CALIFORNIA STATE UNIVERSITY, NORTHRIDGE
A HEALTH EDUCATION INTERVENTION FOR
FAMILY CAREGIVERS OF THE ELDERLY
A graduate project submitted in partial satisfaction
of the requirements for the degree of
Master of Public Health
by
Elaine Chan Pang
May, 1988
The Project of Elaine Chan Pang is approved:
Susan C. Giarratano, Ed.D.
Michael V. Kline, Dr. P. H.
Committee Chairperson
---=
California State University, Northridge
ii
To my Parents
iii
ACKNOWLEDGEMENT
I
would
like
to express my
appreciation
to
many
individuals who have assisted me in the planning, development and completion of this project.
First,
project
wish to thank the members of
I
to
committee:
Dr.
Michael
my
graduate
Kline,
Committee
Chairman, for his inspiration and guidance throughout this
project,
tions
to Dr. Susan Giarratano for her valuable sugges-
and support; and to Mei-Ling Schwartz, M.P.H.,
for
her advice and encouragement.
I
(Elder
am also indebted to the Senior Planning
Task Force) of Kaiser Permanente
Panorama City,
thanks
to
of these members, and
Medical
participated
in the
Roberta
of
the
Madison
California
assistance
in
statistical
providing
Center,
staff
of
Kaiser
of
the
Science
Health
Science
the preparation of the
editorial
I
am
and
James
Dr.
Department
for
Mimee
of
their
questionnaire
grateful to Laura!
assistance
the
and
Department
Northridge,
University,
analysis.
of
would like to thank Dr.
I
who
Hills
Woodland
planning and implementation
Computer
State
in
Center
needs assessment survey.
Flemming
Medical
for their interest in my project. Special
some
Permanente
Committee
Eu
and
for
Tsang
for
husband
and
computer assistance.
Finally,
I
wish
to
thank my beloved
children for their patience,
throughout my M.P.H. Program.
iv
understanding,
and
support
TABLE OF CONTENTS
Page
DEDICATION ..... .
ACKNOWLEDGEMENT.
ABSTRACT . . . . . . .
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Chapter
1. INRODUCTION •.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .
1
Background of the Study ..
4
Statement of the Problem.
6
Purpose of the Study . . . . . . . . . . . . . . . . . . . . . . . .
6
. . . . . . .. . ... .. . . . . . . . . . . . .... . . .
Limitations.
. ............................ .
7
Definition of Terms ..............•..•..•....
8
. . .. . . . . .. . . . .. .... . .
10
Assumptions .
Summary . . . . . . . . . . . . . . . .
2. REVIEW OF THE LITERATURE.
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Introduction .•........•
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Social and Demographic Trends.
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The Family Caregiving Network.
The Caregiving Burden •
7
11
14
. . . . . . . . . . . . . . . . . .. . ..
16
17
Programs for Caregivers •.....
The Role of Health Education as
an Intervention for Caregivers.
Summary ...
19
. .. . .. .. ... .. .. ..... . . . ......... .
3. METHODOLOGY ....
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Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Phase 1 : Selection of Study Population.
22
.....
23
Q
Page
Chapter
Phase 2: Development of the
24
Needs Assessment Instrument.
Phase 3: Distribution and Administration
of.the Needs Assessment Instrument..
26
Phase 4: Data Analysis ..
.....................
28
Phase 5: Program Design.
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RESULTS AND DISCUSSION . . . . . . . . . . . .. . . . . . . . . . . . .
Introduction .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Summary of Data. . . . . . . . . . . . . . . . . . . . . . ....... .
Factors Affecting Degrees of Burden . . . . . . . . . .
Summary .
4.
28
36
38
38
38
69
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
79
5. The Proposed Health Education Intervention.
80
.............. .
Introduction ....
.. . . .. . .. . .. . . .
Guide .... . . . . .. . . . . . . . . .
80
"The Caregivers' Health Fair" .
81
Workshops Curriculum
87
Summary . . . . . . . . . . . . . . . . . . . . . . .
.. . . . .
Introduction •...... .. . . ... . . . . . . . . . . . . . . .. . . .
6. SUMMARY, CONCLUSIONS AND RECOMMENDATIONS •
. .. . . .. . .. . .. . . . . .. . .. . .. .
Conclusions ..... . . . . . . . .. ... . . . . .. .. . . . . . . . . .
Recommendations . . . .... .. .. . .. . .. .. . . . . . ... . ..
Summary of Project .
REFERENCES •••.••••••.•••••••.•.••
vi
.................
104
105
105
105
107
109
112
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APPENDICES
A
e
The Review Panel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
117
B. The Needs Assessment Instrument
"The Caregivers 1 Survey",.....................
119
C. Conference Evaluation.........................
124
D. List of Potential Participating Agencies
at Resource Center............................
126
E. Resources for Caregivers......................
130
F. Common Diseases and Symptoms
of the Elderly.................................
137
G. Exercises for Older Adults . . . . . . . . . . . . . . . . . . . . .
142
H. Stress Management..............................
147
I. Safe use of Medicines and
Accident Prevention . . . . . . . • . . . . . . . . . . . . . . . . . . . .
vii
152
LIST OF TABLES
Page
Table
1. Sources of the Study Sample....................
40
2. Selected Demographic Characteristics
of Caregivers................................
42
3. Household Structure of Family Caregivers.......
44
4. Caregivers' Use of Family and
Community Support. . . . . . . . . . . . . . . . . . . . . . . . . . . .
45
5. Selected Characteristics of Care Recipients....
50
6. Living Arrangement of Care Recipients..........
51
7. Care Recipients' Social Activities
Participation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
52
8. Medical Problems of Care Recipients............
53
9. Care Recipients Dependency Based on
Activities of Daily Living...................
54
10. Care Recipients Dependency Based on
Instrumental Activities of Daily Living......
55
11. Relation of Caregivers to Care Recipients......
60
12. Frequencies of Caregiver/Care Recipients
Communication. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
62
13. Length of Caring...............................
63
14. Caregi ving Hours Per Day. . . . . . . . . . . • . • . • . . • . . . .
64
15. Caregiving Adjustment by
Relation of Caregivers to Care Recipients....
66
16. Caregivers' Perception of
Physical, Financial and Emotional Burden.....
viii
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Page
Table
17. Care Recipients' Dependency and
Physical Burden of Caregivers................
71
18. Relationship of Household Structure
and Emotional Burden of Caregivers...........
73
19. Relationship of Care Recipients' Senior Centers
Participation and Degrees of Burden..........
74
20. Family Support and Emotional Burden of
Caregivers...................................
75
21. Use of Home Health Services and
Degrees of Burden............................
ix
77
ABSTRACT
A HEALTH EDUCATION INTERVENTION FOR
FAMILY CAREGIVERS OF THE ELDERLY
by
Elaine Chan Pang
Master of Public Health
The
purpose of this project was to obtain a
and assess the needs of the
health
profile
family caregiver members of a
maintenance organization (HMO),
and to develop
a
health education intervention for these individuals. Three
areas of activities were involved in this project:
1. Development, implementation and analysis of the
needs assessment questionnaire;
2. Development of a scheme for a health
intervention
for
the
target
education
population
of
family caregivers; and,
3. Development of a curriculum guide for workshops
conducted during the intervention.
A needs assessment questionnaire was developed by the
Investigator, and was implemented by medical center
X
staff
and
the
Based
Investigator in two medical centers of the
HMO.
on the analysis of data from 101 family caregivers,
following conclusions were reached:
1. The
majority of the family caregivers were
their
senior
years
(over
55)
and
in
were
themselves in need.
2. The
family
community
caregivers did not
use
available
resources adequately.
3. Interventions
caregivers
targeted
family
the
inform
and
encourage them to use community resources,
and
to
are clearly
for
needed to
increase their knowledge and skills in home
care.
Following the needs assessment study and an extensive
literature review,
and
a
curriculum
a health education intervention scheme
guide
for
the
workshops
of
the
interventions was developed. The goals of the intervention
were
to
help family caregivers to be more effective
and
less burdened by their caregiving responsibilities and, as
a
result,
to reduce hospital utilization of the
both caregivers and care recipients.
xi
HMO
by
0
Chapter 1
INTRODUCTION
Caregiving haa become one of the most important
personal and public issues of the 80' and beyond.
-Zarit, 1985
In recent years, family caregivers have gained public
attention
as
delivery
the
system
major element of
debates
long-term
for the increasing number
elderly (Gwyther and George,
caregivers
the
has
led
to
of
care
dependent
1986). The important role of
numerous
research
efforts
on public policies of long-term care
and
initiatives
(Comptroller General, 1977; Kane and Kane, 1980).
Social and Demographic Trends
The
family
based
general
and/or
about the
significant
role
members play in long term care for the elderly
on
primary
consensus
two social trends.
source
First,
the family
of care for the growing number
impaired elderly,
is
of
is
the
frail
A study in 1985 indicated
that
eighty percent of care for the impaired elderly came
from
family members .
who
had disabilities that left them in need of help
activities
million
lived
There were 6.8 million elderly Americans
of
daily living.
Of this,
lived in nursing homes,
an estimated
.and another 5.2
in the community under the care of family
1
with
1.4
million
members.
•
(l
(Day, 1985)
Secondly,
of
cost
institutionalization for the frail elderly have caused
policymakers
to consider the significant role
caregiving
and
strengthen
the
escalating health care costs and the
to
search
for
strategies
persons
institutional
in the home as
may
care
be avoided
long
or
family
that
By
this informal support system.
elderly
of
will
maintaining
as
possible,
(Stone,
delayed
Cafferate and Sangl, 1986).
However,
other
demographic trends are
jeopardizing
the future of family care for the elderly. As the nation's
the number of elderly needing
older population increases,
at least minimal help is greater than ever before.
same time,
families are getting smaller.
burden
care is potentially spread among fewer
of
members.
This
means
impaired
elderly
more families are
needing
help
At the
Therefore,
likely
with day
to
the
family
to
day
have
tasks
( Zar it , 19 8 5 ) ,
Because
older men,
family,
the
are
the
tend to marry
and traditionally play the caring role in
the
they usually are chosen to serve as caregivers of
elderly
female
women have longer life spans,
(Sommer,
1985).
Except in cases where
is the more impaired spouse,
primary caregivers.
wives and
Yet, today more
the
daughters
women
are
participating in work force. It is projected that by 1990,
more than 60 percent of women aged 45 to 54 will be in the
2
•
,~
work
force as compared to only about 35 percent in
1950s (Day,
less
1985). This trend is likely to make the women
available
Instead,
early
to
care for
their
impaired
relatives.
more families will seek institutional care as an
alternative.
Delayed
ability
having
childbearing
also
hinders
to provide care for the elderly.
fewer children later in life.
the
Women today are
This trend may lead
to competing demands of the impaired elderly,
children and, perhaps,
family's
the growing
jobs.
The Threefold Burden of Care
The burden of care for the elderly includes financial
costs. Family and friends absorbed the majority of service
costs at all levels of impairment of the elderly (Masnick,
1980).
the
Even though family members provide for the bulk of
nation's care of the elderly,
rarely do they receive
financial remuneration for their efforts (Stone, Cafferata
and Sang!,
The
1986).
financial cost of elderly relatives is only part
of the burden on caregivers.
of
having to assist
activities.
mately
There is the physical demand
the elderly with various
On an average day,
day-to-day
caregivers spend approxi-
four hours on caregiving tasks
(Stone,
Cafferata
and Sang!, 1986).
Caregivers
also
carry
emotional burdens
conflicting demands on their time ~nd
3
energy,
owing
to
disruption
.
of living patterns,
social isolation, and concern for the
conditions of their care recipients (Cantor, 1983).
Supports and Services
As
the
needs
of the
caregivers
are
increasingly
recognized,
new approaches and programs to assist them in
caring. for
the
elderly are being tested.
Most
of
the
projects are experimental, involving short-term studies of
small groups.
(Day, 1985)
Among the projects initiated are cash
attendants,
help
respite care,
services.
innovative
or
day care facilities,
provide
for
home
and home
support,
emotional
attempts include seminars and workshops on
aging process,
help
To
credits,
instructions on caregiving
skills,
support groups and respite services
of
the
selfvarious
lengths of time (Day, 1985).
Background of the Study
With
care
the anticipated growth in the demand for health
for
the
older population
and
limited
resources,
changes in the health and social services delivery systems
are emerging. When the Investigator began an internship at
the
Kaiser
(KPPC),
efficient
members.
An
Permanente Medical Center
the
organization
ways
to
was
in
exploring
provide care for
older
Panorama
City
new
and
more
health
plan
(Murray, 1986)
Elder Care Task Force was formed to ''identify the
4
to improve the quality
needs of the elderly patients,
they
care
receive,
decrease
and
1986).
utilization" (Elderly Health Care,
Task
Force
from
all
included administrators
departments
Investigator
served
of
their
the
of
hospital
Members of the
and
representatives
Center.
Medical
as a student intern member
The
in
this
Task Force.
A
needs
assessment
study of
the
general
elderly
health plan members was initiated when the task force
formed.
The
study.
Investigator
This
process
instrument,
was assigned to
conduct
involved the developing the
implementing the survey,
was
this
survey
analyzing the data
and submitting a report of the results to the Task Force.
At
the
time when the elderly
health
survey
project was terminating,
givers
of the elderly as major long-term
plan
members
the role of family carecare
providers
began
to gain attention in the medical community.
There-
fore,
a
Kaiser
study
of the family caregivers
of
the
Permanente Medical Center became a logical sequence to the
needs assessment survey of senior plan members.
This
graduate project,
assessment
of
caregivers
received
KPPC's
and
which consisted of
a proposed
intervention
for
a
needs
family
the support of the Administrator
Member Health Education
Center's
Elder
Planning
Committee) also played
Department.
The
Care Task Force (later called the
~n
of
Medical
Senior
important role in
the
planning and implementation of the study. This Committee's
5
role will be delineated in Chapter 3, Methodology.
Statement of the Problem
The
group
family
for
majority
of
elderly
search,
patients
in
home
utilization,
lead
to
Finke,
(Murray,
target
for
1986).
the
Through
these family caregivers were shown to
the following needs:
skills
the
this study because they provide care
literature
have
caregivers were selected as
1)
inadequate
care which led to
knowledge
unnecessary
and
hospital
2) negative impact of caregiving which could
physical and emotional
1988;
illness
(Miller,
1981;
Larsen, 1988). These needs were examined in
this study and an intervention was developed to assist the
family members in the care of their elderly at home.
Purpose of the Study
The purposes of this project were:
1. To
two
identify the caregivers and care recipients of
medical centers of Kaiser Permanente
in
the
San Fernando Valley;
2. To
assess
the
specific
needs
of
the
target
caregivers;
3. To identify appropriate content of an intervention
for the family caregivers; and
4. To
design a health education curriculum guide for
the workshops of the intervention.
6
Assumptions
There were four assumptions pertaining to the design of
a health education intervention for the family
caregivers
in this study:
1. The
health- educator
planning
and
assumes the major
implementing
of
the
role
in
proposed
intervention.
2. The health educator has the support of the Medical
Center administration and sufficient resources
to
conduct the intervention.
3. The attitudes of adult learners (the participants)
can
be influenced positively by selected learning
experiences.
4. The increase in knowledge and change in
attitudes
can lead to change in behavior.
Limitations
1. The sampling
method was limited to two medical centers
of the health maintenance
2. Data
obtained
organiza~ion
(HMO).
may reflect special characteristics
of
members who joined this HMO in the two medical centers.
3. Data obtained may further reflect special characteristics
where
of
subjects utilizing the
survey was conducted.
e.g.
specific
Care recipients
Home Health Department may be more frail and
than those of other sources.
7
departments
of
dependent
4. Ethnic
and
levels
cultural backgrounds,
were
not
considered
and
socio-economic
in
the
proposed
intervention.
Definition of Terms
The following terms associated with this project
are
defined:
1. Aging:
All the regular changes that take place in
biologically
through
mature
individuals as they
the life cycle (Harris
and
advance
1980,
Cole,
p.444)
2. Caregiver:
Person who provides care or assistance
(emotional, financial and/or physical).
Caregivers can be formal or professional,
doctors,
nurses,
psychologists,
informal,
social workers,
counselors,
etc.,
or non-professional,
such as
psychiatrists,
or they can be
such as family or
friends.
3. Caregiving Burden: The social, emotional, physical
and financial costs associated with the caregiving
experience.
4. Elderly:
(Stone, Cafferata and Sangl, 1986).
Persons
over 65 years old.
They can be
categorized into three groups:
a. Young old elderly Persons 75 and under.
b. Old old elderly Persons between 75 and 90.
c. Senescence Persons over 90.
8
(Dychtwald, 1986)
p
5. Health
Promotion:
The
National council
on
the
Aging defines health promotion as:
Any combination of health education
and related organizational,
political
and economic interventions designed to
facilitate behavioral and environmental
changes
which
prevent,
delay
the
occurrence, or minimize the impact of
disease or disability while promoting
the independence and well-being of older
adults. (Green, 1980)
6. Home Health:
Agencies that provide multidiscipli-
nary health care service to the sick, disabled and
injured
in
their places of
residence.
(Lauback,
1981)
7. Impaired
or
needing
dependent
help
activities,
with
elderly:
Older
persons
of
daily
performances
and/or emotional, social and economic
support.
8. Intervention (or health education intervention):
Organized
health education
activity
based on the desire to intervene in the
process of development and change in
such a way as to maintain positive
health
behavior or to interrupt
a
behavioral pattern that is linked to
increased risks for illness,
injury,
disability,
or death.
(Green et.al.,
1980)
9. Performance
Geriatric
of
daily
assessment
A
type
of
evaluates
the
activities:
scale which
person's ability to perform the following activities:
a. Activities
feeding,
of
daily
bathing,
9
living:
dressing,
such
as
using
the
•
".
toilet and getting about.
b. Instrumental activities of daily living:
such
as
using
cleaning
the
telephone,
and handling
financial
cooking,
matters
(Williams, 1986).
10. Sandwich Generation: Adult children of the elderly
who
are "sandwiched" between their aging
parents
and their own maturing children (Miller, 1980).
11. Support Group (Self-help group, mutual-aid group):
small
mutual
group
meetings
support,
can
where
members,
through
share
concerns,
clarify
problems and roles, and develop skills for problem
solving and coping.
(Levey, 1983)
Summary
This chapter introduced the important role of
family
caregivers as the major contributors to the long-term care
the
of elderly in the nation.
The social and demographic
trends concerning caregiving and the effects of caregiving
on
family
members,
especially
female
relatives, were
discussed.
The background of this graduate project on the family
caregivers of the elderly was described.
The statement of
the problem of this project, the purpose of this study and
limitations were also presented.
Finally,
of terms used in this document wer~ defined.
10
the definition
Chapter 2
REVIEW OF THE LITERATURE
Introduction
This
provided
and
Chapter
xeviews the pertinent literature
that
a framework for this project's assessment
the design of the intervention and
study
curriculum
guide
for the target caregiver population. Selection of reviewed
literature was based
1. Social
on the following considerations:
and demographic trends leading to the public
awareness
of
the important role played
by
family
caregivers of the elderly;
2. Composition of the family caregiving network and the
role of women as caregivers;
3. Caregiving
burden due to commitment and conflicting
demands;
4. Programs for family caregivers; and
5. The
role of health education as an intervention for
the family caregivers.
Social and Demographic Trends
The body of literature over the last twenty years has
been saturated with reports on the causes and consequences
of
the "senior boom."
In 1965,
nation's attention that,
was
Sussman brought
as a result of longevity,
increase in the number of dependent elderly,
11
to
the
there
and the
bulk of their needs was provided by their adult
This
report
recognized
was
the
regarded
as
a
landmark
children.
study
that
vital role families play in the lives
of
the elderly in this nation (Simmons, 1985).
Shana (1979a) also provided empirical data confirming
that
the
family
"emotional
economic
and
is
a
resource
the
elderly's
crisis intervention
social support,
and
The study dispelled the
myth that
aging persons are isolated from their families.
Actually,
only
assistance."
for
a
small fraction of this nation's aged
isolated.
Subsequently,
prevailing
more
studies
were
truly
established
this
1981;
situation in American families (Miller,
Kay, 1985; Day, 1985; Wood, 1987).
In
trends
1985,
and
Day
reviewed the social
and
demographic
pointed out the following factors that
might
jeopardize the future of family care for the elderly:
1. Longer
is
life expectancy.
longer,
the elderly
Since life expectancy
population
increases
fast, with the age group between 75 to 90 being
the
fastest
growing segment of
With
population.
members,
approximately
representing
the total U.S.
multiplying
the
ten
American
million
roughly four percent of
population,
this age group
is
at nearly three times the rate
of
the overall population. However, this age group
is
also
the most likely to develop
12
long-term
illnesses,
making them dependent on others for
their daily activities.
The number of impaired
Americans
to
is
expected
more
than
double
between 1985 and 2020.
2. The age composition of the population.
time when people live longer,
At
the
family size gets
smaller. Therefore, the proportion of offspring
to elderly becomes larger. The chance of men 65
and older with one or more surviving parents is
expected to increase four-fold between 1975 and
2015.
3. Women
in
labor
force.
Women
traditionally
have provided the bulk of the care for
elderly
relatives. However, more women are entering the
labor
force
available
care.
today
are
not
therefore
for caring for their elderly at home
This
families
and
circumstance
will
more
cause
to choose institutionalization as
an
alternative to keeping the elderly at home.
4. Delayed
fewer
childbearing.
More women
children later in life.
are
This means that
middle aged people have caregiving
lities
elderly.
tional
for
both
children and
Conflicting
demands of
family members will lead
having
responsibi-
the
dependent
multigenerato
stressful
situations.
Unlike
most
previous
13
studies
which
based
their
conclusions
caregivers
small
on
non-representative
restricted to a particular geographic
socio-economic
researchers
status
Stone,
and/or
living
of
samples
region,
arrangement,
Caffetera and Sangl (1986) examined a
nationally representative sample of 2.2 million caregivers
providing
unpaid assistance to 1.2
tionalized
profile
impaired
of
a
million
The
elderly.
non-institu-
results
depicted
vulnerable group caring for an
even
a
more
vulnerable group.
The
findings
showed
that
the
average
of
age
caregivers was 57.3 years, roughly one-third were over age
65,
one-third were poor or near poor, and one-third rated
their health as fair to poor. Many caregivers had problems
of
their
own beyond their
caregiving
responsibilities.
Although
only a small percentage of caregivers
incomes,
many
reported
had
high
that caregiving interfered
with
their work in ways that cost them financially.
Finally, the authors recommended future research that
would
1) explore the caregivers' emotional,
financial
costs of caregiving,
competing
demands on caregivers,
social,
2) assess the
and
impact
and 3) examine
of
factors
influencing the use of paid services.
The
Family Caregiving Network and the
Since
social
the
end
scientists
of 1970s,
wrote
14
many
about the
Role of Women
gerontologists
emergence
of
and
four-
(l
generation
families.
For
in
example,
a
by
report
Silverstone and Hyman (1979) the following was cited:
This is the century not only of old age but of
multigenerational
families....
The
fourgeneration family is here.
One half of all
persons over 65 with living children are
members of four-generation families. This is
a very triumphant and positive event. On the
other
hand we are presented with
harsh
realities that have to be faced.
-Dr. Robert Butl~r
Director of the National Institute on Aging
Shana
more
(1979a) also described the harsh reality
that
and more family members were trying to care for two
generations of retirees while coping with their own
aging
and
their
the
demands
of younger family
members,
and
jobs."
Further studies by Brody (1981, 1985), Johnson (1983)
and
Stroller
(1983)
on the informal caregiving
network
showed that family caregiving was undertaken most often by
one
family
likely
member at a time,
a female.
hierarchy
and this member
Within the female
kinship
was
network,
of caregiver preference seemed to exist.
were the first choices,
most
a
Wives
then adult daughters, followed by
sisters and other female relatives.
Sommer (1985) emphasized the women's role in the care
of
the elderly at home,
issue
of
expectation
and noted that caregiving was an
special concern to women.
Either by
or by personal sense of duty,
caregivers in 1985 were women.
