Caregiver Burden Is Reduced by Social Support Services for Non-Dependent Elderly Persons: Pre-Post Study of 569 Caregivers.

BACKGROUND: Informal care provided by family caregivers (FCGs) to elderly persons is associated with a high risk of burden and poor health status. Social support services (3S) for the elderly persons were characterized by assistance in various activities of daily living. This study aimed to analyze the impact of 3S on the burden of FCGs of elderly persons living in the community and identify factors associated with changes in their burden. METHODS: This pre-post study was performed in the southeast of France: FCGs of non-dependent elderly persons still living at home who received a 3S were consecutively included. FCG burden was assessed with the Mini-Zarit scale before the setting up of the 3S (pre-3S) and 6 months after (post-3S). RESULTS: A total of 569 FCGs were included in the study. Mean age of the FCGs was 62.9 years old (±13.3), 67% were women, 61.2% were children or stepchildren. Burden was present for 81% of FCGs. In most cases, 3S targeted household chores (95.8%); 59.8% of elderly persons and their FCGs were fully satisfied. The improvement in burden was greater for FCGs perceiving less obstacles post-3S in helping elderly persons (OR = 4.083) but also for FCGs fully satisfied with the 3S (OR = 2.809) and for FCGs whose perceived health status had improved post-3S (OR = 2.090). CONCLUSIONS: FCGs of non-dependent elderly persons experience a burden similar to those of dependent elderly persons. The implementation of a 3S in daily life helps to reduce their burden.

[In old people's homes, carers face Covid-19]. / En Ehpad, les soignants face à la Covid-19.

Many ethical issues were raised by the pandemic crisis. Caregivers were under great pressure and stress in their work in residential care facilities for the dependent elderly (Ehpad), both with residents and their families. The implementation of ethical support tools was only gradual, particularly for the management of residents' deaths. Anxiety has set in among all the people working or living in the Ehpad, blurring interpersonal relations and increasing tensions and professional exhaustion.

Experience of General Practice Residents Caring for Dependent Elderly during the First COVID-19 Lockdown-A Qualitative Study.

BACKGROUND: Understanding the experiences of general practice (GP) residents caring for dependent elderly people during the first lockdown as part of the countries COVID-19 pandemic strategy. The aim was to explore themes that could explain the gap between the missions and values at the heart of GP practice during this period of strict isolation. METHOD: Qualitative study using an iterative approach. Semi-structured interviews were conducted with 13 GP residents using a pre-established interview guide. Audio recordings were transcribed verbatim. Data were analyzed according to a coding grid, developed using Nvivo software (NVivo Qualitative Data Analysis Software; QSR International Pty Ltd. Version Release 1.5.1 (940) 2021), to identify emerging themes. RESULTS: Three themes emerged from this qualitative research: cognitive dissonance, psychosocial risks, and fear. General practice residents have lived in the paradox between care and deprivation of liberty of dependent elderly people. CONCLUSION: The results suggest that the GP residents experienced a form of work-related suffering in this situation of deprivation of liberty of dependent elderly people. The present research serves as a pilot study to explore how GP residents experienced their care of locked-up dependent elderly people.

Construção de uma cartilha educativa para familiares cuidadores sobre cuidado domiciliar ao idoso dependente Amazônico / Construction of an educational booklet for family caregivers about home care for the elderly dependent in the amazon / Construcción de un folleto educativo para cuidadores familiares sobre el cuidado en el hogar de ancianos dependientes en la amazonía

OBJETIVO: descrever a construção de uma cartilha educativa para familiares cuidadores sobre o cuidado domiciliar ao idoso dependente no contexto Amazônico. MÉTODO: trata-se de um estudo metodológico, realizado no período de setembro de 2019 a agosto de 2021. A produção tecnológica seguiu quatro etapas: Levantamento bibliográfico; Construção textual da cartilha; Pesquisa e definição das imagens e Layout e diagramação da cartilha. RESULTADOS: a cartilha aborda os cuidados referentes às dificuldades e necessidades dos cuidadores domiciliares ­ higiene corporal, banho no chuveiro, banho na cama, higiene intima, higiene da boca, troca de fraldas, prevenção de quedas, mobilização e transferência, cuidados com a alimentação, cuidados com os medicamentos, cuidados para evitar quedas, cuidados quanto ao uso de redes e cuidados quanto ao uso de remédios caseiros. CONCLUSÃO: a cartilha apresenta orientações sobre as principais atividades assistenciais que o cuidador desempenha no dia a dia no cuidado à pessoa idosa dependente, sendo divididas em tópicos. A cada atividade seguem orientações necessárias ao cuidado para que o cuidador preste uma assistência mais segura e as dificuldades vivenciadas na prática sejam minimizadas. (AU)

