{"id":3377,"date":"2010-11-23T12:00:00","date_gmt":"2010-11-23T12:00:00","guid":{"rendered":"https:\/\/care-givers.com\/articles\/caregiving-to-elders-issues-and-challenges\/"},"modified":"2021-06-22T21:06:18","modified_gmt":"2021-06-22T21:06:18","slug":"caregiving-to-elders-issues-and-challenges","status":"publish","type":"post","link":"https:\/\/care-givers.com\/articles\/caregiving-to-elders-issues-and-challenges\/","title":{"rendered":"Caregiving to elders: Issues and challenges"},"content":{"rendered":"

ABSTRACT:<\/p>\n

The number of old people, who are 60 years and above, is increasing in
\nthe populations throughout the world. Even among the old population,
\npersons who are 80 years and above, called the \u2018oldest old\u2019 are growing
\nfaster. Old age is associated with frailty, disability and disease.
\nHearing and vision impairments, cardio vascular diseases, osteoporosis,
\nstroke and Alzheimer\u2019s disease are some of the major diseases related
\nto old age. The growing number of older individuals in a society
\nnecessitates the need for long term health care. The family is the
\nimmediate caregiving institution and a sick elderly person increases
\nthe burden of the family. Formal caregiving has not yet evolved in
\nIndia as in developed countries. This paper aims to analyze the needs
\nfor elderly caregiving in the twenty first century, the availability of
\nformal and informal caregivers, the problems of the family caregivers
\nand the roles of communities and governments to enhance the level of
\ncaregiving to growing elderly population.
\nCaregiving
\nCaregiving is a noble task but at the same time caring for a loved one
\nis always a stressful and frustrating one. Care may be needed for a
\nshorter or longer duration of time depending on the condition of the
\ncare recipient. Short term care does not have much significance and
\ncaregiving becomes a social issue when it is required for a long time
\nfor a person who is chronically ill or disabled. The care recipient may
\nbe anybody \u2013 a child, an adult or an elderly person of any gender.
\nChronic illness or accident might have necessitated caregiving.
\nCaregiving to a child is different from that of providing care to a
\nmiddle aged or an elderly patient.<\/p>\n

Caregiving includes helping the patient in the activity of daily living
\nlike toileting, bathing, dressing, feeding, walking, administering
\nmedicines, nursing and other related activities. The caregiver may also
\nbe expected to assist the patient in financial and legal matters. There
\nare two types of caregiving \u2013 formal and informal. Formal caregiving is
\na paid service provided by health professionals like doctors, nurses
\nand attendants of hospitals and some social welfare organizations.
\nInformal caregiving refers to unpaid services rendered by family
\nmembers, friends and relatives. Caregivers are falling under two
\ncategories \u2013 primary and secondary. Primary caregivers are those who
\nare mainly responsible for providing care to the patient and those who
\nsupport the primary caregivers in their care giving activities are
\ncalled secondary caregivers. If the wife is a caregiver for her sick
\nhusband, she is the primary caregiver and her sons, daughters-in-law,
\ngrandchildren, friends and relatives who assist her are the secondary
\ncaregivers.
\nPopulation Aging
\nPeople are living longer than their previous generations throughout the
\nworld due to increase in life expectancy. The absolute number and
\nproportion of people who are aged 60 and above are increasing in the
\nworld population. This is the result of demographic transition from
\nhigh birth rate, high death rate and shorter life expectancy to low
\nfertility rate, low mortality rate and longer life expectancy.<\/p>\n

Fall in the birth rates increased the proportion of old people and
\ndeclining mortality rate increased the number of old persons in the
\npopulation. Developing countries have been aging for centuries but this
\nphenomenon is happening in developing countries recently and at a
\nfaster pace.<\/p>\n

The United Nations declares persons who are 60 years and above as old
\nand estimates that there will be around 2 billion old people in the
\nworld by 2050, 80 percent of whom will live in developing countries.
\nThe old population itself is aging and the persons who are 80 years and
\nabove, called the \u2018oldest old\u2019 are aging faster than any other age
\ngroup. Major proportions of elderly persons comprise women in almost
\nall countries. The majority of them are widows and their numbers grow
\nas their age increases.
\nOld age and health
\nOld age is associated with chronic illness, frailty, disability and
\ndependence. All forms of functional impairments increase with age. The
\nmajor diseases relating to old age are cataract, hearing impairment,
\narthritis, diabetes, osteoporosis, heart disease, cancer, stroke,
\nAlzheimer\u2019s disease and neurological disorders. Depression, anxiety and
\nsuicide tendencies are also found to be common among the oldest old.
\nWith the increase in the old population, the chances of rise in the
\ndementia patients also increase. The health problems of the elderly are
\ndifferent from those of younger persons and most of the diseases are
\nchronic (Sitaram Gupta, M S Rathore and S S Shekhawat, 2009). The old
\npersons require life long treatment and an elderly person with chronic
\nillness becomes the matter of financial and emotional burden on the
\nfamily.<\/p>\n

