ISSN: 1981-8963
DOI: 10.5205/reuol.3934-31164-1-SM.0703esp201327
Brito MCC, Oliveira EN, Freitas CASL et al.
Repercussions in the life of the elderly…
CASE REPORT ARTICLE
REPERCUSSIONS IN THE LIFE OF THE ELDERLY PERSON’S CAREGIVER: CASE
STUDY
REPERCUSSÕES NA VIDA DO CUIDADOR DOMICILIAR DO IDOSO: ESTUDO DE CASO
REPERCUSIONES EN LA VIDA DEL CUIDADOR FAMILIAR DEL ANCIANO: ESTUDIO DE CASO
Maria da Conceição Coelho Brito1, Eliany Nazaré Oliveira2, Cibelly Aliny Siqueira Lima Freitas3, Adriana
Gomes Nogueira Ferreira4, Maria Josefina da Silva5, Denise Lima Nogueira6
ABSTRACT
Objective: to identify, through the Systematization of Nursing Care, the way how the health profile of an
elderly person reverberates in the life of the home caregiver. Method: this is a descriptive study, with a case
study design and qualitative approach, supported on the theoretical framework of Orem’s Self-Care. This
study was approved by the Research Ethics Committee of Universidade Estadual Vale do Acarau, under the
CAAE 2534.0.000.039-10. Results: caring for the dependent elderly person reverberates in the caregiver’s
life, generating some levels of stress, deficiencies in the caregiver’s self-care, and lack of performance of
routine activities, since the caregiver attributed to himself the duty of caring for as a strategy to repay the
genitor for all the latter had already provided him with. Conclusion: strategies comprising the quality of life
of the elderly persons’ caregiver are needed, since the Brazilian society, besides caring for those who are
becoming elder, should pay attention to their caregivers before they become “hidden patients”. Descriptors:
Dependent Elderly People; Care; Nursing.
RESUMO
Objetivo: identificar, por meio da Sistematização da Assistência de Enfermagem, como o perfil de saúde do
idoso repercute na vida do cuidador domiciliar. Método: trata-se de estudo descritivo, com delineamento do
tipo estudo de caso e abordagem qualitativa, apoiado no referencial teórico do Autocuidado de Orem. Este
estudo foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Estadual Vale do Acaraú, sob o CAAE n.
2534.0.000.039-10. Resultados: cuidar do idoso dependente repercute na vida do cuidador, gerando níveis de
estresse, deficiências no autocuidado do cuidador, e não realização de atividades rotineiras, uma vez que o
cuidador atribuiu a si o dever de cuidar como uma estratégia de retribuir ao genitor tudo o que este já havia
oferecido a ele. Conclusão: são necessárias estratégias que vislumbrem a qualidade de vida do cuidador de
idosos, uma vez que a sociedade brasileira, além de cuidar dos que envelhecem, deve prestar atenção aos
seus cuidadores antes que eles se tornem “pacientes ocultos”. Descritores: Idosos Dependentes; Assistência;
Enfermagem.
RESUMEN
Objetivo: identificar, por medio de la Sistematización de la Atención de Enfermería, como el perfil de salud
del anciano repercute en la vida del cuidador domiciliario. Métodos: esto es un estudio descriptivo, con
diseño del tipo estudio de caso y abordaje cualitativo, respaldado por el referencial teórico del Autocuidado
de Orem. Este estudio fue aprobado por el Comité de Ética en Investigación de la Universidade Estadual Vale
do Acaraú, bajo el CAAE 2534.0.000.039-10. Resultados: cuidar del anciano dependiente repercute en la vida
del cuidador, generando niveles de estrés, deficiencias en el autocuidado del cuidador, y no realización de
actividades de rutina, ya que el cuidador atribuyó a sí mismo el deber de cuidar como una estrategia para
retribuir al genitor todo lo que este le había ofrecido. Conclusión: son necesarias estrategias que contemplen
la calidad de vida del cuidador de ancianos, ya que la sociedad brasileña, además de cuidar de aquellos que
envejecen, debe prestar atención a sus cuidadores antes que estos se conviertan en “pacientes ocultos”.
Descriptores: Ancianos Dependientes; Atención; Enfermería.
