مراقبت از سالمندان در تلاقی فرایندهای درمانی و حمایتگری خانواده: مطالعه ای کیفی در شهر یزد (مقاله علمی وزارت علوم)
درجه علمی: نشریه علمی (وزارت علوم)
آرشیو
چکیده
سالمندی، به معنای بیماری نیست، اما بار بیماری در آن چشم گیر است. با ورود به سنین سالمندی، افراد به لحاظ جسمی و شرایط فیزیولوژیکی کم توان و نیازمند مراقبت و حمایت رسمی و غیررسمی در این مرحله از چرخه زندگی خود می شوند. در فرهنگ تاریخی جامعه ایران، مسئولیت مراقبت و مواظبت از سالمندان عمدتاً در چارچوب روابط و مناسبات بین نسلی خانواده تعریف و تضمین می شد. امروزه با روند رو به افزایش شمار سالمندان متأثر از گذار ساختار سنی جمعیت و بالا رفتن امید زندگی، خواه ناخواه ابعاد گوناگون موضوع مراقبت از سالمندان، مطالبات نامتوازنی را به طور فزاینده ای، هم بر خانواده و هم بر زیرساخت های مراقبتی تحمیل می کند. یکی از ابعاد مهم مراقبت از سالمند، بار مالی هزینه های مرتبط با مراقبت های درمانی سالمندان است که از قضا در شرایط تورمی و نوسانات اقتصادی کنونی، مسئله ای جدی تر شده است. چگونه خانواده ایرانی در تقلای مدیریت تنگناهای اقتصادی خود، روابط و مناسبات بین نسلی خود را بازتعریف و نقش آفرینی خود را در زمینه مراقبت از سالمندان تداوم بخشیده است؟ در پژوهش حاضر برای پاسخ به این پرسش، کوشش شده است تا ابعاد اقتصادی چالش های مراقبت از سالمندان در بستر خانواده ایرانی در شهر یزد، واکاوی شود. داده های پژوهش بر پایه رویکرد داده بنیاد و مصاحبه عمیق با 22 نفر از افرادی که حداقل از یک عضو سالمند خانواده مراقبت می کنند، گردآوری و درنهایت به شیوه کدگذاری باز، محوری و گزینشی تحلیل شد. یافته های مطالعه در قالب 8 مقوله اصلی شامل اقتصاد مراقبت، مضیقه های مالی، امنیت مالی، نارسایی در نظام درمان، پول سالاری در نظام درمان/مراقبت و ... استخراج شد. براساس جمع بندی مفاهیم و مقوله ها، مقوله هسته با عنوان «مراقبت در گرو پول»، مشخص شد. نتایج پژوهش به اختصار، حکایت از آن دارد که چالش های اقتصادی مرتبط با مراقبت از سالمندان، پیچیده و چندوجهی است و علاوه بر بار هزینه های درمانی درخور توجهی که برای خانواده و مراقبان خانوادگی ایجاد می کند و وضعیت رفاهی و روانی آنان را متأثر می کند، پیامدهای اثرگذاری نیز بر کیفیت درمان و مراقبت از سالمندان دارد. نتایج پژوهش با توجه به چشم انداز سالمندی در آینده جمعیت کشور، ضرورت طراحی سیاست های اجتماعی و حمایتی را منعکس می کند که تقویت حمایت های بین نسلی خانواده را در کانون توجه قرار دهد .Elderly Care at the Crossroads of Therapy and Family Support: A Qualitative Inquiry in Yazd City
Introduction
Family caregivers play a crucial role in elderly care worldwide, with approximately 80% of the elderly receiving care from family members (Given et al., 1999). Historically, family members have been the primary support system for the elderly, especially during periods of physical decline. However, the growing elderly population and increasing life expectancy have placed disproportionate demands on both families and formal care infrastructures. A significant aspect of elderly care is the financial burden associated with medical expenses, which has become more pronounced in the current climate of inflation and economic instability. While extensive research on aging in Iran exists (Ahmadi et al., 2014; Parvai, 2019; Rezaie-Kahrodi, 2018; Zanjari, Sadeghi, and Delbari, 2018; Farhadi et al., 2015; Askarindooshan, Rouhani, and Abedidiznab, 2018; Mohammadi, Dabaghi, and Yadavar Nikroosh, 2016; Razghi Nasrabad, 2014), social research on elderly care issues remains relatively limited (Kososheshi, 2010; Koosheshi, et al., 2013; Modiri and Koosheshi, 2021). Consequently, the challenges faced by family caregivers require further exploration. Understanding the process of elderly care and its impact on various aspects of caregivers' personal and family life can be a complex and multifaceted issue (Charalambous, 2023). Therefore, it is imperative to scientifically investigate the dimensions of social care, socio-economic characteristics of caregivers, and expectations and challenges they face within the socio-cultural framework of Iranian society. This study focused on the experiences and challenges of family caregivers providing elderly care in Yazd, Iran. It analyzed the financial and economic pressures on caregivers and examined how Iranian families manage these constraints based on a field study conducted in Yazd.
