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Thursday, October 21, 2010

Family Caregiving

By : Lamiaa Moustafa Elbosaty

There are only four kinds of people in the world, those who have been caregivers, those who currently are caregivers, those who will be caregivers, and those who will need caregivers. The family has remained the strongest and the only supportive and long-term care institution for demented persons in most of developing countries (Prince, 2004).

          Family members or others caring for a person with dementia have an extremely difficult and stressful job, which become harder as the disease prognosis. Dementia caregivers spend significantly more time on caregiving than do people proving care for those with other type of illnesses. These types of caregiving also had a greater impact in terms of employment complications, caregiver strain, mental and physical health problems, time for leisure, and family conflict then do other types of caregiving. It's common for dementia caregivers to develop feelings of anger, resentment, guilt, and hopelessness, in addition to the sorrow they feel for their loved one and for themselves.

Depression an extremely common consequence of being a full time caregiver for a person with dementia (Nauert, 2006).

          It's estimated that more than 7 of 10 people with Alzheimer's live at home. Almost 75% of home care is provided by family and friends. Mostly, given with love and it is usually the best form of care. The remainder is paid care, costing upward of $12.5 billion per year, most of which is covered by families (Alzheimer Disease and Related Disorders Association, 2001).

          The average family caregivers provide 18 hours of care per week; 20% provide "constant care" or 40 hours a week. Ninety-two percent of elders are related to their working caregivers, and two – thirds of caregivers work full or part time, over half make adjustments in their work schedules, e.g., coming in late, taking time off, dropping back to part time or quitting. The average out-of-pocket expense for a family caregiver is $171 per month. Total un-reimbursed monthly expenses for family caregivers in $1.5 billion. Family caregivers account for and estimated $ 257 billion annually in services, if they were paid (Wart, 2005) .

          Caregivers provide many kinds of help; house cleaning, letter writing, financial management, grocery shopping, bathing, feeding, transportation, dressing, help with walking and much more (Musolf, 2004). Family caregivers provide services to elderly relatives in the home, usually without the benefit of formal training, and they usually don't have choice about assuming care, since the costs for their family person's care often too high for the financial resources available. The numbers of people surviving into their 80s and 90s are expected to grow because of advances in medicine, medical technology, social and environmental conditions. Since the incidence and prevalence of Alzheimer's disease and dementia increases with age, the number of people with these conditions will also grow rapidly (Leahy, 2005).

        Nearly one out of every four US household (23%) is involved in care- giving to persons aged 50 and over-one-quarter of the adult population worldwide help care for family members or friends. While, one in three family caregivers cares for two or more persons. Approximately 64% of caregivers of elderly are employed; they spend an average of 18 to 40 hours per month care giving. The need for health care workers will be tripled by 2050 (Thiemen, 2006).

Tuesday, October 19, 2010

FAMILY CAREGIVERS

By : Lamiaa Moustafa Elbosaty

Dementia affects not only the patient, but also his or her family. The responsibility for caring for the patient often falls on a close family member. This responsibility can take an enormous emotional and physical toll, especially when added to the psychological distress of watching a loved one deteriorate, because of burdens of caregiving, the caregiver of the dementia patient is often referred to as the hidden, or second patient of the disease (American Association for Geriatric Psychiatry, 2004).

           As the caregiving population has grown over the years, the definition of "caregiver" has taken many meanings. The San Francisco Based Family Caregivers Alliance describes caregivers as "Family, friends and neighbors who standby those they love as the face chronic illness, disability, or death. Caregivers are a diverse group of people of all ages and from all walks of life some new to care giving, some just anticipating becoming caregivers, and others for whom providing care has become away of life (Mohoney, 2003).

          A caregiver is anyone who provides assistance to someone who is in need of care. Most caregivers are unpaid family persons or friends who provide care on either a full-or part–time basis. It's estimated that 80 percent of caregivers provide care giving assistance seven days per week, and the care usually involves personal care assistance and household maintenance chores (Arciniegas, & Dubovsky, 2001).

