Showing posts with label caregivers. Show all posts
Showing posts with label caregivers. Show all posts

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).

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).

Thursday, September 23, 2010

AIM OF THE STUDY

By : Lamiaa Moustafa Elbosaty
This study aimed to assess problems and needs of family caregivers dealing with demented persons through:
1.     Assess knowledge, attitude and practice of the family caregiver about problems and needs of demented persons.
2.     Identify problems and needs of the family caregivers of demented persons.
3.     Signify role of the community health services in improving care of demented persons.

Research questions:
1.   What are the problems / needs of demented person?
2.   What are the problems / needs of caregivers of demented persons?
3.   How can caregivers deal with burdens when caring for demented person?   

Wednesday, September 22, 2010

Introduction To Dementia

By : Lamiaa Moustafa Elbosaty

Caregivers are a critical national health care resource, families often are a primary source of home care and support for older relatives, contributing services that would cost hundreds of billion of dollars annually if they had to be purchased (Adams, 2008). Caregivers need to talk about their experiences and to be listened to, and the presence of resources and support requirements. The caregivers said that their ability as caregivers was limited; many did not know what resources are available or how to locate new resources. Many caregivers are carrying out their role dutifully, but feel isolation, suggesting that there is a lack of social understanding and policies about informal caregivers (Zabalequi, et al., 2008).
The family caregiver needs educative support from the nurse on how to care for loved one, who can no longer meet his or her own physical needs or ADLs. Family caregivers assume an exhausting, 24 hours, and 7days a week job for someone who shows less and less appreciation for what they do and, with time, does not even recognize who they are (Ham, 2002).
Nurses can help family caregivers to identify their negative experience about caregiving and can help them reflect upon their coping strategies to find balance in their situation. Risk groups of caregivers may be identified, especially those with low perceived health and sense of coherence, for early intervention to reduce burden. Nurse should be providing emotional support and counseling and serving as a coordinator of available community resources, the nurse can significantly help to relieve the stress on the family caregivers (Signe & Sรถlve, 2008).

The nurse must assess the family and the client to determine their need for information and instruction about the illness, care of the clients, and support for the caregivers. The use of psycho-educational approaches has been demonstrated effective in enhancing family coping, and reducing caregiver depression and anger (Hepburn et al., 2003).
According to McIntyre and Cole (2008), the love stories is a spoken-word performance created from data gathered from family caregivers about their experiences of caring for a loved one with dementia. Loving care brings to the person with dementia opportunities for attachment, identity, inclusion, occupation and comfort.
Significance of the Study:
          Needs and problems due to caregiving of demented persons are a major source of caregiver's burden, and even burnout. Although 80% of caregiving is provided by family caregivers, there is deficit of support and services provided to them. Many international studies have defined the needs and problems of family caregiver dealing with demented person, yet there is a scarcity of local studies dealing with this problem.

Tuesday, September 21, 2010

Introduction To Dementia

By : Lamiaa Moustafa Elbosaty
 

Dementia is the seventh leading cause of all deaths in the United States and the fifth leading cause of death in Americans older than 65 years. Unfortunately, the main cause of dementia or the relationship to other brain abnormalities such as vascular disease and Lewy bodies is not known. There are also no good preventive or treatment strategies (Kuller & Lopez, 2008). Moreover, caring for a patient with dementia is more challenging than caring for a patient with physical disabilities alone. Peoples with dementia typically require more supervision, are less likely to express gratitude for the help they receive, and are more likely to be depressed. All of these factors have been linked to negative caregiver outcomes (Pinquart & Sorensen, 2007).
Caregiving has all the features of a chronic stress experiences; it creates physical and psychological strain over extended periods of time, is accompanied by high levels of unpredictability and uncontrollability, has the capacity to create secondary stress in multiple life domains such as work and family relationships, and frequently high levels of vigilance (Vitaliano, 2003).
Caring for a person with dementia can cause emotional, psychological and physical problems. In most cases of dementia, at least two individuals are affected; the person with condition and the caregiver. (Mannion, 2008).Carers are at high risk of mental health problems and that the comprehensive burden of caring has social, economic and health based elements. Dementia caregivers reported greater levels of physical burden and psychological distress than other caregivers (Kim & Schulz, 2008). Many problems can face the caregivers of people with dementia, which include the effective loss companionship and support of a life partner, social isolation and complex financial, legal and social decision-making. The burden of caring is financially, emotionally and physically significant (Thompson & Brigg, 2000).

Sunday, September 19, 2010

Problems and Needs of Family Caregivers Dealing with Demented Persons

Problems and Needs of Family Caregivers Dealing with Demented Persons

By : Lamiaa Moustafa Elbosaty

ABSTRACT

Problems and Needs of Family Caregivers Dealing with Demented Persons

Behind every case of dementia. there are relatives who are also affected,and both demented persons and carers need support.Aim of study is to assess problems and needs of family caregivers dealing with demented persons through, assess knowledge, attiude and pracitice of the family  caregivers about problems and needs of demented persons, and signify role of the community health services in improving care of demented persons, A descriptive study was conducted at the neuro-psychiatric out-patient clinics at Mansoura Genral and University Hospitals and in-Shams University Hospital. The subject included 60 demented persons and their 60 family caregivers. Tools included an interview questionnaire sheet for demented persons, and their family caregivers. an observation check-list to assess ADLs of demented persons, their home environment hazards, and family caregivers practice, and an attitude and burden assessment scale for family caregivers. Results revealed that although the majority of family caregivers was burden due to demented persons care, they have positive attitude towards demented persons. The majority of family caregivers was fatigue, had problems in dealing with demented person`s behavior, financial problems, social and Psychological problems. The majority of family caregivers have "financial needs to buy medication, informational needs to know how to solve daily problems withe demented persons, social needs to home visits by healthcare team. physcial needs to present of specialized center to host dementia persons for afew days, personal needs to easy access to healthcare facilities, and they had insufficient community healthcare services". Recommendation improving social care services. increase family caregiver`s awareness of community resources, and development of computer networks and hotline services. futere studies are recommended to study variable aspect of dementia. caregiving , and make effective coping strategies for family caregivers of demented persons.
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