Objective: To describe the construction of an educational booklet for family caregivers about home care for dependent elderly in the Amazon context. Methods: This is a methodological study, carried out from September 2019 to August 2021. Technological production followed four stages: Bibliographic survey; Textual construction of the booklet; Research and definition of images and Layout and diagramming of the booklet. Results: The booklet addresses the care related to the difficulties and needs of home caregivers - body hygiene, showering, bathing in bed, intimate hygiene, mouth hygiene, changing diapers, preventing falls, mobilization and transfer, care with food, care with medications, care to prevent falls, care regarding the use of hammocks and care regarding the use of home remedies. Conclusion: The booklet provides guidance on the main care activities that the caregiver performs on a daily basis in caring for the dependent elderly person, being divided into topics. Each activity follows the necessary care guidelines so that the caregiver provides safer care and the difficulties experienced in practice are minimized. (AU)

Objetivo: Describir la construcción de un folleto educativo para cuidadores familiares sobre el cuidado domiciliario de ancianos dependientes en el contexto amazónico. Métodos: Se trata de un estudio metodológico, realizado de septiembre de 2019 a agosto de 2021. La producción tecnológica siguió cuatro etapas: Encuesta bibliográfica; Construcción textual del folleto; Investigación y definición de imágenes y Maquetación y diagramación del folleto. Resultados: El folleto aborda los cuidados relacionados con las dificultades y necesidades de los cuidadores domiciliarios - higiene corporal, bañarse en la ducha, bañarse en la cama, higiene íntima, higiene bucal, cambio de pañales, prevención de caídas, movilización y traslado, cuidados con la alimentación, cuidados con medicamentos, cuidado para evitar caídas, cuidado con el uso de hamacas y cuidado con el uso de remedios caseros. Conclusión: El folleto brinda orientación sobre las principales actividades de cuidado que el cuidador realiza a diario en el cuidado del anciano dependiente, dividido en temas. Cada actividad sigue las pautas de cuidado necesarias para que el cuidador brinde una atención más segura y se minimicen las dificultades experimentadas en la práctica. (AU)

[The "Innovative and learning collective actions" approach in medico-social institutions]. / La démarche des actions collectives innovantes et apprenantes en établissement médico-social.

The innovative and learning collective actions initiative, steered by the Ministry of Health and coordinated and led by the network of the National Agency for the Improvement of Working Conditions and regional associations for the improvement of working conditions with the support of the regional health agencies, has made it possible to deploy quality of life at work initiatives in 277 institutions for the elderly and disabled, between 2018 and 2021.

[Preventing elderly abuse]. / Prévenir la maltraitance des personnes âgées.

While violence permeates society in many ways, it does not spare any age group. The elderly are particularly exposed to violence and abuse, especially in the current pandemic context, which they suffer without being able or daring to defend themselves. Within "Les Petits Frères des Pauvres" association, the support and advice unit for the fight against abuse is designed to support and assist, at their request, teams of volunteers and/or employees who are faced with the questionare wondering about the best choices to make in complex support situations when there is a suspicion of abuse.

[Prevalence of advance directives and impact on the progress of cardiac arrest resuscitation in EHPAD]. / Prévalence des directives anticipées et impact sur le déroulement de la réanimation d'arrêts cardiaques en Ehpad.

Anticipated directives are of great value among patients living in residential care facilities for the elderly. Their prevalence in cases of cardiac arrest was studied. It was found that this issue is not systematically addressed. This results in the inappropriate use of resuscitation manoeuvres that could be avoided. This is an area that needs to be addressed in depth.

[COVID-19, deployment of antigenic tests in EHPAD]. / Covid-19, déploiement des tests antigéniques en Ehpad.