          Carers are non-professionals who provide help and support to people who are sick or disabled. The role of the carer is especially important when the person who receives care is unable to live independently without the carer's help (Singleton et al., 2002).

Sunday, October 17, 2010

Types of Services Needed for Caregivers - 2

By : Lamiaa Moustafa Elbosaty

Community Nursing Staff:

-         Community sister "district nurse". she provides nursing service for the sick elderly people at their own home.

Health visitors: They are specialized in care of elderly people. They also play a valuable role with regard to the following: Giving advice counseling, educating, identifying needs and liaisoning with other services.

-         Community psychiatric nurses: They support the patients and their carers as well as monitor progress and detect any deterioration (Bushy, 2002).

3: Allied Health Professional:

They provide an invaluable service to the elderly. They include: Physiotherapists, rehabilitation therapists, occupational therapists, speech therapists and pharmacologists (Lund & Wright, 2001).

4: Geriatricians:

These are consultant doctors who are specialized in the diseases and problems of aging and who are responsible for geriatric departments. They make home visits to advice in treatment.

5: Social Workers:

They can provide the vital link between the elderly person and the availability of any of the local services. The social worker is usually the key to obtaining extra financial help for an elderly person (Lund & Wright, 2001).

Saturday, October 16, 2010

Types of Services Needed for Caregivers

By : Lamiaa Moustafa Elbosaty

1- Multidisciplinary team:

          Effective teamwork is essential for effective care. The range of physical, psychological and social problems become so complex with elderly people so that no one discipline can work effectively in isolation. It consists of a professional who has training in gerontology, social work, nursing, or counseling. They are able to assist families in assessing their individual needs and arranging services in –home and/or in the community. They are able to review legal, financial, and medical documents and make referrals to appropriate people in the community, also they provide counseling and education and knowledgeable about various community resources to best assist demented persons' family (Beck et al., 2000).

Friday, October 15, 2010

Community services can be divided into two groups which are:

 By : Lamiaa Moustafa Elbosaty

   A: Types of Services provided:

           1- Adult Day Centers: They provide a place for individuals to socialize, exercise, and interact with others, they are generally geared to older adults and offer programs that are designed to promote services often tailored for individuals with cognitive impairments who might be in need of a safe place to be supervised or assisted in their activities of daily living. It provides a variety of mental, physical, and emotional services which benefit both the individual and their families. It offers transportation to and from their center, it also provides nutrition meals and snacks and can accommodate particular diets (e.g. diabetes). Adult day centers employ trained staff and volunteers who are able to assist with numerous aspects of daily living. (e.g., toileting, help with eating /drinking, assistance with walking) (Rose et al., 2000).        

2- Adult Day Service: Users reported greater decrease in hours spent on behavior problems when compared to non users, even after controlling for baseline differences between two groups. They also reported decrease frequency of behavior problems in their relatives who attended adult day programs. Adult day services are effective in restructuring caregiving time and may offer potential benefits not only to family caregivers but also to community-residing older adult who have dementia well (Gauglar et al, 2003).

         3- Special Geriatric Clinics: The goal of these clinics has been to offer coordinated medical and social services to the population of independent, working elderly to aid them in retaining their independence. In addition, they provide important diagnostic services to the elderly (Abido, 2000).

4 - Nursing Homes: There are many forms of these homes, however they could be roughly grouped into three categories. The first type is called the skilled nursing care home, in which residents receive a level of nursing care that requires professional nursing supervision. The second type could be called the personal care with nursing home, in which there may be substantial numbers of residents who require minimal or intermittent nursing and personal care assistance. The last type of homes is the residential homes, which the residents may need assistance with daily living activities but don't require nursing care (Abido, 2000).

