Caregiver Burden and Mental Health Problems among the Caregivers of the Elderly at Home-based Palliative Stage
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Abstract
Most Thai elderly depend on family caregivers to help them with their daily living activities, therefore, family caregivers are concerned with providing physical care rather than psychological care. Nowadays, there are home care services providing care for the Thai elderly with a terminal illness who need palliative care. However, there are not many professionals working for home care services who provide palliative care based on a psychosocial approach. The palliative caregiving role is hard work, and involves prolonged, and complicated care often over 24 hours. Hence, the family caregivers who provide palliative care for an elderly family member face overwhelming issues associated with caring and death. Family caregivers often neglect their own needs, experience stress, suffering and psychological distress. In addition, there is a lack appropriate psychiatric care for them. Therefore, the efforts in caring for the elderly induce mental health and psychiatric symptoms as well as care burden on family caregivers. Nursing care for the family caregiver who has mental health problems and care burden consists of (1) assessing caregiver stress by: 1) the use of tools to assess a caregiver’s stress levels; 2) interviewing and observing, and (2) managing caregiver stress includes: 1) the physical needs of the caregiver; 2) managing the emotional distress of care giving on caregivers such as depression and stress e.g. helping to develop positive self-esteem and encouraging the expression of feelings (anger, guilt, frustration and other feelings) including supporting emotions to minimize negative feelings. The consequences of the care burden and mental health problems on the family caregiver impacts on home-based palliative care in all dimensions. Hence, nurses have to be proactive in the palliative stage of the elderly to reduce care burden and mental health problems and to promote quality of life in the elderly and their family caregivers resulting in a good death as well as promoting dignity in dying.
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