Evaluación del estado de salud mental de los cuidadores de pacientes con enfermedades crónicas no transmisibles de la comunidad de El Llano, provincia Peravia, República Dominicana, durante el período noviembre-diciembre 2019 / Evaluation of mental health status in caregivers of patients with chronic non-communicable diseases of the community of El Llano, Peravia Province, Dominican Republic, during the period November-December 2019

Introducción: el Síndrome del cuidador (CIE-11 QF27) se define como una respuesta inadecuada al estrés emocional crónico, que no aparece exclusivamente en los cuidadores y cuyas principales características son el agotamiento físico y/o psicológico1. Es una entidad de gran prevalencia en la actualidad, y ello se debe tanto al aumento de la esperanza de vida como al auge de las enfermedades crónicas no transmisibles, estas últimas incapacitando a la población y aumentando el número de cuidadores formales e informales, que surgen para atender las necesidades de los afectados2. Objetivos: evaluar el estado de salud mental en cuidadores de pacientes con enfermedades crónicas no transmisibles de la comunidad de El Llano, provincia de Peravia, República Dominicana. Metodología: estudio transversal, prospectivo, observacional y analítico. Se seleccionó una muestra de 115 personas, con un nivel de confianza del 95 % y un margen de error del 8 %, a las que se les aplicaron los cuestionarios. Las variables del cuestionario incluyeron edad, sexo, fecha de la información recolectada, así como los cuestionarios estandarizados de Goldberg para depresión y ansiedad en atención primaria, Cuestionario para la sobrecarga de Zarit y fragmentos del Cuestionario para cuidadores primarios. Además, se incluyó un formulario para adquirir el consentimiento informado. Resultados: se encontró que el 63 % de los cuidadores podía sufrir depresión, el 52 % podía sufrir ansiedad y el 71 % de los cuidadores no presentaba sobrecarga. Sin embargo, la sobrecarga no es suficiente para explicar el comportamiento de depresión (r2=-0,27) o ansiedad (r2=-0,14), ya que ambos demostraron una correlación positiva muy baja. Se demostró que un 76 %, correspondiente a 87 cuidadores, eran del sexo femenino. También la edad fue una variable importante, el 45 % de los cuidadores se encontraron entre las edades de 41-60 años. Conclusiones: la sobrecarga presentada por los encuestados no fue suficiente para explicar los niveles de depresión y ansiedad, por lo tanto, se debe correlacionar con más variables.

Introduction: The Caregiver Stress Syndrome (ICD-11 QF27) is defined as an inadequate response to chronic emotional stress, which does not appear exclusively in caregivers and whose main features are physical and/or psychological exhaustion1. It is an entity of great prevalence nowadays, and this is due both to the increase in life expectancy and to the rise of chronic non-communicable diseases, the latter disabling the population and increasing the number of formal and informal caregivers, who emerge to meet the needs of those affected2. Objectives: Evaluate the mental health status in caregivers of patients with chronic non-communicable diseases of the community of El Llano, Peravia province, Dominican Republic. Methodology: Cross-sectional, prospective, observational, and analytical study. A sample of 115 people was selected, with a 95% confidence level and 8% margin of error, to which the questionnaires were applied. The questionnaire variables included age, gender, date of collected information, as well as Goldberg's standardized questionnaires for depression and anxiety in primary care, Zarit Burden Interview, and fragments of the Primary Caregivers Questionnaire. Additionally, a form to acquire informed consent was included. Results: It was found that 63% of caregivers could suffer from depression, 52% could suffer from anxiety, and 71% of caregivers did not present burden. Meanwhile, the overload is not enough to explain the behavior of depression (r2=-0.27), or anxiety (r2=-0.14) since both demonstrated a very low positive correlation. It was shown that 76% corresponding to 87 caregivers were female. Age was also an important variable, 45% of the caregivers were between the ages of 41-60 years. Conclusions: The overload presented by the respondents was not sufficient to explain the levels of depression and anxiety, hence should be correlated with other variables.

“I WISH YOU WOULD JUST DIE!” MANAGEMENT OF DEMENTIA WITH BPSD, AND CAREGIVER STRESS

This is a case of a patient with Behavioural andPsychological Symptoms of Dementia (BPSD) causingcaregiver burden in her husband. The family physician wasable to lead a multidisciplinary team to manage andoptimise her care in the community.

“I Wish You Would Die!” Management of Dementia with BPSD, and Caregiver Stress

@#This is a case of a patient with Behavioural and Psychological Symptoms of Dementia (BPSD) causing caregiver burden in her husband. The family physician was able to lead a multidisciplinary team to manage and optimise her care in the community.

Factors associated with prolonged length of stay in older patients

<p><b>INTRODUCTION</b>Prolonged stay in acute hospitals increases the risk of hospital-acquired infections in older patients, and disrupts patient flow and access to care due to bed shortages. We aimed to investigate the factors associated with prolonged length of stay (pLOS) among older patients (aged ≥ 78 years) in a tertiary hospital, to identify the potentially modifiable risk factors that could direct interventions to reduce length of stay (LOS).</p><p><b>METHODS</b>During a three-month period from January 2013 to March 2013, we identified 72 patients with pLOS (LOS ≥ 21 days) and compared their demographic and clinical variables with that of 281 randomly selected control patients (LOS < 21 days) using univariate and multivariate logistic regression analyses.</p><p><b>RESULTS</b>The mean age of the patients was 85.30 ± 5.34 years; 54% of them were female and 72% were of Chinese ethnicity. Logistic regression revealed the following significant factors for increased LOS: discharge to intermediate and long-term care services (odds ratio [OR] 9.22, 95% confidence interval [CI] 3.56-23.89; p < 0.001); increased severity of illness (OR 2.41, 95% CI 1.12-5.21; p = 0.025); and presence of caregiver stress (OR 3.85, 95% CI 1.67-8.91; p = 0.002).</p><p><b>CONCLUSION</b>Presence of caregiver stress and nursing home placement are potential modifiable risk factors of pLOS among older patients. Early identification and management of caregiver stress, as well as expediting discharge planning, may help to reduce the length of stay for this cohort.</p>

How do General Practitioners Foster Mutual Support with Family Caregivers in Optimising Healthcare for Persons with Disabilities?

The number of persons with disabilities (PWD) that GPs will attend to will increase due to the rapid ageing population and increasing life expectancy in Singapore. It is important for GPs to work in partnership with family caregivers in order to optimise the healthcare of all PWD, including those with congenital and acquired disabilities. This paper examines the challenges and needs of caregivers; and suggests ways for GPs, caregivers and government to enhance the healthcare experience of PWD.