       5- Support Groups: Families caring for patients often find it helpful to share their experiences and thoughts in a group setting. Support groups provide an opportunity for family person to come together with others in similar situation. Strategies on providing care can be exchanged in a group, problems can be discussed, feelings can be aired and medical information or research on dementia can be discussed. More recently, support groups are also being offered for patients in the early stages of the illness (Haley, 2001).

The support groups are groups of people who have lived through the same difficult experiences and want to help themselves and others by sharing coping strategies. Mental health professionals strongly recommend that family caregivers take part in support groups (Rodring & Nestor, 2007).

There are several types of support groups such as the Alzheimer's association support groups which provide information about care receiver management, share coping strategies and provide support in discussion group with others caregivers. This type of support group may be more important to caregivers who are concerned about the future of their relatives who are in the later stage of Alzheimer's disease (Parks & Novielli, 2000).

In Egypt, Alzheimer's association address is Center for Psychiatric Hospitals, Ain Shams University - Cairo, Tel. +0223920074. Unfortunately, there are no institutions or qualified for care of those patients, which make up the psychological and physical burden on their families a great. Furthermore, there are a number of cases without detection, especially in the non-educated group of society and they will be having lack of patience and neglect for the treatment of their condition and requirement (Abyad et al., 2001).

Alternatively, educational support groups are self-limited and provide information to assist caregivers. This groups provide information about Alzheimer's disease; patient care; legal and financial resources; and available community services. Caregivers who have relatives in the early stages of Alzheimer's disease may be more in join to favor educational group rather than Alzheimer's association support group. Finally, stress management support group helps caregivers identify stresses, and develop strategies to cope with stresses of care giving. Nevertheless, caregivers in a stress management support group were shown to have used more effective coping skills at home, but have not reported reduced stress (Smyer & Qualls, 1999).

6- Home Care: It refers to health care and social services provided to individuals in their homes or in community and home like settings. Home care may include nursing rehabilitation, social work, home health, home care can unable elders to remain in their own homes for as long as possible, relieve the burden on hospitals and improve the quality of life for the elder and the caregiver. As well, home visiting nursing services can be used to good advantages especially when only part-time nursing care is needed such as physical therapy, home delivered meals and assistance in rending care (Jamieson, 2002)

7- Receipt Care Facilities: Provide overnight, weekend, and long stays for someone with Alzheimer's or related dementia, so a caregiver can have longer periods of time off. These facilities provide meals, help with activities of daily living, therapeutic activities to fit the need of residents, and a safe, supervised environment. Examples of such facilities include nursing homes, and residential care facilities (Lawton et al., 2001).

8- Emergency Respite: Is often offered in many nursing homes, residential care facilities, and assessed living facilities. It may be needed when a caregiver becomes ill or must go out of town unexpected by or if the care recipient is at risk of abuse or neglection (Rodring & Nestor, 2007).

9- Other services:

§        Transportation services  

§        Social security services and protective services

§        Short-stay residential accommodation so that the caregiver of an elderly may go away on a holiday.

§        Leisure –time activities (recreational and educational programs).

§        Communication services "phones, emergency access to health care".

§        Visual services, out –patient clinic and dental care services.

§        Dietary guidance and food services

§        Exercise and fitness programs

§        Financial aid, counseling and social assistance services

Home repair and pest control(Lund & Wright, 2001).

Thursday, October 14, 2010

COMMUNITY HEALTH SERVICES

By : Lamiaa Moustafa Elbosaty

Many families care for their elders with very little outside support and a lack of awareness of existing social programs. Family caregivers are often so isolated from support systems that they are not aware such support is needed until they become exhausted (Swanson & Carnahan, 2007).

Family persons providing care for the patient with dementia should familiarize themselves with services offered by community agencies. Some of these services are geared to meet the patient's need, while other addresses the need of the family caregivers. The availability of these services will vary from community to community, as will costs and funding sources (Gauglar, et al., 2003).