1
Nurse, MS student, Federal University of Ceara/UFC. Fortaleza (CE), Brazil. Email: [email protected]; 2Nurse, PhD, Professor at the
Nursing Course of UVA. Sobral (CE), Brazil. Email: [email protected]; 3Nurse, PhD, Professor at the Nursing Course of UVA. Sobral (CE),
Brazil. Email: [email protected]; 4Nurse, PhD student, Federal University of Ceara/UFC. Fortaleza (CE), Brazil. Email:
[email protected]; 5Nurse, PhD degree, Professor at the Nursing Course of UFC. Fortaleza (CE), Brazil. Email:
[email protected]; 6Nurse. Student at the Specialization Course in Audit of Systems and Health Services at the Institute for Applied
Theology (Inta). Service of Permanent Education of Santa Casa de Sobral. Sobral (CE), Brazil. Email: [email protected]
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ISSN: 1981-8963
DOI: 10.5205/reuol.3934-31164-1-SM.0703esp201327
Brito MCC, Oliveira EN, Freitas CASL et al.
INTRODUCTION
Brazil has experienced a process of
demographic transition, mainly due to the
progressive increase in the elderly population,
causing a significant prevalence of illnesses
and disabilities in the population, which
brought the need for changes in the forms of
care, and one of them was resuming the home
care model.1
As a result, there emerged, attached to the
Portaria 1,395/1999, from the Brazilian
Ministry of Health, the National Policy for the
Health of the Elderly (PNSI), which grounds
the Public Power actions in the health care
sector with regard to the elderly population in
Brazil, introduces family care and regards this
model as being crucial for the health care
provided to this population group, setting up
the convergence of the three caring
dimensions.2 In this context, the home
caregiver is back as an important part of
actions for the maintenance of autonomy,
integration, and participation of the elderly
person in society, besides being decisive for
the success of public policies, since it lowers
costs and improves the quality of life of
elderly people.1
Caring for the elderly person at home is an
arduous task, since this care is generally
attributed to a person who doesn’t have only
this activity and she/he ends up combining it
with other tasks, such as taking care of
children and home, besides a professional
activity. This accumulation of activities
results in exhaustion, something which leads
the home caregiver to illness. Thus, home
care is characterized by its repetitive and
unceasing, with the possibility of causing an
overload of tasks and the caregiver’s affective
and social isolation.3
Then, the Family Health Strategy (FHS)
emerges. Created in 1994, FHS has played a
strategic role for the consolidation of the
Unified Health System (SUS), favoring equity
and universality through innovative actions in
the sector. For this, one uses home visit as an
interaction technology of health care,
constituting a basic intervention tool adopted
by the FHS teams to get into and know the
population’s life reality, in order to favor the
establishment of ties with it, and the
understanding of relevant aspects in the
family relations dynamics4, improving the
ability to provide the elderly person with an
effective care.
To achieve this purpose, nurses employ the
Systematization of Nursing Care (SNC), an
important
resource
for
applying
and
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Repercussions in the life of the elderly…
demonstrating the scientific, technical, and
human kinds of knowledge in the client’s
care, besides characterizing the professional
practice.5 Thus, one aims to identify, through
SNC, the way how the health profile of an
elderly person reverberates in the life of the
home caregiver.
METHOD
This is a descriptive study, with a case
study design and a qualitative approach,
supported on the framework of Orem’s SelfCare Theory, carried out from March to June
2010, through 9 home visits to 1 elderly
person’s home caregiver. Data collection was
undertaken through a form addressing aspects
such as the sociodemographic profile,
lifestyle, and daily life activities using the
Barthel’s scale, access to health services,
medicines
currently
used,
and
hospitalizations, besides the questionnaire SF36, an instrument for assessing quality of life.
A genogram and an eco-map were
constructed, which are rich information
sources for planning strategies in the family.
One designed a care plan, whose
implementation was undertaken through SNC.
The information analysis was conducted by
means of the descriptive technique.
The study was approved by the Research
Ethics Committee of Universidade Estadual
Vale do Acarau (UVA), under the CAAE
2534.0.000.039-10 and the Protocol 817/2009.
RESULTS AND DISCUSSION
● Knowing the health profile of the
elderly person
This is a male elderly person, 86 years old
and dependent for 8 years, due to a
cerebrovascular
accident
(CVA),
which
manifested itself in 5 episodes, and the last
one occurred 2 years ago, leading him to a
total dependence degree, according to the
Barthel’s scale, with frequent demand for
health services.
