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Objective: To identify and analyse problems in adapting to change among the family caregivers of relatives with dementia., Method: Qualitative study based on the methodology of Charmaz's Constructivist Grounded Theory. Seven focus groups were conducted in different primary health care centres in the province of Jaen (Spain). Eighty-two primary family caregivers of relatives with dementia participated by purposeful maximum variation sampling and theoretical sampling. Triangulation analysis was carried out to increase internal validity., Results: We obtained three main categories: 'Changing Care', 'Problems in the process of adapting to change' and 'Facilitators of the process of adapting to change'. Family caregivers perform their role in a context characterized by personal change, both in the person receiving the care and in the social and cultural context. The challenge of adaptation lies in the balance between the problems that hamper adaptation of the caregiver to new situations of care and the factors that facilitate the caregiver role., Conclusions: The adaptation of family caregivers to caring for a person with dementia is hindered by the lack of formal support and under-diagnosis of dementia. The adaptation process could be improved by strengthening formal support in the early stages of care to reduce the stress of family caregivers who must teach themselves about their task and by interventions adapted to each phase in the development of the caregiver role., (Copyright © 2016 SESPAS. Published by Elsevier Espana. All rights reserved.)

Despite the importance of family perceptions when analyzing care for the elderly in nursing homes, little is said about this aspect. This study aims to identify preferences and areas for improvement in care for persons with dementia, as perceived by families. A qualitative study was performed, based on Grounded Theory, combining two data collection techniques (participant observation and in-depth interviews) in a theoretical sample of institutionalized persons with dementia. The ideal model of care for persons with dementia, as perceived by participants, was based on specialized and individualized care and family participation in the care provided. Areas for improvement included aspects pertaining to specialized training in geriatrics, human relations, and the culture of institutional work. Faced with the current trend towards technification of care, families are now demanding personalized, small-scale care in which they form an active part of the team.

Objective: To analyse the results of removing physical restraints from elderly patients with dementia living in nursing homes. This objective is part of a wider process of change in residential care., Methods: Quasi-experimental study conducted in two residences from May 2010 to May 2012. Information was collected at 7 time points and longitudinal analyses were performed. After training staff, the physical restraints in El Puig centre were phased out, while in the Conarda centre, restraints were still applied to elderly people. The main variables studied were: falls, psychotropic medication prescriptions, different indicators of mental impairment, and degree of dependence (Norton, NPI, Mini-mental, Tinetti, Barthel)., Results: In the El Puig centre all the physical restraints were removed. A slight improvement was seen in the number of falls, and their consequences. The ANOVA showed significant improvements in the centre that removed restraints in prescribing psychotropic medications, cognitive impairment, and behavioural changes., Discussion: It is shown that removing physical restraints do not cause negative effects as regards the number of falls, and also positively affects the welfare and independence of elderly people (through changes in behaviour and mental impairment). Furthermore, it is demonstrated that this program must be accompanied by the reduction and control of medicines (withdrawal of the number of psychotropic prescriptions)., (Copyright © 2014 SEGG. Published by Elsevier Espana. All rights reserved.)

Objective: To describe the characteristics and determining factors of carer stress in a group of elderly home care patients with dementia evaluated in a Geriatric Assessment Unit., Material and Methods: An observational descriptive cross-sectional study was conducted using an assessment of baseline characteristics of patients and carers. Estimation of caregiver burden was registered by validated scales: Goldberg Anxiety Scale (GAS), Goldberg Depression Scales (GDS), and Zarit Burden Scale (ZS)., Results: A total of 130 patients were included. No item related to dementia patients was associated with caregiver burden. A poor perception of health and quality of life by the caregivers were associated with anxiety risk, depression and burden. Attendance rates for primary care and lack of paid work outside the home were associated with both, depression (GDS>2) and anxiety (GAS>4). Carer age and a lower education were related to depression. Anti-inflammatory, anxiolytics and antidepressants consumption was associated with anxiety, and anti-inflammatory consumption with caregiver burden (ZS >47)., Conclusions: The profile of carers in our sample is comparable to that described in other national studies, but care time is longer. The target population is difficult to identify and in need of help. Although there is not a formal demand for help, we should be encouraged to develop new healthcare methods., (Copyright © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.)

Introduction: Caring for a relative with dementia often has negative effects on the caregiver's physical and psychological health. However, many caregivers successfully cope with the stress factors arising from care, and even have uplifts during their experience, showing high resilience levels. This study presents a preliminary analysis of resilience in caregivers of patients with dementia, exploring its relationship with different variables., Material and Methods: Resilience was assessed (by CD-RISC) in 53 family caregivers of patients with dementia. Resilience was correlated to the following variables: caregiving context, stressors (e.g., cognitive impairment), appraisals (e.g., burden), moderators (e.g., personality traits and resources), and caregiving consequences (physical and psychological health)., Results: The participants showed moderate scores on resilience. Resilience was associated with poor emotional and physical status (significant inverse correlations with anxiety, depression, psycho-active drug use, health habits…). High resilience scores were significantly correlated to burden, neuroticism and extraversion, self-efficacy, self-esteem and less use of emotion focused coping strategies., Conclusions: Higher resilience relates to a good emotional and physical status in caregivers. Moreover, resilience is more associated with caregiver variables (e.g., appraisal and coping with care, personality features), than to situational variables. The data highlight the strengthening of these types of appraisal and coping as a way to improve caregivers' resilience and, consequently, their health., (Copyright © 2011 SEGG. Published by Elsevier Espana. All rights reserved.)

