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제1부
노인에 대한이해
제1장 노인의 기초적 이해 ············································· 11
1. 노인의 개념 ··························································· 11
2. 노화의 개념 ··························································· 12
3. 노년기의 신체적ㆍ심리적ㆍ사회적 변화 ················· 14
4. 우리나라 노인 인구와 특성 ··································· 17
제2장 노인의 특성 이해 ················································· 23
1. 신체적 특성 ··························································· 23
2. 심리적 특성 ··························································· 38
3. 사회적 특성 ··························································· 40
제3장 노인복지의 이해 ·················································· 43
1. 노인복지의 개념 ····················································· 43
2. 노인복지의 원칙 ····················································· 45
3. 노인복지정책 ·························································· 53
제4장 노인상담 모델 ······················································ 65
1. 정신분석적 상담 모델 ············································ 65
2. 행동주의 상담 모델 ··············································· 77
3. 인간 중심 상담 모델 ············································· 85
4. 가족상담 모델 ························································ 90
5. 임파워먼트 상담 모델 ············································ 94
제2부
노인상담의 기초
제5장 노인상담의 이해 ················································ 105
1. 노인상담의 개념과 목적 ······································· 105
2. 노인상담의 필요성 ··············································· 109
3. 노인상담의 특성 ··················································· 111
4. 노인상담의 의의와 역할 ······································· 115
제6장 노인상담의 영역 ················································ 117
1. 경제적 영역 ························································· 117
2. 신체적 영역 ························································· 121
3. 정서적 영역 ························································· 123
4. 사회적ㆍ법률적 영역 ············································ 125
제7장 노인상담의 지침 ················································ 129
1. 노인과 욕구 ························································· 129
2. 상담자의 역할 ······················································ 133
3. 상담자의 자세와 태도 ·········································· 139
4. 상담 시 전이와 역전이 ········································ 146
5. 상담의 과정 ························································· 148
제8장 노인상담 기법 ···················································· 155
1. 의사소통 기법 ······················································ 155
2. 회상 기법 ····························································· 156
3. 가족 조각 기법 ···················································· 160
4. 문장 완성 기법 ···················································· 162
5. 심리극 기법 ························································· 163
6. 적극적 경청 기법 ················································· 181
7. 직면 기법 ····························································· 182
8. 요약ㆍ반복 기법 ·················································· 183
9. 진단 기법 ····························································· 184
10. 동기유발 기법 ···················································· 185
제3부 노인문제와상담
제9장 노인과 치매 ······················································· 189
1. 노인성 치매의 개념 ············································· 189
2. 노인성 치매의 원인과 종류 ································· 191
3. 치매 환자 돌봄 ···················································· 198
4. 치매 가족에 대한 이해 ········································ 202
5. 노인성 치매의 진단검사 ······································· 204
제10장 노인과 우울증 ·················································· 209
1. 노인 우울증의 개념 ············································· 209
2. 노인 우울증의 치료와 상담 ································· 211
3. 노인 우울증의 주요 증상과 노인우울척도 ··········· 218
제11장 노인과 성 ························································· 223
1. 노인의 성 ····························································· 223
2. 노인의 성 상담 ···················································· 229
제12장 노인과 학대 ····················································· 237
1. 노인 학대의 개념 ················································· 237
2. 노인 학대의 유형 ················································· 238
3. 노인 학대와 상담 ················································· 248
제13장 노인과 자살 ····················································· 251
1. 노인의 자살 ························································· 251
2. 노인 자살의 상담 기법과 자살위험성 척도 ······· 259
제14장 노인의 황혼이혼과 고독사 ······························· 265
1. 황혼이혼율과 원인 ··············································· 265
2. 분할연금제도 ························································ 269
3. 고독사 ·································································· 271
제15장 노인의 삶과 웰다잉 ········································· 279
1. 후회 없는 삶 ······················································· 279
2. 죽음준비교육 ························································ 283
3. 죽음에 관한 다양한 이해 ····································· 286
제16장 노인과 돌봄 ····················································· 293
1. 노인 돌봄의 개념 ················································· 293
2. 노인복지법 ··························································· 294
3. 노인복지시설 ························································ 298
4. 노인장기요양보험제도 ·········································· 303
도서소개
지금의 우리 사회는 특별히 획기적인 변화가 있지 않는 한, 2025년 초고령사회에 진입할 것이다. 일이십 년 전만 하더라도 설마설마했던 일이 아닌가! 65세 이상 인구가 전체 인구의 20% 이상일 때 초고령사회라 일컫는데, 현재 상당히 근접한 상황이다. 급격한 노인 인구 증가로 노인 빈곤, 독거노인 등 여러 관련 문제도 수면 위로 떠오르고 있다.
