Factores determinantes de la salud de las cuidadoras principales de personas mayores con dependencia en un centro de salud urbano de Huelva

Abstract

Caring for dependent elderly is done in the familiar environment and in most cases is assumed by a female relative. Carers provide care for numerous basic needs to the people they serve considered a stressful activity that can affect different areas of their lives. General aim To know the health state of primary caregivers of dependent elderly, through the quality of life, fatigue caregiver role and burden perception, and the factors that determine it. Materials and methods. Cross-sectional study in an urban health center of Huelva. The subjects studied were carers and people receiving care included in the home visit program center (86 people). Variables and instruments used for the caregivers were: sociodemographic and health characteristics collected in a format designed for research; social support assessed by the social support questionnaire Duke-UNK version of De la Revilla et al. (1991); coping strategies were assessed by a questionnaire of Carver, Sheider & Weintraub - ' l-s(-nt»i:i dr i jntMncidn (1989); self-efficacy expectations were assessed through general self-efficacy questionnaire (Sanjuan, Perez and Bermudez, 1996); quality of life was assessed by the WHOQOL-BREF (WHO, 1998); burden perception was collected from Zarit burden inventory questionnaire (Zarit, 1982) in the version of Montorio et ai. (1998) and fatigue in the performance of the roll of caregiver by assessing the demonstrations included in the diagnosis. Variables and instruments used for dependent persons were: sociodemographic characteristics and health status were collected in a format designed for this study; functional capacity to perform basic and instrumental activities of daily live was assessed by using the Barthel questionnaire (Shah, Vanclay & Cooper, 1989) and the rate of Lawton (Lawton 8t Brody, 1969) respectively, the cognitive level was assessed by the Pfeiffer questionnaire (Short Portable Mental Status Questionnaire) (Pfeiffer, 1975). Results The caregivers were mostly women (79.1%) with an average age of 61.6 years, married, with low economic status, without education or with primary education and engaged primarily in household chores. Most of the caregivers were diagnostic of chronic illness and perceived their health as fair or poor. They frequently said they had negative and positive feelings of depression, anxiety, sadness and stress. 60.5% of the elderly were women with an average age of 79. The 94.2% had a high dependence in instrumental activities, 38.4% were completely dependent for doing ABVD, 53.6% showed normal cognitive level or mild impairment and 24.4% severe. Women caregivers were mainly the one who takes care of their mothers (36 %) and spouses (26.7 %), while men took care of their mothers and their wives equally (9.3 %). They live with the person they care with an average of nine years of care. 87,2 % of caregivers work in that task during 24 hours every day. They performed multiple care for satisfy the basic needs of the elderly, highlighting the care nutrition needs, hygiene, mobility, elimination, communication, dress and undress, rest and sieep, oxygenation, thermoregulation and avoid hazards. On the other hand, recreational care, learning and working are the least supplied. 64% of caregivers have good relationship with the elderly, although it had deteriorated. 70.9 % were catholic and they consider faith as a great support in their daily lives. Usual social activities had to be changed by 82.7% of the caregivers. 64% of the caregivers were supported by other family members and moreover 57 % received some help from the formal setting and they have suitable perception of social support, confindant (60,5 %) and affective (74,4 %). Coping strategies they frequently used were about seeking social support, planning and active coping, focusing and venting emotions. By contrast, the least frequent were the leaving of efforts to cope, alcohol and drug consumption and evasion. Regarding self-efficacy expectations, it was showed moderate average (62.4 points), being the older carers the one who showed less self-efficacy. Caregivers rated their quality of life (Facet 1) with an average of 2.7 points and 2.6 in satisfaction with health (Facet 2). The best scores to quality of life areas were for the environmental area (58.8 points), the physical area (53.5 points) and lower scores on psychological area (51.9 points) and the area of social relationships (43.4 points). The burden levels of caregivers were moderate, with an average of 34.16 points. Caregivers have shown an average of 11,14 demonstrations in the fatigue role highlighting more demonstration on the emotional area. Caregivers with less perceived burden possessed good social support and improved self-efficacy expectations. The perceived burden increased in carers who performed more care and faced the situation with coping strategies and venting emotions using distracting activities. Caregivers who scored better their quality of life (Facet 1), perceived good social support, had better self-efficacy expectations and they used coping denial strategies. Those who scored lower their life quality were lacking emotional social support, they perceived that their health was poor and they performed cares with movement needs and they were not satisfy with their lives. Caregivers who had more satisfaction with health (Facet 2) were those who cared for their parents, they perceived good social support and were more satisfied with their lives. A better quality of life in the physical area was for the caregivers who maintained their usual outings with friends, for those who had better self-efficacy expectations for those who faced the task of caring using the coping strategy acceptance and were satisfied with their life. Carers who had good social support confidential, had better self-efficacy expectations, maintaining normal social relationships and were satisfied with their life had a better quality of life in the psychological area and the care for satisfy the basic needs of the rest and sleep decreased quality of life in the area. The area of social relationships was better in those caregivers who frequently used coping strategy and seeking social support. They showed better efficacy expectations while the less efficacy expectations were for the one who cared their wives or husbands. They had a poor health autoperception and they cared of people with a higher level of cognitive deterioration. Maintaining normal social relationships, perceiving a good social support, using the coping strategy and active coping favored the quality of life of caregivers in the area of environment. Caregivers with more perceived burden had worse quality of life and more manifestations of fatigue. Tiredness determined the variability of overall quality of life and psychological area. Conclusions Caregivers who took part of that study showed moderate burden levels and they value their life as good, finding relations between load perceptions, life quality and fatigue role. It shows the positive influence that social support caregivers have and self-efficacy expectations with fewer burdens perceived and in a negative way a greater number of care and coping strategy to focus and vent emotions. Moreover, it proves the positive influence of social support, self-efficacy expectations, life satisfaction and maintains normal social relations in a better quality of life.