However,
85 percent
with the
changes now occurring-- women in the work force,
15
society's
of
social
multiple
•
t1
marriages,
and
fewer children-- there would be an impact
on who was to provide the necessary services for an
aging
population.
Caregiving Burden
Many studies have addressed the problem of the
giving
also
burden.
pointed
policies
Kane,
Stroller
for
of
strain
burden
and
public
(Day,
1985;
interventions
would support the caregivers
Brody
(1983)
support
literature on the caregiving
to the need for
that
1985).
level
The
(1981,
have
1985);
provided
( 1983)
Johnson
older relatives was threatened by
meeting competing demands of
the
high
physical
family
members;
fear of the decline and anticipated death of a loved
feelings
of
guilt of not doing enough for the
and
family
that
evidence
stress generated by the emotional and
of
care-
one;
impaired;
frustration due to inability to control the circumstances;
role reversal; and financial pressure.
Snyder
caregiving
They
and
and
Keefe (1985) discussed the
burden
had on the health of
effects
the
family
members.
stated that prolonged stress could lead to
physical
emotional problems ranging from hypertension and back
problems to depression and mental exhaustion.
While
have been
both
most
of the reports on the caregiving
descriptive,
burden
Gwyther and George (1986) offered
substantive and methodological contributions to
understanding
of
the
caregiving
16
experience.
the
These
'
,,
researchers
magnitude
of
presented
demented
elderly.
problems
participation.
These
characteristics
directly
Compared
responsibilities,
experience
resources
first
documentation
of
of the effects of caregiving on family
caregiving
to
the
of
age
members
peers
without
caregivers were most likely
~~ith
mental
findings
the
to
health
and
also suggested
caregiving
situation
social
that
the
and
the
available to the caregiver were more likely
affect
caregiver
the
well-being
rather
than
to
the
condition of the patient.
Programs for Caregivers
The
literature of the helping profession in the late
1970s showed that most programs for the elderly
by
social agencies focused only
and poor elderly.
"tangential"
family
many
on the needs of isolated
Programs for elderly with families were
(Tuzil,
caregivers
new
conducted
1978).
Later, as the
began to draw more
problems
public
of
attention,
programs were developed to include support
and
services for the caregivers as well as the older relatives.
Day (1985) cited a variety of programs that have been
tested
through
experimental
projects
involving
groups of people over limited time periods.
Many of these
programs were funded through the Medicaid waivers:
Cash credits, home attendants 1 respite care, day
care facilities,
and home help services are
being studied. Some of the innovative approaches
17
small
.
to
providing emotional support
to
family
caregivers
are:
family seminars
providing
information about the aging process, instruction
in caregiving skills and emotional support to
give families a greater sense of
control;
support or self-help groups;
respite services
that provide short periods of in-home relief for
caregivers;
and
day or overnight services
outside the home that give caregivers relief for
a few hours or days.
The caregiving problems not only affect the caregivers
In
in their homes but also their work places.
1987,
the
American Association for Retired Persons (AARP) reported a
study
on
the
employment.
problems of caregivers
Some
of
related
the problems included
to
their
absenteeism,
tardiness,
unscheduled time off and excessive use of
telephone.
Many workers had to forego overtime, training,
travel
opportunities,
mid-life
and promotions.
the
Eleven percent of
and older women had to leave their jobs to
care
for an older family member.
In response to the needs of the caregiver
The
employees,
AARP reported that many innovative programs have
launched
companies
at the work sites,
Between 1986
and
been
1987,
have indicated they had such programs for
100
elder
caregivers. For example:
- Southern
setting
Bell
up
is providing flexible
new programs to inform
schedules
employees
and
about
resources in their communities.
- The
Travellers
''caregiving
Insurance
Companies
fairs" which have regularly drawn
100 employees to seminars exploring the subject.
18
held
have
50
to
- American Express and Champion International have used
a
change
set
in the tax law that permitted employees to
aside
up to $5,000 in
tax-deferred
"dependent
care accounts".
- Pepsico spent $50,000 to produce an elaborate 70-page
"Elder Care Resource Guide" for its employees.
Presently there are other experimental projects which
are attempting to coordinate and integrate the efforts
of
informal
by
care
professionals.
by
the
family and formal
assistance
One such example of a formal-informal care
partnership has been reported by Simmons, Ivry and Seltzer
{1985)
in
trained
which family members of elderly
in
clients
case management techniques in order
to
were
work
more effectively with the social worker.
The Role of Health Education as an Intervention
In 1981,
of
Miller reported on the function and
problems
the "sandwich generation" and recommended two kinds of
services for this group of individuals:
1. Education
current
and
knowledge
information
available
preventive
programs
about the
aging
that
process.
should include the community
for
provide
Such
resources
this population and instructions
on
how to maintain a healthy lifestyle.
2. Services
needed
during acute and
chronic
illness
should involve the family and professionals
working
together.
19
The
recommendations
of Miller were adopted
by
many
organizations. In 1983, Clark and Rakowski reviewed several
articles
on programs for family caregivers and found
most
the efforts were educational
of
nature,
and
community
and
supportive
provided the current knowledge about
resources
available,
that
in
aging,
healthy life styles
and
ways to cope with the role of caregiving.
Philosophy of Health Education
A brief review of the literature on the philosophy of
health
education
improve
the
reflects
how
education
can
help
well-being of the family caregivers
of
to
the
elderly.
The modern concept of "health" in health education is
not limited to freedom from diseases. Rather, as Fodor and
Dalis
(1981) indicated,
it places emphasis on the
individual and his or her interrelationship with
Thus,
"health" encompasses the physical,
logical,
emotional,
whole
society.
social,
psycho-
intellectual and spiritual well-being
of the individual.
The
same
"education".
authors
It
also
explained
the
is concerned with the whole
meaning
person,
of
not
merely his or her mental processes. The individual, rather
than the subject matter,
is the focal point. In formulat-
ing the purposes of an educational program, therefore, the
individual
In
and his or her needs become the basic concern.
view
of
the
modern
20
concepts of
"health"
and
''education'',
"health
education'' has been defined
by
the
California Department of Education (1978) as:
The process of providing learning experiences
which
prepare and motivate individuals
to
protect and improve individual,
family and
community health. This includes the development
of self-awareness, decision making, and coping
action.
Lawrence
Green,
et.al.(1980) modified the scope and
purpose of this definition of health education by
ing
the
includ-
overriding principle that health education
must
bring about voluntary behavioral changes. Health education
is then defined as "any combination of learning opportunities designed to facilitate voluntary adaptation of
beha-
vior which will improve or maintain health."
Fodor and Dalis (1981) also noted that health instruc
tion
can
learner
1)
become realistic and meaningful in
helping
the
achieve and maintain a high level of wellness
by,
taking
into account the many factors affecting
health and 2) integrating the various dimensions
one's
believed
to influence health.
Health Education Interventions
Health
been
education
interventions for caregivers
in the form of classes
workshops (Jewish Homes,
and
(Kaiser
1985),
Permanente,
1980
and
Hudis,
1977).
opportunities to provide knowledge,
21
1988),
seminars (Callan, 1985),
self-help or support groups (Zarit,
Peterson,
have
By
Reever and Bachusing
learning
improve attitudes and
health educators
encourage voluntary changes in behavior,
have
strived
to
help the family
caregivers
to
obtain
maximum health for themselves and their elders.
Summary
This
chapter
has
reviewed the
literature
on
the
socio-demographic characteristics of family caregivers
of
the elderly and their related problems, the composition of
family
caregiving network,
and the role of women as
major
family elderly care provider.
used
to select the target population,
the
This information was
develop the
needs
assessment instrument and analyze the data.
Programs for family caregivers and the role of
education
information
as
an
intervention were
provided
also
a framework for the
intervention for the targeted population.
22
health
explored.
design
of
The
an
Chapter 3
METHODOLOGY
Introduction
The
steps
purpose
required
design
of
this
Chapter is
to
describe
the
to carry out the needs assessment and
a program for the targeted
caregiver
to
population.
These steps can be divided into five phases:
Phase 1. Selection of study population
Phase 2. Development of needs assessment instrument
Phase 3. Distribution
and
administration of
Needs
Assessment instrument
Phase 4. Analysis of data
Phase 5. Program design
Phase
The
~
Selection of Study Population
target population for this study was
health
plan
Center
in
(KPWH).
members
Panorama
These
of the
Kaiser
City (KPPC) and
medical
centers
the
Permanente
in
adult
Medical
Woodland
are located in
the
Hills
San
Fernando Valley, a Northwestern suburb of Los Angeles. The
selection of the study samples was based on the
following
criteria:
1. The
plan
participant was a Kaiser Permanente health
member
using either
23
the
Panorama
City
0
or Woodland Hills facility.
2. The
participant
family
member
was caring
physically,
for
an
elderly
or
financially
emotionally.
3. The elderly family member was at least 65 years
old.
The
identified
education
services
home
or
participants,
through
classes,
health
education
out-patient
were
caregivers
family
patient
classes,
clinics,
home
health
and medical center staff members of KPPC and the
health services of KPWH.
Another
interviews
care,
or
group of caregivers were identified
through
of either patients who had elderly under their
they were family members who accompanied
elderly patients to the medical center.
These
their
interviews
were held in hospital lobbies and waiting rooms.
Phase
~
The
Development of the Needs Assessment Instrument
development
of
the
needs
assessment
survey
instrument
(questionnaire) was based on the review of the
literature
on caregivers demographics and the effects
of
caregiving
on the family member,
of
the
Administrator
Department of KPPC.
of
the
and the suggestions
Member
Health
Education
The questionnaire was reviewed by the
Senior
Planning
Committee
(Elder Care
Kaiser
Permanente Medical Center at
professors in Health Education,
24
Task
Panorama
Force)
City,
of
and
Epidemiology and Computer
•
Sciences of California State University at Northridge (see
Appendix A, Review panel).
The N2eds Assessment Survey Questionnaire (Questionnaire)
The
Part
questionnaire
consisted of three
major
one was designed to obtain information
demographic
sex,
on
characteristics of the caregivers,
date of birth,
marital status,
ethnic
parts.
selected
including
background,
educational level, employment, total annual family income,
family
members
he
she
or
in household,
health status, and whether
was a Kaiser Permanente
Medical
Group
Plan
member.
Part two provided the demographic information of
care
recipients,
caregiver,
of
including age;
marital status,
communication
involvement,
with
medical
the
relation to the
the
family
living arrangement, frequency
caregiver,
family
conditions,
social
and ability to perform
activities of daily living.
Part
physical,
three
covered
psychological
information
and
regarding
emotional
the
demands
of
involved
in
caregiving,
including
caregiving,
daily time commitment, life style adjustment,
the
length
of time
and the physical, financial and emotional
burden of care-
giving perceived by the caregiver.
Finally,
the
whether they used,
respondents
were
asked
to
indicate
not used, or did not know about a list
of available family and community services.
25
In addition,
they were asked to comment on their caregiving experiences.
A copy of the needs assessment
questionnaire
~caregiver's
Survey'' can be found in Appendix B.
Pilot Testing
The
pilot-tested in
questionnaire was
A total
Education
classes
completed
the questionnaires.
questionnaire
at KPPC.
from
this
of
two
11
Health
respondents
Suggestions concerning the
group
included
the
need
to
condense its length and to include additional explanations
in the table regarding the use of community services.
A
and
revised version of the questionnaire was critiqued
approved
by the same review panel described in Phase
2. The final draft was then prepared for distribution.
Phase
~
Distribution and administration
of the Questionnaire
The
questionnaires
were distributed
from September to November,
instructions
staff
1987.
and
collected
The questionnaire
on its administration were explained
and
during
meetings or individually through the telephone
and
by mail.
The
questionnaires were distributed and administered
in the following ways:
1. Copies
of the questionnaires were distributed
to
members of the Senior Planning Committee of Kaiser
Permanente
·Medical Center at Panorama City (KPPC)
26
during their monthly meeting.
These members
then
brought the copies to their respective departments.
and
informed
questionnaires
caregivers
their
to
the
staff
to
patients
administer
who
of elderly family members,
the
were
or
also
family
members who took care of elderly patients.
2. The questionnaires were administered by the
staff
of the Home Health Department of Kaiser Permanente
Medical
Center at Woodland Hills (KPWH) when they
visited
the caregivers at their homes.
the
only segment of target population
This
was
from
KPWH
who was involved with the project.
3. The Investigator administered the questionnaire to
caregivers
in various lobbies and
waiting
rooms
throughout the Kaiser Permanente Medical Center in
Panorama
City.
As an incentive,
each respondent
was presented with a mechanical pencil bearing the
Kaiser
Permanente logo after they
completed
the
questionnaire.
In addition,
themselves
some
staff members of KPPC
identified
as caregivers and volunteered to complete some
survey questionnaires.
The questionnaires were color-coded according to
different
groups
of
respondents
described
the
above.
The
completed questionnaires from all the various sources were
delivered
to Member Health Education Department of
KPPC,
except for those handled directly by the Investigator.
27
Phase
The
~
Data Analysis
returned questionnaires were screened
according
to the sample selection criteria. The data were then coded
and
entered for computer analysis using
Package for the Social Sciences (SPSS).
the
Statistical
(Nie, 1975)
The SPSS subprogram Frequency was used to obtain
frequency
distributions
questionnaire.
of
all the
variables
in
the
the
The subprogram Crosstabulation was used to
analyse the relationships between the degree of caregiving
burdens
and
factors that might affect the perception
burden.
The
Chi-square statistic was selected
results of crosstabulation
probability
level
significant.
the
the
to test these relationships. A
of 0.05 was accepted as
statistically
In order to obtain adequate cell numbers for
analysis,
variables.
from
of
some
categories were collapsed
for
some
The results of data analysis are described
in
Chapter 4.
Phase
The
~
Program Design
content of the program,
events of the intervention,
including the scheduled
a one-day conference, and the
curriculum guide for the workshops to be conducted
the
conference,
assessment
givers,
3)
literature
was
study,
based on:
targeted
1) results of the
2) review of the literature
established
health promotion
for
28
during
older 'adults
in
on
needs
care-
programs
general,
and
4)
(\
current events regarding interventions for caregivers; and
5)
review
Medical
of the literature on health education and
Center's
member health
education
core
the
program
policies.
There
tion:
were three areas of methodological
1) The
considera-
guidelines produced by Southern California
Permanente
Medical
Group {regional
Kaiser
Permanente
Medical Group)
Health
Education programs (SCPMG,
utilized to plan the program.
include
details
implementation
for
and
level
for
of
Member
1986)
were
These guidelines
planning,
promotion,
evaluation
health
of
education programs.
2) Psychological and social theories of individual
behavior
and learning
knowledge,
changing
relevant to
and
increasing
inducing
voluntary
behavior were incorporated into the development
of
the
curriculum
intervention
3) The
to
ensure
that
the
had a theoretical basis.
strategies of Fodor and Dalis (1981)
were
used to organize the curriculum guide.
~
Program Planning
The
followed
programs
proposed program for
the
in
SCPMG
family
guidelines
subsidiary
Medical
following steps:
29
for
caregivers,
health
Centers,
which
education
included
the
.
Planning
The
target
first step involves identifying the
population,
materials,
action
staff
plan
personnel
and
and
needs,
resources
facilities for
is developed for specific
the
the
(including
program).
An
including
tasks,
staff responsibilities, communication channels, time frame
and
budget.
program
At this stage,
title
are decided.
the date,
time,
place
and
The plan is then
ready
for
involves
the
review by the organization's decision-makers.
Promotion
The
second
step
is promotion.
design of graphic materials;
posters
and
flyers;
This
printing and distributing of
and writing and
distributing
news
releases. The promotinal activities are documented.
Implementation
The
next step is the implementation of the
program.
The program participants are re-confirmed and the
ties (including details such as assembling area,
facilirefresh-
ments, room arrangements, security signs, and directional)
are
set
up.
Forms and publications such
as
attendance
sheets, questionnaires, reference materials and pamphlets/handouts are prepared and collected. The staff, speakers,
workshops
and participants carry out their
planned.
30
functions
as
Evaluation
The
program
sumruative
1975;
is
methods
by
both
(Fodor and Dalis,
occurs
throughout the
formative
and
1981; Popham,
1971).
Hastings and Madaus,
and Bloom,
evaluation
evaluated
Formative
process of the program
with the expectation of making revisions in the design
the
program when necessary.
after
the
completion
effectiveness
and
Summative evaluation
of the program
efficiency
of
to
the
occurs
determine
program,
of
the
and
to
provide information for future planning. At the end of the
proposed
intervention,
the participants will be asked to
fill an evaluation form for this purpose.
~
(See Appendix C)
Theoretical basis of the program design
The
the
following theories were used as basis
planning of activities and
for
both
the curriculum guide
for
the family caregiver's intervention:
Perception Theory
Perception
is a basic psychological process in which
an object emits energy which stimulates a sensory organ in
the
individual.
The sensory organ codes the energy
into
nerve activity which is then conveyed to the brain,
its
processing results in perception of
this
theory
object
and
sounds,
This
object.
''attention" denotes conscious focus
"perception"
feels,
theory
the
tastes,
denotes how the
where
object
on
In
the
looks,
or smells (Ross and Mica, 1980.)
proposes that perception is the
31
process
by
which
people select,
organize,
and give meaning to
the
external stimuli which affects them.
This
perception
components
four
theory
was
used
of the workshop curriculum
workshops,
interests,
each
dealing
to
select
the
There
are
guide.
different
with
and expectations of the program
needs,
participants.
Motivation Theory
The
study of motivation asks "How does behavior
get
initiated, directed, maintained, or determined?" To answer
this question,
one must distinguish between extrinsic and
intrinsic motivation. Intrinsic behaviors are performed to
meet
a person's needs for competence and
self-determina-
tion. The behaviors may be the seeking of stimulation, the
conquering
or
of challenges,
dissonance.
or the reducing of incongruity
Extrinsic motivators can also
be
called
incentives. Extrinsic motivators may include both physical
and social reinforcers or facilitators (Deci, 1971).
Based
learning
on
this
environment
opportunities
to
theory,
the
which
Investigator
offers
self-determination,
which
may
result
a
participants
the
experience feelings of
chose
competence
in
changes
and
of
attitude and behavior.
Social Learning Theory
In
behavior
his
Social
Learning
in terms of reciprocal
32
Theory,
Bandura
determinism.
analyzes
Reciprocal
determinism
external
suggests that people do not simply reacts
stimulation
in
their
transactions
to
with
the
environment; rather, the external influences are processed
(observed, perceived, analyzed for future use) through the
individual's intermediary cognitive processes.
Viewed from the social learning perspective, behavior
is
influenced
by the environment which is
partly
of
a
person's creation. A person's actions also create a social
milieu.
Thus,
psychological
functioning
involves
a
continuous reciprocal interaction between cognitive, behavioral, and environmental influences (Bandura, 1978).
Bandura's
basis
for
developing the learning opportunities
curriculum.
optimize
Social Learning Theory was also used as
The
in
learning opportunities were designed
a
the
to
the use of the environment and the skills of the
learners/participants.
Learning Theory-Cognitive, Affective and Action Domains
The learning process involves the
tive,
dual's
and
cognitive,
action domains of the individual.
level
of learning rises
as
The indivi-
learning
activities
progress successively through the three domains.
nitive
domain
ability
to
affective
attitudes,
relates
to an
deal with facts and
domain
values,
relates to an
feelings,
33
individual's
other
affec-
The cog-
intellectual
information.
individual's
and emotions.
The
interests,
The
action
domain
relates
to
all
psychomotor
behavior
including
neuromuscular motor coordination (Ross and Mica, 1980; and
Bloom, 1956).
In the curriculum guide,
three
domains
of
the Investigator has used the
the learning theory
to
classify
the
objectives of each content area.
The Attitude Change Theory
developed by Carl
The Yale Attitude Change Approach,
Hovland at Yale University, emphasizes information processing
with
persuasive communication as the instrument
of
attitude change (Zimbardo, Ebbesen and Maslach, 1977.)
Persuasive
curriculum
communication techniques are used in
to
present
facts
and
the
on
future
four
parts,
project
consequences of actions.
~
Organization of Curriculum Guide
The
curriculum
guide was divided into
each covering a major topic area for individual
which
The
comprises much of the program for the intervention.
components of the curriculum guide were organized
using
Each
the method recommended by Fodor and
topic
area
objectives,
learning
consisted of
evaluative
a
topic
criteria,
opportunities,
and
Dalis
content,
is
a brief review of each
34
(1981).
suggested
content
Audiovisual materials
related topics were included in the resource
Folllowing
by
generalization,
resources for both
materials and suggested activities.
on
workshops
component
section.
of
the
Q
curriculum guide:
Generalization
This is the major learning concept of a subject.
generalization
provides
content. Since each
specific
aspect
a
~orkshop
of
focus for
the
selection
The
of
in the intervention covered a
each will has
caregiving,
its
own
generalization or learning concept.
Objectives
The
objectives provided the basis for
specific content to be learned;
vior
of
the target
evaluative criteria.
selection
of
expected changes in behalearning
population;
opportunities
Objectives in the cognitive,
action
and affective domains.
In the proposed program, the objectives served as the
guidelines
learner;
choice
for
of
the
the selection of content for each workshop;
the
of
determining
presentation
the desired outcome
methods and the
evaluation of the participants,
the
overall
effectiveness of
basis
for
the
the workshop leaders, and
the
intervention
(SCPMG,
1987).
Learning Opportunities
In
order to enable students to attain
objectives,
learning
opportunities
were
the
specific
formulated.
Learning opportunities are instructional methods which are
determined several factors:
35
1) the psychosocial status of
•
,,
the
participants, 2) the skills of the instructor, 3) the
learning environment,
6) time allotment,
4) equipment available,
7) class size and
8) the
5) budget,
application
of psychosocial and learning theories.
The learning opportunities for the workshops included
lectures,
demonstrations,
discussion,
visual
presentations,
and individual counseling. In addition to the
workshops,
interact
audio
a resource center at which participants
with
participants
the staff of the
and
medical
center,
agency representatives (see
could
fellow
curriculum
guide, Chapter 5).
Resources
Fodor
importance
current
of
Dalis
health
materials."
curriculum
including
The
p.140) have
(1981,
educators to
information ....
resources,
for
and
be
stressed
"keep
abreast
familiar with a
resource
Investigator
people
has
guide a list of useful and
and
included
current
variety
the
with
of
reference
in
the
resources
each workshop both for reference and for presentation
during the workshop sessions.
Summary
This
program
First,
chapter
has
presented two
development for the targeted
major
family
aspects
of
caregivers.
the procedure to carry out the needs assessment of
the family caregivers was described. Second, the rationale
36
.
Q
and development of a health education intervention for the
target
population,
including a curriculum guide for four
workshops, were presented.
37
•
Chapter 4
RESULTS AND DISCUSSION
Introduction
In this Chapter, the results of the data analysis are
presented and discussed.
survey
of
Medical
family
data
caregivers in
Centers,
Hills (KPWH).
shown
including
The data were obtained from
in
two
Kaiser
Panorama City (KPPC)
the
Permanente
and
Woodland
The first group of results are summaries of
in
the
frequency
distributions
demographic data of both
care recipients,
of
variables,
caregivers
and
the relationship between family members,
adjustments due to caregiving demands, and caregivers' use
of support network.
The
analysis
show
second
group
of
results
were
obtained
from
of data consisted of various crosstabulations to
relationships
between
emotional
burdens
of
mentioned
above.
Only
physical,
caregiving
the
and
financial
the
statistically
and
variables
significant
relationships (p< .05) are reported in this Chapter.
A. Summary of Data
~
Sample Size
A total of 200 needs assessment questionnaires
distributed
to
the Member Health
38
Education
were
Department,
Social
Services
Department,
lities
Department,
Administration
Hospital
Home Health Department, skilled nursing faci-
and hospital business office of KPPC.
Another
50
copies were sent to the Home Health Department of KPWH. In
addition,
in
the
the Investigator administered 75 questionnaires
KPPC
hospital lobbies
and
waiting
rooms.
respondents in this group were either ambulatory
who
indicated
that they were taking care of
The
patients
an
elderly
family member, or they were family members who accompanied
the
elderly
"ambulatory"
patients
to
the
term
The
hospital.
is used to describe this group of data
(see
Table 1).
