Psychosocial Adjustment of In-Home Caregivers of Family Members with Dementia and Parkinson's Disease: A Comparative Study.

Neurodegenerative diseases such as Parkinson's and dementia are highly prevalent worldwide. People who suffer from these disorders often receive in-home care and assistance from family members, who must dedicate a considerable amount of time to the care recipient. The study of family caregivers' psychosocial adjustment to the degenerative processes of both conditions is of interest due to the implications for the quality of life of both the care receiver and the caregiver, as well as other family members. This study compares the psychosocial adjustment of family members who care for people with dementia and Parkinson's disease and identifies the main sociodemographic variables that affect the processes of adjustment to both conditions. To this end, the Psychosocial Adjustment to Illness Scale (PAIS-SR) and a sociodemographic form were administered to 157 family caregivers in Navarre, Spain. The results show that adjustment to the disease in family caregivers of people with Parkinson's disease and dementia is, in general, satisfactory and related to variables such as place of residence, income, and employment status. The illness itself (Parkinson's or dementia), however, is found to be the most influential variable in the level of psychosocial adjustment.

Factors influencing psychosocial adjustment and quality of life in Parkinson patients and informal caregivers.

OBJECTIVE: The influence that social conditions and personal attitudes may have on the quality of life (QoL) of Parkinson's disease (PD) patients and informal caregivers does not receive enough attention in health care, as a result of it not being clearly identified, especially in informal caregivers. The aim of this study was to provide a comprehensive analysis of psychosocial adjustment and QoL determinants in PD patients and informal caregivers. METHODS: Ninety-one PD patients and 83 caregivers participated in the study. Multiple regression analyses were performed including benefit finding, coping, disease severity and socio-demographic factors, in order to determine how these aspects influence the psychosocial adjustment and QoL in PD patients and caregivers. RESULTS: Regression models showed that severity of PD was the main predictor of psychosocial adjustment and QoL in patients. Nevertheless, multiple regression analyses also revealed that coping was a significant predictor of psychosocial adjustment in patients and caregivers. Furthermore, psychosocial adjustment was significantly related to QoL in patients and caregivers. Also, coping and benefit finding were predictors of QoL in caregivers but not in patients. CONCLUSIONS: Multidisciplinary interventions aimed at improving PD patients' QoL may have more effective outcomes if education about coping skills, and how these can help towards a positive psychosocial adjustment to illness, were included, and targeted not only at patients, but also at informal caregivers.

Living with chronic illness in adults: a concept analysis.

AIMS AND OBJECTIVES: To report an analysis of the concept of Living with chronic illness in adults, using Rodger's evolutionary analytical methodology. BACKGROUND: In the literature, several qualitative studies exist that address the question of Living with chronic illness from the adult patient's perspective. However, the lack of clarity and consensus among the existing studies renders this concept ambiguous when it is analysed in depth. DESIGN: A narrative review. METHODS: A systematic search has been carried out on electronic databases such as Medline (PubMed), Cinahl (Ebsco), Cochrane Library, PsycINFO (Ovid), Embase, Cuiden, Dialnet and Scielo. This was limited to articles published in either Spanish or English, from 2003-2013. RESULTS: Living with chronic illness is a complex, dynamic, cyclic and multidimensional process, and involves the development of five different attributes: Acceptance, Coping, Self-management, Integration and Adjustment. Depending on how these attributes operate, there are four different ways of living which can result from the process of Living with chronic illness: (1) Disavowal, (2) False Normality, (3) The New Normal and (4) Disruption. CONCLUSIONS: This paper contributes to the understanding of the concept 'Living with chronic illness'. Findings in this analysis have to be evaluated with caution and further research is needed on this topic to confirm them. Also, more studies in evaluating how patients live a long-term condition are recommended to foster patient-centred care. RELEVANCE TO CLINICAL PRACTICE: Findings generated from this concept analysis can raise awareness of Living with chronic illness so that this process could be assessed in a correct and uniform way in the clinical community and improved when needed.

Modelos de financiación pública de las residencias para personas mayores. Análisis comparativo por comunidades autónomas / Models of public financing of rest homes. A comparative analysis of autonomous regions

Introducción: se presenta un estudio comparativo de los modelos de financiación pública de las residencias para personas mayores a partir de la normativa autonómica vigente. Material y método: se ha procedido a recoger y analizar toda la normativa vigente en las diferentes comunidades autónomas (CCAA) acerca de residencias para personas mayores. Para ello se ha realizado una búsqueda exhaustiva en diversos servidores y se ha confeccionado un cuestionario. Los ejes temáticos del mismo eran: legislación específica referida a personas mayores, datos generales acerca de las residencias y normativa y datos cuantitativos acerca de su financiación. A ello se suma la aportación obtenida de la bibliografía existente. Resultados: se constata que la intensa labor legislativa de las CCAA en la última década en materia de políticas sociales para personas mayores y dependencia ha consolidado un modelo-base de financiación pública de las residencias. Este modelo se ha centrado en 3 áreas: inversiones, funcionamiento y ayuda directa a los usuarios, y en una tipología de beneficiario que se ajusta a ellas. Igualmente, se ha puesto de manifiesto la diversidad de propuestas y actuaciones que incorpora la normativa autonómica, dando forma a una serie de modelos autonómicos de financiación pública que introducen diferencias organizativas y de acceso a los servicios y prestaciones por parte de las personas mayores. Discusión: los resultados apuntan a que el usuario o su familia son la principal fuente de financiación de las residencias. Los modelos autonómicos de financiación pública se han centrado en garantizar el derecho de los mayores, sobre todo dependientes, a ser atendidos en las residencias y en completar la función social que corresponde a las administraciones públicas. Obviamente, ello está en relación con una prolija normativa sobre financiación para el funcionamiento de las residencias

Introduction: this study presents a comparative analysis of models of public financing of rest homes based on the current regulations in the distinct Autonomous Regions in Spain. Material and methods: the regulations for rest homes of the various Autonomous Regions were compiled and analysed. To do this, an exhaustive search of databases was performed and a survey was designed. The principal focus of this survey was on the specific legislation relating to the elderly, general data about rest homes, and regulations and quantifiable data about their financing. Information was also obtained from existing publications on this subject. Results: the study shows that the intense efforts of the Autonomous Regions on social policies for the elderly and care of the elderly in the last decade have consolidated a model for the public financing of rest homes. This model focuses on 3 areas: investments, the running of rest homes and financial aid for the residents, and criteria that entitle residents to receive financial aid. It also shows the wide variety of proposals and procedures incorporated in the regulations of the Autonomous Regions, giving shape to a series of public financing models with distinct organization and procedures to access services and benefits for the elderly. Discussion: the results indicate that residents and their families are the principal source of finance for rest homes. Public financing models have focused on guaranteeing the rights of the elderly (especially the rights of those in need of care) to be cared for in rest homes, and on fulfilling the social responsibility of public administrations. All of this is related to prolix regulations on financing the running of rest homes