ROLE OF NURSE IN THE CARE GIVERS OF ELDERLY

ROLE OF FAMILY FORMAL AND INFORMAL CARE GIVERS

Definition
Caregiver burden is defined as the strain or load borne by a person, who cares for a
chronically ill, disabled, or elderly family member. It is a multidimensional response to
physical, psychological, emotional, social, and financial stressors associated with the care
giving experience. (Stucki&Mulvey, 2000)
Factors Associated with Caregiver Burden

(i)Relationship quality: it is the most immediate determinant of burden. Caregivers often

express feelings of closeness to the care-recipient. Recent studies suggest that emotional
closeness between the caregiver and care receiver in a relationship is an important factor in
explaining the level of caregiver burden. The caregivers, who report positive relationships
with the care recipients, are less likely to report high levels of caregiver burden, regardless of
the amount of care they provide.
(ii) G e n d e r: Care giving within the family is bounded by normative gender specific
expectations of considerable importance to Indian families. Given the role of women as
caregivers in the Indian context, women are generally more likely to provide care to the
elderly and therefore more likely to experience perceived caregiver burden than males.
Therefore, women are likely to report greater burden than men. Since care giving duties may
be imposed on women (primarily daughters-in-law) because of gender related expectations,
their relationship with the care recipient may become strained.
(iii) Role Conflict: Role conflict refers to discrepant expectations, irrespective of time
pressures. Role conflict has been defined as the incompatibility of demands in the form of
conflict between organizational demands and one’s own values, problems of personal
resource allocation, and conflict among obligations to several different people. Within the
family system, the amount of care giving provided by individuals is a function of the social
positions they occupy. As the number of social positions an individual occupies increases,
caregivers are likely to experience both role conflict and role overload. As a source of
stressor, increases in role conflict are likely to increase caregiver burden. As care givers
experience role conflict, their relationship with the care recipient is likely to be strained.
Consequently, there is likely to be a negative relationship between quality and caregiver
burden. Since most relationships are reciprocal in nature, care recipients are likely to react to
caregiver’s experiences of role conflict. Care recipients attempt to increase their own task
performances. Thus, role conflict of the caregiver is likely to increase the support tasks
provided by the elderly care recipient.
(iv) Role Overload: Multiple role involvements are associated with a caregiver’s concurrent
commitment to a number of social role positions. Multiple role involvements may lead to
inadequate allocation of resources, such as time, for the fulfillment of all the roles the
caregivers play. Role overload refers to perceived constraints imposed by time and energy.
As role overload increases, caregiver burden is likely to increase. However, role overload is
likely to influence caregiver’s choices as well as capacity to provide care, resulting in an
erosion of relationship quality with the care recipient.
(v) Health Problems of Care Recipient: The health problems of the elderly are also an
important determinant of perceived caregiver burden. An older person with many health
problems is likely to demand more energy, time and money from the family system. Care
giving entails high costs to the caregiver. The degree of caregiver burden is likely to depend
upon the extent of physical and mental health problems. In general, mental health problems
are more likely to increase the level of burden than elderly physical health problems.
However, the high care giving costs may be mitigated, if socio-emotional and/or material
rewards are extended to the caregiver.

Interventions to address care giver burden

1. Information and training

2. Professional support

3. Effective communication

4. Public and financial support

Caregiver burnout

Caregiver burnout is a state of physical, emotional, and mental exhaustion, that may be
accompanied by a change in attitude from positive and caring to negative and unconcerned

Signs and symptoms

(i)withdrawal from friends and family, (ii) loss of interest in activities previously enjoyed,
(iii)feeling irritable, hopeless, and helpless, (iv)changes in appetite, weight or both,
(v)changes in sleep patterns, (vi) getting sick more often, (vii) feelings of wanting to hurt
oneself or the person, whom one is caring, (viii) emotional and physical exhaustion,
(ix)excessive use of alcohol and/or sleep medications and (x) irritability.
Causes of care giver burn out
a) Role confusion: Many people are confused when thrust into the role of caregiver. It can be
difficult for a person to separate her role as caregiver from her role as spouse, lover, child,
friend, etc.
b) Unrealistic expectations: Many caregivers expect their involvement to have a positive
effect on the health and happiness of the patient. This may be unrealistic for patients suffering
from a progressive disease, such as Parkinson's or Alzheimer's.
c) Lack of control: Many caregivers become frustrated by a lack of money, resources, and
skills to effectively plan, manage, and organize their loved one's care.
d) Unreasonable demands: Some caregivers place unreasonable burdens upon themselves, in
part because they see providing care as their exclusive responsibility.
e) Other factors: Many caregivers cannot recognize when they are suffering burnout and
eventually get to the point where they cannot function effectively. They may even become
sick themselves.

