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Young MJ. Disorders of Consciousness Rehabilitation: Ethical Dimensions and Epistemic Dilemmas. Phys Med Rehabil Clin N Am 2024; 35:209-221. [PMID: 37993190 DOI: 10.1016/j.pmr.2023.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Patients with disorders of consciousness who survive to discharge following severe acute brain injury may face profoundly complex medical, ethical, and psychosocial challenges during their courses of recovery and rehabilitation. Although issues encountered in caring for such patients during acute hospitalization have received substantial attention, ethical challenges that may arise in subacute and chronic phases have been underexplored. Shedding light on these issues, this article explores the landscape of normative issues in the course of treating and facilitating access to care for persons with disorders of consciousness during rehabilitation and examines potential implications for patients, clinicians, family members, and society.
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Affiliation(s)
- Michael J Young
- Department of Neurology, Massachusetts General Hospital, Center for Neurotechnology and Neurorecovery, 101 Merrimac Street, Suite 310, Boston, MA 02114, USA.
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Dixe MDACR, da Conceição Teixeira LF, Areosa TJTCC, Frontini RC, de Jesus Almeida Peralta T, Querido AIF. Needs and skills of informal caregivers to care for a dependent person: a cross-sectional study. BMC Geriatr 2019; 19:255. [PMID: 31533637 PMCID: PMC6749667 DOI: 10.1186/s12877-019-1274-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 09/10/2019] [Indexed: 01/10/2023] Open
Abstract
Background The world is facing many socio-demographic changes, such as an increased average life expectancy and the presence of chronic and non-communicable diseases, which in turn, leads to an enhanced dependency on others. Consequently, the demand for informal caregivers has significantly increased during the past few years. Caring for a dependent person is linked to a series of burdens that often leads to physical, psychological and emotional difficulties. Taking into consideration the difficulties faced by informal caregivers, knowing in which areas of functioning they need more guidance may help to relieve their burden. Therefore, the main goal of this study is to better understand the needs and competencies of the informal caregiver when caring for a dependent person in the different self-care domains. Methods This cross-sectional study used a questionnaire administered on a single occasion by face-to-face interview. Descriptive and inferential statistics alongside non-parametric statistical techniques such as the Mann-Whitney test and Spearman’s correlation were used. Results The average age of the 143 informal caregivers is 58 years old, with the youngest in our sample being 21 years of age. Most of them are female, and 50% of them are children taking care of one of their parents. Most of the dependent people are completely dependent in the areas of comfort and hygiene (53.8%) and medication management (55.9%). The female informal caregivers see themselves as having more competencies in sanitary hygiene than the male ones, with no significant differences in their competencies’ perception in the other areas of self-care. Older caregivers see themselves as less competent in certain areas of self-care such as feeding, mobility, transfers, medication and symptoms management and communication. Most of the information given to the informal caregiver is about the disease (82.3%) and the medication management (80.4%). There are still a lot of areas of self-care, where no information, or almost none, is given to the informal caregivers. Conclusions Before home discharge of a dependent person, it is important to acknowledge the needs and competencies of the informal caregiver, to capacitate them in looking after their relatives, to help decrease their burden and consequently, decrease the number of hospital readmissions.
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Affiliation(s)
- Maria Dos Anjos Coelho Rodrigues Dixe
- Center for Innovative Care and Health Technology, Escola Superior de Saúde do instituto Politécnico de Leiria, Campus 2 - Morro do Lena, Alto do Vieiro - Apartado 4137, 2411-901, Leiria, Portugal. .,Escola Superior de Saúde do instituto Politécnico de Leiria, Campus 2 - Morro do Lena, Alto do Vieiro - Apartado 4137, 2411-901, Leiria, Portugal.
| | - Liliana Fernanda da Conceição Teixeira
- Center for Innovative Care and Health Technology, Escola Superior de Saúde do instituto Politécnico de Leiria, Campus 2 - Morro do Lena, Alto do Vieiro - Apartado 4137, 2411-901, Leiria, Portugal.,Escola Superior de Saúde do instituto Politécnico de Leiria, Campus 2 - Morro do Lena, Alto do Vieiro - Apartado 4137, 2411-901, Leiria, Portugal
| | - Timóteo João Teixeira Camacho Coelho Areosa
- Center for Innovative Care and Health Technology, Escola Superior de Saúde do instituto Politécnico de Leiria, Campus 2 - Morro do Lena, Alto do Vieiro - Apartado 4137, 2411-901, Leiria, Portugal
| | - Roberta Caçador Frontini
- Center for Innovative Care and Health Technology, Escola Superior de Saúde do instituto Politécnico de Leiria, Campus 2 - Morro do Lena, Alto do Vieiro - Apartado 4137, 2411-901, Leiria, Portugal
| | - Teresa de Jesus Almeida Peralta
- Center for Innovative Care and Health Technology, Escola Superior de Saúde do instituto Politécnico de Leiria, Campus 2 - Morro do Lena, Alto do Vieiro - Apartado 4137, 2411-901, Leiria, Portugal.,Centro Hospitalar de Leiria, Rua das Olhalvas, 2410-197, Leiria, Portugal
| | - Ana Isabel Fernandes Querido
- Center for Innovative Care and Health Technology, Escola Superior de Saúde do instituto Politécnico de Leiria, Campus 2 - Morro do Lena, Alto do Vieiro - Apartado 4137, 2411-901, Leiria, Portugal
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