Materials & Methods
This qualitative study employed a grounded theory approach to explore the experiences of 22 family caregivers in Yazd, Iran, each responsible for at least one elderly family member. In-depth interviews served as the primary data collection method. The study utilized purposeful and theoretical sampling strategies to select participants. Data analysis followed a systematic approach involving open, axial, and selective coding. The results were organized into main categories and subcategories to facilitate the identification of patterns and relationships within the data, thereby enhancing understanding of the phenomenon under study. The analytical process yielded 41 subcategories, which were further consolidated into 8 main categories. This structured approach allowed for a comprehensive examination of the caregivers' experiences and the challenges they faced in providing care for elderly family members.
Discussion of Results & Conclusion
This study identified "Monetization in the treatment/care system" as the central phenomenon. The analysis revealed several key components:
Causal conditions: 'care economics' and 'financial constraint'
Background conditions: 'financial security'
Intervening conditions: 'inadequacies in the treatment system'
Strategies: 'financial balance' and 'levels of access to treatment'
Consequence: 'quality of access to treatment'
The core category emerging from this analysis was "Care Conditional on Money."
In our paradigm model, economic factors as causal conditions directly impacted families' abilities to cover care costs. Financial security, a background condition, played a crucial role in determining access to medical care. The main phenomenon, monetization in the treatment/care system, demonstrated how financial capacity influenced care and treatment decisions. Inadequacies in the treatment system served as intervening conditions, creating challenges for families caring for the elderly. The strategies of financial balance and treatment access levels reflected families' efforts to manage care costs effectively. The consequence, quality of access to treatment, illustrated the direct impact of financial security on the level and quality of medical services received. This model underscored the complex interplay between economic factors and healthcare access in elderly care, highlighting the critical role of financial resources in determining the quality and extent of care provision.
The rapidly growing elderly population in Iran necessitates addressing their needs, particularly economic issues. The quality of life and health status of the elderly are inextricably linked to financial security. Family care driven by emotional bonds often proves more effective than professional care. Globally, family support is recognized as essential for elderly individuals with chronic conditions, highlighting the need for complementary formal and informal support systems. Financial resources can mitigate many challenges associated with elderly care. The high costs of hospital stays, treatments, medications, medical equipment, and consultations create significant burdens for family caregivers. This is particularly pronounced for elderly individuals requiring continuous rehabilitation therapies and lacking health insurance. Moreover, the expenses associated with nutritious meals and essential medicines are difficult to manage without economic stability. Consequently, many families rely on public health services or neglect necessary treatments. The findings of this study demonstrated that financially stable families could access better medical services, leading to improved treatment outcomes and health monitoring. Conversely, financially strained families often resorted to lower-quality government services, resulting in treatment delays. These disparities significantly impacted both the health of the elderly and the self-esteem of caregivers. The role of financial stability in ensuring quality care and caregiver well-being was evident. Therefore, policy measures to expand insurance coverage and provide financial support were crucial for improving care quality and reducing caregiver burdens. Further social research is needed to comprehend the multifaceted aspects of elderly care within the Iranian cultural context. Future studies should build upon earlier findings to inform care policies and plans for the growing elderly population. In conclusion, addressing the economic challenges of elderly care is paramount in ensuring the well-being of both the elderly and their caregivers. A comprehensive approach that combines financial support, improved healthcare access, and culturally sensitive policies is essential to meet the evolving needs of Iran's aging population.
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