dependents 
PSYCHOSOCIAL CONSEQUENCES IN FAMILY CAREGIVERS OF ELDERLY DEPENDENT. PROPOSALS TO RAISE THE QUALITY OF LIFE
By: Livia Villafuerte Asto
Master of Social Work Community, management and evaluation of social programs and projects
I. INTRODUCTION
aging population in Spain, is undoubtedly the main demographic feature today and prospect, given their economic and social implications. According to the IMSERSO
in Spain is estimated that the percentage of older people who have a significant dependence is between 10% and 15% of people over 65 years, also according to this latest census, the population figure of Spain amounts to 45,200,737 people, 2.4 times the number of people recorded in the early twentieth century (18618086). According to the IMSERSO
in Spain is estimated that the percentage of older people who have a significant dependence is between 10 and 15% of people over 65 years. As of 1 January 2007, there A total of 7,531,826 people 65 and older. This figure corresponds to 16.7% of the total population.
Usually, the family is the one that takes care of most of these people in Spain (85% of aid). In every family there is usually a primary caregiver who responds to the circumstances of each family, without having reached it by an explicit agreement among the members of the family.
Studies in the last twenty years in Spain, support the conclusion that family caregivers are exposed to a stressful situation that increases the risk of several physical and emotional problems, especially anxiety and depression
In an attempt to analyze the psychosocial impact on family caregivers, focusing on stress and quality of life, have carried out literature reviews, especially with the search for material on websites such as MEDLINE, PsycINFO, PORTAL ELDERLY Library Virtual Health (IBECS), Invest-Joana Briggs, City, DIALNET, COCHRANE, and THESEUS INAHTA etc. where research is taken and proposals for intervention such as psycho-educational programs, mutual aid groups, psychotherapeutic interventions, etc. intended to reduce the socio-emotional distress of family caregivers of dependent elderly today.
II. PRESENTATION
In recent years there is recognition of the need for attention to the group of people in a state of dependency and their families. Care for dependent people has been traditionally carried out by their families in the community environment, responding to the interests of older people and their families and the institutions, in what has been called "principle aging at home. "
The important implications of this situation demands usually have a significant negative impact on different areas of the life of the carer (health, social and family relations, economics, etc.). Guidelines as reflected in works such as: When older people need help, carers and families Guide (INSERSO, 1997) have represented a contribution of great interest and value to this community.
These issues are included in the Law for Promotion of Personal Autonomy and Care for Dependent Persons, including actions to incorporate training and information to carers.
This work, carried out during this month, has been prepared and reviewed during the course Advanced Techniques of social work, counting with consultancies permanent teaching. It is out of a concern to identify those risks for caregivers of negative consequences for the care, also know the characteristics of family caregivers of older people and give proposals psychosocial level to achieve better quality of life for them.
In short, this paper intends to give the value due to family caregivers of dependent elderly people, as a large group and need in our current reality by providing an important contribution to families in English society also will provide professional interventions to address adequately the needs and improve the quality of life of the growing number of families who have a person more reliant on its members, and need help to continue doing so in the right conditions and avoid the expense of bio-psychosocial health.
III. BASICS
Caregiver:
Caregiving is a situation that many people throughout their lives have just experienced. Caregiver has been defined as "any person who attends or care to another affected all forms of disability, handicap or disability that hampers or prevents the normal development of vital activities or social relationships."
[1]
Family caregivers:
Someone who is part of the family (son / daughter, spouse, grandchild or, etc.) Which, for different reasons, agree on the task that occupies much of his time and effort and allows other family members can function in their daily life, helps the older person to adapt to the limitations of her health problems of aging, prevents them.
Stress:
Mezerville Dr. Gaston Zeller (1998) has written about stress, and tells us that it was the Canadian physician Hans Selye coined the term to mean " the individual's response to the demands it receives, including all stress and wear caused by life. "
Cargo Joint physical, mental and socioeconomic family experienced caregivers for the elderly, which can affect leisure activities, social relationships, friendships, intimacy, emotional balance and freedom.
Mayor dependent the person is in a state of functional reserves decrease, leading to increased susceptibility and vulnerability to physical, chemical, biological and psychosocial and depend on someone else to meet your needs.
IV. THE TASKS OF THE FAMILY CAREGIVER Caring involves multiple and varied activities to provide assistance. Although the areas where care is provided and the tasks involved in such assistance depends on each particular situation, many of the routine tasks involved in the provision of aid to a dependent elderly are common.
is important to note that when assuming the care of the family, you think it will be a temporary situation, though, often lasting several years with a growing demand for care.