One estimates that about 40% to 50% of
individuals who suffer a CVA die after 6
months. In turn, survivors present neurological
deficits and significant residual disabilities6;
it’s in this context that the family caregiver
emerges. The dependent elderly person
reverberates in the caregiver and his family’s
life dynamics, since the tasks assigned to him,
often without proper guidance, support from
health institutions, a fact with reflects on the
caregiver’s quality of life. The activity of
caring for an elderly relative who is ill and
dependent at home takes place in space
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Repercussions in the life of the elderly…
where a significant part of life is lived, in
which knowledge and memory regarding facts
and intimate relationships are important both
for the caregiver and the individual who is
being cared for7, governed by subjective and
affective
relations,
named
family
relationships.
have an assessment tool which takes into
account structure, development over time,
and family functioning, by proposing care
actions for this elderly person, in order to
help understanding family as a care unit,
instead of a mere sum of the individualities of
all family members in many contexts.8
● Understanding family and the intra and
extra-family relationships
In Figure 1, the index-user is indicated as
“B” and he maintains a strong relationship
with his father, being his caregiver, an aspect
requiring effort and time. Due to his genitor’s
dependence, “B” has a stressful relationship
with the FHS, because of the precarious
assistance provided by it. The caregiver has
few support sources in society.
In the geriatrics and gerontology field, by
regarding family as a system, that is, as a unit
in which it’s possible to view the interaction
between its members, the presence of an
elderly person who depends on care affects all
components in the group, in varied degrees.
Thus, it’s important that health professionals
Figure 1. Genogram and an eco-map of the study family.
He also presents a moderate relationship
with the other family members. His mother
died recently, increasing his burden as
caregiver and head of an unstructured family
due to the illness. There’s a strong
relationship between the index-subject and
religion, too.
Knowing
the
family
structure,
its
composition, the way how members organize
themselves and interact with each other and
with the environment, the health problems,
the risk situations, the vulnerability patterns
is something crucial for the planning of family
health care.8
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The intervention of health services along
with this caregiver requires a greater effort,
since there’re few support sources in the
community, an aspect which may adversely
interfere with the user’s life dynamics and in
his
health-illness
process.
It’s
worth
highlighting that only the genitor and his
daughter who cares for him at home are
there. This is due to the new chain of issues
and demographic changes, where the family
structure
changes,
going
from
the
predominance of multiple and extended
families to families which tend to consist of a
single core, that of parents and children.9
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It’s essential to establish care strategies
fostering the promotion of caregivers’ health
and quality of life, aspects which may be
better worked out when nurses use a care
method directing its practices, SNC.
● Systematizing care for the caregiver
according to Orem’s Theory
This is a female caregiver client, 50 years
old, single, with no occupation and complete
high school, catholic. For 3 years, provides
integral care for her genitor, the reason why
she no longer performs her routine activities,
quit her job and ended a love relationship.
She has 8 brothers, who don’t help to provide
care. She has no leisure activities. She feels
depressed, has no mood to perform basic
activities, doesn’t eat or sleep well, live
under constant stress; she doesn’t perform
physical activities neither seeks health
services. On physical examination, the
following changes were found: low back pain,
and neglect of physical appearance. Blood
pressure: 120 x 80 mmHg; temperature:
36.7ºC; breathing: 18 rpm; and pulse: 86 bpm.
Repercussions in the life of the elderly…
structure and functioning of the human body;
the developmental ones are those which offer
the needed conditions for changes occurring
throughout
the
life
cycles,
allowing
adaptations for the individual’s development;
in turn, health deviations are the self-care
needs manifested in the presence of illness,
disabilities,
and
treatments
for
the
individual’s recovery.10
One designed a nursing care plan, as shown
in Figure 2, displaying a predominance of
actions aimed at the support-education
system, where the individual has skills for
performing the therapeutic self-care, he’s
able to learn putting it into practice, but he
needs professional support. In this case, nurse
will be responsible for his training to be the
agent of his own self-care, since the nursing
process, as proposed by Orem, is a method
seeking to determine the self-care deficits, as
well as the role that the nurse (or person) will
play to meet the requirements needed for a
satisfactory self-care.10
Orem’s Self-Care Theory comprises three
requirements: universal, developmental, and
health deviation. The universal requirements
relate to the quest for sustaining life, the
Nursing diagnoses
Performance of a modified role, related to an ineffective
support, as evidenced by caregiver’s overload.
Acute pain, related to back pain, evidenced by his
description.
Impaired social interaction, related to caregiver’s overload,
as evidenced by isolation.
Nursing prescriptions
- Listen actively;
- Express one’s own thoughts and feelings;
- Encourage self-care activities.
- Evaluate signs and symptoms of pain;
- Provide information to help increasing pain tolerance.
- Plan along with relatives a schedule of care actions for
the elderly person.
Leisure deficit, related to caregiver’s overload, as
evidenced by discouragement.
- Try performing pleasurable activities;
- Modify the environment and the family relationships
experienced.
Impaired home maintenance, related to inadequate support
system, as evidenced by the requirement of the caregiver
role.
- Explore available alternatives for a rearrangement of
roles.
Disturbed nutrition, less than body demands, related to
caregiver’s overload, as evidenced by poor food intake.