After three months of data collection,
110 completed
these,
101
met
criteria for data analysis (see Chapter 3).
The
majority
questionnaires
were
67.4 percent (n=68)
the
ambulatory
gathered.
Of
the
of the total usable samples came from
group.
Another 19.8 percent (n=20)
came
from the two Home Health Departments. The remainder of the
sample
were
Center
staff,
from health education
which
constituted
classes
9.9
and
percent
Medical
and
2.9
percent of the total sample, respectively.
Among
the
101 respondents,
17 indicated that
their
care recipients, although suffering from medical problems,
did
not have disabilities and did not need assistance
the activities of daily living.
dents
The remaining 84
in
respon-
took care of rlependent elderly who needed help with
39
at
Table
least one kind of activity of daily living.
summarizes
the
distribution by sources
of
1
sample
the
population for both the total study sample and sample with
dependent care recipients.
Table 1
Sources of the Study Sample
All Samples
Source
n
%
Samples with
Dependent Elderly
n
%
Ambulatory
68
67.4
52
61.9
Home Health
20
19.8
20
23.8
Member Health Education
10
9.9
9
10.7
3
2.9
3
3.6
101
100.0
84
100.0
Other
Total
( N)
Discussion
The majority (n=68,
in
this
tives.
67.4 percent) of the respondents
survey were ambulatory patients or
Each
waiting rooms.
their
rela-
was interviewed in KPPC hospital lobbies and
Within this group most took care of
their
own elderly spouses. Thus, it was not surprising that when
asked
about
care recipient's
40
dependency,
all
but
one
indicated
the
they felt no burden of caregiving.
care recipients had obvious
caregivers
They
physical
Even though
problems,
the
did not perceive them as a form of dependency.
simply accepted the situations
as
daily
routines.
This perception had to be considered when interpreting the
data.
Sample
obtained
data
by
from the Home Health
nurses
Departments
who administered the survey
were
in
the
homes of the caregivers or their care recipients. The care
recipients were usually homebound and were more likely
depend
on
samples
others
in their
daily
activities.
were found to belong to the group with
All
to
the
dependent
elderly care recipients.
It is necessary to discuss the total study sample and
the group with dependent elderly separately in this
study
because most of the current national studies (Parent Care,
1987;
Stone,
include
Cafferata and Sangl,
only
assistance
1986; Day, 1985) only
caregivers with dependent elderly
with
at least one kind of activity
needing
of
daily
living.
~
Selected Demographic Characteristics of Caregivers
Table
2
shows the majority of the respondent
care-
givers were female (n=65, 64.4 percent) and married (n=84,
83.2 percent). Their ages ranged from 27 years old to over
80
years old,
majority
with an average age of 64 years
of respondents were white (n=84,
41
83.2
old.
The
percent)
p '
Table 2
Selected Characteristics of the Caregivers
Characteristic
N
Gender
Male
Female
%
101
Marital Status
Married
Never Married
Divorced
Widowed
Other
*Age
36
65
35.6
64.4
84
83.2
4.0
5.9
5.9
1.0
88
4
6
6
1
91
Under 50
51-60
61-70
71-80
81-90
14
11
36
29
1
Ethnic Background
Asian
Black
Hispanic
White
Other
Educational Level
Below Hi School
Hi Sch Graduate
College
Graduate School
Employment
Full Time
Part Time
Retired
Never employed
Family Income
Under $20,000
$20-40,000
Over $40,000
Health Status
Good-Excellent
Fair-Poor
* M=62.4
n
s.d.=12.0
42
15.4
12.1
39.5
31.9
1.1
101
4
4
7
84
2
4.0
4.0
6.8
83.2
2.0
93
10
36
30
17
10.8
38.7
32.3
17
11
59
14
16.8
10.9
58.4
13.9
30
49
16
31.6
51.6
16.8
71
30
70.3
29.7
18.2
101
95
101
and fairly well educated,
a
high
school
with 90 percent having at least
education.
More
than
18
percent
also
respondents
were
indicated they had post graduate training.
Slightly
more
than half of
the
retired, although 28 percent still held full-time or parttime jobs.
family
About half of the respondents reported
income between $20,000 to
$40,000.
having
Another
one-
third had family income below $20,000, while an impressive
17
percent
of the respondents had annual
family
income
of $40,000 and above.
Most
of
the
caregivers
(n:71,
perceived their health status as good or
about one-third (n=30,
70.3
percent)
excellent.
29.7 percent) rated their
Only
general
health as fair or poor.
With
percent
regards to family structure,
approximately 62
of the caregivers lived alone with their
spouses
(see Table 3). Ten percent lived with spouses and children
whose ages ranged from under ten to over 20
seven percent lived with their mothers;
with spouses and parents;
multigenerational
years.
About
two percent lived
and only one percent lived in a
household
with
spouse,
parents
and
children.
Use of Family or Community Support
An attempt was made in the needs assessment survey to
determine
whether
the
caregivers used
informal
family
support and/or formal community services. Table 4 presents
43
Table 3
Household Structure of Caregivers
Caregiver Living with
n
%
Spouse
63
62.3
Mother
7
6.9
Children
4
4.0
10
9.9
Spouse/Parent
2
2.0
Spouse/Parent/Child
1
1.0
14
13.9
101
100.0
Spouse/Child(ren)
Other
Total ( N l
Ages of Children in Household
Under 10
4
4.0
11-15
6
5.9
16-20
6
5.9
Over 20
10
9.9
No Children
75
74.3
101
100.0
Total ( N)
the results which showed that about half of the caregivers
received help from other family members.
Another half had
sole responsibility for the needy·elderly without the help
of other family members.
44
Table 4
Caregivers' Use of Family and Community Support
Type of Support
Yes
n
Family Support
%
Don't Know
About Support
No
n
%
n
%
51
50.5
49
48.5
1
1.0
Support Group
4
4.0
72
71.3
25
24.8
Day Care
2
2.0
87
86.1
12
11.9
Senior Center
14
13.9
83
82.2
4
4.0
Home Health
22
21.8
72
71.3
7
6.9
7
6.9
86
85.1
8
7.9
Telephone Assistance 6
5.9
84
83.2
11
10.9
Home Personal Care
Counseling
15
14.9
79
78.2
7
6.9
Health Education
11
10.9
81
80.2
9
8.9
Hospice
3
3.0
92
91.1
5
5.0
Congregated Meal
5
5.0
91
90.1
5
5.0
Home Delivered Meal
4
4.0
94
93.1
3
3.0
16
15.8
80
79.2
5
5.0
5
5.0
85
84.2
11
10.9
19
18.8
82
81.2
0
Transportation
Case Management
Church/Synagogue
Note:
0
Totals
in the n or percent columns do
not
necessarily equal 100 percent as more than one
response was possible for types of support used.
45
The
caregivers drew upon even less support from the
community agencies, The data show that 21.8 percent (n=22)
of
them
used
percent
the Home
Health
services.
Another
(n=19) attended churches or synagogues.
18.8
Only
14
percent participated in senior center programs.
With
related
regards
to
services,
specifically
Kaiser Permanente
about 16 percent
for
senior
Medical
used
citizens;
Center
transportation
15
used
percent
counseling services; and 11 percent participated in health
education
respite
adult
for
classes.
services
such as a caregivers support
day care.
the
Less than 10 percent used support and
group
Only five percent or less used
caregivers
of
very
frail
elderly,
or
services
including
hospice, home delivered meals and case management.
Discussion
The profile of the caregivers in this study
supports
the findings of previous researchers (Stone, Cafferata and
Sangl,
1986)
Permanente
Medical
and
Health
another
Plan
survey
members
in
of
elderly
the
Kaiser
Panorama
Center by the Investigator (Senior Members
City
Needs
Assessment, 1987).
The
typical
sixties,
female
college training.
elderly
having
caregiver
and
a
was
white,
in
high school graduate
the
with
She was likely to be the spouse of
midsome
the
dependent, or belong to the "sandwich generation"
to
give
care to the elderly
46
while
meeting
the
competing
demands
household.
tion"
of
her growing children in
the
The situation of being in a "sandwich
could
be very stressful,
coping with aging herself.
same
genera-
especially when she
(Larsen
Cantor,
1988;
was
1983;
Miller, 1981)
Family Income
With
respect
caregivers
in
to
family
the study sample were more
many of their peers. This is
Kaiser Permanente,
generally
professionals
who
affluent
than
largely due to the fact that
as a Health Maintenance
attracts
average
the
income,
employees
of large
hold steady jobs,
Organization,
institutions
many
of
whom
or
are
fairly well-educated.
The
lower income group of this population
includes
the
incomes.
This
the
Kaiser
retired
caregivers
who
probably
fixed
receive
finding is supported by another survey
Permanente
senior
health
plan
members
of
in
Panorama City Medical Center by the Investigator, in which
more
and
than half (62 percent;
older
N=l57) of the group aged
reported having annual income of
$20,000
65
and
below (Senior Members Assessment, 1987).
Use of Family and Community Support
The
more
caregivers
found
support from
frequently than from community
respondents
(50. 5 .p.ercent)
47
their
services.
indicated that they
families
Fifty-one
received
support
from
elderly.
other
care
of
the
However, this also meant that almost half of the
respondents (n=49,
from
family members in the
family
caregiving
48.5 percent) did not receive any help
members
alone.
and
had to
carry
the
burden
of
Considering the general phenomenon
of
shrinking family size and the growing number of elderly in
our society (Day, 1985) ,·more and more family members will
have
to
be
involved with the care for
their
dependent
elderly.
The result of home health care being used most often
(n=22,
was
21.8
percent) could be due to the way the
conducted.
collected
the
About
one-fifth
the
sample
were
by the staff of the Home Health Departments
two medical centers.
Department,
contacting
the
of
survey
no
Except for the Health Education
other departments were as
the caregivers for this study.
ambulatory
of
samples (n=68,
successful
Reponses
67.4 percent)
in
from
were
more
evenly distributed among the various classifications.
A
18.8
relatively high proportion
percent)
of caregivers
also found solace and
emotional
(n=l9,
strength
from religious organizations. Many churches and synagogues
not
only
programs
provide
that
spiritual
could
improve
support
the
but
social,
also
sponsor
mental
and
physical well-being of the participants.
The
fact that caregivers rely mostly on the
assis-
tance
of other family members and use community
to
very limited degree appeared to be a general
a
48
services
trend
Older care recipients are more apt
among the elderly.
turn
to
support
their families for both emotional
long
and
physical
before they resort to requesting help
the network of community services (Johnson and
to
from
Cantalano,
1983). Another reason for heavy reliance on family support
could be the lack of knowledge of the availability of such
services,
or
limited
understanding
of how to
use
the
formal support system.
~
Selected Characteristics of the Care Recipients
Table
ten
5 shows that the average care recipients
years older than their caregivers
(average
were
age=73.6
years), with two of them older than 90 years. The majority
were female (n=61,
percent).
60.4 percent) and married (n=68,
Nearly
one-third
(n=27,
26.7
percent)
67.3
were
widowed.
Living Arrangement
percent)
of
the
care
caregivers
in
the
same
Another 13.9 percent (n=14) lived within
five
Three-quarters
recipients
lived
household.
(n=76,
with
75.2
their
miles away, while slightly more than 10 percent lived more
than five miles away.
The
care
majority (n=72, 71.3 percent) of
recipients
the
elderly
owned their homes or condominiums
while
about ten percent lived in apartments. Only ten percent of
them
lived
in
formal
housing
49
for
senior
citizens,
Table 5
Selected Characteristics of Care Recipients
Characteristic
N
Gender
101
Male
Female
Marital Status
*Age
39.6
60.4
68
1
27
2
67.3
1.0
3.0
26.7
2.0
40
37
13
2
43.5
40.2
14. 1
2.2
3
92
61-70
71-80
81-90
91-100
M: 73.6
40
61
101
Married
Never Married
Divorced
Widowed
Other
*
%
n
s.d.= 7.3
including retirement homes, nursing homes and convalescent
homes.
Table
6 summarizes the living
arrangement of the
care recipients.
Social Activities
In general, the elderly care recipients were not very
active socially. For example, senior centers and religious
groups
drew
only about one quarter of
(n=23,
22.8 percent;
n=24,
the
23.8 percent, respectively).
About 16 percent of the care recipients also
50
participants
belonged
to
Table 6
Living Arrangement of Care Recipients
Living Arrangement
n
%
Living Distance
from Caregivers
Same House
0-5 Miles
Over 5 Miles
Total {N)
76
14
11
75.2
13.9
10.9
101
100.0
72
8
3
3
1
14
71.3
7.9
3.0
3.0
0.9
13.9
Type of Housing
Own House/Condo
Apartment
Retirement Home
Nursing Home
Convalescent Home
Other
Total (N)
social
101
100.0
and recreation groups and two percent belonged
professional
contributed
organizations.
their
services to
to
percent
Another
five
voluntary
organizations.
Table 7 summarizes the data on the care recipients' social
activities.
Medical Problems
The
varied.
medical
While
problems of the care
som~·
had only one
51
recipients
controllable
were
problem,
Table 7
Care Recipients' Social Activities Participation
Social Activity
(N=101)
Senior Center
n
%
23
22.8
2
2.0
Social and
Recreation Group
16
15.8
Religious Group
24
23.8
5
5.0
Professional
Organization
Voluntary
Organization
Note: Totals do not equal 100 percent since there was
more than one response possible.
others had multiple life threatening physical
Table 8 indicates
the
care
percent).
percent;
that the most common health problem
recipients
Cancer
conditions.
was
and
cardiovascular
diabetes were next
(n=35,
(n=
17,
of
34.7
16.8
and n= 14, 13.9 percent respectively). About ten
percent of individuals suffered from urinary
incontinence
and arthritis.
Other
aging
that
medical
problems
impaired
orthopedic problems,
the
generally
study
associated
population
with
included
hearing and vision problems, stroke,
Alzheimer's disease and respiratory diseases.
52
Table 8
Medical Problems of Care Recipients
Medical Problem
(N=101)
%
n
Cardiovascular
Diseases
35
34.7
Cancer
17
16.8
Diabetes
14
13.9
Incontinence
11
10.9
Arthritis
11
10.9
Orthopedic Problems
9
8.9
Eye/ear problems
8
7.9
Stroke
8
7.9
Alzheimer's Disease
7
6.9
Respiratory Disease
7
6.9
Neuromuscular Disease
3
3.0
Other
8
7.9
Note: Totals do not equal 100 percent since there
more than one response possible.
was
Performance of Daily Activities
The
of
assessment of the care recipients'
activities
measures
of
daily living (ADL)
on their degree of dependency.
provides
This
generally evaluates the person's ability to
dress,
toilet
summarizes
the
and get about (Williams,
performance
specific
assessment
feed,
1986).
results of the assessment of ADL
53
bathe,
Table
of
9
the
care recipients.
Table 9
Care Recipients Dependency Based on Impairment of
Activities of Daily Living (ADL)
(N:lOl)
Impairment of ADL
%
n
Walking
35
34.7
Bathing
32
31.7
Grooming
24
23.8
Dressing
23
22.8
Feeding
19
18.8
In and Out of Bed
24
23.8
Toilet
22
21.8
Note: Totals do not equal 100 percent since there was
more than one response possible.
Among
problem
third
the physically disabled,
(n:35,
had
34.7 percent).
walking was the main
Slightly less than
difficulty bathing themselves
and
one-
one-fourth
could not even perform personal grooming and dressing. The
same
number
assistance.
could
About
not
one
get in and out
of
in five also required
bed
without
help
with
feeding.
The fundamental skills of ADL are often supplemented
with
instrumental
measurements
to use the
activities of daily living
of dependency.
telephone,
drive,
54
(IADL)
as
The .IADL include the ability
do
housework,
or
handle
financial matters.
Table 10 summarizes the results of the
assessment of IADL of the care recipients.
Table 10
Care RecipientscDependency Based on Impairment of
Instrumental Activities of Daily Living (IADLl
IADL (N=101)
n
%
Use Phone
19
18.8
Drive Car
41
40.6
Shop for Groceries
41
40.6
Prepare Meal
40
39.6
HouseWork
44
43.6
Handyman Work
40
39.6
Laundry
34
33.7
Take Medicine
25
24.8
Personal Finance
35
34.7
Fill Out Forms
33
32.7
Note: Totals do not equal 100 percent since there was more
than one response possible.
The
results
indicated
that of the total
101
care
recipients in the study sample,
84 needed assistance with
at
IADL.
least
responded
one
that
type of ADL
their
or
elderly
care
The
remaining
recipients,
17
though
having medical conditions, had no disabilities and did not
depend on others for their daily activities.
55
Among the dependent elderly,
see
Table
IADL.
ADL
half (n=42, 50 percent,
17) needed help with one to three
ADL
and/or
Another half needed help with four or more types of
or
IADL.
Less than a quarter (n=19,
needed
help with four to ten
(n=23,
27.4
needing
percent)
assistance
surprisingly,
the
22.6
ADL/IADL and the
remaining
were almost completely
with
11
or
more
percent)
dependent,
Not
ADL/IADL.
care recipients samples from
the
Home Health Departments belonged to the last group.
two
These
individuals were homebound, extremely frail and dependent.
the
daily
with which the respondents help the most
(n=44,
Table
activity
43.6
10
percent).
frequently
handyman
respondents
shows
that
housework
Transportation
demanded,
work
with
(n=35,
34.7
assistance was almost
chores such
following.
was
About
as
cooking
one-third
as
and
of
the
percent) also required help
in
personal financial management.
Discussion
The
profile
of the care recipients in
again closely resembled
this
study
the national survey which studied
1.2 million frail elderly receiving informal care in
1985
by Stone, Cafferata and Sangl. The average age of the care
recipients were in their mid 70s,
which
with one-fifth over 80,
is now recognized as the fastest growing age
group
in the United States (Dychtwald, 1986).
The number of female care recipients
56
were over
60.4
i'
percent ( n=61) ,
greater
a majority
in the study population.
The
number of these females reinforced the studies of
previous researchers (Stone,
1986).
Cafferata and Sangl,
This trend can be explained by the fact that women tend to
marry
men
older
than themselves and
tend
to
live
an
average of eight years longer than men (Dychtwald, 1986.)
Living Arrangement
The
pattern
of
living
generally
arrangements
preferred by older Americans can be described as "modified
extended family".
This term is used because the older and
younger
generations
separate
households
relationship
(Day,
live
apart
from
while
still
maintaining
1985).
The
one
results
another
of
in
a
close
the
survey
parallel this living pattern.
The
long
elderly usually turn to their spouses first
term
personal
They live
apart
depend heavily on
from
children
but
support.
When the spouses were not available,
they
still
help.
turn to their children,
daughter-in-law,
then
them
In this study,
their
social
they would
usually a daughter,
to other relatives.
they turn to formal care.
for
for
then a
Rarely
would
only 11 percent
of the 101 care recipients were in formal care facilities,
compared to 21 percent of disabled women and 16 percent of
disabled
men
in a national study
1986).
57
(George
and
Gwyther,
.
Social Support
The
social
support data revealed the
nature of family relationship,
strength
and
contact with relatives and
friends, and involvement in community activities. Participation
and
involvement in the available activities
indicative of the individual's social,
mental,
were
spiritual
and physical well-being. The population of care recipients
in this study clearly indicated that they lean heavily
on
family support rather than community support.
Medical Problem
The
major
medical problems of the study
population
followed
the
national trend of medical problems
elderly.
The
most prevalent problem was
including
of
the
cardiovascular,
high blood pressure and heart conditions.
This
was followed by cancer and diabetes. Other common ailments
also
included
arthritis
and
urinary
incontinence
(Ouslander, 1982).
Activities of Daily Living
The
U.S.
Senate Committee on Aging reported in 1985
that 6.6 million,
65
and
group,
older
5.2
community
with
or almost one in four of Americans aged
were in need of long term
million
(79
percent)
Of
living
in
this
the
with disabilities that required help associated
the activities of daily living.
persons lived in nursing homes.
In
were
care.
this
study,
the
58
Another 1.4 million
(Day, 1985)
proportion of care
recipients
needing help with activities of daily living was
higher:
83
national
needs
slightly
percent as compared to the 79 percent in
study.
were
It was not clear whether some
of
traditional or due to disabilities.
the
their
Since
a
large proportion of this population was married and living
with
dependent spouse,
many male
they
needed help with cooking,
respondents
indicated
and the female repondents
indicated that they needed help with handyman's work.
Transportation
was
another common
elderly care recipients,
need
among
the
and concommitantly, the need for
help with shopping. Because there was no convenient public
transit
system,
residing
in
even
the
the physically mobile
San Fernando Valley
had
individuals
rely
to
on
relatives or friends for transportation.
~
As
Relation of Caregivers to Care Recipients
indicated in Table 11,
most of the 101
dents
were
spouses of the care recipients (61
About
one-third of them were the children of the
responpercent).
respon-
dents and about ten percent were relatives such as
grand-
children, siblings or in-laws.
While
the
number
of male spouse
about the same as female,
children
or
There
was
than
sons
percent,
relatives
the female caregivers who
clearly
outnumbered
six times more daughters who
(n=25,
24.7
respectively).
caregivers
were
percent compared
the
was
were
male.
caregivers
with
n=4,
4
And among the relatives who were
59
caregivers, none of them were male.
Table 11
Relation of Caregivers to Care Recipients
Caregivers (N:101)
Female
Male
Relation to
Care Recipient
n
Spouse
n
%
%
32
31.7
30
29.7
Child
4
4.0
25
24.7
Other
0
0
10
9.9
Total
36
65
64.3
35.7
Discussion
The
of
results show that most of the
caregiving
fell on the female
caregivers were wives,
was
about
percent)
female
spouses
was
the same as
in
relatives.
husband
caregivers
were
But
(N=32,
daughters
the primary caregivers
were not present (see Table 11).
This
similar to the findings of other researchers
Cafferata, and Sangl, 1986;
60
Sommers, 1985;
When
the
29.7 percent)
their number (n=30,
this study population .
relatives
responsibilities
when
31.7
and
the
situation
(Stone,
Day, 1985).
It
almost
is interesting to note that husbands constituted
one-third
of the caregivers
population
in
this
study. In the national study by Stone, Caffetara and Sangl
(1986), only 12.8 percent (N=282,000) of the husbands were
caregivers.
givers
used
high number of husbands who
collect the samples population.
patients
contacted
were
oldest
mostly brought in by their
subgroup
greatest
number
care-
recognize
and
waiting
with
a
the
of caregivers and reported spending
the
of
extra
hours
1985).
fulfilling
elderly
caregiving
Therefore, while realizing
and respite services,
that
ambulatory
spouses,
the majority of caregivers were women,
support
method
These husbands were
responsibilities (Day,
for
The
in the hospital lobbies
large proportion being husbands.
that
were
in this study population may be due to the
to
rooms
The
husbands
it
is
caring
in
planning
important
for
to
dependent
spouses are also potential targets.
~
This
Caregiving Commitment
section includes the data showing the frequency
with which the caregivers and care recipients communicated
with each other,
length of time of caregiving and
of hours per day spent in caring.
made
number
Data on the adjustments
in work and leisure activities because of caregiving
responsibilities and the level of physical, financial
emotional
burden
perceived
presented and discussed.
61
by the caregivers
are
and
also
I
Communication with Care Recipients
About three-quarters of the family members indicated
that they were together all day long (n=76, 15.2 percent).
Almost
20
percent
(n=19) saw or talked
recipients at least once a week.
to
their
care
More caregivers made
an
effort to talk with their care recipients than seeing them
each
day.
Table 12 summarizes the data on how often
the
caregivers saw or and talk to their care recipients.
Table 12
Frequencies of Caregivers Seeing and Talking
Care Recipients
Talking
Seeing
Frequency
n
with
n
%
%
76
75.2
76
75.2
4
4.0
10
9.9
15
14.9
9
8.9
1-5 Times/Month
5
5.0
1
1.0
1-5 Times/Year
1
1.0
5
5.0
101
100.0
101
100.0
All Day
1-5 Times/Day
1-5 Times/Week
Total
( N)
Length of Caregiving
Most
givers
of the respondents in this study became
within the last five years
62
(n=63,
care-
71.6 percent).