[2] common tasks:
- Help in household activities (cooking, washing, cleaning, ironing, etc.).
- Help for transport outside the home (for example, accompany him to the doctor)
- Help for the movement inside the home .
- Help with personal hygiene (grooming, bathing, etc.).
- Help for managing money and property.
- supervision in taking medications.
- Collaboration in nursing tasks.
- call or visit regularly to the person who cares.
- Resolve conflict situations arising from the care (for example, behaves when agitated).
- Support for communication with others when it is difficult to express.
- Ask lots of "little things" (eg, take a glass of water, bring the radio, etc.).
According to various studies in Spain, shows the following: Ø
As for the motivations identified family caregivers to do their homework, most do because of emotional ties to his family.
Ø With regard to whether caregivers have information about the illness or problems in older people and their management, it appears that the majority is zero, the vast majority have no experience. Ø
health problems that predominantly have family caregivers of older people are nerve problems, bone problems, muscular, headaches, heart problems and hypertension.
Ø With regard to the psychological, anxiety, fear and hopelessness are more negative feelings experienced by carers, although most feel anger and loneliness.
V. CONSEQUENCES OF MAJOR DEPENDENT CARE IN THE FAMILY CAREGIVER.
life of those caring for a dependent elderly person may be affected in many ways.
According to a study conducted in Extremadura, in the year 2004 to the question about the consequences that brings greater attention in normal life, the answers are: Ø
can not work out, have stopped working or have reduced hours or reduced
leisure Ø No
can care for others or unable to care for themselves / as or lack of self
Ø Decreased quality of life, friendships
not see or feel tired / as
or psychological problems (depression, anxiety, stress). Sleep disturbances
Ø Ø Ø
have financial problems have health problems
Ø Increased risk of mortality of care
Ø Risk inappropriate for the elderly. Ø Ø
Abuse
closer relationship with the person receiving care.
is also common for people caring for a dependent elderly person to undergo changes in the following areas: Ø
family relationships or at work and in their economic situation
Ø
In his spare time or your state Ø
encouragement satisfaction
care or your health
- Family relationships are given disagreements between the caregiver and other family members in relation to the behavior, decisions and attitudes toward one or another older person or the way they provide care.
The person who has assumed greater responsibility for collecting the rest of the family does not appreciate his effort, also the partner of the person who has assumed responsibility for the care or the children are upset by the fact that the older person living in the same house. This creates many difficulties in the relationship and the children who miss the caregiver time for them.
[3]
- Labour and economic situation
In Spain, 50% of caregivers can not be made to work, have left work or have reduced their working hours. In this are frequent economic difficulties, either because incomes decline (decreased work commitment) or because they increase the costs of elderly care.
- Leisure
The family caregiver perceives that he has no time for leisure, also may have feelings of guilt for thinking that if you take time for yourself is abandoning its responsibility. The reduced activities in general is very common and is closely related to feelings of sadness and isolation.
- Health
Family caregivers often feel physical exhaustion, fatigue, risk of disease and the feeling that his health has worsened since taking care of your family. Studies have shown that people who care more doctor visits and take longer to recover from illness.
physical health problems, somatic complaints are many, emphasizing those related to chronic mechanical pain of the musculoskeletal system, other features common are tension headaches, fatigue, chronic fatigue, change in cycle sleep-wakefulness, insomnia and other generally ill-defined, clearly chronic and impairing their quality of life diminished.
mental health problems: The prevalence of mental disorders in the area reached 50%, often difficult to verbalize and defined and vague somatic or type of discouragement or lack of strength. Feelings of sadness, despair, helplessness and hopelessness. I have found is the presence of a high number of depressive symptoms in family caregivers. This may be due to a decline in the situation they see in the family, the reduction of their free time, feelings of anger and irritability to think that not doing everything we can, and want the family to die (to stop suffering or to "liberate" the keeper of the situation), by neglecting other responsibilities, etc. ..
The main caregiver's psychological problems include depression, anxiety and insomnia, which are the way to express their emotional stress. Caregivers have a high rate of self-medication, especially various types of psychotropic drugs and analgesics.
[4]
VI. STRESS IN THE FAMILY CAREGIVER
Family caregivers, are under a stressful situation and a danger of flooding and depletion of resources that can affect their physical health and also in the state morale and changing the thresholds of perception of suffering and caring person, with which they are in continuous interaction
[5] . As noted by Craig
[6] , "the perception of pain can be mitigated or exacerbated by emotional processes."
