22
ISSUES AND CONCEPTS IN AGING Caring For the Frail Elderly Chapter 12
ISSUES AND CONCEPTS IN AGING
Caring For the Frail Elderly
Chapter 12
© 2011 McGraw-Hill Higher Education. All rights reserved.
A PROFILE OF CAREGIVING
Approximately ____ million people needed some assistance with daily living
Only ___ percent of people aged 65 to 69 need help with activities of daily living.
While ___ percent of those older than 85 needed help
_______ are most likely to provide care to aging parents. followed by a __________
© 2011 McGraw-Hill Higher Education. All rights reserved.
FAMILY CAREA PROFILE OF CAREGIVING
Activities of daily living (ADLs): questionnaire is designed to measure the capability of elderly living on their own.
Instrumental activities of daily living (IADLs): keeping track of money, doing light housework, taking medicine, running errands.
Long-term care: a range of services designed to help people with chronic conditions compensate for limitations in their ability to function independently.
© 2011 McGraw-Hill Higher Education. All rights reserved.
GENDER DIFFERENCES IN CAREGIVING
Primary caregivers: usually women; Why? tends to be the daughter who has fewer competing
obligations. Usually one who is not working or is unmarried – many
daughters take on the caregiving role regardless of their other responsibilities.
Gender differences in the caregiving experience may reflect that daughters perform more intimate tasks for their elderly parents than sons do and that they spend many more hours providing care.
© 2011 McGraw-Hill Higher Education. All rights reserved.
WORK AND CAREGIVING
__/__ of caregivers are no longer working, __/__ are employed full-time or part-time.
Since 1970, there has been a substantial increase in paid employment among women.
Why would Caregivers experience greater job stress and more work/family conflicts than non-caregivers?
Employer concerns over caregiving Employers often recognize that caregiving affects the job
performance of caregivers.
© 2011 McGraw-Hill Higher Education. All rights reserved.
THE CAREGIVER BURDEN
The Cost of Being a Caregiver Many caregivers are additionally stressed by financial
worry associated with paying for home care services, health care, nursing home care.
Caregiver burden: management of the tasks. Coping Skills Caregiver stress: the strain felt by the caregiver.
The degree of stress felt by a caregiver depends partly on the coping skills she or he may have developed to deal with other life events, and partly on the kind of social support available.
© 2011 McGraw-Hill Higher Education. All rights reserved.
HOW CAREGIVING AFFECTS FAMILY RELATIONSHIPS
First research on caregiving focused on primary caregiver in isolation from other family members.
New research suggests that caregiving not only affects the emotional well-being of the caregiver but reverberates across other family relationships.
Caregiving can also be a positive influence on the family relationship by bringing kin together to accomplish a shared goal.
© 2011 McGraw-Hill Higher Education. All rights reserved.
THE EFFECT ON PARENT-CHILD RELATIONSHIPS
Relationship between the caregiver and an elderly parent can take many forms.
Mutuality: both mother and daughter describing a rewarding relationship characterized by joint activities and minimal conflicts.
Ambivalent: mothers and daughters had relationships where there were rewards and costs; relationships were sometimes tense.
Conflicted: few rewards and frequent costs. (“She’s generous and compassionate to others, but not to me”.)
Stress can increase role reversal. The parent becomes the dependent one.
© 2011 McGraw-Hill Higher Education. All rights reserved.
EFFECT ON SIBLING RELATIONSHIPS
Caregiving can generate tension between primary caregivers and their siblings.
Why? One study found that greatest source of stress for women
caring for parent with Alzheimer’s was siblings. Different types of sibling conflict create different
responses on the part of caregivers. Disagreements over how to care for a parent may lead to
depression.
© 2011 McGraw-Hill Higher Education. All rights reserved.
CARFGIVING EFFECTS ON MARITAL RELATIONSHIPS
The Bad The Good
© 2011 McGraw-Hill Higher Education. All rights reserved.