'
About
18
percent
(n=16) had been taking care
of
their
family members for ten or more years.
Table
13
caregiving.
indicated
presents the responses on the
Out
that
caregiving
of
they
the total
of
101
length
of
respondents,
13
were not certain of the
length
of
care
of
as they·have been married and taking
their spouses "all their lives",
These responses were not
included in the data.
Table 13
Length of Caregiving
Year
%
n
1 or Less
30
34. 1
1-5
33
37.5
6-9
9
10.2
10 or More
16
18.2
Total (N)
88
100.0
Caregiving Hours
The
data
percent) of
day
to
percent
ving,
in Table 14 show
that the
majority
(57
the caregivers devoted six or more hours
per
care for their elderly family
member.
About
also spent five or less hours per day on
The
remaining 13 percent did not live
63
with
30
caregitheir
care
recipients
and
did not care for them
on
a
daily
basis.
Caregiving Adjustment
The
forms
commitment
of caregiving necessitated
of adjustment,
various
the most common being reduction
of
Table 14
Caregiving Hours Per Day
Number of Hours per Day
n
%
Not On Daily Basis
13
12.9
Five or Less
30
29.7
Six or more
58
57.4
101
100.0
Total (N)
leisure time (n=44,
(n=27,
26.7
43.6 percent).
percent)
of
More than one-quarter
caregivers
had
to
rearrange
working schedules in order to accommodate their caregiving
responsibilities. About ten percent of the respondents had
to
reduce working time or quit entirely.
note,
one
On the positive
daughter indicated that caring for her
mother
sometimes increased her leisure time.
As expected,
jobs
or
spouses were more likely to quit their
reduce working time to
64
care for their
loved
ones.
None of the other relatives quit their
jobs
and only one adult child reduced her working schedule for
caregiving,
However,
nearly half (n=13,
44.8 percent of
children; and n=4, 40 percent of other relatives) of these
relatives rearranged their schedules.
each
of
More than half
group of children and relatives (n=17,
children;
and
n=rl,
80 percent of
58.6 percent
other
reduced their leisure time for caregiving.
of
relatives)
The summary of
data on caregiving adjustment can be found in Table 15.
Table 15
Caregiving Adjustment by Relation of Caregivers to
Care Recipients
Relation of Caregivers to Care Recipients
Total Sample
N=lOl
Spouse
N=62
Other Relative
N=lO
Child
N=29
Adjustment
n
%
n
%
n
%
n
%
Quit Job
5
5.0
5
5.0
0
0
0
0
Reduce Work
4
4.0
3
4.8
1
3.4
0
0
27 26.7
10
16.1
13
44.8
4
40
Reduce
Leisure Time 44 43.6
19
30.6
17
58.6
8
80
1
1.0
0
0
Rearrange
Schedule
Increase
Leisure Time
1
1.0
0
0
Note: Totals do not equal 100 percent since there was
0 to 5 response possible.
65
Caregiving Burden
The
caregiving
them
financial
physical,
(52.5
~ere
rated by 101 respondents.
percent)
responsibilities
percent)
and emotional
a
thought
did not consider
physical burden.
burdens of
About half
their
of
caregiving
{47.5
Another half
or
extremely
aspect of caregiving was
relatively
. it
was
moderately
burdensome physically.
The
financial
less of a concern to the majority of the caregivers.
Only
26.7 percent rated this type of burden as moderate and 7.9
percent thought it was an extreme burden.
The
the
emotional burden of caregiving appeared
most
prevalent and serious.
About
to
one-third
be
(32.7
percent) of the respondents thought that caregiving was an
extreme
emotional
strain and almost 29.7
percent
rated
this type of burden as moderate.
Table
16
presents
the data
on
the
respondents'
perception of the physical, financial and emotional burden
of caregiving.
Discussion
The results obtained from the caregiving
of
the
neglect
survey revealed that the family members
their needy elderly.
percent)
Rather,
commitment
did
not
the majority (57.4
spent long hours (six or more hours per day) for
their care.
And,
sacrificed
their
as shown in Table 15, most of them also
personal
66
leisure
time,
rearranged
schedules, reduced working hours or even quit their jobs
entirely because of their caregiving commitment.
Table 16
Caregivers' Perception of Physical, Financial and
" Emotional Burden
Physical
Degree of Burden
n
Emotional
Financial
n
%
n
%
%
No Burden
55
52.5
66
65.3
38
37.6
Moderate Burden
33
32.7
27
26.7
30
29.7
Extreme Burden
15
14.9
8
7.9
33
32.7
101
100.0
101
100.0
101
100.0
Total ( N)
Almost
all the caregivers in this study
maintained
close communication with their care recipients. This might
be
due
to the fact that 76 percent of them
married
each
other
household.
The
majority
assistance
seven
hours
to
a
day on
support
the
days
or lived together
the
in
activities.
more
than
These
(Stone,
same
provided
six
findings
profile on caregivers as
other studies by previous researchers
either
the
caregivers
a week and spent
caregiving
national
of
were
well
as
Cafferata,
Sangl, 1986; Day, 1985; Ory, 1985).
The
degree
of
demands
of
commitment,
caregiving. require
a
tremendous
especially when there are
67
other
competing
demands
such
as a job and
children in the same household.
giving
growing
care-
commitment was reflected by loss of leisure
time,
of daily schedule and reduced working hours
or inability to keep.their jobs.
spouses
had
for
The demands of the
rearrangement
~•orking
care
were
In the study population,
most likely to quit their
jobs
or
reduce
hours. However, almost all the caregiver relatives
to
either
rearrange their schedules
or
lose
some
personal leisure time.
Caregiving,
financial
of
therefore,
could
and emotional burden.
burden,
emotional
burden
become
a
Of the three
seemed
to
physical,
dimensions
affect
caregivers
the most.
caregiving
responsibilities an extreme emotional
This
might
resources
be
as
One third of them considered
due to the demands on
their
their
burden.
energy
well as concern for the well-being
the
of
and
the
care recipients.
Although the physical demands of caregiving affected
slightly
less than half of the
percent),
individuals
for
this
could
be
a
respondents
serious
(n:48,
problem
for
47.6
some
who have to spend long hours every day caring
their needy family members.
The physical demand
and
lack of time to relax can jeopardize their health and lead
to illness.
Financially,
even
though almost all the caregivers
received no remuneration for their caregiving duties, only
68
7.8
percent (n=8) thought that caregiving was an
burden
for
them financially.
relatively
Their
high
This might be due
income status of the
study
had held steady jobs and
senior
members,
still
receiving
adequate
fixed
income
to
the
population.
like most of Kaiser
care recipients,
extreme
Permanente's
probably
and
were
insurance
benefits.
The emotional burden was due to the long hours spent
on caregiving which led to physical and mental exhaustion,
less
time
for
outside
activities
breakdown of social circle.
ing
difficulties
frustration,
were
guilt
caregivers
become
The long hours and accompany-
often compounded by
and
bitterness as the
become increasing dependent.
that
consequently,
and
feelings
ill
relative
Many researchers have
often suffer from emotional turmoil
vulnerable
to
drug
and
of
found
and
abuse
alcohol
(Chenoweth:267).
The
emotional
intervention
services,
needs
programs
that
of the
not
financial assistance,
caregivers
only
provide
call
for
physical
but also emotion support
that can alleviate the stresses of caregiving.
B. Factors Affecting Degrees of Burden
The
following
sections present the results of
crosstabulation analysis showing the relationship
the degrees of physical,
of
caregiving
and,
financial,
between
and emotional burden
1) the degree of dependency of
69
the
care
reci-pients,
senior
2) household structure,
centers,
Health
4)
family support and 5)
services.
statistically
3) participation in
Only
the
the
at
0.05
significant
use
factors
level
of
Home
that
are
were
reported
below.
Dependency of Care Recipients
Table
17
relationship
degrees
presents the summary of data showing
of
of
the
physical,
care
recipient's
financial
and
the
dependency
emotional
and
burdens
perceived by the caregivers.
The
degree of dependency of the care recipients was
reflected
daily
by the needs for assistance with activities
living (ADL) and instrumental activities
of
of
daily
living (IADL). These two indices appeared to have a direct
relationship
with the degree of physical burden perceived
by the caregivers.
Of the total of 84 respondents who had
dependent care recipients,
that
they
felt
17.9 percent (n=l5)
extreme physical
burden
in
indicated
caregiving
activities. All except two (2.4 percent) of this group had
elderly
who
were totally dependent,
needing
assistance
with 11 or more ADL/IADL.
On
the
other
hand,
more
than
one-third
(44.3
percent) of the respondents who assisted individuals
three
or
less
ADL/IADL
indicated
that
they
felt
with
no
physical burden. Only one caregiver of a totally dependent
individual indicated that caregiving was no burden at all.
70
~
Table 17
Care Recipients' Dependency and Physical Burden
of Caregivers
Degree of Dependency
0-3 ADL/IADL
Degree of Burden
4-10 ADL/IADL
11+ ADL/IADL
%
n
%
n
%
32
38.1
5
6.0
1
1.2
Moderate
9
10.7
13
15.4
9
10.7
Extreme
1
1.2
1
1.2
13
15.5
42
50.0
19
22.6
23
27.4
n
PHYSICAL BURDEN
No Burden
Total
~4, N:84) = 53.3' p< .00
FINANCIAL BURDEN
No Burden
33
39.3
9
10.7
8
9.5
Moderate
7
8.3
10
11.9
9
10.7
Extreme
2
2.4
0
0
6
7.1
42
50.0
19
22.6
23
27.4
Total
:\1'( 4'
N:84) = 21.0' p< .00
EMOTIONAL BURDEN
No Burden
21
25.0
2
2.4
1
1.2
Moderate
14
16.7
6
7. 1
8
9.5
7
8.3
11
13.1
14
16.7
42
50.0
19
22.6
23
27.4
Extreme
Total
x.'t 4'
N=84) = 23 •. 8' p< .00
71
.
Similarly,
elderly
were
who
three
individuals
with
needed assistance with 11 or
times
as likely to
impaired
severely
feel
more
ADL/IADL
extreme
financial
burden.
The relationship was just as significant between the
degree of dependency and the degree of perceived emotional
burden. Caregivers of
more
likely
th~
totally dependent were two times
to indicate extreme
emotional
caregivers of the least dependent group.
burden
than
Conversely, only
one from the former group compared with 21 from the latter
group
indicated
that
there was no emotional
burden
in
caregiving.
Household Structure
The
household
significant
of
structure did not appear to
have
effect on the physical and financial
caregiving.
relationship
However,
between
aspects
as shown in Table 18,
household structure
and
a
a direct
emotional
burden is apparent.
The
dependent
than
children
with
elderly alone experience less emotional
a household
percent
for
data indicate that spouses who lived
stress
with both spouse and children. Seventy
of the respondents in households with spouse
indicated that caregiving was an extreme
them. Children who lived with their parents
relatives
the
felt about the same degree of emotional
(42.8 percent and 47.4 percent, respectively).
72
and
burden
or
other
burden
Table 18
Relationship of Household Structure and Emotional Burden of
Caregivers With Dependent Elderly
Household Structure
Caregiver Living with
Spouse
Degree of
Emotional Burden
No
n
Spouse +
Children
Mother
Other
Relatives
%
n
%
n
%
n
%
Burden
18
37.5
1
14.3
3
30
2
10.5
Moderate Burden
17
35.4
3
42.8
0
0
8
42.1
Extreme Burden
13
27.1
3
42.8
7
70
9
47.4
Total
48 100.0
7 100.0
10 100.0
19 100.0
:;((6, N:84) = 12.7, p< .05
Senior Center Participation
Interestingly,
in
senior
physical
center
the care recipients who
activities appeared to be
participated
less
and emotional burden to their caregivers.
of
a
Table
19 shows this relationship. Fifteen (17.9 percent) of nonparticipants (N=67) indicated extreme physical burden.
By
comparison, none of the senior centers participants (N=17)
indicated extreme physical burden.
Only four showed
that
they perceived some moderate degree of physical burden.
73
With regards to emotional burden, 34.5 percent (n:29)
non-participants
while
caregivers
experienced
extreme
burden
only 3.5 percent (n=3) of the caregivers whose care
recipients
participated
in
senior
activities
centers
indicated extreme burden from the caregiving experience.
Table 19
Relationship of Care Recipient's Senior Center Participation
and Degree of Burden
Participants
Degree of Burden
Non-Participants
n
n
%
13
15.5
25
29.8
Moderate Burden
4
4.8
27
32. 1
Extreme Burden
0
0
15
17.9
20.2
67
79.8
%
Physical Burden
No Burden
Total
;tz..( 2
t
17
N=84) = 9. 4 t p< .01
Emotional Burden
No Burden
9
10.7
15
17.9
Moderate Burden
5
6.0
23
27.4
Extreme Burden
3
3.5
29
34.5
17
20.2
67
79.8
Total
Z~2, N=84) = 6.87, p< .03
74
Use of Family Support
Family
caregivers
relieving
support
appeared
to
be
helpful
to
the
emotionally but played no significant role
the
physical
and
financial
burdens
of
in
the
caregivers in this study population.
Caregivers, especially those who found caregiving an
extreme burden, tended to rely on their family members for
emotional
support.
This
situation was reflected by
data summarized in Table 20.
duals
While the number of
the
indivi-
who felt moderate burden was about the same with or
without
family
(N= 83,
n=23, 27.4 percent) were three times more like to
use
family
support,
support
those who felt
than those who
did
extreme
not
burden
(n=8,
9.5
percent).
Table 20
Use of Family Support and Emotional Burden Of Caregivers
Use of Family Support
Yes
No
Degree of Burden
n
%
No Burden
8
9.5
16
19.0
Moderate
13
15.5
15
17.9
Extreme
23
27.4
8
9.5
Total
44
52.4
39
46.4
/t.1(4, N=83) = 11.39-,. p< .02
75
n
%
Use of Home Health Services
Slightly
more
than a quarter of the
families
with
dependent elderly used Home Health services. These elderly
were
of
patients that needed the
daily
sample.
most
most help with
living among the care recipients in
Thus
activities
study
the
they belonged to the group that evoked
physical,
financial
and
emotional
burdens
the
of
caregiving.
As
shown in Table 21,
caregivers who felt
extreme
physical, financial and emotional burdens were more likely
to use the home health services.
Discussion
The
intensity of burden reported by the
caregivers
appeared to relate directly to the degree of dependency of
the
elderly
structure,
care
social
recipients,
involvement
the
family
and the
use
household
of
support
network.
Degree of Dependency
The impaired functional status of the care recipient
strongly
This
affected
phenomenon
the caregiver's perception of
was understandable,
burden.
since the more
im-
paired the individual, the more time, energy and financial
resources will be demanded.
Corollarily,
the increase in
demand also decreases the opportunities for the caregivers
to pursue their own interests, to relax and to socialize.
76
,, .
Table 21
Use of Home Health Services and Degrees of Burden
Non-User
User
Degree of Burden.
n
%
n
2
2.5
32
:!0.5
Moderate
10
12.7
20
25.3
Extreme
10
12.7
5
6.3
Total
22
27.9
57
72.1
6
7.6
40
50.6
10
12.7
15
19.0
6
7.6
2
2.5
22
27.9
57
72. 1
%
PHYSICAL BURDEN
No Burden
::t,z( 4, N:79)
=
22.97, p< .00
FINANCIAL BURDEN
No Burden
Moderate
Extreme
Total
:t"< 4'
N=79) = 17.29, p< .00
EMOTIONAL BURDEN
No Burden
0
0
21
26.6
Moderate
6
7.6
21
26.6
Extreme
16
20.2
15
19.0
Total
22
27.8
57
72.2
.~t?< 4' N=79) = 19.53, p< .00
77
Household Structure
The results of this study confirmed the descriptions
of
many
previous
researchers
"sandwich
the
on
generation'' (Miller, 1981; Ory, 1985; Larsen, 1988).
In
a
multigenerational family
elderly,
the
growing
be
"sandwich"
children,
of
dependent
or "middle" generation and
the
caring for the elderly dependent could
a special strain.
with
consisting
The middle generation have to
cope
the needs of their older relatives while caring
for
their own children.
On
the other hand,
husband
or
wives
respondents
their
found
it
less
stressful.
expressed during the survey,
spouses
respondents
was
a
their
spouses who took care of
daily
routine.
belonged to the older age
many
As
taking care
of
This
of
group
group.
They
were
more likely to be retired and did not have as many demands
in their daily life.
Social Involvement
The
results
participation
percent)
of this study on the care
in
represent
researchers
who
recipient's
senior
centers
(slightly
the
reports
by
studied
the
below
previous
many
socialization
25
of
senior
citizens (Dychtwald, 1986, p.106; Davis, 1973, p.57).
The
reflects
important
social
their
in
involvement
of
the
care
recipients
mental and physical well-being.
caregiving
78
as socialization
This
creates
is
more
stimulation in life.
as
less
a
developed
result which will help the dependent elderly to
demanding
Another
effects
to
Positive attitudes may be
be
and less critical.
explanation of the results of the
positive
of social involvement is that those who are
participate
in
the social groups
are
able
usually
more
independent and emotionally sound.
It will be
of interest to explore the association between
functional
physically
impairment
status and the senior citizen's
participation
in social groups.
Summary
This chapter has reported and discussed the frequency
data
on the demographic characteristics of caregivers and
care recipients;
the relationship between caregivers
the
recipients;
care
caregivers'
caregiving
perception
of the
and
the
financial
and
commitment
physical,
and
emotional burden due to caregiving.
In
addition,
data
showing
statistically
the
significant relationships between physical,
emotional
burden
recipients'
involvement,
of caregiving and the
dependency,
family
household
support
and
degree
structure,
use
of
services were also presented and discussed.
79
financial and
home
of
care
social
health
Chapter 5
HEALTH EDUCATION INTERVENTION
Introduction
The
previous Chapter reported on the lack of use
available
support
and services by the target
who indeed have experienced the emotional,
physical
burdens of caregiving.
and similar
(Chapter
2),
of
caregivers
financial
Based on these
and
findings
studies cited in the review of the literature
a
health education intervention
designed for Kaiser Permanente Medical Center in
has
been
Panorama
City.
The needs assessment study,
together with the scheme
of the intervention will be presented to the KPPC
Center's Senior Planning Committee.
after
will
this
Medical
Decision will be made
presentation about whether
the
intervention
be implemented as one of the Medical Center's health
educational and promotional efforts in the coming year.
The
the
rationale behind the design and
development
of
intervention program and curriculum was described
in
Chapter
3.
This Chapter presents the description of
program
and the curriculum guide used for the
conducted during the intervention.
80
the
workshops
The Caregivers' Health Fair
The
proposed format of the intervention program is a
one-day conference or "Caregivers' Health
ing
of
Fair." consist-
opening and closing sessions
workshops,
and
resource
center.
The
concept
of a "Health Fair''
by
literature reviewed in Chapter 2
firstly,
described
such
the
can
various forms of interventions
as
be
supported,
for
seminars and workshops.
classes,
a
which
caregivers
The
proposed
program also includes four workshops with topics that will
help the participants to be more effective caregivers.
Secondly,
the
"Health Fair" concept is supported by
social learning and the learning theories which
been
reviewed
target
in Chapter 3.
population
middle-aged
have
the
of
One must
this intervention is
or senior caregivers,
limited social involvement.
relaxed
environment
caregivers
The
because:
to
1)
a
has a
that
the
group
of
mostly women,
A
warm,
in the scheduled
one-day
who may
cheerful
of a "Fair" can motivate
participate
intervention
recall
have
the
and
these
activities.
conference
format
the target population and professionals
are
more likely to participate if they need to commit only one
day out of their busy schedules;
of
the
and, 2) the main purpose
the intervention is to expose the target population to
variety
of
information
and
resources
available.
(Further training can be done in follow-up programs.)
The
''Caregivers' Health Fair" will be held in Kaiser
81
Permanente Medical Center, Panorama City from 8:30 a.m. to
3:30 p.m. It will include an opening session and a closing
session, and four workshops to be held concurrently in the
morning
and
Participants
afternoon.
sessions
that
resource
center
best meet their needs.
with displays and
will
There
select
will
representatives
the
be
a
from
agencies involved with elderly care.
The agenda of the intervention is as follows:
AGENDA
8:30 A.M.
REGISTRATION
9:00 A.M.
OPENING SESSION
INTRODUCTION
KEYNOTE ADDRESS
10:00 A.M.
BREAK/RESOURCE CENTER/REFRESHMENTS
10:15 A.M.
CONCURRENT WORKSHOPS
12:00 P.M.
LUNCH
1:00 P.M.
CONCURRENT WORKSHOPS
2:30 P.M.
BREAK/RESOURCE CENTER/REFRESHMENTS
3:00 P.M.
CLOSING SESSION/EVALUATION
3:30 P.M.
ADJOURNMENT/RESOURCE CENTER
LIST OF WORKSHOPS
The following list describes the four workshops
82
that
are
available for participants to make their
These
workshops are held twice,
once in the afternoon.
selections.
once in the morning
and
Participants can attend up to
two
workshops during the conference.
1. UNDERSTANDING THE CAREGIVERS
- Who are they?
What are their responsibilities and
problems?
- What
are
the
positive and negative
aspects
of
caregiving?
How
can the caregivers make decisions
them
help
meet
the
challenges
that
of
will
caregiving
without undue stress?
2. THE AGING PROCESS
- What are the physical, psychological and emotional
changes
of
aging
and how
do
they
affect
the
overall health?
What
can caregivers expect and how can they
ways
to
cope
with anticipated
changes
find
due
to
one improve his/ her quality of life
by
aging?
3. HEALTH PROMOTION FOR OLDER ADULTS
- How
can
leading a positive lifestyle?
- How
can
health
the
caregiver/care
fitness,
manage
recipient
stress,
maintain
obtain
proper
nutrition and establish social relationships?
4. HOME CARE
- What
are the skills caregivers can learn to
83
take
better care of their ailing elders at home?
- How can caregivers better communicate and collaborate with professionals?
- How
can
one
manage
and
medication
prevent
accidental injuries?
Planning for the Intervention
Although
the
Permanente health
promotion
and
community.
charge
intervention
plan
members,
public service,
Health
is intended
for
for
the
it will be
Kaiser
purpose
open
to
of
the
plan members will be admitted free
while others will pay $5.00 for registration.
of
The
personnel of the HMO will also be encouraged to attend the
day's activities.
Facilities
The
enough
conference will be in a centralized
to hold a registration desk,
and refreshment area.
resource
center
In addition,
area
large
an information
desk
it should also hold a
with display booths for area
and
local
agencies.
Sound
the
room
systems can be set up in or near this area for
opening and closing addresses.
enough
to hold about 100-200
facilities are:
There should also
be
people.
of
front lawn with tents set up,
Examples
cafeteria,
large conference rooms, and large lobbies. Since this is a
"fair'', the atmosphere will be festive. Bright decorations
84
such as posters and balloons will adorn the facilities.
A refreshment table will be set up near the
resource
center. Beverages will be served throughout the day. Light
refreshments
Partici-
will be served during break times.
pants will provide their own lunches.
For the four workshops,
conference rooms and
health
education classrooms can be used. The Health Promotion and
Home
Care
movement
larger
workshops
which
involve
demonstrations
of professionals and participants
spaces
with
adequate
lighting,
will
and
require
furniture
and
outlets.
Resource Center
The
Resource Center will be open during the entire
conference. In the Resource Center, materials from various
agencies
area
serving
the elderly in the Greater Los
will be displayed.
agencies
representatives from
the
will be available to explain their services
and
to answers question.
Also,
Angeles
(See Appendix D,
List of
potential
participating agencies at Resource Center)
Speakers and Workshop Leaders
The
Committee
describe
and
give
Chair
will
of the Medical Center's
welcome
the objectives,
the
the
conference
Senior
Planning
participants,
introduce the day's activities,
closing remarks.
A person
who
has
political prominence and social conern for the health
some
and
welfare of the elderly will be invited to give the keynote
85
address during the opening session.
Experts
servicas,
in
the
fields
of
gerontology,
social
health education and geriatrics will be invited
to lead the four workshops.
