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      Caracterización psicosocial de cuidadores informales de adultos mayores con demencia Translated title: Psychosocial characterization of informal caregivers of older adults suffering from dementia

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          Abstract

          IntroducciónEl envejecimiento de la población es sin duda la principal característica demográfica de Cuba, en la actualidad y también perspectivamente, dada sus implicaciones económicas y sociales. Objetivos Describir características demográficas, sociales, psicológicas y otras de 61 cuidadores informales de personas que padecen demencia y que habían recibido atención en el Centro Iberoamericano para la Tercera Edad en La Habana, de 2004 a 2005. Métodos Se utilizó para la recogida de los datos el Cuestionario de Caracterización y la Escala Psicosocial del cuidador. Resultados Los cuidadores informales estudiados se caracterizaron por ser en su mayoría del sexo femenino, entre los 40 y 59 años, hijos de los enfermos, casados, sin vínculo laboral en un alto porcentaje y predominio de universitarios en la muestra. La mayoría de los cuidadores atendían al enfermo por razones afectivas, no tenían experiencia de cuidar a un enfermo crónico y llevaban menos de 1 año en esta labor, no tenían información acerca de la enfermedad, padecían de problemas nerviosos, óseos y musculares, entre otros y su estrategia de afrontamiento era, funadamentalmente, la búsqueda de apoyo externo. La afectación de índole socioeconómica se encontró mayormente en el poco tiempo libre, problemas económicos y conflictos familiares. Los sentimientos negativos más frecuentes fueron la angustia o aflicción, la ira, el miedo y la desesperanza. Conclusiones Los cuidadores informales tiene afectaciones múltiples relacionadas con la salud física y mental así como en el orden social y económico, por lo que se hace inminente la búsqueda de alternativas de apoyo puesto que, además de las dificultades planteadas, no cuentan con un mínimo de información acerca de la demencia y de los problemas que tiene el adulto mayor al que ofrecen sus cuidados, a pesar de tener un nivel de enseñanza superior en su mayoría.

          Translated abstract

          Introduction Population aging is beyond any doubt the main demographic feature in Cuba at present day and in prospect, given its economic and social implications. Objectives To describe demographic, social, psychological and other kind of characteristics of 61 informal caregivers of persons suffering from dementia who had been treated at the Ibero-American Center of the Old Age located in the City of Havana from 2004 to 2005. Methods The Characterization Questionnaire and the Psychosocial Scale of the Caregiver were the means to collect data. Results The studied informal caregivers were females aged 40 to 59 years, daughters of the sick persons, married, non-working women at that time and predominantly with a university degree. The majority of caregivers took care of the sick people because of affectionate reasons, was inexperienced in managing a chronically ill patient and had spent less than a year in doing this task. They did not have any sort of information about the disease, suffered nervous, bone and muscle problems and their strategy to address the situation was mainly to look for third-party support. The socioeconomic effects basically centered in little leisure time, financial restrains and family conflicts. The most frequent negative feelings were anguish, anger, fear and hopelessness. Conclusions Informal caregivers are affected in multiple ways related to their physical and mental health, as well as in the economic and social fields, so it is urgent to look for supporting alternatives since, in addition to the stated difficulties, the caregivers do not have basic information about dementia and the problems that the affected older person may face, despite the fact that most of them have higher educational level.

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          Caregiving as a risk factor for mortality: the Caregiver Health Effects Study.

