Variables related to the informal caregivers’ burden of dependent senior citizens in Spain
Introduction
The main objective of this work is to analyze the variables associated with the informal caregivers’ burden of dependent senior citizens. Specifically, it evaluates the influence of characteristics associated to the care context and the informal caregiver as well as the health and sociofamily situation of the dependent senior citizens on the level of the informal caregivers’ burden, with the final aim to establish psychosocial guidelines to relieve their burden.
In Spain, the same as in other developed countries, the dependency, i.e., the state in which persons, by reason of lack or loss of physical or psychological autonomy, require assistance or help from others to perform daily activities (Council of Europe, 1998), is currently a worrying problem, especially for women, the primary caregivers to family members and closed friends with a dependency condition. For example, the latest data from the Spanish Ministry of Work and Social Affairs reports that 84% of the informal caregivers of dependent older people are women (IMSERSO, 2004). In many cases, the burden appears as the result of the years and constant dedication of care, which the caregiver women provide to the dependent persons. This burden leads to the appearance of physical health problems and especially psychological problems, which in turn undermine their caregiver capacity. In our context, the solutions for this burden still have a limited development.
The Spanish Government has recently implemented legislative modifications in relation to the protection of dependency situations, where a new law called the Law of Promotion of Personal Autonomy and Care to Persons in a Dependency Situation is entered into force on first January 2007 (Available in English at: http://www.seg-social.es/imserso/normativas/lawdependentpersons.pdf). This new legislative framework will suppose greater care to dependent persons and their caregivers from the Spanish Social Protection system. Although the definitions of the measures that shall be adopted are still very general, the law has focused on respite services and economic aid to the caregivers to relieve their burden situation. Notwithstanding, as acknowledged in the White Paper on Dependency, a basic preliminary text to make government decisions and policies for this new Law, the implantation and start-up of actions are also required in favor of the well-being of the caregivers and the maintenance of the informal care system in Spain as represented by the psychosocial programs which shall contribute to prevent the abandonment and institutionalization of the dependent person (MTAS, 2005).
The complementarity and suitability of the psychosocial programs for the burdened informal caregivers with the respite services is especially relevant in Spain if we take into account the current low coverage of the respite services available in the Spanish General Public Network of Social Services such as the HHS and the Day Centers and the practically non-existent psychological care to the caregivers in or outside this type of resources from the public Administration (Garcés, 2000, MTAS, 2005).
The effectiveness in the design of the psychosocial intervention programs involves the knowledge of the main variables related to the appearance of the burden in the informal caregivers of dependent senior citizens. The results of the research, guided in the majority of cases by the theoretical framework of Pearlin by means of his Stress Process Model (Pearlin et al., 1989, Pearlin et al., 1990, Pearlin, 1991) has determined the choice for the study of the determining variables of the informal caregiver burden. In this sense, scientific thought shows the existence of multiple variables associated to the caregiver burden, among which it is possible to highlight, in Pearlin's terms, that the variables of the care context as well as the primary stress factors comprise a primary generator core of the burden whereas the secondary stress factors represent the proliferation of the emotional discomfort and burden in other areas of life.
The studies have shown that care context variables such as sociodemographic variables of the caregiver, specifically the young age, being female, the low income level of the caregiver and if this person has a job, and the relationship between the caregiver and the care recipient, such as the caregiver, the spouse, before the children and the coexistence of the day caregiver and the dependent person, appear as variables intensely related to the burden of the caregiver (Gaugler et al., 2000, IPA, 2002, FCA, 2003). Equally, the primary stress factors such as the behavioral problems of the dependent person to a great degree cause burden, emotional discomfort, exhaustion, and emotional mood disorders in the caregiver more than the cognitive deficiencies and dependency for the activities of daily life (Dunkin and Anderson-Hanley, 1998, Gaugler et al., 1999, Hawranik and Strain, 2000).
Section snippets
Sample and data collection
This study forms a part of a more extensive investigation focused on analyzing the impact of the Spanish public HHS on the informal caregivers’ burden of dependent senior citizens. The sample of dependent persons was selected at random based on the population of HHS users and by means of the waiting lists of the applicants for this service, respectively, in cities of the Valencian Community (Spain) during 2001. The sample was comprised by 296 subjects, 236 dependent users of HHS and 60
Health and sociofamily profile of the dependent senior citizens
In relation to the health indicators measured, the results indicate that dependent senior citizens of this study show a slight degree of dependency in order to perform the BADL (); a serious dependency on others to carry out the IADL , with an average of 4.7 ± 3.9 BADL and 3.3 ± 2.8 IADL with dependency, and they essentially suffer (Table 2) from diseases of the circulatory system (28.3%) and the musculoskeletal and connective tissue (16.2%) with an average number
Discussion
The main objective of this investigation has been focused on analyzing the variables associated with the informal caregivers’ burdens of dependent senior citizens in a Spanish Autonomous Region (Valencian Community). Specifically, this work has studied the variables in reference to the characteristics of the provision of care, the caregiver, and the dependent person on the informal caregiver's burden in their relation with the burden to plan future interventions from psychology.
In the first
Conclusions
The exhaustive analysis which we have performed until now allows us to extract a series of conclusions which are relevant at the time of proposing intervention strategies destined to relieve the informal caregiver's burden: the variables which appear to determine the caregiver burden in a greater degree in a joint way are those associated to the specific disease and social situation of the dependent person; the greater frequency and intense attention invested in the care determines the high
Acknowledgements
The authors acknowledge the Ministry of Science and Education (SEC 2002-02634) and the Consellerías de Sanitat y de Bienestar Social of the Generalitat Valenciana (Spain) for the funding provided for this project.
References (52)
- et al.
The daily center care on impact of family burden
Arch. Gerontol. Geriatr.