Interventions for effective management of burn out

o Find someone to trust; such as a friend, co-worker, or neighbor; to talk to about your
feelings and frustrations.

o Set realistic goals; accept that help, may be needed with care giving, and seek support of
others with different tasks.

o Don't forget about self needs; set aside time for yourself.
o Seek advice from a professional. Most therapists, social workers, and clergy members are
trained to counsel individuals dealing with a wide range of physical and emotional issues.

o Take advantage of respite care services. Respite care provides a temporary break for
caregivers. This can range from a few hours of in-home care to a short stay in a nursing home
or in an assisted living facility.

o It is necessary to be aware on self-limits and do a reality check on own personal situation.

Recognize and accept your potential for caregiver burnout.

o Educate yourself; the more the knowledge on illness, the more effective will be the care
delivery.

o Develop new tools for coping; remember to lighten up and accentuate the positive thoughts.

o Maintain health; by eating right and getting plenty of rest, exercise and sleep.

o Accept feelings; negative feelings like frustration or anger have to be expressed out,
without harming the receipt of care.

Alternative strategies for managing burn out

o Respite care: Look for in-home services provided by volunteers (palliative services,
ASHA, AWW, NGO etc), either occasionally or on a regular basis. Also explore adult day
care centers and nursing homes in local community, which is accessible and cost effective.
o Speak up: Discuss broadly with friends and family members about the resources required,
personal needs and own feeling about the care process. If you have concerns or thoughts
about improving the situation, suggest the alternatives.
o Share the responsibility: Divide the care giving tasks and try to involve family members
as far as possible. Specify the particular roles, which need to be taken up;for example,as one
person take care of medical responsibilities, another finances and bills, and another shopping.
o Set up a regular check-in: Multiple checks at times are required for maintaining care
giving potential. Ask a family member, friend, or volunteer call you on a set basis (daily or
weekly). This person can give you status updates and coordinate with other family members.
o Say “yes” when someone offers assistance: Always try to invite those willing to join the
care process. It’s smart to have a list ready of small tasks that others could easily take care of,
such as shopping or getting elderly ready for an appointment.

ROLE OF NURSE FOR CARE GIVERS OF ELDERLY

 Care giver assessment

 Providing information
 Linking care giver to resources
 Interventions to reduce burden and burnout
 Interventions to improve competence
 Prevent harm
ROLE OF FAMILY,FORMAL AND INFORMAL CARE GIVERS
Formal care givers

Formal care for older people usually refers to paid care services provided by a healthcare
institution or individual for a person in need. Informal care refers to unpaid care provided
by family, close relatives, friends, and neighbours. Both forms of caregiving involve a
spectrum of tasks, but informal caregivers seldom receive enough training for these tasks.
Formal caregivers are trained in the field, but the depth of their training varies.

Formal care can be organized into three different categories: (1) home-based care; (2)
community-based care (such as day care centres with trained staff); and (3) residential care
in the form of nursing homes. Residential care is the most traditional and predominant type
of formal care.
Informal care givers
These are care providers without receiving money that include family, friends or relatives

Informal care comprises assistance in four main areas: (1) routine activities of daily living
(e.g., bathing, toileting, and eating); (2) instrumental activities of daily living (e.g.,
housework, transportation, and managing finances); (3) companionship and emotional
support; and (4) medical and nursing tasks, such as injections and colostomy care

Role of caregivers

 Advisor/consultant
 Teacher
 Sponsor
 Organizer/coordinator

Implications to strengthen and develop the informal care giving

• Services should be made better known.

• The regional availability of support services should be made increased.

• Case management services should increase the effectivity of unburdening concepts.

• Public financial support should be made more available.

• The basic conditions of care giving should allow the combination of care and occupation.

• Job conditions should be developed. No disadvantages should arise for caregivers, who
restrict the scope of their employment or temporarily give it up completely
Reference
. Gupta Rashmi, Pillai Vijayanet. al. Relationship Quality and Elder Care Giver Burden in
India. ournal of Social Intervention: Theory and Practice – 2012 – Volume 21, Issue 2.

1. Barbabella F, Poli A, Santini S et al (2018) The role of informal caregivers in long-term

care for older people. In: Boll T, Ferring D, Valsiner J (eds) Cultures of care in aging.
Information Age Publishing, Charlotte, pp 193–212