During the second epidemic wave of COVID-19 in the fall of 2020, residents of accommodation facilities for dependent elderly people were not totally confined. They were able to continue to receive visits from their families under a strict health protocol. But these facilities are very fragile, and many have been affected. The marketing of rapid detection tests for severe acute respiratory syndrome coronavirus 2 using an antigenic method has made it possible to carry out massive screening campaigns for staff in these facilities since the beginning of November.

Delivery of mobile dental services to dependent elderly people: results from a pilot study in rural Switzerland.

The objective of this pilot study was to provide data on the oral health status and oral health behaviour of care-dependent elderly people in the canton of Uri. The study aimed at assessing whether age and duration of living in a nursing home is associated with dental attendance, whether there is a relationship between age and the DMF-T index, and how high the risk was for participants to develop oral health problems. The study offered mobile dental services to people residing in nursing homes (NHG) and to community dwellers (CDG). Data was collected on demographics, medical history, presence of pain, ability to eat and oral health behaviour by means of a questionnaire. A clinical examination was performed and data on the oral status was collected. Statistical methods were: median tests, linear regressions and descriptive statistics. Uptake of the programme was low. 56 participants were examined. 47 participants (24 females, 23 males, average age 86.3 ± 7.36 years) resided in nursing home, nine participants (seven females, two males, average age 76 ± 12.8 years) were community dwellers. No significant differences were found between frequency of dental attendance and age (p = 0.35) or duration of stay in a nursing home (p = 0.55). The number of decayed teeth (p=0.005), missing teeth (p=0.01), and the DMF-T index (average in NHG = 26.5, CDG = 20.2, p < 0.001) increased, the number of filled teeth (p=0.02) decreased as age increased. Upon calculation of the 'Teamwerk-index', which takes into account oral health behaviour, dental caries, periodontal status, the majority of participants had a medium risk of developing oral health problems. Our pilot study in rural Switzerland provides first results of the oral health status in dependent elderly people. As people age, oral health deteriorates. More attention should be given in order to achieve better oral hygiene maintenance and more regular dental visits, to ensure a better oral health status in dependent elderly people.

Cuidadores formais de idosos dependentes no domicílio: desafios vivenciados / Formal caregivers of dependent elderly people in the home: challenges experienced

Resumo O objetivo deste artigo é analisar as características e os desafios vivenciados pelos cuidadores formais de idosos dependentes no domicílio. Estudo qualitativo multicêntrico, realizado em 6 cidades brasileiras, com cuidadores formais de idosos dependentes. As entrevistas foram realizadas mediante utilização de um roteiro semiestruturado, no domicílio, nos meses de maio a agosto de 2019, com duração média de 60 minutos. Participaram 27 cuidadores formais com idade média de 46 anos, predominantemente do sexo feminino, com tempo médio de cuidado ao idoso de 2 anos e 6 meses, sem formação profissional de cuidador. A análise e a interpretação das falas conduziram à formulação de três categorias temáticas: Condições de trabalho e de saúde do cuidador formal; Perfil e modos de cuidar; e Desafios para cuidar. É necessário conhecer as características e as demandas dos cuidadores formais de idosos dependentes domiciliados para que políticas públicas e intervenções eficazes possam ser desenvolvidas, levando-se em consideração as necessidades apresentadas por esses profissionais.

Abstract Objective: To analyze the characteristics and challenges experienced by formal caregivers of dependent elderly at home. Methods: Multicenter qualitative study, conducted in six Brazilian cities, with formal caregivers of dependent elderly people. The interviews were conducted using a semi-structured guide, at their homes, from May to August 2019, lasting an average of 60 minutes. Results: Participants were 27 formal caregivers with a mean age of 46 years, predominantly female, with mean care time for the elderly of two years and six months, without professional training of caregivers. The analysis and interpretation of the statements led to the formulation of three thematic categories: Working and health conditions of the formal caregiver; Profile and ways of caring; and Care challenges. Final thoughts: There is need to know the characteristics and demands of formal caregivers of dependent elderly people domiciled for the development of public policies and effective interventions, taking into account the needs presented by these professionals.