- Encourage regular feeding habits;
- Diet diversification, and at appropriate intervals.
Disturbed sleep patterns, related to caregiver’s overload,
as evidenced by insomnia.
- Use strategies which optimize sleep patterns;
- Plan along with relatives the care for the elderly person,
in order to offer uninterrupted sleeping hours.
Loneliness risk, related to social isolation.
- Plan along with relatives the care for the elderly person,
in order to offer hours for extra-family relationships.
Figure 2. Nursing diagnoses and prescriptions.
However, the care plan proposed to the
caregiver wasn’t successful, because there
was no family support. The caregiver
participating in this study lives with the
genitor and has only sporadic visits from other
relatives, thus, the care for the elderly person
is under his responsibility, preventing the
implementation of the proposed self-care
strategies. Here, one emphasizes the State’s
role in the care for the elderly person at
home, since, even returning to the family
environment, this must offer a support for the
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caregiver, otherwise, it’ll promote new
pathways for illness. Thus, there’s a need to
be alert in order to recognize the caregiver as
a “hidden patient”, who lacks appropriate
interventions.11
● Implications for nursing
This study shows the difficulty the nurse
faces within the family environment, which
has its own culturally assigned peculiarities.
The caregiver attributed to himself the duty
of caring for as a strategy to repay the genitor
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all he had already offered him. This becomes
so ingrained that prevents the caregiver from
having a different look without experiencing a
guilt feeling. In this conflict, thus, nursing
needs to operationalize and optimize care for
the elderly person, as well as the caregiver’s
quality of life, in order to allow the
participation of the elderly subject, and his
family caregiver, in the care process,
potentiating a qualified care.
It’s worth implementing health actions
aimed at the biological, psychological, social,
and spiritual needs of the caregiver of a
totally dependent individual on their roles,
since the overload of care actions negatively
affects his life in society.12 One also highlights
that caregivers need a support with regard to
training and education, as well as rest and
physical and mental health, so that programs
and policies provide them with coping
strategies to face specific stressful situations
and negative consequences, too.13
CONCLUSION
The study had as its object to identify,
through SNC, based on the concepts proposed
by Orem’s Self-Care Theory and the support
systems surrounding the caregiver, the way
how the health profile of an elderly person
reverberates in the life of the home caregiver.
It became evident, thus, that one of the
effects on the caregiver’s life is the
deprivation of his self-care. So, there’s a need
for implementing strategies which envisage
the quality of life of the elderly person’s
caregivers, since the Brazilian society is aging
and it lacks more support for aging with
quality, besides providing those who care for
with a better care.
This study shows that there’s a need for
public policies aimed at the elderly person’s
caregivers, in order to promote a better
quality of life, and further researches
involving the caregiver in his various facets
are also needed, incorporating aspects from
his training to his professional practice, so
that he’s able to intervene in the most
coherent way with regard to the reality of
caregivers and elderly people.
REFERENCES
1. Resende MCF, Dias EC. Cuidadores de
idosos: um novo/velho trabalho. Physis
[Internet]. 2008 [cited 2010 Apr 25];
18(4):[about
7
p.].
Available
from:
http://www.scielo.br/scielo.php?script=sci_ar
ttext&pid=S0103-73312008000400010.
2. Ministério da Saúde (Brasil), Secretaria de
Atenção à Saúde. Portaria nº 2.528, de
English/Portuguese
J Nurs UFPE on line., Recife, 7(spc):1030-35, Mar., 2013
DOI: 10.5205/reuol.3934-31164-1-SM.0703esp201327
Repercussions in the life of the elderly…
outubro de 2006 [internet]. Política Nacional
de Saúde da Pessoa Idosa. Brasília: Ministério
da Saúde; 2006 [cited 201º Apr 30]. Available
from:
http://portal.saude.gov.br/portal/arquivos/p
df/2528%20aprova%20a%20politica%20nacional
%20de%20saude%20da%20pessoa%20idosa.pdf.
3. Schossler T, Crossetti MG. Cuidador
domiciliar do idoso e o cuidado de si: uma
análise através da teoria do cuidado humano
de Jean Watson. Texto & contexto enferm
[Internet]. 2008 apr/june [cited 2010 Apr
25];17(2):[about 7 p.]. Available from:
http://www.scielo.br/pdf/tce/v17n2/09.pdf.
4. Martins JJ, Albuquerque GL, Nascimento
ERP, Barra DCC, Souza WGA, Pacheco WNS.
Necessidades de educação em saúde dos
cuidadores de pessoas idosas no domicílio.