These leaders may be selected
from the staff of the medical center.
During the planning
stage of the program, the workshop leaders will meet twice
with
the
planning committee prior to
During the first meeting,
the
intervention.
the leaders will receive a full
orientation to the objectives,
of
the
philosophy and limitations
intervention and discuss the curriculum
workshop.
During
the
second meeting,
of
each
the content
and
learning opportunities for the workshops will be
and
reviewed
specific audiovisual materials will be collected
and
pretested.
Volunteers and Staff
Volunteer
areas
of
planning
assistants
for
the workshops
the intervention will be recruited
stage.
Workshop
their workshop assistants.
such as reception,
and
during
leaders will select and
Other volunteers
other
the
brief
in the areas
registration and running the
resource
center will be oriented by the planning committee members.
Existing staff at the medical center will be instructed by
the
program
chairperson regarding the use of
facilities
for assembly, workshops, resource center and refreshments.
Publicity
Posters
and
brochures
86
regarding
the
"Caregivers'
Health
Fair'' will be developed,
printed and sent out
various departments of the medical center and in
to
selected
locations in the community. Members will be notified about
the "Fair" through membership newsletters.
Press releases
will be sent out to newspapers.
"CAREGIVERS' HEALTH FAIR" WORKSHOPS CURRICULUM GUIDE
The
content
of
the
curriculum
is
based
assessed needs and the review of the literature.
on
the
Although
the curriculum guide is designed for the four workshops of
this
proposed
conference,
the
materials
may
also
be
modified and used for a series of health education classes
for
caregivers and/or used as part of other programs
for
the elderly.
The
following
sections,
section
curriculum guide is divided into four
each covering a topic area for a workshop. Each
conists of a
evaluative
topic
criteria,
generalization,
content,
suggested
objectives,
learning
opportunities, and resources for both content material and
suggested activities. Topics for the four workshops are:
Workshop 1. Understanding the Caregivers;
Workshop 2. The Aging Process;
Workshop 3. Health Promotion for Older Adults; and
Workshop 4. Home Care.
The
curriculum guide for the workshops are presented
in the following pages.
87
WORKSHOP #1: UNDERSTANDING THE CAREGIVERS
Generalization:
Caregiving
for the elderly at home can
be
rewarding
but
it can also be a
stressful
experience which calls for support and services.
Objectives:
the
instruction and discussion,
participant will be able to identify the
reasons for his or her stressful experiences
in caring for elders at home. (Comprehension)
1.1: Following
1.2: Following instruction and discussion,
the
participant will identify the seven steps
utilized in the problem solving technique
(Fodor and Dalis, 1981, p.69). (Knowledge)
1.3: Given the information concerning the available
resources,
the participant will be able to
identify relevant supports to help him/her
become a more effective caregiver (Knowledge)
Evaluative Criteria:
1.1: The participant will identify (list) one or
more
reason(s)
for his or her stressful
experiences in caring for the elder at home.
(Knowledge)
1.2: a. The participant will identify the seven
steps
of
problem
solving
technique.
(Knowledge)
b. The participant will participate
in
a
role-play activity using the seven steps
of the
problem
solving
technique.
(Knowledge/Application)
1.3: The participant will identify relavent support
to his/her needs by:
a. signing up with a support group;
b. signing up with health education classes;
c. talking with a counselor;
d. contacting agencies at the resource center.
(Application)
88
CONTENT
LEARNING OPPORTUNITIES
1. Introduction of
workshop
1. Introduce workshop by
presenting a news item, a
case study of an 83 year
old woman caring for her
86 year old sister.
2. Positive aspects
of caregiving
2. Describe the positive aspects
of caregiving
3. Common problems of
the caregivers:
a. psychological
b. emotional
c. physical
d. financial
3. Describe common problems of
the caregivers.
4. Problem solving
technique
a. problem identification
b. analysis and
clarification of
the problem
c. gathering information
d. formulation of
possible solutions
e. anticipating consequences of each
solution
f. appraising the value
of each solution
g. selecting the best
solution
4. Present a problem solving
technique.
Demonstrate problem solving
technique by role play.
5. Available resources
5. Present the overview of
supports
available
for
caregivers.
Distribute lists of resources for caregivers.
(See Appendix E).
6. Resource center
6. Explain
and
encourage
participants to visit the
resource
center
during
break time.
7. Video presentation
7. Present a video cassette
film "Till Tomorrow Comes."
89
8. Open discussion
8. Open discussion
the film.
9. Group discussion
9. Form small groups to discuss
participants' own experiences.
10. Counseling
regarding
10. Have
opportunities for
brief individual counseling
with the workshop leader
while discussions are in
session.
RESOURCES
Publications:
1. Anderson,
M.
(1979). You can en,ioy your aging
parents. Missouri: Concordia Publishing House.
2. Brook, H. (1984, October). Coping as an adult child,
50 Plus, pp.66-67.
3. Callan, M.A. (1985, February 15). Support for those
who care for the elderly at home. Los Angeles Times.
4. Fanning, M.
(1984, Sept./Oct.). Caring for your
aging parents. Today's Christian Woman, pp. 56-59.
5. Finke, N.
(1988, March 30). A tale of two sisters.
Los Angeles Times, Part V. pp. 1,2.
6. Lester, A.D. and Lester, J.L. (1980). Understanding
aging parents. Pennsylvania: Westminster Press.
7. Rosenthal, T.T.
(1980, May/June). What to do with
grandma?
Health
values:
Achieving high level
wellness, IV. 4 (3): 110-116.
8. Schwartz,
A.N.
(1977).
Survival handbook for
children of aging
parents,
Illinois:
Follett
Publishing Co.
9. Silverstone, B. and Human, H.K. (1982). You and your
aging parents. New York: Pantheon Books.
10. Simon, B.
(1983, May). Adult children and
aging parents. Social Work. 'pp.78-85.
90
their
{l
Audiovisuals:
1. "The Wilson Crisis"
University of Maryland School of Medicine
Department of Physical Therapy
32 S. Greene St.
Baltimore, MD 21201
(301) 528-7720
(Video)
2. "Till Tomorrow Comes"
KCET Channel 28
4401 Sunset Blvd.
Los Angeles, CA 90027
(213) 666-6500
(Video) 25 minutes
3. "What Shall We Do About Mother"
Carousel Films, Inc.
241 E. 34th St., No.304
New York, NY 10016
(212) 538-1660
(16mm film or video)
4. "Where Do We Go From Here?"
EDC Customer Service Center
Suite 701
55 Chapel St.
Newton, MA 02160
(800) 225-4276
(16mm film or video)
91
'
WORKSHOP #2: THE AGING PROCESS
Generalization:
the
Understanding
the
process of aging and
differences between biological and pathological
changes will enable the caregiver to accept his/her
role better.
Objectives
2.1: Following instruction and discussion,
the
participants will acquire an awareness of what
constitutes natural aging as contrasted to
pathological aging.
(Knowledge/Awareness)
2.2: Participants will be able to indicate the
common signs of trouble for major problems of
aging. (Knowledge)
Evaluative Criteria:
2.1: The participants will list two physiological
changes due to natural aging and two physical
conditions caused by pathological
aging.
2.2: The participants will identify two common
signs associated with health problems in the
elderly.
CONTENT
LEARNING OPPORTUNITIES
1. Introduction
1. Introduce workshop.
2. Aging
a. Biological
b. Pathological
2. Lecture on natural biological changes associated
with the aging process as
contrasted to pathological
aspects of aging.
3. Symptoms of common
diseases associated
3. Describe the symptoms of
common diseases associated
92
with aging. (See Appendex
with aging:
F)
a.
b.
c.
d.
Arthritis
Lung diseases
Coronary diesease
Dementia/Alzheimer's
diseases
e. Dental diseases
f. Osteoporosis
g. Urinary incontinence
4. Film presentation
4. Introduce and show film or
video on aging.
5. Question and answer
5. Lead a question and answer
period.
6. Resource center
6. Inform
participants
to
visit the resource center
during
break
time.
Explain
the
available
resources in the medical
center and the community.
Encourage participant to
sign up for support group
and/or classes.
RESOURCES
Publications:
1. American Association of Retired Persons,
Truth about aging.
2. Kart,
C.S.
(1985). The realities
Massachusetts: Allyn and Bacon,Inc.
(1984).
of
aging.
3. Pizer, H. (Ed.) (1983). Over fifty-five, healthy and
alive.
New York: Van Nostrand Reinhold Company,
pp.53-148.
4. Aging, can it be slowed? (1988, February 8).
Week. pp.58-64.
Business
5. Witkin, R.K. and Nissen, R.J. (Eds.). (1978). How to
live better after 60. New York: Regency Press,
pp.98-168.
93
Audiovisuals:
1. "General Conditions in Health and Disease
Elderly''
University of Maryland School of Medicine
Office of Medical Education
Room 334 MSTF
10 S. Pine St.
Baltimore, MD 21201
(301) 528-6613
(Video) 25 minutes
in
2. "Behavioral Manifestations in Aging''
Sandoz Pharmaceuticals
Medical Film Library
East Hanover, NJ 07936
( 201) 386-7677
(16 mm film) 16 minutes
3. "Communications and Sensory Changes in the Elderly"
University of Maryland School Medicine
Office of Medical Education
Room 334 MSTF
10 Pine St.
Baltimore, MD 21201
(301)528-6613
(Video) 26 minutes
94
the
WORKSHOP #3:
HEALTH
PROMOTION
FOR
OLDER ADULTS
Generalization:
Positive lifestyle, which includes health fitness,
stress management, nutrition and social relationships,
can~ help preserve health and improve
the
quality of life.
Objectives:
3.1: Following instruction and demonstration on
health fitness,
the participant will be able
to
identify an exercise and
recreation
program that will enable the individual to
enjoy better health. (Knowledge)
3.2: Following lecture and demonstration on stress
management, the participant will be able to:
a, explain
his/her
sources
of
stress.
(Comprehension)
b. apply
the
use of
stress
reduction
techniques. (Application)
3.3: Following lecture and class discussion on
good nutrition for older adults, the participant will be able to:
a. explain the dietary needs of older adults.
(comprehension)
b. identify the reasons why some older people
are not eating nutritious meals.
(Comprehension)
c. identify good sources of nutrition for
daily diet.
(Synthesis)
3.4. Following short lecture and class discussion
on the importance of social involvement on
one's emotional and physical well-being,
the
participant will be able to:
a, identify the problems associated with the
negative effects of isolation. (Analysis)
b. identify the ways that participants can
get involved with people. (Synthesis)
95
Evaluative Criteria
3.1: The participant will identify one exercise
and recreation program that will enable him/her to enjoy better health.
3.2: The
participant will demonstrate his/her
comprehension of stress management by:
a. listing the causes of his/her stress.
b. using
at least one stress
reduction
technique appropriately.
3.3: The participant will:
a. recall the basic food groups and nutrients.
b. suggest at least one way to improve the
eating
environment of the older adults.
c. list the type of nutritious foods suitable
for older adults.
3.4: The participant will:
a. describe at least one of his/her problems
that social involvement can alleviate.
b. recall at least two ways he/she can get
involved.
CONTENT
LEARNING OPPORTUNITIES
1. Introduction of
four areas of health
promotion:
a. Health fitness
b. Stress management
c. Nutrition
c. Social relationship
1. The workshop leader will
briefly introduce
the
health
four
areas of
promotion.
2. Health fitness
a. Exercises for older
adults
2. a. Lecture on health fitness.
b. Introduce four common
exercises for seniors.
c. Demonstrate exercises
with participants.
d. Hand out information
on some guidelines for
exercise and fitness
programs.
(See Appendix G)
3. Stress management
a. Causes of stress
c. Stress management
3. a. Lecture on causes
stress
and ways
reduce stress.
96
of
to
,, .
(See Appendix H)
b. Demonstrate a stress
management technique.
c. Hand out materials on
stress reduction
techniques.
4 • a. Lecture
4. Nutrition
a. Basic nutritional
needs of older
adults
b. Reasons for seniors
not eating nutritiously
c. Ways to improve eating
habits
d. Conclusion
5. Social involvement
a. Negative results
of social isolation
b. Ways to get involved:
Community activities
Support groups
adult classes
Volunteering
6. Resource center
on basic
nutritional needs of
older adults.
reasons
why
b. Explain
some older people are
not eating nutritiously.
and
open
c. Lecture
discussion on how to
improve eating environment and eat more
nutritiously.
d. Conclude discussion,
summarize important
points of the
whole
workshop.
5. Lecture on importance of
social involvement
a. Explain negative results
of social isolation.
b. Explain
ways to be
socially involved.
6. Inform participants about
resource center, and
invite them to sign up
for support groups and/or
health education classes.
RESOURCES
Publications
A. Health Promotion
1. Aging and health promotion: Marketing research for
public education.
(1984).
National Technical
Information Service.
2. Dychtwald,
Ken.
97
(1986).
Wellness
and
health
@
promotion for the elderly.
Aspen.
Rockville,
Maryland:
3. Pizer,
H.
(Ed.). (1983), Over fifty-five healthy
and alive. New York: Van Nostrand Reinhold Company.
4. Strategies
for promoting health for specific
populations. (1986). U.S. Department of Health and
Human Services, Public Health Services, Washington,
D.c.
B. Health Fitness and Recreation
1. Bender, R. (1985). Be young and flexible after 3040-50-60. Connecticut: Ruben Publishing Company.
2. Donaldson,
G. (1977). The walking book. New York:
Holt, Rinehard and Winston.
3. Harris, R. and Frankel, L. (1977) Guide to fitness
after fifty. New York: Plenum Press.
4. Jamieson, R.
(1982).
New York: Madelyn.
Exercises for the elderly,
5. National
Association
for Human
Development.
Exercises for people ~sixty (Series l=il· 1750
Pennsylvania Ave., N.W. Washington, D.C. 20006.
6. Raynor, M.H. AHOY leadership training manual. P.O.
Box 12233, Raleight, N.C. 27605.
7. Smith, E.L. Aging and exercise. Department
Preventive Medicine, Wisconsin, 53706.
8. Vickery,
F.E.
(1972),
Creative programming
older adults. New York: Association Press.
of
for
C. Stress Management
1. Ardell, D. High level wellness.
nia: Rodale Press.
2. Benson, H.
(1976). The
York: Avon Books.
(1977). Pennsylva-
relaxation response. New
3. Rosen,
trated
Hall.
G.
(1977). The relaxation book: An illusselfhelp program. New Jersey: Prentice-
4. Staff.
Stress management for caregivers.
98
Los An-
•
geles Resource Center, Torrance, CA 90503.
D. Nutrition
1. Be sensible about salt. (1984). National Institute
on Aging, Information Office, Maryland, 20205.
2. Cooking for two (1973). Program Aid No. 1043. Food
and Nutrition Service. U.S. Department of Agriculture.
3. Dietary supplements: More is not always better.
(1983).
National Institute on Aging,
Information
Office, Bethesda, MD. 20205.
4. Food:
Staying healthy after 65. (1980). National
Institute on Aging. Information office, MD. 20205.
5. Food
is more than something to
eat.
U.S.
Department of Agriculture Home and Garden Bulletin
No. 216.b.
6. Mayer,
J.
(1976).
Pocket Books.
A diet for living.
New York:
(1980). Food
7. Pennington,
J.A.
and H.N.
Church.
Value of Portions Commonly Used. New York: J.P.
Lippincott Company.
Audiovisuals:
1. "Armchair Fitness" by Betty Switkes
CC-M Productions, Inc.
P.O. Box 15707
Chevy Chase, MD 20815
2. "Fitness for Seniors" by Stephanie Sovine
(Record)
Kimbo Educational
P.O. Box 477
Long Brance, NJ 07740
(202) 291-4949
3. "Help Yourself to Better Health"
(Nutrition in later years)
Roger G. Whitley Film Library
(Color video) 16 minutes
4. "For Tomorrow We Shall Diet"
(Diet and weight control)
Roger G. Whitley Film Library
P.O. Box 2091
99
Raleigh, North Carolina, 27602
(Color video) 24 minutes
5. "Sittercise: by Billy Gober
(Record)
Kimbo Educational
P.O. Box 477
Long Brance, NJ 07740
(202) 291-4949
6. "Staying Active: Wellness after Sixty"
Spectrum Films, Inc.
P.O. Box 801
Carlsbad, California 92008-9965
(Video) 24 minutes
7. "Taking Stress in Stride"
Spectrum Films
P.O. Box 801
Carlsbad, California 92008-9965
(16 mm film, color) 22 minutes
100
WORKSHOP #4: HOMECARE
Generalization:
With minimal training,
the caregivers can
a variety o~·skills and aids to take care of
older family member at home.
learn
their
Objectives:
4.1: After instruction and demonstration from a
nursing point of view on the physical care of
an ailing person in the home, the participant
will be able to apply the principles at home.
(Application)
4.2: Following explanation by the workshop leader,
the participant will recall the most effective
ways to communicate with medical personnel
regarding his/her ailing parents. (Knowledge)
4.3: Given instruction and handouts on medication
management,
the participant will be able to
apply the principles at home. (Application)
4.4: Given facts about accidental injuries being
the leading cause of death and disability
among
the
elderly and ways to
prevent
accidents at home, the participant will:
a. be aware of the need to prevent accidents
at home.
b. apply four (4) ways to prevent accidents
at home: safe proofing the home; maintaining mental and physical health; and cultivating good safety habits. (Application)
Evaluative Criteria:
4.1: The participant will be able to demonstrate
at least one home care technique of his or
her choice.
4.2: When asked during review/discussion time, the
participant will recall accurately at least
one effective way to communicate with medical
personnnel.
101
4.3: When asked during review/discussion time, the
participant will identify at least one area
of unsafe drug use that he/she can improve at
home.
4.4: The participant will:
a. identify the areas in his/her home that
are accident prone.
b. identify at least one way that he/she can
impr_ove the situation.
CONTENT
LEARNING OPPORTUNITIES
1. Introduction
workshop and
1. Introduce
subjects which will be
presented.
2. Home care skills
a. Use of special
equipments
b. Taking vital signs
c. Collecting specimens
d. Transferring patients
e. Making occupied bed
f. Cleaning and dressing
patients
2. Lecture and demonstration
on home care skills with
the help of a volunteer.
Materials needed:
Long table as bed
flannelized rubber sheet
disposable underpads
bedpan and urinal
call bell, thermometer
sphygmomanometer
3. Communication with
medical personnel
3. Lecture on how to
communicate with medical
personnel
4. Medication Management
Accident prevention
4. Distribute handout materials with explanation on
each item: safe use of
medicines,
medical
record, and accident
prevention. (See Appendix
I)
5. Review and discussion
5. Review and open discussion
6. Resource center
6. Inform participants about
the resource center, and
invite them to sign up
for support groups and/or
health education classes.
102
7. Practice of patient
care
7. The
participants
will
practice the skills of
patient care.
RESOURCES
Publications:
1. "Accidents and the elderly". ( 1980). Age Page, Information Office, National Institute on Aging, Bethesda,
Maryland.
2. Galton, L. Don't give~ on aging parent,
York. Crown Publishing, Inc.
(1975). New
3. LIFE health promotion for older adults. (1980). North
Carolina Division of Aging, Raleigh, North Carolina.
4. Ross, E.B. (1984). When illness strikes, ~guide for
patient home care. New Milford, CT.
06776: Autumn
Leave Press.
5. "Safe use of medicine by older people".
(1980). Ase
Pase,
Information Office, National Institute on
Aging, Bethesda, Maryland.
6. Trocchip,
J.
(1981). Home care for the elderly. CBI
Publishing Co. Inc. Boston, MA.
Audiovisuals:
1. "The Geriatric Patient"
University of Washington
Instructional Media Services
Kane Hall, DG 10
Seattle, WN 98195
(206) 543-9909
2. "There is no Place like Home"
Denver Visiting Nurse Service
605 Bannock Street
Denver, CO 80204
(303) 893-6251
(16mm film or video) 25 minutes
103
Summary
This
for
Chapter has described a
proposed
intervention
the caregivers of Kaiser Permanente Medical Center in
Panorama City. Included in the proposal are: 1) a description
of
the
process
of
planning,
implementation
and
evaluation of the intervention which consists of a one-day
conference
with
workshops,
and
opening and closing
2)
a
curriculum
workshops.
104
sessions
guide
for
and
four
the
four
Chapter 6
SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
Introduction
The
assess
of
purposes
of this project were to
identify
and
the needs of the caregivers of two Medical Centers
Kaiser
Fernando
Permanente
Valley;
assessment
health
and,
in
(HMO)
the
to
San
based on the results of the needs
study and review of the literature,
education
caregivers
Medical Group
intervention
perform
their
to
assist
design
family
the
multi-faceted
a
roles
more
effectively and with more positive attitudes. This chapter
will
present
a
summary
of
the
study,
discuss
the
conclusions and make recommendations for further research.
Summary
This project was prompted by the growing
of
the
elderly population's family caregivers
long-term
reduce
recognition
care
providers,
and
by the HMO's
as
major
target
hospital utilization by the ever-increasing
to
frail
elderly members. The background and justification
of this
study
of
were
presented in Chapter 1.
literature
in
Chapter
assessment
study
The
review
2 provided a basis of
and the design of
a
intervention for the target population.
105
health
the
the
needs
education
The methodology and rationale of the needs assessment
and
development
of
the intervention were
presented
Chapter 3. The
first part of the project
involved
identification
of the family caregivers of the
in
the
HMO,
and
and an assessment of their needs. This was accomplished by
a
survey
of 101 caregivers receiving services
from
two
medical centers of the HMO.
The
ment
second part of the project involved the develop-
of an intervention scheme including a description of
the process of the intervention and a curriculum guide for
the four workshops to be conducted during the intervention.
In
were
Chapter
reported
majority
of
married,
high
4,
the needs assessment survey
and discussed.
the family
The data showed
caregivers
were
school or college trained,
results
that
women,
the
white,
middle income,
retired, and had an average age of 62.4 years. Most of the
caregivers
nearly
all
were
spouses
of their
of the other caregivers
care
were
recipients
female
and
family
members of the care recipients.
More
than
half of the caregivers spent six or
hours per day on the care of their
elderly
members.
caregiving responsibilities caused the caregivers to
jobs,
reduce
working
hours,
rearrange
schedules
more
The
quit
and
reduced leisure time.
Many
physical,
family caregivers
financial
and
106
indicated various degrees of
emotional burden due
to
their
caregiving experiences.
the
greatest
effect
Emotional stress appeared to have
on the
caregivers.
However,
only
approximately half of the caregivers received support from
other family members,
while less than one-quarter
sought
assistance from community resources.
In
intervention
was
the scheme for the
health
education
and curriculum guide for the four
workshops
Chapter 5,
This proposed intervention is a
described.
conference
includes
called
an
morning
"The
opening
and
session
afternoon
Fair."
Caregivers'
with
a
Its
keynote
workshop sessions and
one-day
agenda
speaker;
a
closing
session. In addition, there is a resource center with area
and local agencies providing information about
available
process
throughout the day.
of
the
caregiving
This Chapter discussed the
intervention
including
planning,
implementation and evaluation of the event.
The
Curriculum Guide in the second part of Chapter 5
included
topics
four
of
Caregivers,
Older
workshops.
The
the four workshops were: 1) Understanding
The
four
2) The Aging Process,
Adults,
generalization,
learning
topic areas for the
and 4) Home Care.
3) Health Promotionfor
Each topic areas has
a
objectives, evaluative criteria, content,
opportunities
and
resources
for
curriculum
content and learning activities.
Conclusions
Based
on
the- results reported
107
in
Chapter
4,
the
following conclusions could be drawn:
1. Similar to other previous studies, the majority of
the respondents were women. Their ages varied from
young adult to octogenarians, with the average age
being in the mid-sixties.
2. Contrary to popular belief, the caregivers did not
neglect
The
their
majority
dependent elderly family
of the respondents
members.
indicated
they
spent more than six hours per day caring for their
elders.
3. The caregiving role has caused the respondents
give
up
much of their personal life to care
to
for
their relatives.
4. The
respondents
physical,
the
experienced varying
financial
degrees
of
and emotional burdens due to
caregiving role.