(2007) - et al.
Burden and quality of life of caregivers for hemodialysis patients
Am. J. Kidney Dis.
(2002) The costs of family caregiving: implications for geriatric oncology
Crit. Rev. Oncol. Hematol.
(2003)- et al.
Profiles in Caregiving: The Unexpected Career
(1995) - Bass, D.M., 2002. Content and Implementation of a Caregiver Assessment. Issue Brief, National Family Caregiver Support...
Carers: training informal carers
- et al.
Psychosocial effects on carers of living with persons with dementia
Aust. N. Z. J. Psychiatry
(1990) - et al.
Evaluación de la fiabilidad y validez de una escala de valoración social en el anciano
Atención Primaria
(1999) - et al.
Reverberations of family illness: a longitudinal assessment of informal caregiving and mental health status in the Nurses’ Health Study
Am. J. Public Health
(2002) - et al.
Evaluation of “The Home Help Service” and its impact on the informal caregiver's burden of dependent elders
Int. J. Geriatr. Psychol.
(2007)
Burden and well-being among caregivers: examining the distinction
Gerontologist
Caregiving tasks as predictors of mental health of wife caregivers of men with chronic obstructive pulmonary disease
Res. Nurs. Health
Resultados de la aplicación de una escala de valoración sociofamiliar en Atención Primaria
Rev. Españ. Geriatr. Gerontol.
Dementia caregiver burden: a review of the literature and guidelines for assessment and intervention
Neurology
Fact Sheet: Women and Caregiving: Facts and Figures
Change in indices of distress among Latino and Anglo female caregivers of elderly relatives with dementia: site-specific results from the REACH national collaborative study
Gerontologist
Predictors of decreased self-care among spouse caregivers of older adults with dementing illnesses
J. Aging Health
La nueva sostenibilidad social
Caregiving and institutionalization: perceptions of family conflict and socioemotional support
Int. J. Aging Hum. Dev.
Modeling caregiver adaptation over time: the longitudinal impact of behavior problems
Psychol. Aging
Family caregiver burden: results of a longitudinal study of breast cancer patients and their principal caregivers
Can. Med. Assoc. J.
Health of Informal Caregivers: Effects of Gender, Employment, and Use of Home Care Services
Behavioral and Psychological Symptoms of Dementia (BPSD) Educational Pack
Cited by (24)
Time trends in health inequalities due to care in the context of the Spanish Dependency Law
2017, Gaceta SanitariaCitation Excerpt :Caring for others also affects other aspects of life, undermining personal development and opportunities to enjoy leisure time and a social life.6 These health effects are due to the conditions under which care is given, rather the care itself, and are likely modulated by the amount of time devoted to caregiving,7,8 the type of activities carried out,9 social support,10 and formal and informal networks to complement care activities.7,11 In addition, cultural norms and motivation to provide care could also influence the burden.12
Association of impairments of older persons with caregiver burden among family caregivers: Findings from rural South India
2017, Archives of Gerontology and GeriatricsCitation Excerpt :Further, we concentrate on assessing the association of specific impairments of the older person with family caregiver burden. Most previous studies on correlates of caregiver burden consider only impairments in physical function (measured as an ADL limitation score, or number of ADL limitations, or limitation in a particular ADL item, or extent of ADL limitation) (Awad, El Gammal, Fahmy, & Imam, 2010; Faison, Faria, & Frank, 1999; Garcés, Carretero, Ródenas, & Sanjosé, 2009; Lee, Yoon, & Kropf, 2007; Salama & El-Soud, 2012) and/or cognition (measured as a score) (Awad et al., 2010; Lee et al., 2007) of the older person, neglecting sensory impairments such as in vision and hearing. Considering the stress process model (Pearlin et al., 1990), detailed above, which portrays impairments of the older person as ‘primary stressors’, as the theoretical basis for our analysis, we test the following hypotheses: (1) Presence of each type of impairment (in physical function, cognition, near vision and hearing) of older persons is independently associated with family caregiver burden, and (2) Increase in the number of impairments of older persons is associated with an increase in family caregiver burden.
Burden reduction of caregivers for users of care services provided by the public long-term care insurance system in Japan
2014, Archives of Gerontology and GeriatricsCitation Excerpt :In Japanese LTCI care recipients with more advanced care need certifications are afforded more services. Greater frequency and intensity of care services have been associated with the perception of reduced care burden (Garcés, Carretero, Ródenas, & Sanjosé, 2009). In the current study adjustment by the number of different types of care services used did not change the association of the need classification with the reduction of care burden in the multiple logistic analysis.
The influence of neuroticism and extraversion on the perceived burden of dementia caregivers: An exploratory study
2013, Archives of Gerontology and GeriatricsCitation Excerpt :An increasing caregiver burden is known to decrease life satisfaction (Andrén & Elmståhl, 2008). Diverse variables in reference to the care context and the caregiver as well as the care recipient show major associations with the burden: those associated to disease and the social situation of the dependent person, the greater frequency and intensity of care, and the low frequency in which the caregiver receives help from others (Garcés, Carretero, Ródenas, & Sanjosé, 2009). However, it is important to highlight that, in general, those studies are focused on the burden of immediate factors such as the impact of the cognitive deficits, help with everyday functioning and behavioral and psychological factors.
A review of programs to alleviate the burden of informal caregivers of dependent persons
2010, Archives of Gerontology and GeriatricsCitation Excerpt :In the Spanish context, it is especially important that such programs address the female population considering that recent data shows that in Spain, 84% of the informal care of dependents is given by women (IMSERSO, 2004); and (c) further study of other variables of the dependent person and of the care context that are associated with the caregiver burden, in order to determine which characteristics can be modified by psycho-educational intervention (Carretero et al., 2007, 2008; Garcés et al., 2009).