Coping strategies Stress Burnout among Carers for Older
Coping strategies – Stress & Burnout among Carers for Older persons in LTC Assoc. Prof. Siriphan Sasat, Faculty of Nursing, Chulalongkorn University, Thailand
Content Challenges of caregiving Who are carers? Human resources for LTC Typology of caring activities Composition of the General Stress-Coping Model • Therapeutic interventions • Coping strategies • • •
Challenges of caregiving • Carers having enormous responsibility and facing the following challenges; – Caregivers are less likely to get proper rest, exercise and set aside time for their own health. Mental & Emotional strain contributes to diminishes physical health (Schulz et al. , 1997) – Caregiving is related negative effect on physical health (Pinquart & Sorensen, 2007) – Caregiver experience physical & psychological problems due to caring activities (Ostwald, 2009) – Caregivers typically experience high levels of stress, burden and declining mental health (Semlak & Pearson, 2011) – Spousal caregivers have more physical burden, financial burden, relationship strain, and depressive symptoms than adult children caregiver (Pinquart & Sorensen, 2011)
Who are Carers?
Who are Carers?
Formal Carer NGO Elder care Volunteer Neighbour Health volunteer Care assistant Physician Informal Carer Older Persons Husband/W ife Nurses Friends Adult children Other health professionals
Characteristic of Carers • Helped with any of the self-care activities • Have not been trained in caring • Work on unpaid basis • Having one to one relationship • Feeling of love, obligation and duty • They can be family members, cousins, friends, ad neighbour.
Informal Carers Relationship Quantity of care provided • Family carers/caregiver • Informal helper: • Main carers/caregiver or primary caregiver): – Self-identified – Care receivers identified who spent most time helping them. • Secondary carers/caregiver
Classification of Formal Carers • Professionals: – – – Physician, Nurses, Social workers PT, OT, Psychologist, etc • Non-professionals: – Care assistant, – Paid caregiver – Helper • Volunteer: – Voluntary elder care, – Volunteer disabled care – Elderly club members
Differences between Informal carers & Formal carers Informal cares Formal cares • Informal cares or carer refers to people who find themselves caring for an elderly dependent person - unpaid, untrained and for up to a full 24 hours each day. • Formal cares refers to people from the statutory and voluntary sector, both professional and others, who are paid and often highly trained to do a job of work which brings them in touch with elderly people and/or their carers.
Human Resources for LTC
Nursing staff Intervention - Stressful job - Staff rotation - Low job satisfaction - Using assistive device - High turn over rate - Staff support - counselling - Skill training - benefits - Create working environment (Engstrom, Skytt & Nilsson, 2011)
Typology of Caring activities based on 8 tasks the General Household survey • Help with personal care, e. g. dressing, bathing, toileting • Physical help, e. g. walking, getting in and out of bed or up and down stairs • Help with paper work or financial matters • Other practical help, e. g. preparing meals , doing shopping, housework or financial matters • Keeping the helped person company • Taking the helped person out • Giving medicine, including giving injections, changing dressings • Keeping an eye on the helped person to see that she/he is all right. Parker & Lawton (1990)
Composition of the General Stress-Coping Model Schulz (1990) and Giegel et al. (1991), based on their reviews of theoretical framework of stress, the majority of conceptual stresscoping models are concerned with the relationship between stressors, mediators and outcome, outcome to assess the well-being of individuals who provide care for their relatives Independent Variables Objective stressor - Patients illness & Disabilities Contextual Var, /Mediators Demographic Var. - Age - Sex - Socio-economic status - Type & Quality of relationship - Social support - Personal characteristics Outcome Primary outcome - Perceived stress/burden Secondary outcome - Decision to institutionalised - Psychiatric & physical mobility
Perceived stress and associated factors in elderly caregivers (Luchesi et al. , 2016) Factors • • • Self-reported pain Difficult to sleep Very poor/poor self rated health Impaired cognitive status More people living in the house Higher level of burden related to care Perceived Stress
Therapeutic interventions Intervention v Aim to enhance the carer’s skill v Intervention techniques include; - Behaviour approaches – Training carers - Carers’ support groups - Change the physical and psychological environment, include; - Practical advice, - General guidelines and - Problem solving. v Carer support - Educating carers about disease (eg. Dementia) and caring skills, - Encouraging carers to draw strength from each other- sharing problems & feelings within a group can significantly lower psychological stress among carers - Help to maintain their independents in the community. Outcomes - Coping with the caring situation, - Reduce stress in carers.