Emotional stress seemed
affect the caregivers more severely than
to
physical
or financial demands.
5. Many
factors
experienced
affected
by
the
and
social
recipients
had
a
caregiver.
degrees
caregivers.
dependency
physical,
the
financial
Household
The
involvement of
direct
burden
of
relationship
level
the
care
to
the
and emotional burden of
structure
also
of
had
the
a
significant relationship with the emotional burden
of caregiving.
6. About
half
of the respondents did not
108
seek
any
form
of support or services.
The other half
receive support from other members in the
did
family.
Beyond this few would seek help from the available
resources.
7. Interventions
are
needed.
bolster
targeted for the caregivers clearly
efforts are needed
In addition,
the social networks
of
caregivers.
to
The
alternative may well be serious family conflict or
estrangement.
8. A well-publicized,
tion
and
ties
large scale, one-day interven-
can help link the caregivers with
medical center resources,
to
care,
provide opportuni-
acquire information and skills
and
just
themselves
as
community
importantly,
in
learn
and ways to improve their own
home
about
quality
of life.
Recommendations
The
Investigator recommends that the proposed inter-
vention scheme be accepted and implemented.
the
following
suggestions
are
made
In
addition,
regarding
the
intervention:
1. The
Medical
intervention
participating
attending
Center
should
use
the
proposed
as a staff training opportunity.
in
the
the workshops,
day's
events
.the staff
By
including
health
care
providers will become more knowledgeable, skillful
109
and sensitive towards the elderly, and thus better
meet
the
needs
families.
of elderly
patients
and
their
Six contact hours of CME and CEU credit
should be made available for their participation.
2. Based
on
the
responses
appropriate services,
should
be
that
elderly
the
participants,
classes and support
groups
made available as a follow up
conference.
showed
of
For
example,
the
the
assessment
most caregivers were women and
husbands
caregiving.
were
also
Therefore,
more,
the
respondents
most
affected
by
Thus
involved
with
individuals.
Further-
indicated that they
the
new
many
the classes and support
groups should target these
caregiving.
needs
to
emotional
or
existing
were
aspect
of
classes
or
services that will help alleviate emotional stress
should
be
developed
and
offered
to
these
individuals.
3. Follow-up communication should be made with participating
agencies about the community's responses
to the use of available resources.
Regarding
caregivers
further
of
research involving
elderly
in
general,
the
informal
following
the
recommendations are made:
1.
The
HMO should explore the function of
caregivers as cost-effective agents.
110
informal
For example,
the costs of more efforts in helping and
caregivers
home,
to
care for the elderly
should
training
patients
at
be compared to the Medical Center's
hospital costs.
2. Research
for
should be conducted concerning the
need
intra-agency (within an HMO) and inter-agency
(within the community) collaboration of activities
and
services for the
projects
caregivers.
For
examples,
such as newsletter for caregivers in the
community, a respite care co-op, and classes could
be
undertaken by several departments
Kaiser
Permanente
Medical
Group
within
or
the
area
by
agencies.
3. In
depth
needs
studies
of
informal
populations.
ethnic
needs
groups
which
should be made to
For
caregivers
example,
could have
might
intervention.
111
assess
of
the
special
caregivers of certain
their
call for a
own
special
particular
kind
of
REFERENCES
Bandura,
A.
(1978).
The self system in reciprocal
determinism. American Psychologist, 33, 344-358.
Bloom,
B.S.
(ED.).
(1956).
Taxonomy
objectives. New York: David McKay Co.
of
education
Bloom, B.S., Hast~ngs,
J.T., and Madus, G.F.
(1971).
Handbook on formative and summative evaluation of
student learning. New .York: McGRaw Hill Bood Company.
Brody, E.M. (1981). Women in the middle and family help to
older people. The Gerontologist, 25, 19-29.
California State Department of Education.
(1978). Health
Instruction Framework for California Public Schools.
Sacramento, California, p.71.
Callan, M.A.
(1985,
February 15). Support for those who
care for the elderly at home. Los Angeles Times,
Part V, pp.1, 16, 17.
Cantor, M.H.
(1983). Strain among caregivers: a study of
experience in the United States. The Gerontologist,
ll(6), 597-604.
Comptroller General.
(1977). Home health: the need for a
national policy to better p;o;ide for the--;Id~y~
United States Government Printing Office, Washington,
D.C.
Davis, R.H.
(Ed.) (1973). Aging: prospects and Issues.
Ethel Percy Andrus Gerontology Center. University of
Southern California, Los Angeles.
Day, A.
(1985, September). Who cares? Demographic trends
challenge family care for the elderly. Population
trends and public policy. The Population Reference
Bureau. Washington, D.C.
Deci, E.L. (1971). Effects of externally mediated rewards
on intrinsic motivation. Journal of personality and
social psychology, ~~ 105-115.
Dychtwald, K.
(1986). Wellness and health promotion for
the elderly. Aspen Publications.
Elderly
health
~·
(1986)., Southern
California
Permanente Medical Group. Regional Coordinator Report.
112
Finke,
N.
(1988, March 30). A tale of two sisters. Los
Angeles Times. Part V, pp. 1, 2.
Fodor,
J.T. and Dalis, G.T. (1981). Health instruction;
theory and application.
3rd. ed. Philadelphia: Lea and
Febiger.
George,
L.K. and Gwyther, L.P. (1986). Caregiver wellbeing:
a
multidimensional examination of
family
caregivers of demented adults.
The Gerontologist,
26(23), 253-259.
Green,
L.W., Kreuter. M.W., Deeds, S.G. and Partridge,
K.B.
(1980).
Health education planning: ~ diagonostic
approach. Palo Alto: Mayfield Publishing Company.
Gwyther,
L.P.
and George,
L.K.
(1986). Symposium:
Caregivers for dementia patients: complex determinants
of well-being and burden. The Gerontologist,
26(3),
245-247.
Harris, D.K. and Cole, W.E. (1980). Sociology of Aging.
Boston: Houghton Mifflin Company.
Hudis, I.E. (1977, November 20). A support program for
family
of
the aging;
a service
strategy
strengthening natural supports. Paper presented at
30th Annual meeting of the Gerontological Society.
Francisco, Ca.
the
for
the
San
Jewish Homes for the Aging of Greater Los Angeles.
(1985,
October 13). Changing years, changing gears-- your
aging parents and your tomorrow.
5th Annual Seminar.
Los Angeles.
Johnson, C.L.
(1983). Dyadic family relations and social
support. The Gerontologist, ~ 377-383.
Johnson, C.L. and Catalano, D.J. (1983). A longitudinal
study of family supports to impaired elderly. The
Gerontologist, ~(6), 612-618.
Kaiser
Permanente East San
Education Programs. (1988).
Fernando
Valley
Health
Kane, R.A.
(1985,
Fall). A family caregiving policy-should we have one? Generations, 33-36.
Kane,
R.L.
and Kane, R.A.
(1980), Alternatives to
institutional
care
of the elderly:
beyond
the
dichotomy. The Gerontologist, ~~ 249-259.
Kaye, L. W. (1985, July-August). Home care for the aged: a
113
fragile partnership. Social Work, 312-317.
Larsen,
D. (1988, April, 17). Caring for our parents. Los
Angeles Times, Part V, pp.1, 6, 7.
Laubach,
C.L.
(1981). Consumer perceptions as~ guide to
home health planning. Unpublished master 1 s thesis,
California State University, Northridge.
Levey,
S.Z.
(1983). Support groups for caregivers of
chronically ill .persons. Unpublished master's thesis,
California State University, Northridge.
Litwak,
E. (1980). Research patterns in the health of the
elderly.
In E.
Borgatta and N.
McClusky (Eds.) ,Aging
and society. Beverly Hills: Sage Publications.
Masnick,
G.S.
(1980).
The nation's families: 1960-1990.
Boston: Auburn House.
McNeil,
J.D.
(1985).
introduction.
3rd.ed.
Company, p. 6.
Curriculum:
~
comprehensive
Massachusetts: Little, Brown and
Member health education core program.
California Permanente Medical Group.
(1987).
Southern
Miller, D.A.
(1981, September). The sandwich generation:
adult children of the aging. Social Work, 419-423.
Murray,
F.E.
(1986). Elderly Task Force report. Regional
elderly health care symposium. Southern California
Permanente Medical Group.
Nie, N.H., Hull, C.H., Jenkins, J.G., Steinbrenner, K. and
Bent, D.H.
(1975). Statistical package for the social
sciences. 2nd. ed. McGraw-Hill.
Ory, M.
(1985,
Fall). The burden of care,
perspective. The Generation. 14-18.
Ouslander, J.G. and Beck, J.C.
problems of the elderly.
Health, ~' 55-83.
a familial
(1982). Defining the health
Annual Review of Public
Parent care. (1987, March/April). The University of Kansas
Gerontology Center. ~' 3.
Popham,
J.
(1975). Educational
Cliff: Prentice-Hall.
evaluation.
Englewood
Ross,
H.S. and Mico, P.R. (1980). Theory and practice in
health education. Palo Alto:
Mayfield
Publishing
114
Company, pp. 7, 40.
Senior members needs assessment.
{1987). Member Health
Education Department, Kaiser Permanente Medical Center
in Panorama City, California. Unpublished report.
Shanas, E. (1979a). The family as a social support system
in old age. The Gerontologist, ~ 169-175.
Shanas, E. (1979b). Social myth as hypothesis: the case of
the family relations of old people.
The Gerontologist,
~~ 3-9.
Silverstone, B. and Hyman, H.K. (1976). You and your aging
parents. New York: Pantheon Books.
Simmons, K.H., Ivry, J., and Seltzer, M.M. (1985). Agencyfamily collaboration. The Gerontologist, £[(4),
343346.
Snyder, B. and Keffe, K. (1985). The unmet needs of family
caregivers for frail and disabled adults. Social Work
in Health Care, 1Q(3), 1-14.
Soldo, B.J. and Myllyluoma, J. {1983). Caregivers who live
with dependent elderly.
The Gerontologist, ~(6), 605611.
Sommers,
T.
(1985,
Fall).
Generations, 9-13.
Caregiving, a woman's issue.
Stoller,
E.P.
(1983,
November).
Parental caregiving by
adult children.
Journal of Marriage and the Family,
851-858.
Stone,
R.,
Cafferata,
G.L.
and Sangl, J.
(1986).
Caregivers of the frail elderly: ~ national profile.
United States Department of Health and Human Services.
Public Health Service.
Sussman, M.B. (1985). Relationships of adult children with
their parents in the United States. In E. Shanas and G.
Streib
(Eds. },
Social
structure
and
family:
generational
relations.
Eaglewood
Cliffs,
N.J.:
Prentice Hall, 62-69.
Tuzil,
T. (1978, May). The agency role in helping middleaged children and their parents. Social Casework,
59,
302-305.
Williams,
M.E.
(1986).
Geriatric assessment. Annuals of
115
Internal Medicine, 104(5), 720-721.
Wood,
J.
(1987, August/September). Labor of love. Modern
Maturity, 28-34; 91-94.
Zarit, S. H.
(1985, Fall). New directions. Generations, 6-
8•
Zarit, S.H., Reever, K.E., and Bach-Peter,
(1980). J.
Relatives of the impaired elderly:
correlates of
feelings of burden. The Gerontologist, 20 (6), 649-655.
Zimbardo, P.
G., Ebbesen, E.B. and Maslach, C. (1977).
Influencing attitudes and changing behavior.
2nd ed.,
Massachusetts: Addison-Wesley Publishing Company, 56.
116
APPENDIX A
THE REVIEW PANEL
117
THE REVIEW PANEL
The
Committee
Review
Panel consisted of the
Senior
(formerly The Elder Care Task Force) of
Permanente
Medical Center in Panorama
City
University
professors
State
of
California
Planning
Kaiser
(KPPC)t
University,
Northridge (CSUN).
1. Members of the Senior Planning Committee of KPPC
Hospital Administration: J. Smith
Medical Staff: Dr. V. Ambrosini
Business Office: C. Casas
Social Services: F. Crittenden-Kelman
Home Health: J. Banks
Member Health Education: M.L. Schwartz
Skilled Nursing Facilities: V. Levin
Pharmacy: J. Nishida
Community at Large: D. Rothfarb
2. Professors at CSUN
Health Education: Dr. M. Kline
Dr. S. Giarratano
Epidemiology: Dr. R. Madison
Computer Science: Dr. J. Flemming
118
and
APPENDIX B
THE NEEDS ASSESSMENT QUESTIONNAIRE
"THE CAREGIVERS' SURVEY"
119
KAISER PERMANENTE MEDICAL CENTER
SURVEY OF FAMILY CAREGIVERS
This survey is being conducted to gather information about
Kaiser Permanente members who take care of their own family
members who are 65 years and older.
Please fill out a separate
survey for each individual you care for.
All of your answers are
confidential. Thank you for your help.
EAHI.QH& Information about~
1•
Sex
Oa. Male
JHE
CAREGIVER.
2. Date of Birth
Ob. Female
3. Marital status
Qa. Married
Qb. Never married
Qc. Separated
Qd. Divorced
oe. Widowed
Other
or.
4. Ethnic background
oa. American Indian
Qb. Asian/Pacific Islander
Qc. Black
Od. Hispanic
oe. White
OF. Other
<Specify>
5. Highest grade completed <Please circle one number>
Grade 1 2 3 4 5 6 7 8 9 1 0 11 1 2 1 3 1 4 1 5 1 6 17+
6. Current employment
Qa. Full-time
Qb. Part-time
Oc. Retired
Qd. Not employed
Qe. Other
<Specify)
7. Total family income for the past year
da. Less than $10,000
Qd. $30,000- $39,999
Qb. $10,000- $19,999
oe. $40,000- $49,999
Qc. $20,000- $29,999
Qf. More than $50,000
8. Family member<s> currently residing with you
Qa. Spouse
Ob. Mother
Qc. Father
Qd. Child(ren) Age<s>______
Oe. Other___________________
<Specify>
9. Your present health status
Qa. Excellent
Qb. Good
Oc. Fair
Qd. Poor
10. Are you a member of Kaiser Permanente Medical Group?
Oa. Yes
Qb. No
120
EAHI
~
Inronnation about JHE FAMILY MEMBER you are takinK
care or.
11, His/her age:
years old
12, His/her relationship to you
Od. Brother
De. Sister
Cif. Other_ _ _ _ _ _ __
<Specify>
Oa. Spouse
Qb. Father
De. Mother
13. His/her present marital status
Qa. Married
Ob. Never married
De. Separated
Od. Divorced
De. Widowed
Of. Other
14. Does he/she live with you?
a. Yes
b. No
If ''Yes", please go to item No .15. If .. No", please continue:
A. How far does he/she live from you?
Qa. Less than 1 mile
Od. 21- 50 miles
Db. 1- 5 miles
De. 50- 1 00 miles
Of. Other_ _ _ _ _ _ _ _ __
De. 6- 20 miles
<Specify)
B. Does he/she live alone?
Da. Yes
Db. No
C. What type of housing does he/she live in?
Da. Own house/condo
Od. Nursing home
Qe, Convalescent home
Db. Apartment
Qc. Retirement housing
Of. Other
<Specify>
D. On the
Da.
Db.
De.
average, how often do you see him/her?
1-5 times per day
Od. 1-5 times per year
De. Other_ _ _ _ _ _ _ _ __
1-5 times per week
1-5 times per month
<Specify>
E. On the average,
how often do you talk to him/her on the
telephone?
Da. 1-5 times per day
Od. 1-5 times per year
Db. 1-5 times per week
oe. Other
<Specify>
De. 1-5 times per month
15. Which of these social activities does he/she participate in?
<Please check all that apply>
Da. Senior citizen center group
Db. Profess1onal organization
De. Social or recreational group
Od. Religious group
De. Volunteer
DVolunteer at Kaiser Permanents
Of. Other
<Specify>
121
1 6.
Which of the following health conditions does he/she have?
(Please check all that apply)
Qe. Broken or fractured hip
Qa. Heart disease
Ob. Stroke
Of. Diabetes
Qg. High blood pressure
De. Cancer
Oh. Other_ _ _ _ _ _ _ __
Od •. Incontinent
<Specify>
17. With which of the following activities of daily living does
he/she need help from another person or special device?
<Please check all" that apply>
Qa. Walking
Of. Getting in and
Ob. Bathing
out of bed
Og. Using a toilet
Qc. Personal grooming
Od. Dressing
Oh. Other
<Specify>
De. Eating
which of the following instrumental activities of daily
living does he/she need help from others? <Please check all
that apply>
Qg. Do laundry
oa. Use of telephone
Ob. Drive a car
Oh. Take medicine
De. Shop for groceries
OL Budget and pay bills
Od. Prepare meals
OJ. Submit Medicare and
Insurance forms
Oe. Do house work
Of. Do handyman work
l.Jk. Other
<Specify>
18. With
EARI THREE Information
about
the
demands you face
aa
a
caregiver.
19. On the average,
how many hours per day do you provide care for
this family member?
0 a. Less than 1 hr.
Od. 6-10 hrs.
De. More than 10 hrs.
Ob •. 1-2 hrs.
De. 3-5 hrs.
Df. Not on a daily basis
20. How long have you been caring for this family member?
[Ja. Less than 1 yr
Ob. 1-5 yrs.
0 c. 6-1 0 yrs •
Od. More than 10 yrs.
21. Do you receive financial remuneration for caring for this
family member?
Oa. Yes
Ob. No
22. Have your caregiving responsibilities caused you to do any of
the following? <Please check all that apply)
Oa. Quit a job
Db. Reduce working hours
De. Rearrange working echedule
Od. Reduce leisure activities
De. Increase leisure activities
122
23. Please use the scale of 1-5 to rate the degree of burden in
caring
for your family member with regards to your physical,
financial and emotional ~tatus.
1= No burden at all, 2= Somewhat of a burden, 3=Moderate burden
4= Substantial burden, and 5= Extreme burden
<·No
Burden) 1
2
3
4
5<Extreme Burden)
Physical
Financial
Emotional
24. Do
you use the following support or services to help you
in
your role as a caregiver? <Please check all that apply)
.YJll!
JiQ
Don't ~ Q£ Service
Support of Family Members
Caregivers Support Group
Adult Day Care
Senior Center
Home Health Care
Homemaker/Personal Care Help
Telephone Assistance
Counseling
Health Education Programs
Hospice
Congregate Meals
Home Delivered Meals
Transportation
Case Management
Church/Synagogue
25. Would you be interested in supporting a Senior Service Center
at Kaiser Permanents Medical Center?
a. Yes
b. No
Please indicate what type of services/activities you would
like to have available at this Center :
Would you like to be a volunteer at this Center?
Qa. Yes
Qb. No
26. Please give us your comments and suggestions regarding caregiving.
THANK YOUI
123
APPENDIX C
CONFERENCE EVALUATION
124
@
KAISER PERMANENTE MEDICAL CENTER, PANORAMA CITY
CAREGIVERS HEALTH FAIR
EVALUATION FORM
Please complete the following questionnaire and LEAVE
THIS FORM AT THE REGISTRATION DESK AT THE CONCLUSION OF
THE CONFERENCE.
Your comments will be very helpful in
planning future programs. Thank you.
1. Today's presentations were:
enjoyable
okay
not enjoyable
2. The subjects and content were:
of importance and interest to me
not of importance and interest to me
3. The information presented and discussed was:
useful and new
useful, already know
not useful
4. How helpful were the following to you?
VERY
HELPFUL
SOMEWHAT
HELPFUL
NOT
HELPFUL
Opening Session
The Caregivers
The Aging Process
Health Promotion
Homecare
Closing Session
Handouts
Resource Center
5. Any additional comments you would like to make about
the conference? ______________~-----------------------------
6. If you are interested in helping develop support groups
and other programs for caregivers in your area,
please
complete the following:
NAME ________________________________________________
ADDRESS _____________________________________________
CITY
TELE~P~HO_N_E~-----------------------------------------
125
•
APPENDIX D
LIST OF POTENTIAL PARTICIPATING AGENCIES
AT RESOURCE CENTER
126
LIST OF PARTICIPATING AGENCIES AT RESOURCE CENTER
The
following agencies will be invited to
participate
at the conference with displays and/or literature for
the
intervention:
AMERICAN ASSOCIATION OF RETIRED PERSONS (AARP)
3200 East Carson Street, Suite 900
Lakewood, 90712
(213) 496-2277
General information and referral, community service,
social interaction,
tax preparation, discounts on
insurance and travel. Membership.
ANDRUS OLDER ADULT CENTER
University of Southern California
1002 Child's Way
University Park- MC1591
Los Angeles, 90089-1591
(213) 743-3493
Information and referral, counseling for older adults
and their families,
occasional workshops,
support
groups. Sliding fee scale.
JEWISH FAMILY SERVICE OF LOS ANGELES
The Valley Storefront Multipurpose Center for Seniors
Information and referral, counseling services, support
groups,
adult day health care,
linkages program,
protective services, nutrition programs, classes, legal
services, etc.
LOS ANGELES RESOURCE CENTER
21231 Hawthorne Boulevard, Suite 310
Torrance, 90503
(213) 543-4808
For adults with brain impairments and their caregivers.
Provides information and referral, also counsels and
pays for limited services to caregivers not eligible
for public assistance. Offers respite care along with
legal consultation.
SAN FERNANDO VALLEY INTERFAITH COUNCIL (L.A. AAA)
6850 Van Nuys Boulevard, Suite 110
Van Nuys, 91405
(818) 781-3300
10 nutrition sites; home-delivered meals in East
Mid Valley and part of Eastside.
127
and
SENIOR CITIZENS AFFAIRS, AREA AGENCY ON AGING. L.A.COUNTY
1102 Crenshaw Boulevard
Los Angeles, 90019-3198
(213) 857-6466
Information
and referral for all senior citizens
services provided in Los Angeles County, Gerontology
Library.
SENIOR HEALTH AND PEER COUNSELING CENTER
2125 Arizona Avenue
Santa Monica, 90404
(213) 829-4715
Peer counseling, health screening,
health educational
workshops,
special programs for older women and the
chronically mentally ill.
SENIOR MULTIPURPOSE CENTERS IN THE SAN FERNANDO VALLEY
These centers offer many programs at one site to
eliminate unnecessary travel.
Every center offers
information and referral,
in-home services for the
homebound,
nutrition, transportation, escort services,
case management,
advocacy, and consumer services. Most
centers provide housing,
crime
security,
health
services,
community services, legal services, and
employment assistance.
WACHS MULTIPURPOSE SENIOR CENTER
5000 Colfax Avenue
North Hollywood, 91601
(818) 766-5165
PACOIMA MULTIPURPOSE SENIOR CENTER
12550 Van Nuys Boulevard
Pacoima, 91331
(818) 899-9548
ROBERT M. WILKINSON SENIOR MULTIPURPOSE CENTER
8956 Vanalden Avenue
Northridge, 91324
(818) 701-0141
BERNARDI MULTIPURPOSE SENIOR CENTER
6514 Sylmar Avenue
Van Nuys, 91401
(818) 781-1101
VBS RESEDA MULTIPURPOSE SENIOR CENTER
18255 Victory Boulevard
Reseda, 91335
(818) 705-2345
128
UCLA/USC LONG TERM CARE GERONTOLOGY CENTER
10833 Le Conte Avenue, A-671 Factor Building
Los Angeles, 90024
(213) 825-9897
Physical examination, evaluation, follow-up.
129
APPENDIX E
RESOURCES FOR CAREGIVERS
Source: Caring for Older Adults: Meeting the Challenge.
(1988). County of Los Angeles.
Used by permission.
130
RESOURCES FOR CAREGIVERS
Community Resources
Many types of services are available to assist dependent older adults
and their families. A recent article in the Los Angeles Times talks about the
idea of a "Nursing Home Without Walls," in which a combination of services,
such as health care, housekeeping, and meal deliveries can help older
people remain at home longer. Often, caregivers are not even aware of the
many kinds of services in their communities. It helps to be familiar with
community resources so that you can locate them if the need arises. Such
resources can greatly reduce the pressure on the caregiver by helping to
relieve some of the caregiving responsibilities. Public or private agencies,
such as family or home health services may offer an entire range of services
to families.