Old persons have to depend on others due to poor health, disability and
\neconomic situation. Old people have fear for their future and
\ndependency (Dias A and Patel V, 2009). More number of elderly persons
\nin a society puts pressure on the family and governments to provide for
\ntheir welfare.<\/p>\n

Availability of formal care in the public health sector is very scarce
\nfor elders and geriatric medicines and specialist health services for
\nold people are not well established in India.
\nChallenges of Caregiving to elders
\nThe elders need more care when their vitality is reduced due to
\nweakness and sickness (Carol Bradley Bursack, 2009). Family plays an
\nimportant role in providing health care to the needy old persons.
\nFamily remains the only source of care and support for the vast
\nmajority of Indian elders (Dias A and Patel V, 2009). The caregivers
\nare normally the spouses and majority of the caregivers in our society
\nare women since women have the time, patience, tolerance, nursing
\nability and helping tendency. The family members who provide caregiving
\nto ill or disabled relatives are great assets to the society (Richard
\nSchultz and Scott R. Beach, 1999). The illness of old people cannot be
\ncured and only palliative care can be provided. Due to frailty, the
\ndependence of old persons increases with age and caregiving to them
\nwill not be so easy. When the old person is suffering from disability
\nor dementia, caregiving becomes very difficult and complicated.
\nMajority of dementia patients are cared at home by a family member and
\nthe mental health of the care givers deteriorates in due course (Shaji
\nKS et al, 2009).<\/p>\n

Poverty is one of the major problems for caregiving to elders.
\nUnavailability of affordable health care makes it difficult for poor
\nfamilies to provide adequate care for old people. Poor elders who do
\nnot have children will have to depend on relatives and friends for
\nsurvival and support.<\/p>\n

If the caregiver is a spouse, child or somebody who loves the elderly
\npatient, witnessing the suffering of the patient will be a very sad
\nexperience for the caregiver. The sorrow and the inability to mitigate
\nthe suffering of the patient will increase the frustration and affect
\nthe caregiver psychologically. The burden of woman caregiver will be
\ntremendous as she has to balance her time between the elderly person
\nand the rest of the family.<\/p>\n

Providing assistance to the old person in the activities of daily
\nliving like toileting, bathing, dressing etc, may be an unpleasant
\nexperience affecting the self esteem of the caregiver. Caring an
\nelderly person is a very stressful job. Due to advanced age, the
\ncognitive abilities of the elders will be on decline and their demands
\non the caregivers will be unbearable. At times they may abuse the
\ncaregiver and behave irrationally which will add to the mental agony of
\nthe caregiver. In some cases, the old couple may live alone and
\ncaregiving by the elderly spouse will be very tiresome. Sleeplessness,
\nuntimely intake of food, attending the visitors and providing timely
\ncare will result in fatigue and depression.<\/p>\n

The caregiver is likely to be affected psychologically and
\nphysiologically due to pressure, exhaustion, stress and strain of
\ncaregiving. Depression and anxiety are the outcomes of the stress faced
\nby the caregiver. The possibility of the caregiver suffering from
\ninfectious sickness cannot be ruled out. In order to provide proper
\ncaregiving, the caregiver has to take adequate measures to keep his
\nbody and mind fit to meet the challenges of caregiving To be effective
\ncaregiver, one has to understand the disease, the patient and manage
\nthe time effectively. Regular well planned breaks from caregiving
\nactivities will definitely ease the pressure. The caregiver also should
\ntake the help of other family members, friends and relatives. By
\nignoring his own health for the sake of caregiving, the caregiver is
\nlikely to become patient himself.
\nFuture of caregiving to elders
\nThe average life expectancy of Indians is increasing steadily from 32
\nyears at the time of independence to 63 years in 2001. As per the
\nestimate of United Nations, the life expectancy of males will be 68.8
\nyears and females will be 72.1 in the period 2020-25. The population of
\nold persons in India was 12 million in 1901. It increased to 76 million
\nin 2001 and is expected to be 326 million in 2050.<\/p>\n

Growing number of elderly persons will increase the demand for
\ncaregiving dramatically in the coming decades. Joint family system is
\ndisintegrating and one child families and nuclear families have become
\ncommon nowadays. Migration of younger generations, women employment,
\nmodernization and globalization resulted in shortage of care givers to
\nthe elderly. Informal or family caregiving cannot be sustained in
\nfuture and due to the social changes, it will be difficult to find
\nfamily members for caregiving except the living spouse.<\/p>\n

