الفهرس 
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Abstract
Introduction
Aging may describe as a stage of life change marked by physiological, biological and cognitive transformations. In human developmental stages, physiological changes are beginning to appear at the commencement of the slowing, stopping and depreciation of body renewal in consecutive years. as there has occurred a meaningful increase in chronic illnesses and retrogradation in cognitive functions as people get older. While these changes appear to exacerbate the body’s susceptibility to pathogens and increase chronic illnesses on a daily basis, diseases often cause each other by expediting aging’s implications. This reduces the elderly’s perceptual elasticity also increases their physical dependency. This limits the elderly’s functional independence and increases their physical reliance on others to complete everyday life tasks (e.g., diet, self-care). In short, old age has a consequence on one’s life well-being.
Caregivers are known as the person or persons who are most closely involved in caring for the elderly patient and assisting the patient to accommodate and maintain his chronic illness during treatment Family caregivers are people who meet the majority of the patient’s physical, psychological, emotional, social and financial, care needs across the continuum of care, from hospitalization to home care, without being compensated. Caregivers are people who deal with stigmatic convictions on a regular basis and are usually a close relative, parent or spouse.
Caregiver’s burden is defined as the caregiver’s perception of their physical and mental state, including their emotions, psychological state, personal importance and social life, which may be the result of caring for their family. The accumulation of activities can generate stress and affect many aspects of a person’s life, putting the quality of life of the caregiver at risk The burden of caregivers is defined as objective and subjective negative consequences, such as psychological stress, physical health problems, social and financial problems, family relationships breakdown. Desperate relationships and feelings caused by caregiver pressure.
Coping techniques are the behavioral and psychological efforts of individuals to explain and overcome problems, which typically include all analytical studies that describe coping as the process by which a person attempts to deal with stress. The emotional approach to coping strategies includes the desire to forget the problem or seeking emotional encouragement from those around.
Primary, secondary and tertiary health promotion are the three levels of health promotion. All levels are critical in preventing disease and providing starting points for health care practitioners to promote good, effective change to patients. Nursing is significant at all levels because nurses can participate in practically every step of the promotion process. There are five steps within the three tiers of promotion. “Health promotion and specific protection (primary prevention); early diagnosis, rapid treatment and disability limitation (secondary prevention); and restoration and rehabilitation (tertiary prevention)” are among the processes (tertiary prevention).
Significant of the study
Caregiving influences all phases of life including the bodily, mental, economic and moral. Caregivers reported the following physical issues as the most common: difficulty falling asleep, weariness and lethargy, discomfort, lack of physical strength, loss of desire to eat and weight loss. caregivers interrupt social connections, events and activities because their attention and time are concentrated on the patient and their rehabilitation.
Aims OF The Study: -
The aim of this study was to assess burden and coping mechanism among caregiver for old age with advanced illness.
Research Questions: -
What is the level of the caregiver’s burden?
What are the factors affecting the caregiver’s burden?
What are the coping strategies used by the caregivers?
Subject And Methods: -
Recherche Design: -
A descriptive prospective study design was utilized to assess the burden and coping mechanism among caregivers for old age with advanced illness.
Study Sample:
A Convenience sample of caregivers was selected according to the following criteria: primary caregivers who provide care for the patients for at least one year and accept to participate in the study.
Research Setting: -
The current study conducted in Beni-Suef university hospital. Beni-Suef university hospital consists of 16 main departments and 11units providing services.
Study Subject
Subjects in this study were all the caregivers attending with their elderly patients to Beni suef university hospital who match the criteria of the study they were 100 of patients’ relatives from an estimated total of 2500 caregivers attending with their elderly patients visiting Beni suef university hospital.
Tool Of the Study:
Tools of data collection:
Data for the present study was collected using the following: -
One tool of six parts was used by the researcher for the collection of the required data based on the review of relevant literature.
Interviewing questionnaire was developed by the researcher and is composed of 6 parts: -
Part I: Socio-demographic data of caregivers (appendix I) (El-Gilany et al., 2012)
It consists of 7 items and is designed to collect data on age, gender, educational level, marital status, financial status, occupational status and place of residence.
Part II: Questionnaire to assess the medical history of the older adults patients. (Damasceno et al., 2019)
It is designed to collect data about the medical history of older adults patients’ such as diseases, the onset of the diseases .and the stages of the diseases.
Part III: Questionnaire to assess the ability of older adults to perform the activities of daily living independently. (Liebzeit et al., 2018)
It is design to collect data about the patient’s ability to perform six related functions: Bathing, dressing, toileting, transferring, continence, and eating.
Part IV: Questionnaire to assess total level of knowledge of caregivers about the diseases of their patients. ((O’Malley & Qualls, 2016, Zuazua-Rico et al., 2019)
It is designed to collect data on caregivers’ knowledge included 7 closed-ended questions about their patients, diseases & causes, risk factors, symptoms, complications of the diseases and nutrition of patients.
PART V: Questionnaire to assess the burden of caregivers. (Gonçalves-Pereira et al., 2017)
It is a 15-question tool that measures caregivers’ burden such as physical, psychological, social and financial burden attributable to caregiving.