Some types of help may be covered by insurance or Medicare. The cost
of the service is often determined on a sliding scale, based on the income of
the person needing the service. When you call an agency, ask about their fee
structure - each agency has its own - and make arrangements for
payment when you order the service.
Here are some examples of the types of service which may be of help to
you.
Information and Referral
Information and referral services can give you
information on exactly what services are available in the
community, and which ones you or your care-receiver are
eligible to use. Foreign-language information and referral
numbers are also available.
Case Management
Often, when an agency agrees to provide services, a
case manager is assigned to the family to make an
assessment, develop a care plan, and help the family to
locate the needed services. The case manager also
provides counseling to family members, and generally tries
to make sure that once the services are being provided,
everything runs smoothly.
131
Home Health Aides
Home health aides are specially trained in personal care, and work under the
supervision of a nurse, providing assistance with bathing and other needs. Home
health services may be sponsored by public or private agencies, which usually
charge on a sliding scale. Such services can be covered by insurance or Medicare if
they are deemed medically necessary and ordered by a physician.
In-Home Supportive Services' at the Department of Public Social Services
The County Department of Public Social Services (DPSS) offers financial
assistance for qualifying low-income individuals requiring in-home assistance.
Homemakers
Homemakers assist primarily with day-to-day household chores, such as light
cleaning, laundry, shopping, or food preparation. Sometimes, one person will perform
a combination of home health aide and homemaker's duties. When you hire a home
health aide or homemaker, it is important thatJou interview and select your aide
carefully. Find out about her experience an ask for references. Discuss the
care-receiver's condition and the services that will be needed. See that the
homemaker and the care-receiver will be comfortable with one another.
Companions
Companions are non-medical personnel who stay with someone who can't be
left alone, something like a "grandparent-sitter". They may work for short periods
when you need to go out, or on a full-time basis.
Chore Services
These services provide people to do handyman duties, such as home-repair and
maintenance, and installation of safety equipment and wheelchair ramps. Service may
be provided by an agency or a private individual.
Friendly Visitor and Telephone Reassurance Volunteers
Friendly visitors are often students or retirees who stop in on a regular basis to
visit and spend time with homebound elders. Telephone reassurance can be a lifeline
for older people who must be left at home alone during the day. A daily phone call by a
regular caller at a prearranged time can assure that all is well.
Visiting Nurse Services
Visiting nurses provide regular nursing supervision in the
'home for persons with chronic illnesses or those who are
recovering from an acute illness. Visiting schedules vary
according to the needs of the patient - they may come every
day or every week. Such services may be provided by hospitals,
home health agencies, or private practitioners. Services may be
ordered by a doctor and covered by Medicare or insurance.
132
Horne Delivered Meals
Home-delivered meals programs, such as "Meals-on-Wheels" deliver a ho~
well-balanced lunch, and sometimes a cold evening meal directly to the home, usually
at a reduced cost
Congregate Meal Sites
There are many meals programs throughout the county at sites such as
churches, schools, and senior centers. Low-cost, nourishing meals are served five
days a week in a sociable atmosphere. This service is available to all seniors.
Senior Multipurpose Centers
Senior centers may offer a broad range of activities and services. They often
provide information and referral services, as well as other services such as
assessment, counseling, health screening, meals programs, social activities, homemakers and respite care.
Transportation and Escort Services
Some older people may be unable to use public transportation. Transportation
services, often sponsored by religious groups, or organizations such as the American
Red Cross or "Dial-A-Ride", make transportation available in private cars or vans for
elders who need to get out to medical appointments or for other reasons. Wheelchairs
can often be accommodated.
Counseling
Counseling can be a great help, both to older adults and to caregivers.
Counseling can help make situations such as bereavement or loss, depression,
working out family relationships, adjusting to life changes, or alcohol or drug problems
easier to cope with. Counseling services are generally provided by family service
agencies, community mental health centers, senior centers, or private practitioners.
Support Groups
Support groups are informal groups of people who are in a similar situation and
who can understand what you are going through. Like counseling, support groups
can be very helpful for both older adults and caregivers. Support groups have been
established for widows and widowers, for stroke and cancer patients, for families of·
victims of Alzheimer's disease, and for caregivers, to share common problems and
discuss coping strategies. Sometimes you may need to try more than one group in
order to find the one in which you feel most comfortable. Support groups are
sponsored by hospitals, adult day care centers or senior centers, family service
agencies or specific organizations such as the Arthritis Foundation or the American
Cancer Society.
133
Adult Day Care
Adult day care centers provide social and recreational programs designed
especially for mentally or physically frail older adults. They fill the gap for people
who are too dependent to manage alone, but too independent for nursing home
placement. Adult day care enables the caregiver to have time off during the day,
while knowing that the care-receiver will be safe and well cared for. There are
several different types of adult day care centers, each of which provides different
kinds of services. Some also provide psychological services.
Adult Day Health Care
Adult day health care centers specialize in offering therapeutic, social, and
health services to frail older adults. They are sometimes known as day hospitals.
Adult day health care services can often be paid for through Medi-Cal or private
insurance reimbursements. Transportation to the centers may also be provided.
Respite Care
Respite care allows temporary relief for the caregiver. With overnight
respite care, the care-receiver can stay at a nursing facility for a short time, such as
a weekend or vacation period.
Education and Training for Caregivers
Many places, such as the American Red Cross, senior centers, community
colleges, and disease-related organizations (such as the American Heart
Association, the American Cancer Society, and the Alzheimer's Disease
Foundation) sponsor classes and support groups especially for caregivers, to help
them understand how to better cope with the needs of the care-receiver.
Obtaining Services
In order to get the services you need, you may need to speak with several
different people, and make quite a few phone calls. Here are some pointers that
can help make the process a little easier.
1.. Write down the name of the person you speak with, so you can reach
him/her again if necessary.
2. Be persistent and don't Jet frustration get in your way.
3. You may need to explain your problem more than once.
4. Be polite but firm - don't Jose your temper and hang up.
5. Try to be specific about the kinds of services you need.
6. If you aren't sure, start by calling INFO-LINE (24-hour information and referral
service about human service agencies in LA County) for guidance.
134
Important Phone Numbers in Los Angeles County
Now that you know what kinds of services could help you, here are some information
and referral phone numbers that can help you get in touch with specific services
which are available in your area. In the next section, you will find addresses of places
to write for more extensive resource guides.
Information and Referral (I&R):
INFO-LINE provides I&R about human service agencies in Los Angeles
County, 24 hours per day, multilingual:
All Lines
(800) 242-4612
Los Angeles
(213) 686-0950
San Gabriel Valley
(818) 350-6833
(213) 551-2929
West Los Angeles
Airport
(213) 671-7464
(818) 956-1100
Burbank/Glendale
Long Beach
(213) 603-8962
San Fernando Valley
(818) 501-4447
Hearing Impaired (TOO)
(800) 242-4026
ELDER ABUSE HOTLINE (24-hours)
(800) 992-1660
LOS ANGELES COUNTY, AREA AGENCY ON AGING
(213) 857-6466
LOS ANGELES CITY, AREA AGENCY ON AGING
(213) 485-4402
DEPARTMENT OF PUBLIC SOCIAL SERVICES, ADULT PROTECTIVE SERVICES
Long Beach/South Los Angeles
San Gabriel Valley
South Central Los Angeles
Central and East Los Angeles
East San Fernando Valley
West San Fernando Valley
Lancaster I Antelope Valley
West Los Angeles/South Bay
(213)
(818)
(213)
(213)
(818)
(818)
(805)
(213)
599-9162
350-4570
744-6072
669-3655
500-57 49
901-4448
945-7361
399-9213
HEALTH LINE
(213) 974-7711
MENTAL HEALTH INFO LINE
(213) 738-4961
NURSING HOME l&R SERVICES
(213) 974-7779
AMERICAN ASSOCIATION OF RETIRED PERSONS (AARP)
(213) 427-9611
ANDRUS OLDER ADULT CENTER,
UNIVERSITY OF SOUTHERN CALIFORNIA
(213) 743-3493
LOS ANGELES COUNTY VOLUNTEER PROGRAMS
(213) 974-1767
135
Foreign Language Information and Referral
ASIAN/PACIFIC COALITION ON AGING
(213) 933-4982
Gives I&R outreach and direct services for Elderly Asian people
INTERNATIONAL SENIOR CENTER
(213) 380-1115
Education and Training for Caregivers
Training for caregivers is offered by several community organizations. The
American Red Cross offers a 6-week course in home nursing and home health care
at several locations in the county. For further information, contact your local Red
Cross office.
Help with Medicare and Medi-Cal
Many people find that applying for and getting Medicare can be very difficult if
they don't know which channels to go through. Here are some resources that may be
of assistance in helping you get through the system.
AARP (AMERICAN ASSOCIATION OF RETIRED PERSONS) publishes an
excellent booklet on Medicare's prospective payment system, called, "KNOWING
YOUR RIGHTS: CHECK OUT THE FACTS BEFORE YOU CHECK INTO THE
HOSPITAL"
To get a free copy, write to AARP at
4201 Long Beach Boulevard
Long Beach, CA 90807
or call: (213) 427-9611
MEDICARE ADVOCACY PROJECT (MAP)
(213) 741-0566
is a non-profit organization which is partly
funded by the LA County Area Agency on
Aging. They can offer information and assistance with problems you might have in the
Medicare system. Call them for help with
Medicare or HMO (Health Maintenance
Organization) problems, Medicare forms,
related health problems, or private supplemental insurance.
Your local Department of Public Social Services (DPSS) office can give you
information and assistance in applying for Medi-Cal.
136
APPENDIX F
COMMON DISEASES AND SYMPTOMS OF THE ELDERLY
137
-.....-.
..
The most common form, coiled "'ltD«r/hrilis, Ia due to the we•r ~nd tear proceu
Involving the Joint• thai ucompaniea aging. Osteoporo•i1, or thinning of the benet
with .tging. eopeci.tlly In women, contributes to tht' 1um tot•l of arthritis. lnflamm.ttory Involvement In the Joints, rlrtuma~iJ ttrlhrifis, Is len c"mmon In the aged.
wul, .a meubolic disea1e of lhe joinh •ccompanied by severe pain and signs of
lnfl•mmdion, Ia also I<'Cn in the •ged.
Treatment of .arthrilia varie~ with the c.tuse ~nd includes physiothe,.py, use of
cortilone products and upirin, orthopedic devices, .tnd increased diet•ry vil•minl
and c.tlclum-cont.tining foods. There are specific drugs for treJting gout. The use
of female 1e>e homtonea for truting ost•oporosis I• contro~rrsial.
,..,.
•• ·- t:
Common Diseases c.nd
Symptoms of the Elderly
Droochili•
t.
DISEASES
Some dise ..ea, .tlthough they m.ty .tl•o occur eulier In life, .tre much more likely
to .tppeu In the Iotter ye.tro. Usted below ue " number of common diaeuea lh.tl
o~fflictthe elderty o~nd oume w~ys in which they m.ty be.r·re.tled. All ,..timts JlroMI,f.
•f coury, lfltuMittl1rir ,ttJic~tl Joe/Drs for Ji"J""sil •nrl lrNI'11tnl #{ tlrrir """' inJipiJultl
nmJiti•n•.
Acl.:cio•clera•••
Bronchlti1 i1 an Inflammation of the cells that line the bronchial air tubes. It may
be caused by Infection,. or by chronic Irritation following lhe inh~lation of some
~nnful subst.tnce. lnfectloua bronchitis ia lre•ted with antibiotic.. In the c••e of
chronic bronchitis, cessation of cigarette smoking Is, of course; imperative. If un•
treated, chronic bronchill1 will progress guaually Into pulmonary emphysema.
PulmMIIry mpl.yStma, which re1ults when the air ucs in the lungs are damaged,
Ia often found In heavy 1moktn. The p.ttienl suffen from recurrent episodes of
1hortneu of breath and a penistent h.acking cough. Trulmenl centers .tround relief
of chronic bronchi• I obstruction .tnd inflammation and lh<! provision of oxygen to
the rem.tlnlns air lacs. Devices hove been developed to aid the emphysem• patient
In bre.tthlns. and a variety of drugs and ex•rcis•s are of value.
I
This 11 a sener.tlterm for a number of dlse.ses of lhi blood vessels auoclaled
with the thickening .tnd hardening of the arteries. Ar erloaclemala Involves the
narrowing .tnd closing of .t blood vessel due to .tccu ul.ttion of f.tls, comple>e
c"rbohydr•les, blood o~nd blood products, fibers, tissue , .tnd c.tlcium depo1ils In
its inner w.tll.
Arterlosclero•i• Is "lso rel.tted lo hypertension, or hi h blood pressure, In th"l
ills more •enre where hypcrten•ion is present. The ext nl of uleri.tllnvolvemenl
lncre.tSes with •11e .tnd c"n •ff«l •lithe uleries of the dy ,Including those of Ihe
br.tin. When lhe blood supply to the br .. in is reduced b nurowlng of the arteries
supplying the br.tln, disturb~nce• in beh .. vior .tnd cog ilion m•y result.
Arteriosclerosis in Ihe •Red is tre~led prim~rily by ~ed cing the blood f.tls by diet
where they ~rc •it;nitic.nlly elcv•l<'ll. Drugs to reduce b oJ f.lls .tl this"&" are not
of provrn Vdluc ~nd mu•l b<• u••-..1 with c•utinn lo .tVI id side effecll. Definitely,
eleuted blood prcnure should be reduc"d with a lo• -ull diet "nd lhe milder
.tnllhyperlensive dru~:s. Cit~•relle 1mokin& should be dl continued, .tnd .t progr•m
of •upervi•cd phy~i•~l •ctivily I• helpful, as Is the '' nlrol of obesity. Surgic"l
procedures.for obstruction of blood vencla in the ch.. ti neck, heart, "nd extremities m•y be of v.. lue .tfter cueful work-up .tnd evJiu•li1n of the benefit• .tnd rl1k1
Involved.
i
C6DCI!T
Cancer, or m.tlign.tnttumor, Involves the growth of new tinues th.tt con spre•d
from one port of the body to another. Cancer can occur In the throat, larynx,
mouth, g.t~trolntellln•l lrut, skin, bones, thyroid, bladder, kidney, and so forth.
A• cancer aymptoms In the .tged m•y be atypical, or may be ignored by th• aged
p.ttlenlaffilcted with other 1ymptoms and often with .a poor memory, comprehenlive annu•l examln.ttions are vit•l lo early detection and lre•tmenl.
Prompt detection and therapy ~re cruci.tl lo lre.tlmenl of c~ncer by surgery,
X-uy, or chemic.tl me.tnl. As life ~xpect.tncy in the aged Is limited and the growth
of many of the cancen lh.tl afflict them Is alow, there ohould be cardul conslder.tlion of the value ~nd potential sid" effect• of potent method• of therapy before
they are undertaken.
.
Cong••ti.-• llurl F•llurtt
Conge1tlve hurt failure Is • condition wherein tho? he•rl muscle h.IS been so
we.tkened thai ill pumping performance 11 lmp.tlred .md It c•nnot provide suffident clrculallon for body tissues. Thi• condition m•y be produced by other he~rt
problema, such as hypertensive he~rt disease, coronory he•rl >llJcks, and rheumatic heart disc.t~e. It m•y also b~ p10duccd by .-onditions •uch ~• chronic lung
din,~se, .1nemi.a, infection. ~nd emolion..JI
Aclbrltl•
Arthritis Is • gener.tlt~rm tderrlng iu ""Y degener.tliun ot lnfi.tmtn.tllon of lhe
!oint.. It I• cl•ssllied .tccordlnJ: lo 111 ~cuteness or Its dur.tllon .tnd .tccordins io lh~
1pec1Rc joints Involved, .tlong wllh olher conslder.tllona. M~ny older Ameriuna
1uffrr (rum ~•lhrili•. some lo J aniiJ drr;rc~ ~nd olhrrr. aevuely.
138
stress.
Treatment for congeotlve hurt failure is directed ~t impruvin1: the hc.~rt's pumpIng efficiency, elimin.tling ex<o>S fluids, •nd reducing the overlu•u on the hc•rl.
Digitalis II often u•ed to alrengthen the hcJrl muscle, and diurrtics to remove
ucen Ould from the body. Tr.. tment of the prccipitJting diseJsc, such •• hyperlehaluH, DVet.tclivlly of the thyroid giJnd, or anrml.t, h .tlsu ncccss••y.
Coroo.ry H"•rl Di•e•••
This dlse•sr. which Is present in almost all indlvidw1ls over the ar:e of seventy .
In the United States, involves deterioration of or d•m•s~ to the venelsthat supply
blood to the heart. In older persons It is superimpo1ec on a heart where there Ia
a gener•l decreue in muscle-cell•ize ;and efficiency, .m:l where there Is a progressive lack of ability to de•l with stress.
One serious condition th•t c;an result from coronary teart disease Ia llfWit my«llr·
Ji11l in{llrrliun. wherein the blood supply to the hearth cut off. In the elderly It Is
not unusu~l for there to be no o1pp•rent symptoms;acccmpanying an Infarction, in
contrast to the crushing p•in uperienced by younger p!rsons. Substitution symp·
toms ue Ollso common in the elderly. Fur ex;ample, when the elderly heart fails
under the stress of acute n•yocuo.li~l injury. blood may lo;ack up behind the left side .
of the heart into the blood vessels of the lungs, causing shortness of breath Instead '
of chest pain. Or the blood m;ay back up behind the righ: side of the heart ;and c;ause
congestion of the ;abdomin•l blood vessels; in this case ;abdomin•l dlstreu will be
substituted for chest p•in.ln still other coses, the Oow of blood from the wukened
hurt Into the broin is diminished, with result•nt diz:!lneu ;and blntnen uther
than chest pain.
Modern tre~tment of the complicotions of acute m:•ocardiallnfarctlon (which
Include lrregul•r he•rtbe•t•nd he•rt foilure) with new~r drugs, oxygen, ;and eltc·
tricol equipment is uving m•ny lives and enabling tloe period of bed rest to be
shortened. Favorable cases now gel up out of bed .and Into a ch•ir much eulier than
before, ;and c•r~ioc whabilitation is bea;un e•rly with rood results. C•rdl•c shock,
however, rem;ains • difficult problem with • high mmtallty r.ate.
A common episode in individu,;ls with le55 sever1 coron•ry he;art di• .. se Is
•nzin• p«luru. This condition results from • temper•• y ln•dequ;acy In the blood
supply to the heut. It Is ch;aracterized by severe but brief r;adi.allng p;aln over the
mi.J-chc•• .an.J is lrc.atC'd t·uutnu.tt•ly .uu.l w(cly with r Uro~lyccrin.
Di•bttt,.
The most common form of dl~bet"" Is JiddN mrllilus • chronic Inherited disuse
In which~ deficiency of Insulin or • disturbance In the .tction of Insulin Interferes
with the body's ;ability to mrt;aboll•r Cilrbohydrotes. The elderly di•betlc m•y
present few or no clinic•l symptoms. In f•ct, compile. tion• uloln& from dl•betes
m•y be the first signs of this diseJse in the elderly. C.ttaracts, neurili&, heut attacks,
•nd ~(iiUt:Um..l, rur t"X.lmp(r••Ut• R1Urt.• frni\IC'Ut in I he di.1\lt"tic. ThttC II~ rcl.ltivrl)'
high inridenc~ of di•betl:li in tlw ~a:~d. with n•ven· complications Involving the
l~rger blood V<"Sscls.
Mu•l ddt·rly oli.tht•tit·• '"tllirt" unly wnhol uf lh~ir dlt•l. Lon nf weight •nd
avoidance of obMity are ~I so helpful. Insulin injtctiontre needed by only a sm•ll
number. An occasion•lsevrre c••e requires very core! I treatment by all;anll;able
me.m•. Th•· foot <an· uf dolt•rly tli.ll.,lln .huuld !><! m. ••t:nl hy a pc>dl,ttrlst, olurc
their poor circulation •nd their lowerctl re•istancl.' to nfectlon make them prune
to lnfrctlon, which may be loll1>wed by the dre;ad co plic.ttion of s•ngrene.
Di•e•u• Df th• &r
The ear consi•ls of the extcrn.ll, the middlc. ;and th1•' nner e•n. Problems In ;any
of thcnt un •lh·ll lu·•rlur,. Any ..,,,.Jitluu llt~l pl't'Vl't ts oouno.l (tom rr•chinc tlu!
l!•rdrum un c~u•e • htwiur: Joss. Common problem affectln& lhe extern•l e•t
Include imp•cted ear w•x ;and swelling uf the llssur linlnt:~ the can•l c;aused by
139
Jn0amnutlon. Problemsth•t frequently affect the middle ear Include fluid accumulation and Infection within the Inner rar covlty. Heuing losses c.aused by condiUons of the extem..t or middle e;ar are known •s rrmtlutiitN losses, sincP they affect
the pathw•y by which sound Is conducted to the inner ear.
Conductive h .. ring losses are frequently treat;able by • physician. Hearing problems involving the middle eu In the ;aged •re similar to those occurring urlier in
life. The most common cou•e Is infection. In the elderly, however, infection may
Indicate • more •eriouo di••a•e. such ;as di•betrs. Hcaring loss in the middle ear th•t
Is not due to Infection c.an often be corrected by surgety. Lesion• oft he inner e.tr,
If not too extensive, e.tn be helped by the proper use of hearing •ids.
Another type o( he;aring lou re•ults from damage to the innrr e.11. Th•l Is
unS<Jrintomtl hearing Jon, often coiled """" Jtafntss. The inner eJr houses the nerve
structures that receive the sound w;avn and begin lo transmit them to the br;ain.
In most lnst;ancet, 1ensorineural l1>sses are lrrevenible.
Dl""" of lh• Ey.
C.hl,.cls ;are op;aque spots that form in the lens of the eye and interfere with the
pasuge of light r,;ys. Often the lint Indication Is a blurring •nd dimming of vision.
If the retln• Is usentl•lly norm•l. u It often Is, the removal of the clouded len•
c•n lead to restoration of a gratifying amount of vision. Surgical ;advances have
m;ade the rrmov;aJ of cat;auct• comparatively .. sy, even for the •ged •nd infirm.
C.tuact rrmov•l con be performed under local anesthesi;a. Many surgeons now
;allow patients out of bed thr day •Iter the operation. Since the lens i• needed for
focusing. sptcl•l gluses •re rrqulred alter It has been removed.
Gl.urom~t. a major couse of blindness, Is characterized by Increased pressure in
the ryeb•ll because fluid Is unable to duln properly. Thr disea•e drvelops slowly
and palnles1ly but c;an be arre•ted If detected early enough. Thorough evaluation
by an ophthalmologiotl; needed to determine who will benefil from •urg~ry ~nd
who requires appropriate therapy with eyedrops and drugs. Routine determination• of the pressure In the rye& of aged Individuals are essenlial for the detection
of at.ucom• before symptom•. •nd at limes lrreveroible d;amage, develop. Such
delermin•tlons, u put of annual comprehensive examin;ation• or in large-scale
screenlns drives for sJaucom• •lone, are of great value.
M4llll•r Jisnr~< loa dtgenerotlon of the uu of the retina that permits perception
of line det;alls, such ao print. When maculu disease results from inO•mmation, it
may re•pond to cortisone drugs th•t have anti-inflammatory dlect1. When it hu
con•ideubly progressed, older persons wllh poor oight can be helped with low•l•ion aids such •• m;agnilylng devices.
Hyptrrlttatloa
Hy~rlmsion. olherwin· known .u hir.h t,1,~,d pn.•nun•, u,.,., hmt: r.._·r·i,,ds ,,( tim••
un lead to arterl•l dloeue and eventually to heart fJilurc. (Nel'>r.•l throml>osio
(blood clotf or hemorrhage, or kidney fdilure. In the cldcrly, hit:h blood pre•surc
Is unlikely to be of recent origin. and much of the dJm.ogt• tu th~ .lfh·ri.tl system
has already been done. Hypertension in the aged m•y leJd to • stroke. or the
rupture of a blood ventlln tht brain. Most strokr1 In elol .. rly l><"t•ons. however,
are uusod by thruml>oslo, or blucl<.ag~ by o~l>loud dntln th~ n·r~br.1t ns•d. aiH•aJy
narrowed by hardtnlns of lhe ;arterle• or .,.heme diminution of the blood supply
through ouch • narrowed YeiBrl.
