[The experience of women care cargivers with chronic conditions of dependent relatives]

Effectiveness of interventions aimed at improving grief and depression in caregivers of people with dementia: A systematic review and meta-analysis

Caregivers of people suffering from dementia may go through a grieving process prior to the death of the cared-for person, which is related to mental health and physical problems. Interventions aimed at improving grief and depression are being used in response to these difficulties. The aim of this study was to synthesize and evaluate the evidence for the effectiveness of interventions aimed at improving the grief process in home-based caregivers of people with dementia with the aim of reducing grief and depression. A systematic review, including a meta-analysis, was designed. Following the PRISMA guideline, original articles were searched in the databases: Medline, WOS, Scopus and PsycINFO, up to September 2022. Articles that evaluated interventions aimed at improving the grief process in caregivers of people with dementia, whose care recipients were alive at the beginning of the study at minimum and living at home were selected. Grief and depression were considered outcome variables. A meta-analysis was carried out with a fixed effects model for these variables and for the domains of the Caregiver Grief Scale (CGS). Eight articles met the inclusion and exclusion criteria. Most of the interventions aimed at improving the grief process showed an improvement in grief and depression. The 'emotional pain' and 'absolute loss' domains of the CGS stood out with an improvement in these variables. Interventions aimed at improving the grief process are relatively effective in reducing grief and depression. Interventions that are even more effective and more robust studies are needed.

A Cross-Sectional Study about the Associations between Physical Activity Level, Self-Perceived Health Perception and Mental Health in Informal Caregivers of Elderly or People with Chronic Conditions in Spain

Providing informal care for older people, or people with chronic conditions, is associated with poorer physical and mental health and reduced quality of life. This task, in many cases, often relies on the women in the immediate family. Physical activity (PA) is a tool to enhance caregivers' physical and mental health and their quality of life. Thus, this study aimed to analyse the associations between the physical activity level (PAL), self-perceived health (SPH) and mental health (SM) and its factors (positive coping, self-esteem, and stress) by conducting a cross-sectional study by using data from in the National Health Survey 2017 (ENSE 2017), the last one before the COVID-19 pandemic. The sample included 2225 caregivers (866 men and 1361 women). Descriptive analysis and non-parametric statistical tests, including chi-square, the Kruskal-Wallis test, the Mann-Whitney U test, and the Spearman's rho correlation coefficient, were used. Dependence relationships were found between PAL and SPH and MH and their factors. The population groups that performed moderate or vigorous PA showed better results in both SPH and MH. Women scored worse than men in all the variables analysed. Hence, intense, or moderate PA practice may improve SPH and MH in Spanish informal caregivers, requiring the implementation of policies and programs considering the differences found between men and women in PAL, SPH, and MH.

Mobile Apps for Helping Informal Caregivers: A Systematic Review

(1) Background: The physical and psychological consequences suffered by informal caregivers have been extensively studied. MHealth solutions appear to be an opportunity to help overcome the caregiver burden. The objective of this study was to evaluate available mobile applications for informal caregivers of people who are ill and to determine whether these mobile applications were developed considering the needs of caregiver users. (2) Methods: A systematic review was carried out using the MEDLINE, ProQuest, and Scopus databases. The information about mobile applications for informal caregivers was analyzed. This review examined studies published between January 2011 and July 2020 in English. The data extracted from each paper included the development of the mobile application, if that application was assessed considering the caregivers’ needs, functions of the mobile application, measures for evaluating caregivers’ needs, measures for evaluating the effectiveness of the mobile application, and the main results obtained. (3) Results: Eleven studies fulfilled the inclusion criteria. The most common functions of the apps were summaries with information about the person they care for, educational information, resources and services for caregivers, solutions to common problems during care, and questionnaires to assess caregivers’ well-being. Most of these studies assessed caregivers’ needs before designing mobile applications to adapt them to the needs of their users. (4) Conclusions: Mobile applications for caregivers appear to provide solutions for them. Moreover, the effectiveness of these apps will depend largely on whether their characteristics match users’ needs. Current studies have shown the poor quality of evidence.

