Showing posts with label family. Show all posts
Showing posts with label family. 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).

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).

Saturday, October 9, 2010

Severe Alzheimer's Disease

By : Lamiaa Moustafa Elbosaty


At this stage of Alzheimer's disease only fragments of memory remain. There may be emotional recognition of family, but names and relationships identification are lost. There is orientation to self only. Language is limited to short phrases and repeated words, and only simple spoken language is understood. The individual may eventually become mute and unable to communicate. There is complete dependence on others for all care, behavior manifestation disappear, although vocalization (screaming, cursing, or crying) may continue at this stage (Cotter, 2002).
Neurological changes may include Parkinsonism (slow, shuffling gait, falls, rigidity, and brady kinesis), occurrence of generalized tonic–colonic seizures, and myoclonus, weight loss, dysphagia, increased sleeping, fecal and urinary incontinence. At the end, the individual spends most of time in bed. Death is frequently attributed to complications associated with chronic debilitation, aspiration pneumonia, sepsis, urinary tract infection, pulmonary embolus or inanition (NIH, 2003).

Friday, October 8, 2010

Mild Alzheimer's Disease

By : Lamiaa Moustafa Elbosaty



          The individual with mild Alzheimer's disease continues to look and act normally to others, and only close family or friends may note any change. There is moderate memory loss, more marked for recent events that interfere with every day activities. The individual has difficulty learning and retaining new information. In addition, there may be disorientation in familiar places, difficulty handling complex financial transactions (paying bills, balancing a check book), and poor problem solving (Reisberg, et al., 2003).
The individual is independent in completing usual activities of daily livings (ADLs) but may need prompting to complete tasks. The ability to participate in complex home repairs and hobbies is reduced. The individual may experience personality changes of withdrawal from usual social activities because of fear of others detecting changes, lack of confidence in function, or lack of interest in his/her usual activities (Linton & Lach, 2007).
·        Moderate Alzheimer's Disease:
In moderate Alzheimer's disease, memory loss is sever and only highly learned material or established memory is retained, while new material is lost rapidly. As the damage of Alzheimer's disease spreads in cerebral cortex, language, reasoning, sensory processing, and conscious thought are impaired. The individual may be confused about the identity and relationships of relatives. The individual becomes increasingly dependent on the others and assistance is needed to carry out ADLs (Monias & Meier, 2003).
The individual may get lost in familiar settings, language changes are revealed as incomplete sentences and poor comprehension of written and spoken language. At this stage of Alzheimer's disease, disruptive behavioral changes often emerge. Agitation, restlessness (including wandering), sleep disturbances, day-night disorientation, verbal or physical aggression, suspiciousness, and hallucinations are common behaviors manifested (ADRDA, 2004).
The individual has decreased tolerance for stress and can't reliably interpret the environment. Disinhibition, socially in appropriate behaviors, and saying or doing things not usually said or done in public occur at this stage. Also there are weight loss, and dehydration which require careful monitoring (Monias & Meier, 2003).

Thursday, October 7, 2010

Clinical features

By : Lamiaa Moustafa Elbosaty


Alzheimer's disease is classified according to the stage of the degenerative process. The number of stages defined ranges from three to seven, depending on the source. However, four stages, as discussed subsequently, are commonly to categorize the progressive deterioration seen in those diagnosed with Alzheimer's disease (Varcarolis, 2006).
· Very Mild Alzheimer's Disease: At this stage, cognitive changes is subtle, typically this stage of the disease is only detected by dementia specialists because of the very mild nature of the changes. Individuals may dismiss these very mild changes as normal aging (National Institute on Aging, 2007).
Memory is consistently impaired, and details of recent events are only partially recalled. Although the individual may be fully oriented, there may be difficulty with time relationships, knowing when events happen in relation to one another. The family/individual may note slight impairment in community activities or slight change in interest or participation in hobbies. Complex tasks take longer and errors are evident. The working individual may continue to work but will require support to function at the same level or will assume decreased responsibility (Galvin et al., 2005).
Personality changes such as lack of spontaneity and initiative, loss of a previously sharp sense of humor, lack of energy and enthusiasm, or decreased interest in work, family may be noted at this stage. Anxiety and depression are not uncommon at this stage and should be treated. The duration of the disease from onset to death a mostly average 8 to 10 years, but can range from 3 to 10 years (Duchek et al., 2003).

Wednesday, September 29, 2010

Types of Dementia -3

By : Lamiaa Moustafa Elbosaty

Dementia due to Parkinson's Disease: Risk factors for dementia include increased age and a typical presence of speech changes and axial involvement, severe motor involvement, rapid progression of Parkinson's disease, and depression. It occurs in later stage of the Parkinson's disease. Behavioral and personality changes occur in dementia caused by Parkinson's disease, with increased incidence of depression and visual hallucinations when compared with the behavioral changes of Alzheimer's disease (Meara, 2003).
- Front-temporal Dementia: is estimated to account for between 5 and 15 percent of degenerative dementias. In younger populations (younger than 65 years of age). Front-temporal dementia probably accounts for a larger percentage of total dementia cases, but overall prevalence rates remain relatively low. Men and women are probably equally affected, and studies have documented that between 20 and 40 percent of patients have a family history of front-temporal dementia (Dawson & Hodges, 2002).  
v    Clinical criteria:
1.       The development of behavioral or cognitive deficits manifested by :
(a) Early and progressive change in personality, characterized by diffi­culty in modulating behavior, often resulting in inappropriate responses or activities .
(b) Early and progressive change in language, characterized by prob­lems with expression of language or severe naming difficulty and problems with word meaning.
The deficits outlined in 1a or 1b cause significant impairment in social or occupational functioning and represent a significant decline from a previous
2.     level of functioning.
3.       The course is characterized by a gradual onset and continuing decline in function.
4.            The deficits in la or 1b are not due to other nervous system conditions (e.g., cerebrovascular disease), systemic conditions (e.g., hypo- thyroidism), or substance-induced conditions.
5.            The deficits do not occur exclusively during a delirium.
6.            The disturbance is not better accounted for by a psychiatric diagnosis (e.g., depression) (McKhann 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.

Monday, September 20, 2010

INTRODUCTION

INTRODUCTION
By : Lamiaa Moustafa Elbosaty

Dementia is an umbrella term, when we hear that someone is diagnosed with dementia there is more to the story as a patient, family person, and the type of dementia. Each disease under the umbrella has different courses of illness, different symptoms and different challenges. The drugs' treatment and interventions may be different as well (Cooper, et al., 2007). Dementia is frequently associated with the elderly, and is often incorrectly assumed to be a part of the aging process. Actually, many elderly people retain their intellectual functioning into their eighties and nineties. Dementia becomes a public health issue facing the whole world in the next decades (Brierley, 2008).
 The number of persons with dementia was estimated at about 25 million persons worldwide (about 0.5% of the whole worldwide population), of which 59% were females, 52% live in less developed countries. The number of new cases of dementia in 2000 was estimated to be 4.6 million, and it is forecasted that by 2030, 63 million people will suffer from dementia. More than 5 million American are estimated to have dementia. In Europe there are 7.2 million persons have dementia and it will be 16.5 in 2050. In Africa, there are 1.3 million and it will be 6.3 million in 2050, while in the Arab world there are 1.5 million person suffering from dementia. In Egypt, there are about one million cases and it is expected to continue to increase in the coming decades (Ashour,2007). Significant cost implications related to dementia include an estimated $148 billion annually direct (Medicare/Medicaid) and indirect (e.g., caregiver lost wages and out-of-pocket expenses, decreased business productivity) costs (Alzheimer's Association, 2008).

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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