To care for someone who suffers a chronic disease is a very complex activity which implies more than a strict medical aspect. The families affected, especially those from the lower income brackets, must confront difficult situations; for the majority of these families, enrolling the ill patient in a residential treatment center is not an option and as time passes, these families will depend on their own aid mechanisms more and more; this makes this family care situation a public health affair and one for nurses in particular. This article shows how these caretakers are active creators of a world which provides them with the resources to deal with the daily care of these patients.

Aim: To study the profile and burden of care in carers of patients with dementia who participated in the ALOIS program. A second objective was to evaluate caregiver satisfaction with the intervention, and changes in caregiver burden after participation in the program., Design: Descriptive study of a specific intervention with no control group., Setting: Primary care centers., Participants: Principal caregivers of patients with dementia., Interventions: Group education sessions led by multidisciplinary teams comprising physicians, nurses and social workers., Measures: Caregiver profile; mean caregiver burden before and 3 months after the intervention (Caregiver Burden Interview, Zarit); caregivers' evaluation of the program., Results: Participants N=245. Profile (N=173): women (83%), mean age 54.6 years (range, 26-83 years), married (82.5%), no formal education or primary school only (70.2%), housewife (54.3%), patient's daughter (58.5%). More than 60% of the caregivers received informal help, and fewer than 5% received formal help. 72.5% of the caregivers were considered overburdened at the start of the intervention, and the burden was greater in older caregivers. No differences were detected in caregiver relation to the patient, marital status or employment status of the caregiver. Participants rated the program very highly, emphasizing the opportunity to share their experiences with other caregivers and to obtain knowledge and skills that helped them provide better care. Pre- and postintervention burden of care was compared in 68 participants (54.76+/-15.16 points vs 53.02+/-12.55), and no statistically significant difference was found., Conclusions: The burden of care was high among caregivers, and increased as caregivers aged. Caregivers considered participation in the program to be highly useful. Care for caregivers should form part of care provided for patients with dementia.

Objectives: To characterise the Andalusian nurses providing home care (HC), to describe the activities developed, to define the components of nursing practice and to identify differences between the care of terminal cancer, of AIDS patients, of elderly people with dementia and of patients who had undergone more serious out-patient surgery., Design: Cross-sectional descriptive study using a postal questionnaire., Setting: Primary care centres in Andalusia., Participants: 348 PC nurses working in home care. Multi-stage sampling, proportional by provinces., Main Measurements: Social-demographic and work characteristics, nursing activity in the home, type and frequency of activities performed in the care of each kind of patient and use of protocols., Results: 61.14% reply rate. 65.5% were women, with mean age of 39.7 and averaging 10 years of PC experience. Mean number of patients attended was 10.5 per week, and mean time was 20.7 minutes. 90.1% had attended cancer patients, 16.7% AIDS patients, 83.3% elderly people with dementia, and 87.2% patients discharged early. In all cases the most commonly developed item was the technical one, followed by preventive/health promotion and psycho-social. Except in the case of evaluation of physiological needs, in all the other activities the frequency of the item was in function of the pathology of the patient (P<.05). Nursing practice in the home of terminal cancer patients and of elderly people with dementia only differs in the handling of emotional problems in both patient and carer, and in the preventive item (P<.05). 60% of the sample said they used no protocol in home care., Conclusions: The most common activities in care of home care patients are giving treatment, dressings, bandages, and monitoring of the vital constants, followed by assessment of physiological needs. Nursing practice does not seem to be fully conditioned by the pathology, but rather in function of groups of patients with similar needs and problems. Most Andalusian home-care nurses use no protocol in caring for these four classes of patient.

Objective: To describe the physical and psychological morbidity of carers of patients with dementia and to compare them with a group of carers of non-demented patients in the home care programme., Design: Descriptive crossover study, based on face-to-face interviews, with a reference group for comparison., Setting: Community, Toledo and Esquivias Health Districts., Participants: 61 carers of patients with dementia, and 61 of patients in home care., Measurements and Main Results: The interview collected the following variables: social, demographic, morbidity (chronic pathologies, insomnia, anxiety-depression...), medication and interference with social life. Both samples were homogeneous for age, sex, marital status, relationship to patient and educational level of the carers, and age and sex of the patients. The problems most often referred to by the two groups of carers were osteo-muscular. The most commonly used drugs were analgesic-NSAIDs, hypertension and anxiety-depression drugs. Insomnia was significantly more common (p < 0.05) in carers of demented patients (63.93%) than in the other group (44.26%), although consumption of sleeping draughts was similar. The Goldberg test was positive in 49.18% of carers of demented patients and in 31.15% of the others (p < 0.05). Carers of demented patients had a more restricted social life (p < 0.01). Only 25.41% thought that their doctor and/or nurse were concerned about their situation as carer., Conclusions: We found more anxiety-depression and insomnia in carers of demented patients. Interference of care with their social life was greater in this group. Carers view the interest shown in their problems by health-workers as insufficient.

This article deals with the impact dementia can cause in a family in our modern society, an impact which often leads to a crisis or a rupture in a family. Due to the evolution in family structure in Spain over the last few decades, as evidenced by separations, divorces, reconstructed families, a descent in birth rate, and especially by women joining the work force, the possibilities for traditional family care of the elderly have become complicated and have been reduced, which leads to a tremendous physical and psychological wear on the person who takes on the largest part of this care, the so-called main caretaker, usually a woman. In consequence to this situation, dysfunctional behaviors may develop in this caretaker which, if not treated, may early or later on develop into the caretaker syndrome. The effects of this syndrome include subjective ones such as emotional suffering and objective ones such as a loss of health. This article presents a proposal for action by nurses acting out of primary health care centers which leads to a series of measures providing containing methods and formal support structures, in other words prevention, for the family and especially for the main caretaker of patients suffering from dementia.