Patients with dementia normally experience continuous weakening of their cognitive ability. This requires specialized care that offers dignified treatment that is holistic in addressing the patients’ social, physical, mental and emotional health. In many circumstances, this personal care is administered by family caregivers who undertake the roles of healthcare professionals. This is in spite of the fact that these family caregivers are usually untrained. Caregiving to dementia patients is difficult and can have lethal effects on the quality of life of the caregivers. This paper, therefore, examines the nursing considerations on the hardships caregivers face in attending to their loved ones living with dementia and the support that is available and can be done for the untrained caregivers.
Literature Review
In the current state of events, dementia remains incurable and its global prevalence has been on the rise. Research shows, for instance, that an estimated 35.6 million people, by 2010, lived with dementia. The study indicated too that by 2050, the population cohort is projected to have risen to 115 million. In the U.S. alone, it was found that, in 2015, more than 15 million people offered voluntary and unpaid services of caregiving to their loved ones who lived with the dementia-related complication of Alzheimer’s disease (Cinahl Information Services, 2016). This statistics must be of concern because the burden faced by caregivers not only affects the care receivers but also the quality of life of these nonprofessional caregivers.
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Family members and relatives usually undertake the role of caregiving to their aging loved ones living with dementia and related complications at home settings. The care provided includes assistance in daily living activities such as household financial management, transportation, and mobility, feeding, bathing and dressing among others. They also aid in the administration of treatment therapies, supervision of behavioral expressions, and management of other in-home care programs. This process is very demanding and burdensome to the untrained caregivers hence may result in the impairment of the caregiver’s health.
It is evident that as the cognitive and functional ability of the patient increases with time, the psychological and behavioral symptoms grow severer and as a result, the help required is of a higher magnitude than before hence an increase in the burden on the caregiver. As the misery increases, the caregiver develops neuropsychiatric signs such as hallucinations, anxiety, irritability, depression, and sleep disorders whose severity grows over time as the care receiver/patient’s condition deteriorates (Cinahl Information Services, 2016).
The lifestyle, relationship, obligations, and occupational status of caregivers become transformed because their time is confined to providing care to their loved ones. For instance, spousal caregivers suffer a change in marital relationships as they forgo self-care and renounce the marital lifestyle of and adopt caregiving lifestyle and education for the sake of their loved ones. They forgo self-care activities such as exercises, hobbies, and care appointments and sacrifice friendships in order to be there for their suffering loved ones. Research studies indicate that female caregivers suffer unfulfilled goals and forgone opportunities while older caregivers faced the burden of the physical toll, chronic stress, poor health and time constrain. During such circumstances, the sandwich generation suffers the guilt of neglect and inequity in trying to strike a balance in attending to caregiving responsibilities on one side and interaction demands with their young family members on the other.
There are other physical, social, legal, and financial issues that are burdensome to caregivers. These include inadequate social support, depressions, uncertainties, advocacy for the patient, difficulty in accessing diagnosis, constrained out-of-pocket expenditure on respite care, loss of freedom, and exhaustion among others (Feinberg & Levine, 2015). The caregiver’s reduced capacity to work worsens the financial burden as the caregiver needs to meet the payment of bills and insurance requirements. Even after nursing home placement, the caregiver is tasked with the responsibility of ensuring dignified care is given and coordinating appointments.
Implications for Nursing Practice or Healthcare
Despite the hardships that befall caregivers, there are various support services that have been made available to the caregivers. The healthcare sector offers respite care staff that aid in the in-home care service provision. Upon the caregiver’s trust, respite care staff can be very helpful in substituting caregiver’s services. Nurses’ evaluation, advice, and therapeutic communication are critical to a depressed caregiver in the healing process of the family during sickness and after the loss of a loved one. Also, the availability of financial assistance to caregivers for accessing support services has enhanced usage of support service thus instrumental in the reduction of depression among caregivers (Wennberg, Dye, Streetman-Loy, & Hiep, 2015).
In addition, there are multicomponent programs that initiate caregiver beneficial interventions such as behavior management, physical exercising, and dementia-related education whose objectives are to enhance caregiver efficacy in care provision and relieving physical health strain. Studies in the U.S. on this multicomponent program show that the interventions have positive impacts for the dementia patients. Physical exercising boosts the cognitive functioning and maintains strong muscles and joints. This preserves the independence levels of a person thus lowers the incidence of risk factors such as hypertension and cardiovascular complications among individuals with dementia. Exercising is also another way of improving patient socialization thus decreasing seclusion-related depression that is characteristic of dementia patients.
Furthermore, caregiver training increases the self-efficacy levels and hence the efficiency of care given. Specialized aid and support group attendance through dementia education is necessary for preparing and providing necessary counseling to the family in the period of dementia calamity and after the death of the patient. Pseudo-educational and cognitive-behavioral group therapies are essential in suppressing neuropsychiatric signs and psychological stress respectively among caregivers (Washington et al., 2014).
Dementia progressively worsens one’s ability to carry out day-to-day activities independently by attacking the cognitive capacity. Dementia patients heavily rely on nursing services in their personal treatment needs. In most cases, this care is administered by untrained family caregivers. Due to the deteriorating health of their loved ones, caregivers suffer physical, social, psychological, and financial challenges. Some of these challenges are inadequate social support, worries and uncertainties, difficulty accessing diagnosis, constrained out-of-pocket expenditure on respite care, loss of freedom, and exhaustion among others. There are various support services that have been made available for the support of these untrained caregivers such as respite care staff, caregiver training and counseling through support group attendance, financial assistance, and multilevel interdisciplinary programs and interventions. Wennberg, Streetman-Loy, and Hiep (2015) propose an interdisciplinary team approach focused on the development of a continuum of services and resources tailored to the individual needs of caregivers throughout the stages of the disease.
References
Cinahl Information Services. (2016, January 1). Evidenced Based Care Sheet [Brochure]. Retrieved from https://www.ebsco.com/files/promo/downloads/2SWRC_AlzheimersDiseaseSupportforCaregivers_EBCS.pdf
Feinberg, L. F., & Levine, C. (2015). Family Caregiving: Looking to the Future. Generations, 39 (4), 11-20.
Washington, K. T., Wittenberg-Lyles, E., Parker Oliver, D., Baldwin, P. K., Tappana, J., Wright, J. H., & Demiris, G. (2014). Rethinking Family Caregiving: Tailoring Cognitive--Behavioral Therapies to the Hospice Experience. Health & Social Work, 39 (4), 244-250. doi:hsw/hlu031
Wennberg, A., Dye, C., Streetman-Loy, B., & Hiep, P. (2015). Alzheimer's Patient Familial Caregivers: A Review of Burden and Interventions. Health & Social Work, 40 (4), e162-e169. doi:10.1093/hsw/hlv062