EFFECT ON MARITAL RELATIONSHIPS
Caregiving can reduce the time husbands and wives have for each other.
Women may be too worn out from performing caregiving duties to spend quality time with their husbands and may worry about whether caregiving demands are harming their marriage.
The most stressful caregiving situation occurs with Alzheimer’s disease.
© 2011 McGraw-Hill Higher Education. All rights reserved.
EFFECT ON GRANDCHILDREN
The Bad: Problems that arise: stress between grandparent
and grandchild, disruption of teen’s social life, resentment of their mother’s caregiver burden.
Children may have to compete with their grandparents for their parent’s attention.
Despite such potential strains, several studies have found that family caregiving may also have positive consequences for grandchildren.
© 2011 McGraw-Hill Higher Education. All rights reserved.
EFFECT ON GRANDCHILDREN (CONT)
The Good: Most grandchildren felt the caregiving situation
had a positive influence on family relationships. Another positive effect: it made the young people
more empathetic toward other adults and their grandparents.
The adolescents repeatedly described feeling closer to their mothers, who were nearly always primary caregivers.
© 2011 McGraw-Hill Higher Education. All rights reserved.
HOME AND COMMUNITY-BASED SERVICES
Home and community-based services: most common are:
Case management is provided by a social worker who assists frail elderly people and their families in obtaining the medical, social, and personal services needed.
© 2011 McGraw-Hill Higher Education. All rights reserved.
INSTITUTIONAL CARE
Nursing homes: the long-term care option of last resort.
Why is it the last resort? More than ___ percent of Americans who turned
65 in 1990 will spend some time in a nursing home.
© 2011 McGraw-Hill Higher Education. All rights reserved.
THE NURSING HOME INDUSTRY
People who reach age 65 have 40% chance of entering a nursing home at some point during their lives.
Problems: Although many nursing homes provide adequate and, in
some cases, exceptional care, poor-quality care is a continuing problem.
Among the problems documented were untrained staff, poor health care, unsanitary conditions, poor food, and unenforced safety regulations.
© 2011 McGraw-Hill Higher Education. All rights reserved.
STAFF TURNOVER IN LONG-TERM CARE
High turnover leads to _____ care, placing the most vulnerable population group at risk of __________, falls, and inadequate _______.
© 2011 McGraw-Hill Higher Education. All rights reserved.
PROBLEMS IN ADJUSTING TO A NURSING HOME
People who live independently in a community find the transition to institutional life difficult.
People sometimes wept recalling a cherished piece of furniture or a comforting daily routine.
Older Hispanics or other immigrants who enter nursing homes face unique obstacles in adjusting to institutionalization, including language and cultural differences.
© 2011 McGraw-Hill Higher Education. All rights reserved.
PATIENT ABUSE IN NURSING HOMES
Patient abuse very/not very common; may be ______ or ________
High turnover and high absenteeism among staff creates situations that provoke abuse.
Aides may use _________s to control patients, pinch or slap them.
© 2011 McGraw-Hill Higher Education. All rights reserved.
PATIENT ABUSE IN NURSING HOMES (CONT)
More often abuse is more subtle and psychological.
Federal government and states have established vigilant rules in an attempt to protect patients.
Greatest protection against abuse in nursing homes is presence of an “Ombudsman program”. Serve as watchdogs, monitor the quality of care
in nursing homes by investigating complaints by families and residents against facilities.
© 2011 McGraw-Hill Higher Education. All rights reserved.
FAMILIES OF THE INSTITUTIONALIZED ELDERLY
Caregiver stress often does not end after an aging parent or spouse is admitted to a nursing home.
Constant conflict with the staff adds to the stress, as caregivers who formerly attended to every need of their loved ones now find they are at the mercy of strangers.
Highest levels of stress and depression occur among caregivers of patients with severe behavioral problems and memory loss.
© 2011 McGraw-Hill Higher Education. All rights reserved.
NEXT WEEK
Review for the final exam Student Learning Outcomes Quiz
review Student Presentations