In the vast majority of research on the impact caring for an elderly dependent on their primary caregiver has been based on the caregiver's own opinion. From research conducted in Extremadura in 2004, we conducted a survey that valued caregiver stress from the point of view of the old man who was interviewed.
has been observed in research that 22 per 100 family caregivers suffer a significant degree of stress, from the perspective of the old man himself. 11 per 100 of those interviewed considered highly dependent on their caregiver attention facing high psychological stress.
When a man interviewed stressed that there is "concern of the caregiver the situation ", especially in younger age groups, then the percentage drops. When is a woman who values \u200b\u200bthe percentage of stress that gives the caregiver is higher.
Consider the occurrence of an immunosuppressive state that can increase biological vulnerability and compromise the caregiver's health.
Research by Kiecolt-Glaser et al
[7] has shown , dramatically, some of the organizational changes experienced by family caregivers in a very stressful situation Extended: caring for Alzheimer patients.
Studied 13 women attending a family with dementia and 13 control women, matched for age and household income, and virtually all biopsy wound of 3.5 mm, has seen the healing required significantly longer in women who took care of demented relatives compared with control women. The authors conclude that these deficiencies could have important clinical consequences for the recovery of the caretaker if it had to submit, at the time, any surgery. According to Vitaliano
[8] , "the more time the caregivers are healthy, the longer able to maintain their independence, live a full life and provide adequate care to their loved ones."
In his studies of stress, Dr. Mezerville says there is the stress of being alive, because "every cell, tissue, organ or body system undergoes a basic tension that keeps life "
In a general sense, stress is the body's response by which it adapts. The body to give this response has evolved a mechanism that activates the autonomic nervous system to train the body to fight or flee. Biologically, the stimulation is shown by the secretion of the hormone called norepinephrine, epinephrine and cortisol.
The first two are known as adrenaline, which is associated with cortisone to raise the heart rate and blood pressure and galvanic response of the skin by perspiration, and increased the percentage of sugar in the blood and some fatty acids are released from adipose stores. All this biological response is given to to provide energy for defense against aggression, for the achievement of survival and adaptation to new living conditions.
stress-related factors:
psycho: Anger, frustration, fear, jealousy, envy, and other pleasant or unpleasant feelings, feelings of dissatisfaction, lack of motivation and purpose in life.
Physical: hunger, disease, exhaustion, heat or cold, severe climate changes, excessive noise environment, among others.
Biological: malnutrition, poor nutrition caused by excess sugar, salt, fat, coffee, snuff, or alcohol.
Warning signs in front of the stress on care over
- Trouble sleeping (early morning awakening, difficulty sleeping, too much sleep, etc.).
- Loss of energy, chronic fatigue , constant tiredness, etc.
- Isolation
- Excessive consumption of caffeinated beverages, alcohol or snuff. Excessive consumption of sleeping pills or other medications
- Physical problems: palpitations, trembling hands, stomach aches
- memory problems and difficulty concentrating
- Less interest in activities and people who previously were the subject of interest
- Increased or decreased appetite
- repetitive routine acts such as ,
continuously clean - easily get angry
- Giving too much importance to small details
- Frequent changes in mood or mood
- proneness to accidents
- Difficult to overcome feelings of depression or nervousness
- Do not admit the existence of symptoms physical or psychological substantiated by other causes beyond the
care - Treat others the family considered a less than usual. Recommendations
against stress
1. The caregiver must be aware of your stress. 2. From this we must define the areas that generate more stress: bathing, preparing food, cleaning the house. 3. Should make a list of people who can support the Care 4. Coordinate with the learners to support. 5. Divide the task in days, for example on Monday, washing clothes and ironing, Tuesday: cleaning bathroom and the older person, etc.. 6. Caring for food, eating rice, beans, meat cooked, you can keep cooling and heating when necessary.
VII. Caring for the Caregiver. HOW TO IMPROVE THE QUALITY OF LIFE? The Caregiver Support manual prepared by the Social Work Service of the United States, recommends five strategies for caregivers to improve their control over the situation in which they will provide, or are already providing, care
[ 9] : 1) Set yourself realistic goals and expectations, 2) Set your own limits, 3) Ask for and accept help, 4) Taking care of themselves, and 5) Engaging in caring for others.
a) The self-care and the importance of careful planning: It is very important to plan carefully to avoid the negative consequences of caregiver stress. This requires taking into account:
- Division of responsibilities, coordination with other family members, partners and children of the caregiver-social relations, personal needs: to avoid "loss of self" - the place where care-work situation, economy-professional relationship with
Division responsibilities
The elder care involves a variety of tasks and responsibilities, including time and effort, features that make it impossible that the situation could be assumed without problems by one person, it creates a burden. To avoid these situations, it is advisable to clarify who will participate in the care of older people and how they will distribute the roles and responsibilities of care.
