neurol Assoc 2005; 23: 463-70. 12. American Psychiatric A. Diagnostic and statistical manual of mental disorders: DSM-IV. Washington, D.C.: American Psychiatric Association, 1994; 886. 13. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer s disease: report of the NINCDS- ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer s Disease. Neurology 1984; 34: 939-44. 14. Erkinjuntti T, Inzitari D, Pantoni L, Wallin A, Scheltens P, Rockwood K, et al. Research criteria for subcortical vascular dementia in clinical trials. Journal of Neural Transmission Supplementum 2000; 59: 23-30. 15. Emre M, Aarsland D, Brown R, Burn DJ, Duyckaerts C, Mizuno Y, et al. Clinical diagnostic criteria for dementia associated with Parkinson s disease. Movement disorders: official journal of the Movement Disorder Society 2007 Sep 15; 22: 1689-707; quiz 837. 16. Kang Y, Na DL, Hahn S. Validity study on the Korean mini-mental state examination (K-MMSE) in demented patients. J Korean Neurol Assoc 1997; 15: 300-8. 17. Reisberg B, Ferris SH, de Leon MJ, Crook T. The Global Deterioration Scale for assessment of primary degenerative dementia. The American Journal of Psychiatry 1982; 139: 1136-9. 18. Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. The British Journal of Psychiatry: the Journal of Mental Science 1982; 140: 566-72. 19. Burke WJ, Roccaforte WH, Wengel SP. The short form of the Geriatric Depression Scale: a comparison with the 30-item form. Journal of Geriatric Psychiatry and Neurology 1991; 4: 173-8. 20. Kang SJ, Choi SH, Lee BH, Kwon JC, Na DL, Han SH. The reliability and validity of the Korean instrumental activities of daily living (K-IADL). J Korean Neurol Assoc 2002; 20: 8-14. 21. Gu HM, Kim JH, Gwon UJ, Kim SH, Lee HS, Go HJ, et al. A study on the reliability and validity of Seoul-instrumental activities of daily living (S-IADL). J Korean Neuropsychiatr Assoc 2004; 43: 189-99. 22. Bae KY, Shin IS, Kim SW, Kim JM, Yang SJ, Mun JU, et al. Careburden of caregivers according to cognitive function of elderly persons. J Korean Soc Biol Ther Psychiatry 2006; 12: 66-75. 23. Zarit SH, Reever KE, Bach-Peterson J. Relatives of the impaired elderly:
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