Investigation of caregiving pressure and its related factors in caregivers of hemodialysis patients referred to Razi Medical Education Center in Rasht in 2012

Abstract

Introduction: In end-stage renal disease, it is necessary for the family to take support measures for the dialysis patient, both at home and in outpatient centers such as hospital dialysis departments. The caregivers of these patients often spend a lot of time taking care of them and bear a lot of fatigue and caregiving pressure.

Aim: This study was conducted in order to determine the amount of caregiving pressure and its related factors in the caregivers of hemodialysis patients referred to the Razi Medical Education Center in Rasht in 2013.

Results: 74.7% of the studied units have severe care pressure. Between the amount of care pressure with the caregiver's age (p = 0.005), the duration of caring for the patient (p = 0.009), the caregiver's marriage (P = 0.001), the caregiver's illness (P = 0.003), the type of housing (P = 0.048), living with the patient (P = 0.001), the caregiver's education (P = 0.001), income status (p = 0.008), relation to the patient (p = 0.017), the patient's ability (p=0.0001), the patient's need for care (p=0.0001) and being a member of the dialysis association (p=0.003) were observed to have a statistically significant relationship. Logistic regression model was used to determine the predicting effect of individual-social variables of patient and caregiver and the results showed that the variables of caregiver's marriage, living with the patient, patient's ability and duration of patient care have a significant relationship with caregivers' care pressure. Caregivers who were married and lived with the patient had more caregiving pressure. Also, with the decrease in the patient's ability to perform tasks and the increase in the duration of patient care, the caregiver's caregiving pressure increased. Conclusion: In this study, the findings showed that some social-individual factors such as the caregiver's marriage, living with the patient, the patient's ability, and the duration of patient care have a significant relationship with caregivers' caregiving pressure and are predictors of caregiving pressure. It is recommended to pay more attention to the caregivers who have these conditions in terms of examining the care pressure and the measures needed to reduce the pressure.

Keywords: care pressure, caregiver, hemodialysis

Field of research:

Illness is one of the challenges that come in the way of many people and prevent them from activities. And his daily life stops. Eliminating the disease is of particular importance due to the impact it has on individual, social and economic dimensions (1). Among the diseases, chronic diseases that have an increasing prevalence in the world, due to the expansion of treatment methods and as a result of reducing attenuation with a long process, make patients in need of care, supervision and rehabilitation. Among chronic diseases, chronic kidney disease[1] is one of the major problems in which most body systems are affected by uremia caused by the disease (2). The prevalence rate of chronic kidney failure in the world is 242 cases in one million population and it increases by 8% annually (3). Chronic kidney disease is the eighth leading cause of death in the United States. It is estimated that more than 31 million Americans (10% of the total population) have chronic kidney disease (4). According to the available statistics in Iran, about 1200 to 1600 people get this disease every year (3). Gilan province is also facing an increasing number of kidney patients, so that in 2013 the number was announced as 3000 people (2). Patients with end-stage renal disease require renal replacement therapy (RRT), including hemodialysis and kidney transplantation, to survive.Due to the significant increase in the need for RRT in recent decades and its upward trend, and due to the lack of kidneys for transplantation, dialysis is the most common method used in these patients (5). The need for hemodialysis in Iran is increasing dramatically, so that the number of hemodialysis patients in Gilan province has increased from 502 patients in 11 centers in 1385 to 807 patients (with an increase of 60%) in 13 centers in 1390, and according to the latest published statistics of the number of hemodialysis patients in 1391, this number has reached 924 (2). Kidney replacement treatments expose patients to a wide range of physical, psychological, economic and social problems, and their quality of life [3] is affected overall (6). This disease leads to important changes in a person's lifestyle and a decrease in energy level, frequent need for hemodialysis and associated health problems, feeling depressed, inability to do normal daily activities and other things that all affect the patient's life and disturb his normal life (7). Alavi et al., in their research, which examined the health status and daily life activities of hemodialysis and kidney transplant patients, reported that dialysis patients do not have a good general and physical health status and face problems in performing their daily life activities. (8). Many studies show that hemodialysis patients suffer from severe fatigue (9, 10) and experience a high level of disability in various areas of life, which ultimately leads to a decrease in their quality of life (11). In addition, the common complications of dialysis, including limited food schedule, reduction of social activities, drug side effects, economic pressure, marital problems, emotional stress and anxiety, put the patient and his caregiver under more pressure. (12).

Chronic illness and disability disrupts the life process and related adjustments, and due to the impact of the illness on the patient and the family, the dynamics of the family often change (13). In the systemic view of the family, a problem for each family member will affect other family members, (14) and in general, chronic disease affects the whole family (15). Due to the chronic nature and long-term treatment of chronic progressive kidney failure, changes in family functioning are inevitable (16). End-stage renal failure is a chronic disease that the family must perform support functions for its dialysis patient, both at home and in outpatient centers such as hospital dialysis departments. Caregivers of these patients often spend a lot of time taking care of these patients and suffer a lot of fatigue and care pressure [4] (7). Caregivers of hemodialysis patients may feel a heavy burden on their shoulders, because they have to play an important role in supporting these patients (9).  Personal hygiene, preparation of medicines, transfer to the dialysis center, help in eating meals, emotional and psychological support are the duties of the caregivers of these patients. These caregivers are usually "one of the family members or friends and acquaintances of the patient who must be in contact with the patient to take care of him (17). It is estimated that in England, 9 out of 10 people who take care of patients with physical or mental disabilities are their close relatives (18). In a study by Hasyali Oqlo[5] et al. (2010), almost half of the family caregivers were children of the patients (19).

Caregivers are the people who are most involved in the care of the patient and help them in order to adapt and manage the chronic disease (9, 20). Caring pressure is a state of physical, emotional and mental pressure that occurs due to long-term care of a person (21). enters and this issue is associated with many problems such as exhaustion, anxiety and depression for caregivers (16). Disruption of activities, recreation, social communication and disability and illness of the caregiver can be caused by this care pressure (7). Caregivers are particularly vulnerable to stress; Because the biological, social and psychological demands of the patient exceed their own needs (20).

Research has shown that family support is associated with the patient's successful adaptation to dialysis, his lack of burden feeling for family members and acceptance of dietary restrictions (20)