Some issues to be addressed would include:
With partner: - To anticipate how it may affect the care situation to the relationship and talk about it with it. - Discuss with your partner about how you feel each one in relation to emerging changes in their lives in relation to the care situation .- aside time for activities with partner .- Involve the pair of any decision regarding the care that children can afectarle.Con: - Explain the situation calmly and sincerity .- Ask them if they are willing to help care .-
Ask them how they feel about the changes that arise in family life in relation to the situation in the care of older family support .- If the older person is provided at home and if the children are willing to cooperate, is advisable to make a distribution of responsibilities and chores .- Let them share in every decision relating to the care that may affect them.
social relations is advisable for caregivers to maintain their social relationships, meaningful social contact with family and friends with whom to laugh and have a good time or mourn and vent their tensions.
In the event that has occurred since the loss of social contacts as a result of the demands of the care situation, it is recommended that the caregiver seek to create new relationships, new relationships positive or friends with whom to share positive experiences that enhance their well-being and lighten your load.
Personal needs: to avoid "losing himself"
Caregivers should keep a list of goals or actions they would like done if you have some free time. So when the time off is given, the person who cares will have objectives and activities which have a good time, training activities, sports, entertainment and more. to help meet their needs and make them feel good.
The place looks
In order to care planning, it is important to note that the place which will take care of the elderly person must meet minimum requirements for space and probably require changes in some of its elements to suit the needs of the elderly.
The employment situation is important to consider the compatibility of careful work to analyze how the employment situation may remain as before or if, conversely, will have to cut working hours or even stop working
economy should assess whether resources are available economic to deal with drug costs, changes in the environment and other aspects of care, also see if other family members are willing to cooperate in economic
The relationship with
professional caregivers can consult with health professionals (doctors, nurses) and social services of any issues related to care. Health professionals should provide quality information about the characteristics of the health problems suffered by elderly dependents, as well as the care they need and how best to provide them.
The social service professionals have to provide caregivers with information on social resources (eg, residential, home care, day care, respite programs, etc.) That can be used, and on the means to access such resources.
b) Intervention by professionals to improve the quality of life of caregivers
To reduce the negative impact on the caregiver, and to improve their quality of life professionals can apply the following measures:
- Information: about the disease, available resources, etc.
- Training: The caregiver should know how to properly care for the elderly (problem solving techniques) and how to take better care of themselves (eg, relaxation).
- Clinical Intervention: Provide psychological support to caregivers dealing with possible psychological problems.
- caregiver support services: The goal of these services is that the caregiver temporary relief from caregiving responsibilities. Can be of different types: short-term stays in nursing homes, home help, volunteering, day center, etc.
- self-help support groups: Encourages emotional expression of the participants and emotional support. Allows them to learn coping strategies and solutions to various difficult situations.
- Psychoeducational interventions are often conducted in groups and the aim is, firstly, to inform and educate caregivers, and other teaching strategies to take better care of themselves.
is important to note that physicians, psychologists, social workers, nurses, etc., Are professionals who can help carers to resolve difficult situations. It is advisable to use them when they detect the "red flags" and not expect to last time.
There are specific guidelines on how to seek help from professionals should be able to convey clearly the problem or need you have.
Then the relationship between the different centers and professional associations:
§ Centers
Councils and Municipal Councils.
Department of Social Services of the Autonomous Community.
Senior Centers (Home and Clubs)
These centers can request information on services and programs for seniors such as home
Help Residential short-term stays. Residential Income
. Day Centres
Financial
, etc.
Associations Volunteer Associations and Services Support of Red Cross and Caritas. Senior
or family associations.
Associations of Relatives of Patients with Alzheimer's. Exist in almost all provinces.
These associations can request all kinds of support and information about services available to seniors and families, and assigning volunteers to assist caregivers. Medical Professionals
Health Center or Clinic. Nurses
Health Center or Clinic.
Personal Social Services.
Medical Services Senior Centers.
These professionals can help caregivers care and advising them how to solve some of the problems to be found.