Other interventions Intervention Outcomes Respite care - Reduce depression Lower caregiver burden Lower cost Support group - Coping ability, knowledge and social support Psychosocial support: education, - Fewer depressive symptoms skill- building, counselling, information and emotional support - Lower stress Information and communication technology - Reduce depression, burden and anxiety Integrates support package: a - Delaying institutionalised holistic person-centred approach, tailor to individual carers Lopes-Hartmann, 2011)
Coping strategies Coping Mechanism/Strategies Outcomes - Allow caregiver to • Humor (20%): Laughter redefined their familial • Positive framing (16%): focuses on roles positive - offer caregiver a break - To find comfort • Acceptance (11%): accepts necessity of (Alpert & Womble, 2015) continuing involvement Emotional-based coping techniques Emotional-focused coping - Reduce perceived stress (Folkman, 2013) - Participation in religious /spiritual activities - Support group - Reduce perceived Caregiver Burden - Improved QOL (Parekh et al. , 2017) • Distancing • Humour • Seeking social support
Self-help group/Support group • A self-help group or support group, is a gathering of people who are caring for family members or friends with specific illness • The purpose of the group is to provide support to the members and thus allow them to cope better by: – Sharing their feelings and experiences – Learning more about the disease and giving care – Giving caregivers an opportunity to talk through problems they are facing or choices they have to make – Listening to others who share similar feelings and experiences – Helping others through the sharing of ideas and information and providing support – Offering caregivers a break and a chance to get out of the house – Encouraging caregivers to take care of themselves in order to safeguard their health and well being – Knowing they are not alone Source: https: //www. alz. co. uk/starting-a-self-help-group
Self-help group/Support group (Cont. ) Aims of the group • To enable caregivers to meet on a regular basis to provide mutual support • To enable caregivers to meet others in the same situation and share their feelings and experiences • To provide caregivers with an opportunity to learn more about dementia and caring Who might be in the group? • A self-help group is not for everyone, but many family members and friends of those with dementia find them helpful. Numbers • Some members may not be able to attend every meeting. Attendance may also drop after the initial meetings. • If the numbers become too large and it becomes difficult for everyone to participate, then dividing into two groups might be considered. Source: https: //www. alz. co. uk/starting-a-self-help-group
Support group for caregiver of person with dementia
Educational session Asst. Prof. Siriphan Sasat, Ph. D. , RN. , 12 July 55
Support group session Asst. Prof. Siriphan Sasat, Ph. D. , RN. , 12 July 55
Support group for carers of people with cancer Asst. Prof. Siriphan Sasat, Ph. D. , RN. , 12 July 55
Chatting during coffee break Skill training
Hotline training
Relaxation technique to reduce stress in Carers - Massage - Sleep - Hydrotherapy - Recreation - Aromatherapy - Yoga - Meditation - Food for relaxation - Regular meeting with friends - Vitamin B, B complex
THE EFFECT OF CAREGIVING SKILL DEVELOPMENT AND CAREGIVER SUPPORT GROUP PROGRAM ON STRESS IN CAREGIVERS OF OLDER PERSONS WITH TERMINAL STAGE CANCER Srihaklang, P and Sasat, S. (2016)
Caregiving skill development Individual skill training
Caregiving skill development Individual skill training
Caregiving skill development Individual skill training
Caregiver support group
References. ADI. Starting a self-help group. Available from Starting a self-help group, retrieved on 2 Oct. 2017. Ostwald, S. K. (2009). Who is caring for caregiver? Promoting spousal caregiver’s health. Family and Community Health, 32(1): 5 -14. Pinquart, M. & Sorensen, S. (2007). Correlates of physical health of informal caregivers: A meta-analysis. Journals of Gerontology Series B: Psychological Science and Social Sciences, 62: 126 -137. Pinquart, M. & Sorensen, S. (2011). Spouse, adult children, and children-in-law as caregivers of older adults: A meta-analytic comparison. Psychology and Aging, 26(1): 1 -14. Schulz, R. , Newton, J. , Mittelmark, M. , Burton, L. , Hirsch, C. & Jackson, S. (1997). Health effects of caregiving: The caregiver health effects study: An ancillary study of the cardiovascular health study. Annals of Behavioural Medicine, 19, 110 -116. Semlak, J. , & Pearson, J. C. (2011). Big Macs/Peanut Butter and Jelly: An exploration of dialectical contradictions experienced by the sandwich generation. Communication Research Reports,
Contact Information Name: Address: Telephone: Fax: E-mail: Website: Assoc. Prof. Siriphan Sasat, Ph. D. , RN. Chulalongkorn University, Phyathai Road, Pathumwan, Bangkok, Thailand 10330 +66 2 2181149 +66 2 2181130 sisasat@gmail. com www. longtermcarethailand. com
- Slides: 34