Jorge Garcés

The informal caregiver's burden of dependent people: Theory and empirical review

This paper reviews the main theories and results of the existing research to date about the concept of the informal caregivers burden. The explanation of the burden concept, the theoretical approaches which attempt to explain it, the variables which have emerged in the investigation, the predictors of its appearance, as well as the intervention programs developed to relieve burden, allow us to approach the appropriate solutions to deal with the current social and political reality of this problem. In this sense, the psycho-educational intervention programs framed within the respite services jointly with the knowledge of the determining variables of the burden can comprise the first optimal approach in order to effectively deal with the burden problem of the informal caregivers of dependent senior citizens.

Towards a new welfare state: the social sustainability principle and health care strategies.

In this paper we propose a social and health care model that offers alternatives to three problems arising in converging European welfare states, particularly in the southern nations: the rise in demand for services and features linked to the ageing process, the increase in dependency and the crisis of informal support. Development of the principles of social sustainability implies re-formulation of the regulatory, care, economic, administrative, cultural, and axiological framework enabling a response to the needs of long term care without compromising the welfare of future generations. Together with this principle, quality of life elevated to a subjective right directs attention towards the sphere closest to citizens, eliminating all barriers, which hamper exercise of this right. All of the above produces economic and social costs which must be accepted from a viewpoint of social co-responsibility, which brings with it the supply of welfare individually, without detriment to the exercise of state responsibility in guaranteeing a social protection system of a universal nature.

A review of programs to alleviate the burden of informal caregivers of dependent persons

The review of interventions currently available to alleviate the burden of informal caregivers of dependent persons has both social and political relevance considering the increasing number of elderly dependent persons. Respite services and programs for psycho-social intervention are the main methods of dealing with this burden. Study of the main research carried out to date on such interventions enables us to organize more efficient services, especially considering the enactment of the Law on Dependence in Spain in January 2007 and the need for other European and international governments to establish systems to meet the needs of the growing dependent population.

La teoría del apoyo social y sus implicaciones para el ajuste psicosocial de los enfermos oncológicos

Desde una perspectiva funcionalista los humanos, en su infancia, pronto des-cubren que deben aprender a ser efectivos con la avalancha estimular de su me-dio concreto; al mover sus miembros se dan cuenta de que pueden hacerlo ysiguen repitiendo los movimientos cual reminiscencia, segun diria Allport (1924),del reflejo circular. Desde este preciso instante podria estar ya haciendo posola futura auto-estima del individuo adulto, retomando la corriente de WilliamJames, para quien la autoestima era una funcion de los exitos que pretendemoso a los que aspiramos.Posteriormente, esa necesidad de efectividad y competencia con el medioambiente —para una distincion de ambos terminos vease White (1959)— quese manifiesta en los primeros actos del recien nacido, se traslada no a las cosassino a las personas. El individuo humano descubre que el sentimiento de con-trolabilidad de su medio ambiente le vendra dado en base a su eficacia en lasrelaciones interpersonales con los demas. Y no solo eso, sino que la misma efi-cacia en sus tareas puede verse alterada por la sola presencia de otras personas.Al fin y a la postre este fue el primer experimento de laboratorio en PsicologiaSocial realizado en 1889 por Triplett. Zajonc (1965) y las nuevas aportacionesa su hipotesis de la «mera presencia» realizadas entre otros por Guerin (1986),seguiria con este tipo de trabajos al proponer que la «mera presencia» de colate-rales aumentaba el nivel de «drive» del sujeto y llevaba a la facilitacion social,si bien variables situaciones o de la tarea modulaban tal facilitacion.Definitivamente, la persona humana sigue mostrando esa necesidad secun-daria en terminos de Maslow de «hacerse con los demas», de comunicarse conellos, de «tenerlos» para que nos sostengan y de sentirse queridos. En otras pa-labras, necesitamos tener apoyo social porque en funcion de la amplitud del mis-mo estara el bienestar social e individual del sujeto humano. Intentaremosdesarrollar teoricamente este concepto.