VIII. ANNEXES socio-demographic description I: Family caregivers according to gender, age, marital status
Source: IMSERSO. Situation and development of informal support to older people in Spain. Performance Report. Madrid: IMSERSO, 2004. Http://www.imsersomayores.csic.es/documentacion/documentos/registro.htm?id=1002 <
>
socio-demographic II Description: Educational level and activity that makes
Source: IMSERSO. Situation and development of informal support to older people in Spain. Performance Report. Madrid: IMSERSO, 2004. Http://www.imsersomayores.csic.es/documentacion/documentos/registro.htm?id=1002 <
>
Description socio-demographic III: Who lives
Source: IMSERSO. Situation and development of informal support to older people in Spain. Performance Report. Madrid: IMSERSO, 2004. Http://www.imsersomayores.csic.es/documentacion/documentos/registro.htm?id=1002 <
>
type of assistance provided
Source: IMSERSO. Situation and development of informal support to older people in Spain. Performance Report. Madrid: IMSERSO, 2004. Http://www.imsersomayores.csic.es/documentacion/documentos/registro.htm?id=1002 <
>
number of older people it serves
Source: IMSERSO. Situation and development of informal support to older people in Spain. Performance Report. Madrid: IMSERSO, 2004. Http://www.imsersomayores.csic.es/documentacion/documentos/registro.htm?id=1002 <
>
The daughters appear as primary caregivers in 38.8% of cases and secondary caregivers in 24, 8%. The spouse also plays an important role in caring. Are primary caregivers in 21.8% of cases.
IX. BIBLIOGRAPHY - Webgraphy
· Bermejo F, Rivera J, Perez del Molino F. Family and social aspects of dementia. Med Clin (Barc) 1997. [
Medline]
· Dunkin JJ, Anderson-Hanley C. Dementia caregiver burden. A review of the literature and guidelines for Assessment and intervention. Neurology 1998, 51 (Suppl 1). [Medline
]
Trocóniz
· Fernandez MI, I Montorio Cerrato, P. Veiga Díaz When older people need ayuda. Guide for caregivers and family members. Madrid: Ministry of Social Affairs and Labour. IMSERSO; 1997.
· Mateos R, MA Ybarzabal intervention and family support. Techniques and their importance. From: Plan Galego care with Alzheimer's disease and other dementias. Rio de Janeiro: Junta de Galicia, Secretary of Health and Social Services.
· Uriarte B, Bouzas. Zaindu program. Paper presented at the III Jornadas Geriatric Role of family in it that people care more. Bilbao, noviembre 2005.
· Rodrigues P, Sancho MT. He apoyo informal Mayor for people in Spain and to social protection for dependency. Del familiarism the rights of citizenship. English Journal of Geriatrics and Gerontology Year 2006.
· Diaz Veiga P, Montorio I, J. Yanguas Intervention caregivers of older people. In: Izal M, Montorio I, editors. Behavioral Gerontology: Basis for action and scope. Madrid: Síntesis, 1999.
· Losada A. Influence of dysfunctional thoughts about care in the psychological distress of caregivers of dependent elderly. Universidad Autónoma de Madrid: Unpublished thesis, 2005.
·
http://www.alz.org/ ·
http://www.caregiver.org/ ·
http://www.portalmayores.com/
·
http://www.medline.com/ ·
http://www.psycinfo.com/ http://www.dialnet.com/ [1] MC De los Reyes. Building the concept of elder-care. Research Forum, aging population. Curitiba, Brazil: MERCOSUR, 2001.
[2] Trocóniz Fernandez MI, I Montorio Cerrato, P. Veiga Díaz When older people need help. Guide for carers and family. Madrid: Ministry of Labour and Social Affairs. Imserso, 1997.
[3] Bermejo F, Rivera J, Perez del Molino F. Family issues and social dementia. Med Clin (boat) 1997, 109:140-146. [
Medlin ]
[4] Mateos R, MA Ybarzabal intervention and family support. Techniques and their importance. From: Plan Galego care with Alzheimer's disease and other dementias. Rio de Janeiro: Junta de Galicia, Secretary of Health and Social Services. p. 126-129.
[5] Baines M. Tackling total pain. In Saunders C ed Hospice and palliative care. London: Arnold 1990, 26-38. 6
Craig KD. Emotional aspect of Pain. In Wall PD Melzack R eds Texbook of pain. Edinburgh: Churchill Livingstone 1984, 153-161.
[7] Kiecolt-Glaser JK, Marucha PT, Malarkey AM, Mercado AM, Glaser R. Psychological stress slows wound healing. Lancet (Ed Esp) 1996, 28, 188-191.
[8] Vitaliano PP. Physiological and physical concomitants of caregiving: Introduction to special issue. Ann Behav Med 1997, 19 (2), 75-77
[9] Social Work Service. Caregivers support group manual. Topeka, Kansas: Colmery-O'Neil VA Medical Center, 1990