Cuidar de quem cuida de idosos dependentes: por uma política necessária e urgente / Caring for those who care for dependent older adults: for a necessary and urgent policy

Resumo Apresenta-se e discute-se a situação das cuidadoras e dos cuidadores familiares de idosos dependentes. Ressaltam-se sua dedicação, seus problemas e os encaminhamentos para valorizá-los. Sabe-se que a tarefa de cuidar é eminentemente feminina, invisível, não remunerada, que afeta a sociedade como um todo. Descrevem-se as políticas vigentes em alguns países europeus, no Canadá e nos Estados Unidos a favor das cuidadoras e cuidadores. A maioria dos modelos de suporte existentes apresenta lacunas. Leis e regulações criadas têm sido pouco compreensivas, inorgânicas e a família continua a ser a responsável pelos parentes longevos que perderam autonomia. Em vários desses países, além de outras medidas, a tendência é integrar os cuidados familiares como primeiro patamar da atenção básica em saúde, universalizando o apoio aos cuidadores. Não se pode esquecer que a tendência de manter o idoso dependente em casa é uma aquiescência a seu próprio desejo, embora também oculte a delegação de responsabilidade do Estado às famílias por meio das políticas de deshospitalização e desinstitucionalização. No Brasil, o tema ainda não entrou no radar das políticas públicas, embora seja urgente pelo acelerado aumento da população idosa, em particular, que tem 80 anos e mais.

Abstract The situation of caregivers and family caregivers of dependent older adults is presented and discussed, highlighting their dedication, problems, and possible recommendations to value them. The task of caring is known to be eminently feminine, invisible, unpaid, but affects society as a whole. Policies of some European countries, Canada, and the United States in favor of male and female caregivers are described. However, most existing support models have gaps. The laws and regulations enacted have been poorly comprehensive, inorganic, and the family remains responsible for long-lived relatives who have lost their autonomy. In many countries, besides other measures, the tendency is to integrate the family care as the first PHC level, universalizing support to caregivers. One must not be forgotten that the tendency to keep dependent older adults at home is acquiescence to their desire, but it also hides the delegation of responsibility from the State to families through dehospitalization and deinstitutionalization policies. In Brazil, the issue has not yet entered the public policy radar, although it is urgent because of the accelerated increase of the elderly population, particularly those aged 80 and over.

[COVID-19 in accommodation facilities for dependent elderly, testimony from a healthcare executive]. / La Covid-19 en Ehpad, témoignage d'un cadre de santé.

Sunday, day of rest in a pavilion of Seine-Saint-Denis in this so particular period of confinement because of the coronavirus disease 2019. Time seems to stand still. A healthcare executive shares his experiences at the "Les 4 Saisons" accommodation facility for dependent elderly, located in Bagnolet.

[COVID-19, impact on residents and caregivers]. / Covid-19, impact sur les résidents et les soignants.

Following the COVID-19's entry into France, in order to protect the residents, the doors of the accommodation facilities for dependent elderly have been closed and a complete reorganization has been necessary. This confinement and restructuring behind closed doors has many consequences both for the residents and for the staff who accompany them on a daily basis. For the resident, the physical and/or psychological impact will be different depending on his degree of autonomy. The staff fear for their health, their families health, and the one of the elderly they accompany.

[Entertainment committee in accommodation facilities for dependent elderly, functional importance and psychic stakes]. / Comité d'animation en Ehpad, importance fonctionnelle et enjeux.

In accommodation facilities for dependent elderly, entertainment is found in various forms. It is the place that promotes the stability and development of the relational, social and cultural life of the residents. Listening to what is said and experienced during the sessions allows a useful representation of the movements within the establishment. If daily difficulties may be encountered, the creation of an entertainment committee offers the opportunity to combine them and make them an added value.

[COVID pandemic in accommodation facilities for dependent elderly]. / Pandémie de Covid dans les Ehpad.

During the coronavirus outbreak, accommodation facilities for dependent elderly (Ehpad) had to adapt quickly to an unknown and dangerous situation for residents, putting all the resources of these places to the test. Caregivers faced clinical and organizational emergencies with the coordinating doctors and nurse, going through different individual and collective phases. The directors, who are legally responsible for Ehpad, had to make room for the "we", anticipate, apprehend and evaluate the crisis but also deal with paradoxical recommendations.