Relationship of Perceived Social Support with Mental Health in Older Caregivers

Background: Elderly caregivers present increased physical and mental health problems. These factors can lead to a lack of autonomy and a need for social support. This study aims to analyse the relationships between perceived social support and mental health status in elderly caregivers aged 65 and older. Methods: a cross-sectional study based on data from the Spanish National Health Survey (ENSE-17) carried out on 7023 people. The study population was restricted to 431 caregivers aged ≥65 years. A study of the correlation between the mental health state and the perceived social support was carried out. Both variables were related to the sex of the caregiver. Results: Perceived social support by older caregivers is significantly related to mental health (p = 0.001), and stress (p < 0.001). Also, there is a significant relationship between perceived social support and mental well-being (p = 0.001), self-esteem (p = 0.005) and stress (p = 0.001) in older women caregivers. Conclusions: Older caregivers have adequate mental well-being and perceive high social support. Perceived social support can contribute to improving the mental well-being of older caregivers.

Physical Strength Perception of Older Caregivers in Rural Areas

Background and objective: In an aging population, it is increasingly common for older adults to take care of other older adults. Caregiving tasks may be conditioned by the aging process. This study aims to analyze the perceived physical strength of older caregivers and its impact on the functional capacity to engage in caregiving activities. Methods: A discretionary sampling of caregivers (N = 107), ≥65 years old, in the rural health area of Badajoz (Spain) participated in this cross-sectional study. Measurements included questions about the caregiver’s role (experience, years, hours, difficulties, demands) and their perceived physical strength, ability to perform activities of daily living (ADL), need for help or difficulty for caring. Results: Older caregivers from rural areas perceived a lack of physical strength (71%). These caregivers need more help, have more difficulties, and show less ability to perform ADL. Furthermore, around 80% of the people who had a lack of strength were caring for people with severe or total dependence. There is a direct correlation between the perceived lack of physical strength and the ability to perform basic (r = 0.382, p < 0.01) and instrumental (r = 0.370, p < 0.01) activities. Conclusions: Therefore, the perception of strength and the characteristics of the cared for person may be crucial variables to successfully conduct caregiving tasks.

Experiences of family care during breast cancer: the perspective of caregivers

OBJECTIVE

To describe the experience of family care to women with breast cancer during treatment from the perspective of caregivers in the Mexican context.

METHOD

Qualitative phenomenological study. In-depth interviews were conducted with caregivers of women who survived breast cancer. Participants were selected by intentional, cumulative and sequential sampling. A conventional content analysis was performed.

RESULTS

Participation of seven caregivers, who reported their positive and negative experiences when assuming their role as informal caregivers in the family context. On the strength of the reciprocity of care and its reward, prevailed critical moments, negative feelings, and lack of support resources during the experience. This enables the understanding of the informal care bond in order to enhance it with coping strategies and specific guidance from the nursing staff.

CONCLUSION

Participants experienced a transformation in their identity as caregivers and by being aware of their experience, they could describe their qualities, which increased their coping strategies with the disease and the care challenges.

The gender perspective in the opinions and discourse of women about caregiving

OBJECTIVE

To investigate the meanings given by women caregivers to their care practices and to analyze the relationship between such practices and their work history.

METHOD

This was a phenomenological qualitative cohort study conducted in Seville, Spain, with family caregivers. Data were collected using semi-structured interviews and submitted to content analysis, using Atlas-ti GmbH software version 5.0®. The following categories emerged: caregiving history and work history, and the meaning of care in their lives.

RESULTS

Twenty caregivers participated in the study. Women caregivers told stories of wide-ranging care, including several individuals in their family at different moments. They performed different forms of care, encompassing physical and social dimensions. Their discourse expressed the contradiction between their caregiving role and entering and/or maintaining their place in the labor market.