Case management method applied to older adults in the primary care centres in Burjassot (Valencian Region, Spain)

This research determines if the case management for health primary care means changes in: (a) frequency of use of social and health care resources, (b) number of patients visiting a doctor or social worker in the primary care centre, and visits that these professionals receive, (c) number of drugs consumed, (d) urgent hospital admittances which did not need significant intervention and (e) patients’ and caregivers’ satisfaction towards the social and health care resources received. The data were gathered with a questionnaire elaborated by the Administration and supervised by researchers. One hundred and fifty-two older dependent patients receiving home care in 2004, in a health department of the Valencia Region (Spain) collaborated. Results show: (a) Increase in the use of combined health and social resources in the intervention group; (b) number of patients visiting a practitioner or a social worker is lower in the intervention group, with a significant difference in both cases; (c) 33.3% of the patients in the intervention group versus 60.0% in the control group were admitted by the emergency room service for treatment that did not require surgery, but the difference is not significant; (d) 55.5% of these patients were very much satisfied with the care received and the benefits of the health care resources they had used versus 29.4% in the control group, showing a significant difference, 56.5% of the informal caregivers of patients in the intervention group were satisfied with the health care resources received by their family members, against 31.9% in control group.

Towards a Simulator of Integrated Long-term Care Systems for Elderly People

In this paper, we propose a simulator for integrated long-term care systems using as a starting point a holistic model of care systems for people that need long term care, the Sustainable Socio-Health Model (SSHM). The implementation of the simulator on the Jason multi-agent platform allows the tool to include the human interactions, preferences, and social abilities that take place between elderly people and the staff of healthcare systems (doctors, social workers and nurses). In addition, the use of this multi-agent platform provides the required scalability for simulating population sizes of different orders of magnitude. The paper shows the model to be implemented in the simulator, the simulator architecture, the types of agents considered, their functionality and the information flow among them. Additionally, it shows the validation of the simulator with real data obtained from empirical studies conducted by the Polibienestar Research Institute in Spain, as well as a performance evaluation that sketches the performance of the simulator when using the centralized Jason infrastructure under different population sizes. Effectively, simulation can provide policy makers with the option of going into a decision theatre and virtually knowing the consequences of different policies prior to determining the real policy to be adopted.

Converging Methods to Link Social and Health Care Systems and Informal Care — Confronting Nordic and Mediterranean Approaches

The substantial growth in health expenditures in European countries over recent decades has brought about serious problems for health care management (Burau, 2007; Dixon and Mossialos, 2002; Thomson et al., 2009) and finance (Directorate-General for Economic and Financial Affairs, 2002a, b; Economist Intelligence Unit, 2011), especially in Mediterranean countries. In 2008, European Union (EU) countries devoted 8.3 per cent of their GDP on average (Spain 9 per cent and Finland 8.4 per cent) to health spending, which was up from 7.3 per cent in 1998 (OECD, 2010). This situation can be explained by the concomitance of demographic, social and cultural changes in Europe (Jackson and Howe, 2003; Lee et al., 2010) as well as by the principles that have guided health care policy over the past 40 years. In Spain, for instance, one of the reasons for the sharp increase in health expenditure — with a total outlay on health that increased from 5.3 per cent of GDP in 1980 to 9.2 per cent in 2009 — is the increasingly arbitrary distinction made between health and social care systems and the lack of long-term care (LTC) services, which is typical not only for Mediterranean welfare systems (Garcia-Armesto et al., 2010; OECD, 2011).

