[Perceptions of dependent elderly cared for by immigrant workers concerning the help they need and receive]. / ¿Cómo perciben los mayores a sus cuidadoras inmigrantes? Sobre la ayuda que necesitan y reciben en el domicilio.

INTRODUCTION: Social-demographic changes such as the increasing number of dependent elderly people, the incorporation of women into the workforce, and declining family size have led to the emergence of a new occupation, that of home care for elderly dependents. This work is usually carried out by women immigrants. Little is known about how this care is perceived by the elderly. OBJECTIVE: To evaluate the daily lives of elderly people cared for by hired immigrants to identify aspects of their health and the care they receive. METHODOLOGY: A qualitative study conducted through twelve theoretical sampling interviews that were recorded, transcribed and analyzed with computer support of Atlas Ti V5. RESULTS: The elderly do not anticipate or prepare for the problems of old age. Their main concerns regarding health are illness, pain and death. All wish to remain as autonomous as possible. The need to arrange home care services is often first perceived by the family. Home-help workers assist in basic and instrumental daily activities and provide care and company. Cultural conflicts in the practice of care are rare. Despite general satisfaction with help received, the elderly consider that the workers lack specific training in caring for the elderly. CONCLUSIONS: The elderly are aware of the current difficulties of families to care for them and they are adapting to the new reality of home care. They value the worker who helps them because besides helping with housework, they provide company, entertainment and affection. Primary care nurses can play a key role in training immigrant workers in caring for the elderly.

Patients' Perspective of Medication Adherence in Chronic Conditions: A Qualitative Study.

INTRODUCTION: About 50% of patients do not take their long-term therapy for chronic conditions as prescribed. Many studies have centered on patients' adherence to a specific treatment or single conditions, but few have taken all chronic conditions into consideration from a patient's perspective. This study aims to explore factors that impact on drug compliance and to identify strategies to improve this from the perspective of patients with at least one chronic condition. METHODS: Patients were recruited by healthcare professionals from a hospital pharmacy, four community pharmacies, patient associations, and a primary care center in Barcelona. Five focus groups were conducted (N = 36). Conversations were audiotaped and transcribed verbatim to allow qualitative analysis. RESULTS: Study subjects were aged 39-90 years (mean 65 years) and the mean number of comorbidities per patient was 2.3 (range 1-7). The main modifiers of therapeutic conduct were: patients' health beliefs, patient-prescriber relationships, and patients' motivation and perception of illness control. Study participants wanted greater participation in decision-making concerning their health and increased education about their illness and medication. They also wanted individualized healthcare that took their preferences and personal and emotional issues into account. CONCLUSION: Our results highlight how the patient-prescriber's relationship and factors such as health beliefs, motivation and perception of illness control impact on medication adherence in chronic patients. Future interventions to optimize adherence to treatment should focus on shared decision-making and more extensive health education. FUNDING: Celgene Corporation.