CONCLUSION

The women expressed a concept of comprehensive care that includes responsibility, availability, and companionship, as well as emotional states, which greatly impact health. They tailored their participation in the labor market according to their family's care needs. Thus, the gender perspective must be incorporated by health care providers who work with the health of caregivers.

Being caregiver of people with Parkinson's Disease: experienced situations

ABSTRACT Objective: To understand the experience of caring for a person with Parkinson's Disease. Method: We used the qualitative study and thematic analysis with family caregivers of people with Parkinson's Disease. Results: Three thematic categories were identified, being: Feelings related to Parkinson's Disease; Changes in family daily routines; Caregiver strategies for self-care. Final considerations: Family care has shown the need for health services to provide caregivers support, as they experience situations of overload in care that can contribute to their illness. The findings also allow nurses to see the need for differentiated care for caregivers that, by assisting them with their needs, favor the quality of life of the caregiver, reduce the possibility of illness, allowing a more efficient care to the entity with chronic illness.

[The first moments of the carer: The process of becoming a caregiver of a dependent elderly relative]

Objetivo

Describir el proceso inicial por el que pasan las personas que se convierten inminentemente en cuidadores de algún familiar mayor en situación de dependencia.

Diseño

Estudio cualitativo cuyo análisis se ha regido por los principios de la teoría fundamentada.

Emplazamiento

El estudio se ha realizado en los distritos sanitarios de Jaén, durante 2015 y 2016, a nivel comunitario.

Participantes y/o contextos

La captación se realizó mediante los enfermeros gestores de casos de los Centros de Salud de cada distrito sanitario, los cuales localizaron participantes que cumpliesen los criterios de inclusión y los invitaban a participar en el estudio.

Método

Se han llevado a cabo 11 entrevistas en profundidad a personas que llevan cuidando menos de un año a un familiar mayor con dependencia hasta la saturación de la información.

Resultados

Tres fases han sido descritas durante este proceso. Una fase inicial de cambios, en los que la persona cuidadora asume nuevas actividades; una segunda fase atestada de emociones, en la que emergen necesidades y consecuencias en las personas cuidadoras; y una tercera fase donde destaca la aceptación como estrategia de afrontamiento y la incertidumbre como expectativa de futuro.

Discusión

La descripción de este proceso proporciona una mejor comprensión de la experiencia de convertirse en persona cuidadora familiar, con el fin de ayudar a los profesionales de la salud a adaptar los planes de atención a esta situación inicial.

[Usefulness of the budget and the balanced scorecard in managing Primary Care Centres. Impact on staff motivation]

OBJECTIVE

To analyse the utility perceived by managers of centers of primary care about management tools (budget and balanced scorecard), together their impact on human resources motivation.

DESIGN

Qualitative study (case study) based on grounded theory performed between January and June 2014.

LOCATION

Units of Clinical Management of Primary Health (UGCAP) in Metropolitan Health Area of Seville, Spain.

PARTICIPANTS

UGCAP managers and Health Area (CEO) managers.

METHOD

Data were collected through 8 semi-structured interviews using non-probabilistic intentional sampling with representation and sufficiency criteria of discourse. Interviews were recorded, literally transcripted and analysis through in-vivo codes.

RESULTS

Both tools are fully implemented but differently used in primary care centers. Budget is perceived as a coercive management tool, which has been imposed for cost saving; however, it is scarcely adequate for day-by-day management. While balanced scorecard is a more flexible tool that allows identifying financial and welfare problems, budgeting limits heavily reduce the possibility of implementing adequate solutions. The policy of incentives is not adequate either, leading on de-motivation.

CONCLUSIONS

This study shows that budgeting restrictions have led to a significant reduction in autonomy of Spanish Primary Care centers. Management decision making is much centralised, also focused on cost saving over quality of healthcare. As a result, two needs emerge for the future: increasing centers' autonomy and improving staff commitment through training and professional development programs.