Squaring the welfare circle and government ideology: Greece and Spain in the 1990s

This article examines the “squaring the welfare circle” thesis and its usefulness to our understanding of welfare developments in Greece and Spain in the 1990s. The welfare state in both Greece and Spain was expanded considerably in the early 1980s by the newly elected socialist governments, only to hit the buffers of diminishing resources and rising demands in the late 1980s as well as the hostile neo-liberal welfare ideology. The process of welfare expansion was halted in the 1990s, labour market deregulation was encouraged and containment of welfare expenditure became the dominant aim of government policies. This article concentrates on the actual policies of governments in the 1990s rather than on the rhetoric of political parties. It concludes that governments of both the Left and the Right in both countries attempted to “square the welfare circle” mainly through reductions in the supply of welfare. This general conclusion is country-specific and may not apply to other countries involved in welfare restructuring. While recognizing the significance of institutional factors to welfare reform, the article concentrates on the outcomes of reforms rather than on the political process leading to them.

Perspectivas actuales en Psicología de la Religión

El objetivo del trabajo radica en llevar a cabo una revision sobre el estado actual de las investigaciones rejerentes a los aspectos psicosociales de la religion.Se comienza planteando los problema...

Aplicación de The Community Assessment Risk Screen en centros de atención primaria del Sistema Sanitario Valenciano

Resumen Objetivo Aplicar la herramienta The Community Assessment Risk Screen (CARS) para detectar pacientes mayores con riesgo de reingreso hospitalario y estudiar la viabilidad de su inclusión en los sistemas de información sanitaria. Diseño Estudio de cohortes retrospectivo. Emplazamiento Departamentos de salud 6, 10 y 11 de la Comunidad Valenciana. Participantes Pacientes de 65 años o más atendidos en diciembre de 2008 en 6 centros de salud. La muestra fue de 500 pacientes (error muestral = ± 4,37%, fracción de muestreo = 1/307). Mediciones Instrumento CARS formado por 3 ítems: diagnósticos (enfermedades cardiacas, diabetes, infarto de miocardio, ictus, EPOC, cáncer), número de fármacos prescritos e ingresos hospitalarios o visitas a urgencias en los 6 meses previos. Los datos procedían de SIA-Abucasis, GAIA y CMBD, y fueron contrastados con profesionales de atención primaria. La variable de resultado fue el ingreso durante 2009. Resultados Los niveles de riesgo del CARS están relacionados con el futuro reingreso (p < 0,001). El valor de la sensibilidad y la especificidad es de 0,64, el instrumento identifica mejor a los pacientes con baja probabilidad de ser hospitalizados en el futuro (valor predictivo negativo = 0,91; eficacia diagnóstica = 0,67), pero tiene un valor predictivo positivo del 0,24. Conclusiones El CARS original no identifica adecuadamente a la población con alto riesgo de reingreso hospitalario. No obstante, si fuese revisado y mejora su valor predictivo positivo, podría ser incorporado en los sistemas informáticos de atención primaria, siendo útil en el cribado y la segmentación inicial de la población de pacientes crónicos con riesgo de rehospitalización.OBJECTIVE Application of The Community Assessment Risk Screen (CARS) tool for detection of chronic elderly patients at risk of hospital readmission and the viability study for its inclusion in health information systems. DESIGN Retrospective cohort study. LOCATION Health Departments 6, 10, and 11 from the Valencia Community. PARTICIPANTS Patients of 65 and over seen in 6 Primary Care centres in December 2008. The sample consisted of 500 patients (sampling error=±4.37%, sampling fraction=1/307). VARIABLES The CARS tools includes 3items: Diagnostics (heart diseases, diabetes, myocardial infarction, stroke, COPD, cancer), number of prescribed drugs and hospital admissions or emergency room visits in the previous 6months. The data came from SIA-Abucasis, GAIA and MDS, and were compared by Primary Care professionals. The end-point was hospital admission in 2009. RESULTS CARS risk levels are related to future readmission (P<.001). The value of sensitivity and specificity is 0.64; the tool accurately identifies patients with low probability of being hospitalized in the future (negative predictive value=0.91, diagnostic efficacy=0.67), but has a positive predictive value of 0.24. CONCLUSIONS CARS does not properly identify the population at high risk of hospital readmission. However, if it could be revised and the positive predictive value improved, it could be incorporated into the Primary Care computer systems and be useful in the initial screening and grouping of chronic patients at risk of hospital readmission.