Elder abuses and abandoning the parents are increasing and only a small
\nproportion of children consider it their duty to look after their old
\nparents. The relationship between parents and children deteriorates
\nover a period of time due to inter-personal conflicts and difference of
\nopinions. When the parents become old and sick, they are neglected and
\ninsulted. The number of such neglected parents likely to increase
\nsignificantly in the future.
\nInterventions
\nFamily is the prime social institution to care the elders. However,
\nwhen there will not be sufficient family members, it becomes imperative
\nto involve community members in caregiving activities. The family
\nmembers should change their negative attitude towards old people and
\nwillingly offer their services in providing care to the needy elders.
\nCharity begins at home and if the families change for the better, then
\nthe entire community in total is transformed.<\/p>\n

The children who live away from their parents should make adequate
\narrangements to provide formal care to their parents at the time of
\nneed. Young children should be taught about Aging, the past
\ncontributions of old people and the importance of
\ncaring them. It is important to create positive image of elders in the
\nminds of the younger generations.<\/p>\n

The number of caregivers, both formal and informal, will have to be
\nincreased in future. It would be appropriate if the educational
\ninstitutions take initiatives to train students for voluntary care
\ngiving. Arranging regular visits of students to old age homes will
\nenable the younger generations to understand the plight of old persons.
\nEducational institutes should organize seminars and conferences
\nregularly on the subject of elderly and caregiving needs to create
\nawareness among the students.<\/p>\n

To reduce the financial burden of poor people, the governments should
\nprovide free or subsidized medical care for old persons. Old age homes
\nare spreading throughout India, both in urban and rural areas. However,
\nthey are not geared to provide long term care for old people.
\nGovernment agencies and NGOs who run old age homes may consider adding
\ncaregiving facilities with suitable health care professionals.<\/p>\n

Similar to old age homes, Caregiving Centres can be started throughout
\nIndia by government and NGOs. Leading private hospitals and corporate
\ncompanies can join together and establish care centres which can
\nprovide long term care at affordable cost or free of charge for old
\npersons and other sections of the society.<\/p>\n

Both government and private hospitals should have special geriatric
\nwards with professionals trained to treat old persons. Such wards
\nshould have facilities to provide long term care for old patients
\nwithout the need for any family member to be with the patient.<\/p>\n

Caregiving courses and trainings are offered by certain educational
\ninstitutions in some of the major cities at present. However, medical
\ncolleges and similar institutions should introduce caregiving study
\ncourses on a large scale and raise the quality of caregiving education
\nto the level of nursing by improving the standard of curriculum and
\ntraining. This will enable more young persons choose caregiving as
\ntheir career.<\/p>\n

Old persons, as far as possible, can take care of themselves by forming
\nassociations and clubs. Old people, especially \u2018young old\u2019, who are
\naged between 60 and 70 and active, should take the lead to form
\nsuitable networks to provide care to the fellow old persons.<\/p>\n

In future, almost every household will have one or two old persons who
\nmay require long term health care. When the caregiving need arises, the
\ncaregivers from different families can form informal networks, assess
\ndifferent needs of different patients, consolidate the requirements and
\nshare the total care giving tasks among themselves. Such community
\ncaregiving arrangements will avoid duplication of efforts, save time
\nand ease the pressure.
\nConclusions
\nCaregiving is an act of a civilized and cultured human being.
\nRespecting elders and taking care of them is part of our tradition. By
\ndoing so, we set an example for others to follow and also teach our
\nchildren about the importance of care giving. Caregiving is a rewarding
\nexercise and gives us an opportunity to pay back to the elders against
\nwhat they have given to us.<\/p>\n

It is our duty to provide physical, emotional, social and economic
\nsecurity to old people and ensure that they spend their last phase of
\nlife happily with dignity and satisfaction. We have to commit ourselves
\nfor this noble task and also guide the succeeding generations to follow
\nus.<\/p>\n

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 <\/p>\n

R. Narayanasamy
\nnarayana91@yahoo.com
\nCaregiving to the elderly<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"

This article analyses the caregiving needs for the growing elderly population and also explains the difficulties of caregiving<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5,6],"tags":[],"ppma_author":[934],"class_list":["post-3377","post","type-post","status-publish","format-standard","hentry","category-caregiver-issues","category-eldercare"],"authors":[{"term_id":934,"user_id":0,"is_guest":1,"slug":"narayanasamy","display_name":"R. Narayanasamy","avatar_url":"https:\/\/secure.gravatar.com\/avatar\/?s=96&d=mm&r=g","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":""}],"_links":{"self":[{"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/posts\/3377","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/comments?post=3377"}],"version-history":[{"count":3,"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/posts\/3377\/revisions"}],"predecessor-version":[{"id":4250,"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/posts\/3377\/revisions\/4250"}],"wp:attachment":[{"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/media?parent=3377"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/categories?post=3377"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/tags?post=3377"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/ppma_author?post=3377"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}