An estimated 10 million American needed long-term care in 2000 (Rogers & Komisar, 2003). Most but not all persons in need of long-term care are elderly. Approximately 63% are persons aged 65 and older, the remaining 37% are 64 years of age and younger (Gibson & Writer, 2008). By 2050, the number of individuals using paid long-term care services in any setting (e.g., at home, residential care such as assisted living, or skilled nursing facilities) will likely double from the 13 million using services in 2000, to 27 million people, this estimate is influenced by growth in the population of older people in need of care (USDHHS & US  Department of Labor, 2003).

In Egypt, the healthcare systems have largely ignored the needs of the elderly, there are only sporadic programmes to care for the elderly, mainly initiated by the community or within the private sector. Those above 65 years old represent 4.4% of  Egypt's population, and there are 34 old people's homes for over a million elderly people and some of these homes have waiting lists of over 1000 persons (Okasha, 2004).

The long term care differs from other types of health care in that the goal of long term care is not to cure an illness, but to allow an individual to attain and maintain an optimal level of functioning. Its income passes a wide area of medical, social, person, and supportive and specialized housing services needed by individuals who have lost some capacity for self-care because of a chronic illness or disabling condition (Schulz & Matire, 2004).

The number of dementia people residing within the community is steadily increasing. Community services can alleviate the burden experienced by families, but are used infrequently by family of demented persons. Older and less educated caregivers had higher levels of uncertainly about service availability. Depressed caregivers were less likely to know about service availability (Collins et al., 2001).

Wednesday, October 13, 2010

Table(2): Comparison between Delirium and Dementia

By : Lamiaa Moustafa Elbosaty

 

 

Dementia	Delirium	Characterist
Gradual and insidious development	Rapid development	Onset
Long, with progressive deterioration	Brief duration of 1 month or less, depending on cause	Duration
Stable progression of symptomatology	Diurnal alterations, more nocturnal exacerbations	Course
Short-term and long-term memory impair­ments, with eventual complete loss	Disorganized and impaired	Thinking and short-term memory
Progressively decreases	Markedly decreased, especially to environ- mental cues	Orientation
Difficulty recalling the correct word; later may lose language	Rambling, pressured, irrelevant	Language
Often absent but can progress to paranoia delusions, hallucinations, and illusions	Environment unclear, progressing to illu­sions, hallucinations and delusions.	Perceptual disturbance
Not affected	Cloudiness that fluctuates; inattentiveness to hyper alert with distractibility	Level of consciousness
Piecemeal	Day-night reversal, insomnia, vivid dreams and nightmares	Sleep
Not affected	Sluggish to hyperactive; change of range unpredictable	Psychomotor action
Depression/ anxiety when insight into con­dition is present; late in pathology anger with outburst, restlessness with pacing	Anxious with changes in sleep; fearful if experiencing hallucinations; weeping; yelling	Emotion status

                                                                        Adopted from Mohr (2006).

Tuesday, October 12, 2010

Prognosis

By : Lamiaa Moustafa Elbosaty

Irreversible dementia is difficult to diagnose, especially in the early stages. Once diagnosed, patients must undergo a complete medical and neurological workup, because 10 to 15 percent of all patients have a potentially reversible condition if treatment is initiated before permanent brain damage occurs and therefore inevitably have a poor prognosis (Sadock & Sadock, 2005).

The time from diagnosis to death in Alzheimer's disease is usually estimated to be 8 to 10 years, and the morbidity and mortality of vascular dementia may by worse than Alzheimer's disease, presumably because of risk of further cerebrovascular events, as well as other atherosclerotic disease. The 5– year's survival rate is 40 percent for patients with vascular dementia (Wancata et al., 2003). In general, irreversible dementias have an insidious onset and are gradually declined, followed by a more rapid progression. The most frequent cause of death is pneumonia, and other infections, with malnutrition and dehydration as contributing factors (Gelder & Harrison, 2006).