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Paid and unpaid support received by co-resident informal caregivers attending to community-dwelling older adults in Spain.

ABSTRACT: In this study from Spain, support received from outside the household by informal caregivers of people older than 64 years is analysed. The Spanish Time Use Survey (2002-2003) is used to examine: (1) the proportion of co-resident informal caregivers receiving paid and unpaid support by persons from outside the home; (2) the main factors associated with receipt of external paid and unpaid support; and, (3) factors linked to the amount of support received in terms of time. The study sample included 404 caregivers who cohabited with the person receiving care. We used a modified Andersen Behavioural Model as the analytic framework. Significant differences are observed in receipt of support according to predisposing, enabling and need factors. Overall, support (paid and unpaid) is significantly lower among households with women caregivers. In comparison with the least educated caregivers, higher levels of paid support are observed among those with secondary school or higher education, even when income, household size and receiver's age are included in the model. After controlling for care receivers' disability level and age, unpaid support is significantly higher among employed caregivers, spouses and caregivers living in medium-sized cities, versus unemployed caregivers, other relatives and caregivers living in large cities, respectively. These data highlight the inequalities of resources in terms of caregiver gender, socio-economic status and population size. The findings underscore the need to extend analysis not only to primary caregivers, but to caregiving networks and other types of caregiver support as well.

SUBMITTER: Rogero-Garcia J

PROVIDER: S-EPMC5547290 | biostudies-other | 2011 Jun

REPOSITORIES: biostudies-other

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Project description:BackgroundDue to fragmentation of care, continuity of care is often limited in the care provided to frail older people. Further, frail older people are not always enabled to become involved in their own care. Therefore, we developed the Health and Welfare Information Portal (ZWIP), a shared Electronic Health Record combined with a communication tool for community-dwelling frail older people and primary care professionals. This article describes the process evaluation of its implementation, and aims to establish (1) the outcomes of the implementation process, (2) which implementation strategies and barriers and facilitators contributed to these outcomes, and (3) how its future implementation could be improved.MethodsMixed methods study, consisting of (1) a survey among professionals (n = 118) and monitoring the use of the ZWIP by frail older people and professionals, followed by (2) semi-structured interviews with purposively selected professionals (n = 12).Results290 frail older people and 169 professionals participated in the ZWIP. At the end of the implementation period, 55% of frail older people and informal caregivers, and 84% of professionals had logged on to their ZWIP at least once. For professionals, the exposure to the implementation strategies was generally as planned, they considered the interprofessional educational program and the helpdesk very important strategies. However, frail older people's exposure to the implementation strategies was less than intended. Facilitators for the ZWIP were the perceived need to enhance interprofessional collaboration and the ZWIP application being user-friendly. Barriers included the low computer-literacy of frail older people, a preference for personal communication and limited use of the ZWIP by other professionals and frail older people. Interviewees recommended using the ZWIP for other target populations as well and adding further strategies that may help frail older people to feel more comfortable with computers and the ZWIP.ConclusionsThis study describes the implementation process of an innovative e-health intervention for community-dwelling frail older people, informal caregivers and primary care professionals. As e-health is an important medium for overcoming fragmentation of healthcare and facilitating patient involvement, but its adoption in everyday practice remains a challenge, the positive results of this implementation are promising.

Project description:BackgroundInformal caregivers of critically ill patients in intensive care unit (ICUs) experience negative psychological sequelae that worsen after death. We synthesized outcomes reported from ICU bereavement interventions intended to improve informal caregivers' ability to cope with grief.Data sourcesMEDLINE, EMBASE, CINAHL and PsycINFO from inception to October 2020.Study selectionRandomized controlled trials (RCTs) of bereavement interventions to support informal caregivers of adult patients who died in ICU.Data extractionTwo reviewers independently extracted data in duplicate. Narrative synthesis was conducted.Data synthesisBereavement interventions were categorized according to the UK National Institute for Health and Clinical Excellence three-tiered model of bereavement support according to the level of need: (1) Universal information provided to all those bereaved; (2) Selected or targeted non-specialist support provided to those who are at-risk of developing complex needs; and/or (3) Professional specialist interventions provided to those with a high level of complex needs. Outcome measures were synthesized according to core outcomes established for evaluating bereavement support for adults who have lost other adults to illness.ResultsThree studies of ICU bereavement interventions from 31 ICUs across 26 hospitals were included. One trial examining the effect of family presence at brain death assessment integrated all three categories of support but did not report significant improvement in emotional or psychological distress. Two other trials assessed a condolence letter intervention, which did not decrease grief symptoms and may have increased symptoms of depression and post-traumatic stress disorder, and a storytelling intervention that found no significant improvements in anxiety, depression, post-traumatic stress, or complicated grief. Four of nine core bereavement outcomes were not assessed anytime in follow-up.ConclusionsCurrently available trial evidence is sparse and does not support the use of bereavement interventions for informal caregivers of critically ill patients who die in the ICU.

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Paid and unpaid support received by co-resident informal caregivers attending to community-dwelling older adults in Spain.

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