[Accommodation facilities for dependent elderly people facing the pandemic]. / Les établissements d'hébergement pour personnes âgées dépendantes à l'épreuve de la Covid-19.

The pandemic has severely affected some accommodation facilities for dependent elderly people, but all of them have had to reorganize. Their operation will never be the same again and transparency towards employees and the families of residents has become an obligation. Cooperation with dispensing pharmacists, who can act as information relays for families, must be stepped up.

Support policies for the elderly in situations of dependency: Europe and Brasil: / Políticas de apoio aos idosos em situação de dependência: Europa e Brasil:

This text describes and discusses policies of long term care offered to dependent elderly people. The objective is to analyze the content and strategies that guide the formulation of the so-called "dependency policies" in some European states, seeking guidance for the formulation of actions related to the same issue in the Brazilian case. The knowledge bases are official documents and scientific articles that analyze the institutionalization of the proposals. The study shows: all the countries analyzed included policies on dependency within the framework of their social security system; some offer total protection, others, only partial, which serve the elderly and the family caregiver; in none of them the elderly and their caregiver fail to receive care they need. In Brazil, there are some local experiences that meet the requirements of comprehensive care. Initiatives of Belo Horizonte and São Paulo are narrated. However, the aforementioned experiences are not a policy. They are successful cases that can evolve to increase social awareness or simply disappear. The need for the issue addressed in this article to be taken seriously is imperative, due to the inexorable fact of the accelerate growth of the long-lived population, particularly those aged 80th and over, the most vulnerable.

Neste ensaio teórico discutem-se políticas sobre cuidados de longa duração para pessoas idosas dependentes. O objetivo é analisar o conteúdo e as estratégias que guiaram a formulação das chamadas "políticas de dependência" em alguns estados europeus, buscando orientações para a formulação de ações relativas à mesma questão no caso brasileiro. As bases de conhecimento são documentos oficiais e artigos científicos que descrevem e analisam a institucionalização das propostas. O estudo mostra que os países europeus aqui analisados incluíram as políticas sobre a dependência nos marcos de seu sistema de seguridade social; alguns oferecem proteção total, outros, apenas parcial ao idoso e ao cuidador familiar. Em nenhum deles, a pessoa idosa dependente deixa de receber os cuidados de que precisa. No Brasil, há algumas experiências locais que atendem aos requisitos de atenção integral. São narradas uma de Belo Horizonte e uma de São Paulo. Embora sejam importantes, tais iniciativas não constituem uma política, são casos exitosos que podem evoluir para o aumento da consciência social ou se esvaírem como experiências não institucionalizadas. A questão tratada neste artigo é de grande relevância, pelo fato inexorável do crescimento acelerado da população longeva, a que mais depende do cuidado de terceiros.    

Caring for those who care for dependent elderly: For a necessary and urgent policy / Cuidar de quem cuida de idosos dependentes: Por uma política necessária e urgente

The situation of caregivers and family caregivers of dependent elderly people is presented and discussed, highlighting their dedication, problems and possible referrals to value them. It is known that the task of caring is eminently feminine, invisible, unpaid, but it affects society as a whole. The policies of some European countries, Canada and the United States in favor of caregivers and caregivers are described. However, most existing support models have gaps; the laws and regulations created have been poorly understood, inorganic and the family remains responsible for long-lived relatives who have lost their autonomy. In the European Union, the tendency is to integrate the familiar care as the first level of primary health, making support to the caregivers universal. It must not be forgotten that the tendency to keep the elderly dependent at home is acquiescence to their own desire, but it also hides the delegation of responsibility from the State to families through policies of deshospitalization and deinstitutionalization. In Brazil, the issue has not yet entered the public policy radar, although it is urgent because of the accelerated increase of the elderly population, in particular, those aged 80 and over.  

