The main concepts of the theory of the dynamics of Home Care in Manhattan Beach CA are commitment, the management of expectations and the negotiation of roles. Commitment is the caregiver's ongoing responsibility that inspires changes in life to make the patient a priority. Caregiver stress theory emphasizes abuser stress as the predominant factor that leads to elder abuse. Obligations associated with providing Home Care in Manhattan Beach CA for the elderly can impose demands overwhelming suppliers. Frequent falls, walking, incontinence, nudity, and verbal abuse by the elderly are examples of cases that place excessive pressure on the caregiver.
External stress placed on the caregiver (e.g., maintaining a good relationship between the caregiver and the person receiving care before they become ill or incapacitated) has been shown to minimize stress, even when the caregiver requires a lot of stress. Family members and other caregivers of people with dementia often cite communication problems as an important source of stress for caregivers. Interruptions in communication, whether due to problems finding words, dysarthria, or repetitive questions, can cause other behavioral problems, such as agitation and aggression, and can affect the quality of care. Little systematic research has evaluated intervention and training programs aimed at alleviating communication problems in people with dementia, largely due to the perception that, since they are degenerative diseases, language treatment would be a waste of resources.
In general, advances in training are not maintained and are not generalized in all linguistic areas. Most intervention programs are aimed at caregivers and emphasize the use of functional communication strategies, such as establishing eye contact, repeating key words, using “yes” or no questions and lexical cues, and providing scrapbooks and other conversational stimuli. Other programs have focused on developing techniques to minimize repetitive questions and other disruptive behavior. Two studies on semantic training in semantic dementia have demonstrated immediate improvements in naming ability, but these improvements are not maintained during follow-up.
At least one study has shown that, two months after treatment, the benefits of treatment when naming with images in Alzheimer's disease are maintained. However, most intervention programs are aimed at caregivers and emphasize the use of functional communication strategies, such as establishing eye contact, repeating key words, using “yes” or no questions and lexical cues, and providing scrapbooks and other conversational stimuli. Palliative care for older patients focuses on preserving function, dignity and quality of life so that people can live their lives actively. Attention should be paid to identifying and alleviating caregiver stress. Preparation and open debate about the future, including care at the end of life and death, allow a person to regain control of their lives and alleviate the stress that caregivers feel due to decision-making.
Several studies have focused on the use of technology to help caregivers of people with dementia 34,35. A review of this literature shows that the use of interventions varied between studies and, in general, was low, 36 The results were inconsistent and had only moderate effects on improving caregivers' stress and depression. The effects of treatment were found to vary depending on ethnic groups, formal support and baseline load. However, these findings should be treated with caution, as they often come from analyses of several subgroups. Family doctors are often in a particularly powerful position to address caregiver problems.
In some cases, the family doctor is the doctor of both the patient with dementia and the caregiver. Family medicine's commitment to continuity and a comprehensive biopsychosocial approach provide a useful framework for understanding and addressing stress affecting family members. A meta-analysis of psychosocial interventions for caregivers showed a decrease in caregivers' stress levels, an improvement in knowledge and a better mood for patients, but no effect on the burden that caregivers bear. The participation of both the caregiver and the patient in the intervention increased the benefit.
At least four studies indicate that caregiver interventions delay admission to a nursing home (Brodaty) et al. Sunset refers to the recurrent onset of confusion or agitation in some elderly patients at night and can be a major clinical problem (Bliwise, 199. Circadian rhythms may play an important role in the pathogenesis of sunset) (Klaffke and Staedt, 200). Neurophysiologically, it appears to be mediated by degeneration of the suprachiasmatic nucleus of the hypothalamus and decreased production of melatonin (Khachiyants et al. The maximum behavioral disturbance occurs most often in the late afternoon or evening.
In patients living in communities, this phenomenon has been reported to be associated with significant stress for caregivers (Gallagher-Thompson). et al. Sundowning is in second place after wandering around with disruptive behaviors in institutionalized patients (Khachiyants et al. All of these elements suggest that the exhaustion of informal caregivers is a promising concept for evaluating the impact of care delivery.
Beyond the consequences themselves, caregiver burnout and more general outcomes will, in turn, have an impact through feedback loops and will modify elements related to the caregiver, the context of care delivery and the social environment. In the integrative model of informal care provision, all determinants are considered to have a direct impact on the evaluation of provision of care. Other elements of evaluation, such as feeling trapped in the caregiver role, have not yet been investigated, but are likely related to caregiver burnout (Sörensen et al. The caregiver is faced with several elements that cannot be changed but that, even so, influence the tension they feel while caring.
The revision of the model of labor demands and resources based on the literature on occupational exhaustion and the model of stress and burden of caregivers led to the development of the integrative model of informal care. This circularity has often not been taken into account in models created to understand the stress of providing care (as well as in the JD-R model), but it is essential to address the how that tension can evolve. The consideration of both the caregiver stress model and the JD-R model has made it possible to identify important factors to consider when understanding the exhaustion of informal caregivers. Of course, the quality of the relationship with the person receiving care is determined by many elements, such as the relationship that existed before the provision of care or the attachment style, but the key is to consider the impact that the provision of care can have on this relationship.
The time elapsed since the start of providing care (duration) is often considered a central element of the stress involved in providing care. The Family Caregiver Experience: Examining the Positive and Negative Aspects of Compassion, Satisfaction, and Compassion Fatigue as a Result of provision of care. From this point of view, caregiver burnout can be defined as a three-dimensional syndrome in response to stress that can represent the context of care. Absent in the JD-R, this assessment is the subjective evaluation of the care experience by the caregivers themselves.
Future research should focus on ways to improve support for informal caregivers and on understanding the reasons why informal caregivers request. formal support.