PART VI: Questionnaire to assess coping strategies used by the caregivers to reduce burden. (Martínez Ortega et al., 2016)
It is designed to collect data on the extent to which caregivers use coping strategies and mechanisms to reduce the burden of caregiving for older adults with advanced disease and has seven main components: get respite, set boundaries, accept the limitation, planning, instrumental support, ask for emotional support and religious coping.
Pilot Study:
The pilot study was carried out on10 caregivers to evaluate the applicability, efficiency, clarity of tools, assessment of the feasibility of fieldwork, besides to detect any possible obstacles that might face the researcher and interfere with data collection. Necessary modifications were done.
Ethical Consideration
The study was conducted with careful attention to ethical standards of research and the rights of participants. Verbal and written consent was taken from each relative caregiver as well as patient to participate in this study. During the initial interview, the purpose of the study and the procedures were explained to the participants. The subjects were assured that all information will be confidential and will be used for the research only to assure the confidentiality of the participants. Participants will be assured that their participation in the study is voluntary and that they can refuse to participate in the study. It will be explained that there are no costs to participate in the study.
Field Work:
Data collection of the study was started at the beginning of March 2019 and completed by the end of June 2019; it took four months to collect the data. The researcher attended at the geriatric units three days per week from 9 am to 2 pm at Beni-Suef university hospital for all the older adult is already diagnosed with multi comorbidities disease’, receiving medical and nursing care for at least 3 months. The researcher first explained the aim of the study to the participants and reassures them that information collected will be treated confidentially and that it will be used only for the purpose of the research.
Statistical Design:
The collected data were organized, tabulated and statistically analyzed using SPSS version 19 (Statistical Package for Social Studies) created by IBM, Illinois, Chicago, USA. A Chi-square test was used to detect the statistical differences between variables. When the chi-square test was not suitable due to the presence of observations with a small number, Monte Carlo exact test was used. The level of significance was adopted at p<0.05.
Study Results: -
The results of this study can be summarized as the following.
• The current study revealed that (43%) of the studied caregivers reported a high level of burden and stress, flowed by (32%) reported a medium level of burden and (25%) reported a low level of burden.
• The current study revealed that (59%) of the studied sample had unsatisfactory about their level of knowledge whereas (41%). had a satisfactory level of knowledge.
• The data revealed that 65% of studied caregivers used instrumental support as a coping mechanism followed by (27%) asking for emotional support.
• The factors affecting caregivers’ burden are educational level and place of residence.
• The finding of the current study found that three variables such as age, gender and education had a positive relationship with the level of knowledge (p<.05). but the place of residence had a nonsignificant relationship with the level of knowledge.
• The result of the present study found that two variables such as education and residence had a significant relationship with the level of burden (p <.05). and the other two such as age and gender variables had a nonsignificant relation with the level of burden.
• There is significant positive correlation between the total knowledge of the studied sample of caregivers and their total burden score (p = .003). while there is significant negative correlation between using coping mechanisms and total burden score (p = .0001).
Conclusion: -
Based on the findings of the present study, it can be concluded that:
The participants’ caregivers experienced a high, medium and low level of burden in addition to the majority of the studied sample of caregivers had an unsatisfactory knowledge about their patients’ diseases. The caregiver’s physical, psycho-social and financial aspects of life are more affected by the caregiving of patients with advanced illness.
The instrumental support coping mechanism is most frequently coping used by the participants’ caregivers to reduce stress followed by asking for emotional support while the majority of the studied sample of caregivers do not use accept the limitation. Caregivers’ factors such as educational level and place of the resident are major factors that affected caregivers’ burden. While Caregivers’ factors such as age, gender and education affected the level of knowledge. There is significant positive correlation between the total knowledge of the studied sample of caregivers and their total burden score. While there is significant negative correlation between using coping mechanisms and total burden score.
Recommendations: -
Based on the findings of the present study, the following recommendations are suggested:
• Provide guidelines as well as clinical training to assist caregivers of chronic disease patients at home This helps them deal with the burden of care and manage the stress associated with it.
• Families should be involved in the care program for older adult patients as this helps to increase their knowledge of the care that older adults need and prevent stress and thus reduce their burden.
• Particular attention should be paid to family caregivers to promptly identify those who are at greatest risk of burden. This can be fulfilled by emphasizing the importance of attending health courses on aging-related changes and care of chronic advanced diseases and by informing about available services which can help.
• The burden of caregivers could be reduced by improving communication with healthcare providers through social networks, such as What’s app, Twitter, telephone calls and E-mails. establish hotlines for families’ caregivers of patients with various advanced illnesses. to assist them in making decisions during the caregiving process and to improve their coping abilities
• Family support groups should be established to assist caregivers and advocate for their well-being in society.
• Creating mass media campaigns directed to caregivers in order to improve their awareness and practices about the caregiving process for patients with advanced illness.
• Intervention studies are proposed to assist caregivers in engaging in behaviors that improve their own wellbeing and in developing successful buffers against feeling depressed and distressed.