노인 학대 또한 마찬가지다. 이는 우리 사회 저변에 깔린 노인을 비하하고 혐오하는, 노인에 대한 부정적인 인식과 무관하지 않다. 노인 학대는 쉽게 드러나지 않아 더 심각하다. 대부분의 학대는 가정에서 가족 구성원으로부터 발생하다 보니, 피해자 들이 그 사실을 알리지 않거나 사실 자체를 인정하지 않으려 한다. 그러나 최근 5년간 노인 학대 건수는 매년 증가했다.
국제연합(UN)과 세계보건기구(WHO)는 2006년 노인 학대의 심각성을 알리기 위해 6월 15일을 ‘세계 노인 학대 인식의 날’로 제정했다. 우리나라는 2017년부터 같은날을 ‘노인 학대 예방의 날’로 기념하고 있다. 「노인복지법」 제1조의 2 제4호를 보면, 노인 학대란 ‘65세 이상 노인에 대하여 신체적ㆍ정서적ㆍ성적 폭력 및 경제적 착취 또는 가혹행위를 하거나 유기 또는 방임하는 것’을 말한다.
노인 학대가 증가하는 배경에는 가구 형태의 변화와 돌봄에 대한 부담, 부양에 따른 스트레스 등이 꼽힌다. 특히 노인 단독 가구 형태가 급증하고, 평균 수명이 길어지며, 노인이 노인을 돌보는 ‘노노(老老) 돌봄’도 급격히 늘어나는 상황이다. 이런 면에서 ‘노(老)-노(老) 학대’ 비율도 점차 높아지고 있다. 아무리 배우자라 하더라도 체력적으로나 정신적으로 노인이 노인을 돌보는 데는 한계가 따르기 때문이다.
여성 노인 학대는 더 심각하다. 학대당하는 노인의 대략 75%는 여성이다. 여성 노인은 나이를 먹어도 부양이나 돌봄에서 벗어나지 못한다. 젊을 때는 부모를 부양하고, 자녀를 양육하였다. 나이 들어서는 손자녀를 돌보고, 또 노인이 된 배우자를 살펴야 하는 사례가 많다. 또 대부분 배우자에게 경제적으로 의존했다가 사별 등 이유로 빈곤을 겪게 되고, 사회관계망도 약하기에 우울 속에서 살아간다. 최근에는 독거노인이 많아지며 스스로 생존을 위한 최소한의 권리를 포기하는 자기 방임도 꾸준히 늘고 있다.
노인 학대 예방을 위해서는 세대 공감 및 존중 문화 정착과 노인에 대한 부정적인 인식 개선 등이 기본적인 해결 방안으로 꼽힌다. 세대 공감과 존중 문화를 위해서는 어린이ㆍ청소년 교육 과정에 이를 반영하여야 한다. 학대가 가정에서 은폐되고 계속해서 반복되는 특성이 있으므로 학대 정황이 발견되면 즉시 신고하고 전문가 개입을 통해 학대의 고리를 끊어야 한다. 이러한 상황에서 상담자는 어떻게 할 것인가? 상담자는 노인이 성공적 삶을 마무리하는 데 도움을 주는 봉사적 활동을 해야 한다. 상담자는 노인을 상담하기 위해서 심리적 영역은 물론 신체적 건강, 의료적 진단 및 치료계획에 대한 지식, 재정적ㆍ사회적ㆍ법률적 정보 제공ㆍ영적 등의 영역까지 확대하여 상담하여야 한다. 예컨대 내담자가 이용할 수 있는 지역사회의 자원을 제공하고, 중재자 역할도 해야 한다. 가르치는 교사의 역할도 해야 한다. 때로는 내담자의 법적 대변자로서 문제 해결의 대안 선택을 위한 정보도 제공하여야 한다.
따라서 이 책은 이러한 의도로 집필하였다. 구체적으로 노인의 전반적인 삶 속에서 겪은 여러 가지 어려운 사건이나 상황을 극복한 강점을 확인하고, 보상받았던 경험을 기억 속에서 표출시키는 데 도움이 되고자 한다. 그리하여 그들이 남은 생이라도 후회 없고 행복한 나날이 되기를 기대한다. 2010년부터 노인상담사 양성을 하면서 행복한 노년이 되고 자아통합감을 이룰 수 있도록 길잡이가 되어 줄 교재가 필요하여 집필해 왔는데 출간에 도움을 주신 많은 분들께 진심으로 감사드립니다.