Texto & contexto enferm [Internet] 2007
apr/june [cited 2010 Apr 27]; 16(2):[about 8
p.].
Available
from:
http://www.scielo.br/scielo.php?script=sci_ar
ttext&pid=S010407072007000200007&lng=en&nrm=iso&tlng=pt
.
5. Pereira APS, Teixeira GM, Bressan CAB,
Martini JG. O genograma e o ecomapa no
cuidado de enfermagem em saúde da família.
Rev bras enferm [Internet]. 2009 may/june
[cited 2010 Mar 25]; 62(3):[about 9 p.].
Available
from:
http://www.scielo.br/scielo.php?pid=S003471672009000300012&script=sci_arttext.
6. Teixeira CP, Silva LD. As incapacidades
físicas de pacientes com acidente vascular
cerebral: ações de enfermagem. Enferm Glob
[Internet]. 2009 feb [cited 2010 Apr 26];15
[about
7
p.].
Available
from:
http://scielo.isciii.es/scielo.php?script=sci_ar
ttext&pid=S169561412009000100019&lng=pt&nrm=iso&tlng=pt.
7. Amendola F, Oliveira MAC, Alvarenga MRM.
Qualidade de vida dos cuidadores de pacientes
de dependentes no programa saúde da
família. Texto & context enferm [Internet].
2008 apr/june [cited 2010 June 06];17(2).
Available
from:
http://www.scielo.br/scielo.php?script=sci_ar
ttext&pid=S010407072008000200007&lng=en&nrm=iso&tlng=pt
.
8. Silva L, Bousso RS, Galera SAF. Aplicação do
modelo calgary para avaliação de famílias de
idosos na prática clínica. Rev bras enferm
[Internet]. 2009 july/aug [cited 2010 Apr 25];
62(4): [about 10 p.]. Available from:
http://www.scielo.br/scielo.php?script=sci_ar
ttext&pid=S0034-71672009000400006.
1034
ISSN: 1981-8963
Brito MCC, Oliveira EN, Freitas CASL et al.
DOI: 10.5205/reuol.3934-31164-1-SM.0703esp201327
Repercussions in the life of the elderly…
9. Manzini FC, Simonetti JP. Consulta de
enfermagem aplicada a clientes portadores de
hipertensão arterial: uso da teoria do
autocuidado de Orem. Rev latinoam enferm
[Internet]. 2009 jan/feb [cited 2010 June
06];17(1):[about 10 p.]. Available from:
http://www.scielo.br/scielo.php?script=sci_ar
ttext&pid=S010411692009000100018&lng=en&nrm=iso&tlng=pt
.
10. Feijão AR, Lopes MVO, Galvão MTG.
Importance of the Supportive-educative
System of Orem Model in the patient
compliance – Reflexive study. Online braz j
nurs [Internet]. 2009 nov 18; [Cited 2010 Dec
17];8(2).
Available
from:
http://www.objnursing.uff.br/index.php/nurs
ing/article/view/j.1676-4285.2009.2213/490.
11. Figueiredo D, Lima MP, Sousa L. Os
“pacientes esquecidos”: satisfação com a vida
e percepção de saúde em cuidadores
familiares de idosos. Rev kairós [Internet].
2009 Jan [cited 2010 Apr 25]; 12(1):[about 16
p.].
Available
from:
http://revistas.pucsp.br/index.php/kairos/art
icle/viewFile/2782/1817.
12. Nogueira DL, Oliveira EN, Brito MCC,
Borges VS, Vasconcelos DP, Pinto PD. Processo
de enfermagem: uma ferramenta para o
cuidado ao idoso com Alzheimer. Rev enferm
UFPE on line [Internet]. 2011 aug [cited 2012
June 19];5(6):[about 7 p.]. Available from:
http://www.ufpe.br/revistaenfermagem/inde
x.php/revista/article/view/1666/pdf_600
13. Robison J, Fortinsky R, Kleppinger A,
Shugrue N, Porter M. A broader view of family
caregiving: effects of caregiving and caregiver
conditions on depressive symptoms, health,
work, and social isolation. J Gerontol B
Psychol Sci Soc Sci [Internet]. 2009 Nov [cited
2012 June 19]; 64(6): [about 10 p.]. Available
from:
http://psychsocgerontology.oxfordjournals.or
g/content/64B/6/788.short
Submission: 2012/08/22
Accepted: 2013/01/15
Publishing: 2013/02/01
Corresponding Address
Maria da Conceição Coelho Brito
Rua Cel. Henrique Rodrigues, 164 / Ap. 201
Bairro Campo dos Velhos
CEP: 62030-050 ‒ Sobral (CE), Brazil
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