LDI• of Viliun
Aside from the condition of prnbyopi•-loss of elasticity In the lms, or farsight·
edness-poor vision Is not 10 inevitable n many old people expect. It may be a
symptom of ~ numbrr of underlying conditions wh.ch, If treated properly and
promptly, are amen~ble to medical intervention. Therefore; any Impairment of
vision In an older person warr;~nts examination by a:~ ophthalmologist.
StJizurtJ•
Seizures, or convulsions, may involve the entire bo<ly, or only a part. Whatever
the extent, there are involuntary twltchings of the muscles and usually unconsciousne5S. They may hne their onset in old age. Since they may be a symptom
of some underlying diSI!a~e or abnorm;~l condition, thl y call for a careful examinil•
lion by a neurologist. Seizures ue often succel5fully treated with appropri01te
medication.
141
APPENDIX G
EXERCISE AND FITNESS PROGRAMS FOR OLDER ADULTS
142
EX[JlC !SE:
FACTS f.
r !CTION
Colleen Dwyer, M.E.P.
Exercise Physiologist
During the last decade, one of the most visable and encouraging trends in
this country has been the growing interest and participation in physical fitness
acti \'i ties. Peep le are more aware of the benefits of exercise - that it improves
the way you look, feel and work. Exercise is also fun!
Unfortunately there are still some lingering myths and misconceptions that
.halt many people from participating in regular exercise. Here are some of the
more common ones:
Myth:
Fact:
Exercise makes you tired.
Exercise actually give you more energy as your body becomes •
conditioned. Regular, brisk exercise helps you resist fatigue
and stress.
~lyth:
Exercise will increase your appetite and you'll eat back whatever
you lose.
A sensible exercise program will reduce your appetite, especially
if it is planned just before a meal.
Fact:
Myth:
Fact:
Exercising takes too much time.
Regular exercise does not have to take more than about 25-40 minutes,
three times a week. Once you have established a comfortable exercise
routine, exercising becomes a natural part of your life.
~lyth:
All exercises give you the same benefits.
You do not get the same benefits from all activities. While you
may enjoy many activities, only regular, brisk and sustained exercise
such as brisk walking, bicycling, jogging or swimming improve the
efficiency of your heart .and lungs and burn off
lot of calories.
Other activities may not give you these benefits, although they may
give you other benefits such as increhsed flexibility and muscle
strength.
Fact:
a
Hyth:
Fact:
The older you are, the less exercise you need: ~
No matter what your age is you still need the proper amount of
exercise. You simply have to tailor the exerci~e program to your
own fitness level. Even if you start a fitness program later in
life, you will still reap many benefits. It's never too late!
Whatever your age, regular brisk exercise can become a good health
habit with lifelong benefits -you'll feel better, look better and
enjoy life more fully.
.·,
143
-
.
BASIC GUrDELINES FOR STARTr:-JG YOUR 011':\
~!any
is the best kind of exercise?
How often?
PROGRAN
people are confused about the type and amount of exercise that is
needed to become physically fit and stay fit.
h~at
FrT~IESS
All sorts of questions arise.
How much do I need to exercise?
How long?
Without the proper answers and guidance, most people start out an
exercise program improperly, find it a struggle, become discouraged and quit.
The key for maintaining a successful program is to devise a personali:ed
program that works your
c~rdio~ascular
system ($trengthens your heart and lungs),
and is based on your present fitness level and activity interests.
The five
essential ingredients for a sound exercise program are:
of exercise. The type of activities necessary for increasing
your level of physical fitness are activities that use large muscle groups
(arms, legs) are rhythmic and dynamic in nature and are able to stimulate
the heart and lungs. Such activities as fast walking, jogging, swimming.
bicycling, rope skipping and cross-country skiing are excellent for an
improvement in aerobic capacity, The best exercise is the one you enjoy
the most.
1.
T~~e
2.
Frequency - number of workouts per week. A minimum of three workout
periods per week (with no more than 2 days between workouts) are
needed to produce training benefits in the inactive individual.
However, after you reach a moderate level of training, you should
increase y9ur frequency to 3-6 exercise sessions per week if you want
to continue to improve.
3.
Duration - length of exercise session. In order to strengthen your
heart and lungs, the duration of your~xercise period should be ~0-30
minutes.
4.
Intensity - level of exertion. Your exercise i~tensity (how hard you
work) should reach 60-65 percent of your maximum heart rate (maximum
heart rate ~ 220 - your age} in the beginning stages of your fitness
program. As you become better conditioned, your heart can tolerate
exercise demands up to 85 percent of its maximum rate. But remember,
commitment to exercise is a lifetime proposition. You should not be
overly ambitious at the start, but should begin your program at a
relatively low intensity and gradually increase the level of exertion
over the days and weeks that follow,
5.
Warm-up/warm-down period. Bef~re beginning any single exercise session.
you should gradually_warm-up Wlth 5-10 minutes of stretching exercises.
An ol~er or less act1~e person should warm-up for the longer period.
Immed1ately follow th1s warm-up with your 20-30 minute exercise session
followed by a 5-10 minute cool-down period of diminishing activity and
stretching/relaxation exercises.
144
The North Carolina
Gouemor's Council on
Physical Fitness
and Health
North Caroline;
DlL"ISIOn 01
Healrh
~rL'IU'S
P0Box2Cf.ll
Raleigh. NC 276'J2 2u<J,
1919l7332773
GET ACTIVE
Colleen Dwyer, M.E.P.
Exercise Physiologist
Regular, physical activity improves the way you look, feel and work.
Yet most North Carolinians get little vigorous exercise at work or during
leisure hours. Recent survey data indicates that 45% of the adults in North
Carolina say they never get any physical exercise. People usually ride in
cars, trains, or buses rather than walk, use elevators instead of stairs,
and sit at home during their free ~ime rather than being physically active.
There are many easy and enjoyable ways to get exercise. Some good aerobic
activities are swimming, brisk walking, bicycling, running, and dancing. The
term "aerobics" means that they require the use of a large and steady amount of
oxygen to the body's muscles. To improve cardiovascular health (strengthen
heart and lungs), exercises must be aerobic.
The benefits experienced by people vho exercise regularly (done at least
J times per week, for a period 20-JO minutes at a brisk pace) are numerous:
FEEL BETTER:
•
•
•
•
gives you more energy
improves your self-image
helps in coping with stress
improves your ability to fall asleep
quickly and sleep well
• reduces anxiety and depression
• strengthens heart and lungs giving you
greater stamina
LOOK BETTER:
• tones your muscles
• burns calories to help reduce body
fat or helps you stay your ideal
weiJ;:ht
• helps control your appetite
WORK BETTER:
• contributes to more productivity at
work
• increases your capacity for physical work
• builds stamina for daily routine activities
• increases muscle strength
• strengthens your heart and lungs to work
more efficiently
145
1808
The North Carolina
Gouemor's Council on
Physical Fitness
and Health
NorTh camlu.
fJ/L•/sr.,,; • ..
/ltTIIIh <;.·n .,, ,.,
Pf.Jl:::JIJX :.!t,,:
Ralergh. ,-.;c 2760::2 :.t•' •
1919173.J:Z;;--
TIPS FOR ADDING YEARS AND QUALITY
TO YOUR LIFE
Colleen Dwyer, M.E.P.
Exercise Physiologist
Spice up your life with exercise! Incorporating regular exercise into your
daily routine is extremely important in developing a healthy lifestyle. Exercise
is the best pick-me-up and energy booster that you can find - even better than
munching on a candy bar or phoning long distance. For the shortest route to
feeling better, follow these easy fitness tips to increase your exereise activity
(and burn calories) within the time allotted for daily routines:
• Use stairs instead of the elevator and escalator.
• Replace your coffee break with a brisk walk. Brisk walking relieves
tension, burns calories and is a great energy booster.
• Go dancing for a fun night out on the town.
• When traveling short distances, walk instead of taking a car or
paying money for public transportation.
• Instead of ending your meal with a calorie rich dessert, take an
exhilarating after dinner walk. Digestion is enhanced and calories
are burned.
I
• When driving to work or going shopping, park at the end of the lot,
or a few blocks away, and walk the remaining distance.
• Take an exercise break when feelin~ tense. Get up and stretch, walk
around and give your muscles and mind a chance to relax.
• When traveling by public transportation, get off a few stops early.
It's a· double bonus- exercise activity is increased and money is
saved.
• Find an exercise that you enjoy! Some good aerobic exercises are
brisk walkin~, swimming, jogging, bicycling and active dancing.
Participate in this activity regul~rly for 3 quality and healthy
lifestyle.
NOTE:
(Persons over 40 years old or those who have reason to suspect underlying illness should consult a physician before beginning an exercise
program. At any time severe symptoms arise during or after exercise.
a physician should be consulted.)
146
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APPENDIX H
STRESS MANAGEMENT
147
Los Angeles Resource Center - - - - - - - - - - - - - - - fur Adults with Brain Impairment and their Caregivers
(213) 543-4808
Health Professional's Guide
STRESS MANAGEMENT FOR CAREGIVERS
Use of stress management techniques by caregivers of adults with
chronic diseases is crucial if the caregivers are to maintain
their own physical, mental, and emotional well-being and sustain
the demands of caregiving over time. It is important that health
professionals help caregivers understand the stresses they face
as well as effective methods for coping with these stresses.
Techniques must be tailored to an individual's specific life
style if they are to be used successfully. Most caregivers may
feel they do not have the time or energy to do stress reduction
exercises. They should be encouraged to try them. They will have
more energy to meet all of their caregiving demands when these
exercises are practiced on a regular basis.
A good working knowledge of a number of stress reduction
techniques is essential to this task. The following is a listing
of 10 basic stress management methods. Caregivers may want to
start by choosing one or two that best fit into their life style
and then practice daily until they become a natural part of their
routine.
1.
SUPPORT GROUP: Join a support group if possible or
develop a supportive phone network with others who deal
with a similar situation.
2.
RESPITE: Arrange for respite (someone else· to take care
of the patient) with neighbors, friends, family, or
paid attendants. The goal is to provide unhurried time
for errands or social activities.
3.
RELAXATION: Relax by taking a hot bubble bath by candle
light (soft music may also be included).
4•
VISUALIZ1.TION EXERCISES: Advise clients to sit in a
comfortable chair or lie down with eyes closed. Ask
them to take several
deep
breaths
and imagine
themselves in
a favorite
place. This may be a
comfortable room, a beach, a mountain cabih, etc. They
should involve all of their senses to fully experience
the place--focusing on what they see, smell, hear,
taste, and can feel. Tell them they may take as long as
they want enjoying . this favorite place. When ready,
they may open their eyes and return to daily activity.
21231 Hawthorne Blvd., Suite 310, Torrance, California 90503
A program of Harbor Developmental Disabilities Foundation, Inc.
148
2
5.
MUSCLE TENSE/RELAX EXERCISE: Ask clients to sit in a
comfortable chair or lie down with eyes closed. They
will then tense and relax sets of muscles, three times
each. Direct them to start by tensing the muscles in
toes, feet, and calves,then to relax these muscles.
After this is-repeated three times, proceed to tense
thigh, buttocks, and lower back muscles ~nd relax them,
three times. Next _their chest, abdomen,and stomach
muscles, then shoulder, neck and face muscles. After
this series, they may want to tense and relax all the
muscles in the body three times.
6.
DEEP BREATHING EXERCISES: Ask clients to sit in a
comfortable chair or lie down with their eyes closed.
They should inhale through the nose to the count of
eight (abdomen should be extended as far as possible),
hold the air for the count of four and breath out
slowly through the mouth for the count of eight. This
should be done at least 5 times. With practice, they
should work up to 25 breaths. Clients should imagine
all tension flowing out of the body as they exhale.
7.
PHYSICAL EXERCISE: Clients should be encouraged to go
for walks daily, at a minimum around the block, farther
if time allows.
8.
HOBBI!Sa Time should be taken to work on something
creative. This could include woodwork, needlework,
drawing, writing poetry, etc.
9.
EHTERrAIHMENT: Reading an enjoyable book, going to a
movie, out to dinner with a friend, etc.
10.
PROBLEM SOLVING S~LLS: Clients
should be taught
effective
problem
solving. This includes clearly
defining the problem, being very specific as to details
creating the problem, generating alternative solutions,
examining the strengths
and
weaknesses
of each
alternative, choosing an alternative, and developing
possible solutions to anything that may block the
success of implementing this alternative. After the
alternative is attempted, any changes should be noted.
If problem is not resolved, client should go back to
the alternative-generating step.
KE
2/87
149
Deeo Muscle Relaxation Technique
l.
2.
3.
Sit quietly in a comfortable position.
Close your eyes.·
a. Listen to your breathing.
Deeply tense and relax all your Muscles, beqinnina with
your feet and progressing up to your face.
Muscle
Tensino Method
Toes
Curl toes under as tightly as you can for five
seconds. Relax.
Feet
Bend ankles toward your body as far as you can
for five seconds. Relax.
Thighs
Tighten thigh muscles by pressing legs
together as tightly as you can for five
seconds. Relax.
Hips, buttocks
Tighten buttocks for five seconds.
Stomach
Tighten your stomach muscles for five seconds.
Relax.
Back
Arch your back off the floor or bed for five
seconds. Relax. · Feel the anxiety and tension disappearing.
Shoulders
Shrug shoulders up to your ears for five
seconds. Relax.
Upper
Bend elbows. Tense biceps for five seconds.
Relax, and feel the tension leave your arms.
a~s
Forearms
I.·
Relax.
. Extend arms out against an invisible wall
and push forward with hands·for five seconds.
Relax.
Hands
Extend arms in front of you, clench fists
tightly for five seconds. Relax. Feel the
warmth an~ calmnes~ in your hands.
Lips, cheeks, jaw
Draw corners of your mouth back and grimace
for five seconds. Relax. Feel the calmness
and warmth in your face.
Eyes and nose
Close your eyes as tightly as you can for
five seconds. Relax.
Forehead
Wrinkle forehead. Try to make your eyebrows
touch your hairline for five seconds. Relax.
150
4.
Count from 1-10. At ten (10), begin to visualize a
small white light on a black background.
5.
Continue for 10-20 minutes. Don't worry about whether
you are successfti1 in achieving a deep level relaxation.
Maintain a passive attitude and permit relaxation to
·occur at its own pace. When distracting thoughts enter
your mind, try to ignore them and concentrate on the
white light.
6.
Count from 10-1. At one (1), begin to open your eyes.
Do not try to stand up for a few minutes.
Note:
You may want to tape the instructions for this
relaxation technique in order to avoid having
to read them while trying to practice.
You have just completed one relaxation technique.
In order to be completely successful, you must practice at least once or twice a day.
Deep Breathina Technique
1.
Standing or sitting, fill lungs with air by inhaling
through nostrils as deeply as possible filling the lungs
with as much air as possible or unti! your cnest has
expanded to its fullest.
·
2.
Hold this breath for 5-10 seconds.
3.
Exhale through nostrils slowly until all the air has been
expelled leaving the lungs virtually empty.
4.
Repeat two-three times.
(
.
151
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APPENDIX I
SAFE USE OF MEDICINE
AND
ACCIDENT PREVENTION
152
(l
National Institute on Aging
Safe Use of Medicines
by Older People
Most people, and especially the elderly, use
medicines at some point during their lifetime. When used correctly, medicines can be
of great value. They can help heal wounds,
stop the spread of infections, bring on sleep,
and ease pain, both physical and mental. But
when used incorrectly, drugs have the ability
to injure the patient or change the effects of
other medicines being taken at the same time.
Drugs can be divided imo two major
groups: O\"er-the-counter drugs (also called
patent medicines), which can be bought without a doctor's prescription; and prescription
chugs, which can be ordered only by a doctor
and sold only by a phannacist (druggist). Prescription chugs are ,usually more powerful and
have more side effects than over-the-counter
medicines.
People over 65 make up 11 percent of the
American population, yet they take 25 percent of all prescription drugs sold in this country. One re~n for this more frequent use of
chugs by older people is that, as a group, they
tend to have more long-term illnesses than
they did when they were younger. Also, advancing age sometimes brings with it chan~es
in physical abilities. eatin~ habits. and social
contacts. The result of these changes-whether it is aching rhuscks, constipation from lack
of certain foods, or depression after the loss of
a relative or friend-may often lead an older
person ~o seek medical help. Drug treatment
may be suggested to help overcome many of
these physical and emotional problems.
Safe drug use requires both a wellinformed doctor and a well-informed patient.
New information about drugs and about how
they affect the older user is corning to light
daily. For this reason, those taking drugs
should occasionally review with a doctor their
need for each medicine.
In general, drugs given to older people act
differently than they do when given to young
or middle-aged people. This is probably the
result of the normal changes in body makeup
that occur with age. For example, as the body
grows older, the percent of water and lean tissue (mainly muscle) decreases, while the percent of fat tissue increases. These changes can
affect the length of time a drug stays in the
-body, how a drug will act in the body, and
the amount of drug absorbed by body tissues.
The klcfueys and the liver are two important organs responsible for breaking down
and removing most drugs from the body.
With age, the kidneys and the liver often
begin to function less effu::iently, and thus
drugs leave the body more slowly. Tills may
account for the fact that older people tend to
have more undesirable reactions to drugs
than do younger people.
Because older people can often have a
number of physical problems at the same
time, it is very common for them to be taking
(ovn; pltme_)_
153
•
ny different ruugs. Two or more med.i.es. taken at the same time can sometimes
:t with each other and produt..C harmful ef.s. For this reason, it is important to tell
:h doctor you go to about other drugs you
taking. This will allow the doctor to
::scribe the safest medicines for your situa-
6.
1.
.t3y taking an active part in learning about
drugs you take and their possible side efs, you can help bring about safer and
>ter treatment results. Some basic rules for
! drug use are as follows:
~
7.
8.
Take exactly the amount of drug pre-
•· scribed by your doctor and follow the
· dosage schedule as closely as possible.
_Medicines do not produce the same effects
; in all people. For this reason, you should
·· never take drugs prescribed for a friend or
- relative, even though your symptoms may
.. be the same.
_ Always tell your doctor about past problems you had with drugs, and be sure to
-mention other drugs (including over-the-counter medicines) you are taking.
_It may hdp to keep a :laily record of the
drugs you are taking, especially if your
· treatment schedule is complicated or you
- are taking more than one drug at a time.
. If child-proof containers are hard for you
_______ ·----
......
........
9.
to handle, ask your pharmacist for easyto-open containers. Always be sure, however, that such containers are out of the
reach of children.
Make sure that you understand the directions printed on the drug container and
that the name of the medicine is clearly
printed. Tills will hdp you to avoid taking
the wrong medicine or following the
wrong schedule. Ask your phannacist to
use large type on the label if you find the
regular labds hard to read.
Throw out old medicines, since many
drugs lose their effectiveness over time.
Ask your doctor about side effects that
may occur, about special rules for storage,
and about which foods or beverages, if
any, to avoid.
Always call your doctor promptly if you
notice unusual reactions.
A useful booklet, Using }our Mtdicines Wzst{y: A Guide for tk Elder{)', has been published
by the Kational Institute on Drug Abuse.
Free single copies are available by writing to
Elder-Ed, P.O. Box 416, Kensington, Md.
20795. Multiple copies (in lots of 100) may be
purchased for $17.00 by writing to the SuperintenC.<:nt of Documents, U.S. Government
Printing Office, Washington, D.C. 20402.
No~l980
_ ---------------------
·mnation Offit'l'
Lional lnstitutl.' ~n Aging
~~aiding 31, Room 5C35 .
wthr:sda. Maryland 20205
IL
L
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.
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
154
Public Health Service
Na~ionallnstitute of Health
National Institute on Aging
h\geFage
Accidents and the Elderly
Accidents seldom "just happen," and
many can he prevented. A('ciclental injuries become more frequent and serious in
later life. Thus, atteution to l>":tiCty is especially impartant for older persons.
Several t:actors make people in this age
group prone to &u:c.:ident'i. Poor eyesight
and hearing c.:an decrease awareness of
hai".ards. Arrhritis. neurological diseases,
and impaired c.:o01-dination and lmlance
can m&ake older people unsteady.
Various diseases, mcdic.:&ttions. alc.:ohol,
and preoccupation with personal problems. can result in dmwsiness or distraction. Often mishaps arc expressions of
menl&ll depression or or pom· physical
conditiuning.
0
0
0
0
0
0
0
light switches at both the bottom
and the top.
Provide night light'i or bedside
remote-c.:ontrollight switches.
Be sure both sides of stairn"ays have
sturdy handrails.
Tack down carpeting on stairs and
use nonskid treads.
Remove throw rugs that tend to
slide.
Arnmge furniture and other objects so they are not obstacles.
Use grab bars on bathroom walls
and nonskid mats or strips in the
bathtub.
Keep outdoor steps and walkways in
g<xld repair.
When ac.:cident'i on:m~ older persons
are especially ntlner&~hle to severe irtiury,
and tend to heal slowly. Particularly in
women, the bones often hec.:ome thin and
hriule with age. c.ausing sc.~mingly minm·
(;all'i to n~suh in hrokc.·n hips.
Personal health practices are also imJXlrtant in preventing falls. Bec-.mse older
_persons tend to become faint or dizzy
when standing too quickly, experts recommend &trising slowly from sitting or
lying p<.,sltions. Both illness and the side
cfll.'t:ts of ch·ugs incre&L'iC the risk of f<lils.
M.any acddcnt'i c.·aia he..• pn·vented hy
maint<aining rnemal and physical health
and con~ljtioning.m1d hy c.·ultivating good
safety lmhit'i. For ex&ai'nplc.
Burns <tre especially disabling in the
aged. who recover from such injuries
more slowi}'·
Falls <arc.· the most c.:ommcm c.:ause or l;ttal ir~ju ry in 1he..· a!{ed. Proper liglning can
help prc\'l'lll them. Ht•re"s what you c.:.m
do:
0 Illuminate &all sr;.tirways and provide
0 Never smoke in bed or when drowsy.
0 When cooking. don't wear loosely
fitting flammable clothing. Bath. robes. nightgowns, and pajamas
c.:atch fire.
0 Set water heater thermostats or fau(~P'-J
155
0 Watch for slippery pavement and
other hazards when entering or
leaving a vehicle.
0 Ha\'e fare ready to prevent losing
your balance while fumbling for
change.
0 Do not carry too many packages,
and leave one hand free to grasp
railings.
0 Allow extra time to cross streets. especially in bad weather.
0 At night wear light-colored or fluorescent clothing and carry a flashlight.
cers so that water does not scald the
skin.
0 Plan which emergency exits to use in
case of lire.
Many older people trap rhemselves behind multiple door locks which are hard
·to open during an emergency. Install one
good lock that can be opened froin the inside quickly, rather than many inexpen. si\'e locks.
Motor vehicle accidents are the most
common cause of accidental death
among the 65-to-i4 age group, and the
. second most common cause among older
persons in general. Your ability to drive
may be impaired by such age-related
-c~anges as increased sensitivity to glare,
poorer adaptation to dark, diminished
coordination, and slower reaction time.
·You can compensate for these changes by
· dri\'ing fewer miles; driving less often
· and more slowly; and driving less at night,
• during rush hours, and in the winter.
If you ride on public transportation:
Old people constitute about II percent
of the population, and suffer 23 percent
of all accidental deaths. The National
Safety Council reports that each year
about 24,000 persons over age 65 die
from accidental injuries and at least
800,000 others sustain injuries severe
enough to disable them for at least I day.
Thus attention to safety, especially in later
life, can prevent much untimely death
and disability.
0 Remain alert and brace yourself
when a bus is slpwing down or
July 1980
t~rning.
. lnfonnation omce
National lnstirute on AginR
Building 31, Room 5C36
Belhesda. Maryland 2020.5
' '
U_'i. DEPARTMENT OF HE..S.lJ"H AND HUMAN SERVICES
156
Public: He-..Jth ScnU
Narionallnstitule of Health