Apresenta-se e discute-se a situação das cuidadoras e cuidadores familiares de idosos dependentes. Ressaltam-se sua dedicação, seus problemas e encaminhamentos para valorizá-los. Sabe-se que a tarefa de cuidar é eminentemente feminina, invisível, não remunerada, mas afeta a sociedade como um todo. Descrevem-se as políticas vigentes em alguns países europeus, Canadá e Estados Unidos a favor das cuidadoras e cuidadores. A maioria dos modelos de suporte existentes apresenta lacunas. Leis e regulações criadas têm sido pouco compreensivas, inorgânicas e a família continua a ser a responsável pelos parentes longevos que perderam autonomia. Em vários desses países, além de outras medidas, a tendência é integrar os cuidados familiares como primeiro patamar da atenção básica em saúde, universalizando o apoio aos cuicadores. Não se pode esquecer que a tendência de manter o idoso dependente em casa é uma aquiescência a seu próprio desejo, embora também oculte a delegação de responsabilidade do Estado às famílias por meio das políticas de desospitalização e desinstitucionalização. No Brasil, o tema ainda não entrou no radar das políticas públicas, embora seja urgente pelo acelerado aumento da população idosa, em particular, da que tem 80 anos e mais.

CHRONIC NON-COMMUNICABLE DISEASES AND THEIR IMPLICATIONS IN THE LIFE OF DEPENDENT ELDERLY PEOPLE / DOENÇAS CRÔNICAS NÃO TRANSMISSÍVEIS E SUAS IMPLICAÇOES NA VIDA DE IDOSOS DEPENDENTES

This study aims to investigate the implications of chronic non-communicable diseases in dependent elderly people. whose objective was to investigate the implications of chronic non-communicable diseases in dependent elderly people. It treats multicenter study, with an approach in which semi-structured interviews were carried out with 59 dependent elderly people who were diagnosed with chronic diseases on the following topics: sociodemographic characteristics; family constitution; life situation; experience; functional, cognitive, mental / emotional and social dependence. It was observed that the majority were female, white, with low education and lived with their daughter. All were undergoing drug treatment and cardiocirculatory diseases were the most prevalent. Among the qualitative statements, the following stand out: use of medicines as a risk factor; the use of health services on a larger scale; the economic impact of chronic diseases for families and the state; the multiple chronic diseases presented; precarious family income; social and community support devices.

Este estudo tem como objetivo investigar as implicações das doenças crônicas não transmissíveis em idosos dependentes. Trata-se de um estudo multicêntrico com abordagem qualitativa em que foram realizadas entrevistas semiestruturadas com 59 idosos dependentes que tinham diagnóstico de doença crônica. Para a análise das informações, utilizou-se a técnica da Análise Temática. A maioria dos idosos era do sexo feminino, da raça branca, com baixa escolaridade e vivia com a filha. Todos faziam tratamento medicamentoso e as doenças cardiocirculatórias foram as mais prevalentes. As implicações das doenças crônicas se manifestam no uso de medicamentos, que também se constituem como fator de risco; na condição da dependência e na vivência com doenças crônicas, que denotam em maior uso dos serviços de saúde; no alto impacto econômico das doenças crônicas para as famílias e para o Estado; e na precariedade da renda familiar, que condicionam os idosos a contarem com poucos dispositivos de apoio social e comunitário.

The provision of mobile dental services to dependent elderly people in Switzerland.

OBJECTIVE: This work aimed at describing mobile dental services provided by both the private sector and the universities in Switzerland to dependent elderly people. It also aimed at presenting the views of both sectors on the current status of these services. BACKGROUND: As people age and become more care-dependent, their oral health requirements increase, as access to dental care decreases. METHOD: A survey was sent to practitioners who potentially provided a mobile dental service (n = 253). Five interviews were conducted with six individuals who have a leading role in Geriatric dentistry in the four universities in Switzerland that provide dental training. RESULTS: The private sector provides a mobile dental service to the elderly mainly through the use of portable equipment, while university services are provided by different models. The interviewees discussed the reasons as to why these services were set up. They discussed the challenges associated with treating dependent elderly patients, which often makes work in this field hard and unattractive. Both sectors see the need for better collaboration with other professionals. CONCLUSION: The private sector in Switzerland provides a mobile dental service to elderly people mostly through the use of portable equipment, while university services are provided in a variable configuration of models. Better collaboration is required to improve dental care and service delivery to dependent elders. There is a potential for improvement of these services, in order to meet the demand of an ageing population, catering for both the institutionalised elders and those living at home.