          There is strong consensus that caring for an elderly individual with disability is burdensome and stressful to many family members and contributes to psychiatric morbidity. Researchers have also suggested that the combination of loss, prolonged distress, the physical demands of caregiving, and biological vulnerabilities of older caregivers may compromise their physiological functioning and increase their risk for physical health problems, leading to increased mortality. To examine the relationship between caregiving demands among older spousal caregivers and 4-year all-cause mortality, controlling for sociodemographic factors, prevalent clinical disease, and subclinical disease at baseline. Prospective population-based cohort study, from 1993 through 1998 with an average of 4.5 years of follow-up. Four US communities. A total of 392 caregivers and 427 noncaregivers aged 66 to 96 years who were living with their spouses. Four-year mortality, based on level of caregiving: (1) spouse not disabled; (2) spouse disabled and not helping; (3) spouse disabled and helping with no strain reported; or(4) spouse disabled and helping with mental or emotional strain reported. After 4 years of follow-up, 103 participants (12.6%) died. After adjusting for sociodemographic factors, prevalent disease, and subclinical cardiovascular disease, participants who were providing care and experiencing caregiver strain had mortality risks that were 63% higher than noncaregiving controls (relative risk [RR], 1.63; 95% confidence interval [CI], 1.00-2.65). Participants who were providing care but not experiencing strain (RR, 1.08; 95 % CI, 0.61-1.90) and those with a disabled spouse who were not providing care (RR, 1.37; 95% CI, 0.73-2.58) did not have elevated adjusted mortality rates relative to the noncaregiving controls. Our study suggests that being a caregiver who is experiencing mental or emotional strain is an independent risk factor for mortality among elderly spousal caregivers. Caregivers who report strain associated with caregiving are more likely to die than noncaregiving controls.
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            Dementia caregiver burden: a review of the literature and guidelines for assessment and intervention.

            Alzheimer's disease (AD) and other dementias are common degenerative disorders in the elderly. Most AD patients are cared for at home by family members, usually elderly spouses. Although caregiving is associated with significant psychological and physical morbidity, there are wide individual differences among caregivers in how well they adapt to caregiving demands. In addition, recent data suggest that caregiver variables can be important determinants of AD patient institutionalization and that AD patients living with highly distressed caregivers may exhibit higher frequencies of behavioral problems and agitation than those living with less distressed caregivers. Predictors of caregiver outcome, predictors of institutionalization, and the effect of the caregiver on the course and symptomatology of dementia are described. A model of assessment and intervention for the physician, referral processes, and resources for the caregiver are presented.
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              A population-based assessment of the impact and burden of caregiving for long-term stroke survivors.

              Little attention has been focused on the demands on caregivers in stroke outcome research. A major aim of this study was to identify factors in patients associated with emotional distress in caregivers 1 year after stroke. One-year stroke survivors with residual handicap (defined by the Oxford Handicap Scale) and their chief caregivers were interviewed as part of the follow-up activities for patients (n = 492) registered with the Perth Community Stroke Study. We assessed emotional distress in caregivers using the Hospital Anxiety and Depression Scale and the 28-item General Health Questionnaire. Appropriate sections of the Social Behaviour Assessment Schedule were used to assess the patient's behavior and the impact on the caregiver's life. Other aspects of the patient's functional state were assessed with the Barthel Index, the Mini-Mental State Examination, the Frenchay Activities Index, and the Psychiatric Assessment Schedule (at 4 months after stroke). Of 241 patients who survived to 1 year after stroke and were living outside of an institution, 103 patients (43%; 95% confidence interval, 37% to 49%) were handicapped. Eighty-four patient/caregiver units were assessed from this latter group. Almost all caregivers reported adverse effects on their emotional health, social activities, and leisure time, and more than half reported adverse effects on family relationships. Forty-six caregivers (55%) showed evidence of emotional distress on either of the two screening instruments, particularly if they were caregiving for patients with dementia and/or abnormal behavior. There was no significant relationship between emotional illness among caregivers and the degree of patients' physical disability. In this population, the high level of emotional distress among caregivers of stroke patients suggests that many caregivers have unmet needs. Community services need to focus attention on the neuropsychological aspects of stroke patients and the social functioning of caregivers who support them.
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                Author and article information

                Journal
                rcsp
                Revista Cubana de Salud Pública
                Rev. cub. salud pública
                Centro Nacional de Información de Ciencias Médicas (La Habana, La Habana, Cuba )
                0864-3466
                1561-3127
                September 2008
                : 34
                : 3
                Affiliations
                [01] La Habana orgnameEscuela Latinoamericana de Medicina Cuba
                Article
                S0864-34662008000300008 S0864-3466(08)03400308
                88461e54-4900-4c2d-8c45-1808127c29e4

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 21 March 2008
                : 24 January 2007
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 23, Pages: 0
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                SciELO Public Health

                Self URI: Texto completo solamente en formato PDF (ES)
                Categories
                INVESTIGACION

                Cuidador informal,demencia,anciano dependiente,Informal caregiver,dementia,dependent aged person

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