الفهرس 
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Abstract
Demographic changes and the revolution in medicine are followed by changes in morbidity and mortality of the population, which is evident in the increasing prevalence of chronic diseases among elderly and eventually leads to impaired functional capacity of older adults making them at a great risk for need of a permanent care to perform their basic demands.
Studying family members who render care for dependent elderly revealed that they are prone to negative effects as caregiver burden and affection of their HRQoL. The effect of caring is found to be associated with different factors as economic status, education level and clinic situation of both caregivers and care-recipients.
Furthermore, results of this research should awaken society and government regarding the pressing needs to implement policies to decrease level of dependence, relieve caregivers’ burden and improve their HRQoL and strengthen their coping mechanisms which need to be studied in next research. Additional researches are needed to investigate the needs, obstacles, and expectations of caregivers to undertake the most cost effective interventions.
Recommendations
1. Early detection and proper management of chronic diseases which are the main cause of functional disability especially among elderly.
2. Health insurance agencies should compensate for appropriate care, provided by caregivers, which in most cases is performed using their personal time and resources.
3. Great attention should be given to family caregivers specially those caring for elderly to identify those at risk to develop burden to detect burden early and take a steps to stop its progression.
4. Develop guidelines and teaching groups to provide caregivers with knowledge and skills regarding care for dependent elderly and how to avoid stress.
5. Providing psychological counseling or psychiatric intervention for stress management. For example, forming support groups, providing home visits, online and telephone hot lines for providing support and information.
6. Work policies to provide some administrative support for working caregivers. For example, to encourage the workplace to adopt telecommuting that enable caregivers to work at home while caring for their family member; time flexibility, extended time-off as possible and if feasible.
7. Providing good community services such as respite care and adult day care centers to help family caregivers in their role to alleviate burden.
Summary
In the 21st century, the whole world witness a state of population aging, in where there is a shift in the distribution of a country’s population towards older ages. This is a result of both longer life expectancy and declining fertility rates. By 2010, older adults aged 60 years and above reached 1 billion and they are expected to double reaching 2.1 billion by 2050.
LMIC are experiencing the greatest share of the population transition. By 2050, number of elderly is expected to increase by more than two folds in the LMIC which are expected to harbor 80% of elderly aged 60 years or older. Talking about Egypt, the proportion of elderly is expected to increase from 8% in 2020 to 14% in 2050.
Medical and technological improvements and developments achieved a great progress in treating acute conditions, controlling chronic conditions and extending the life span of elderly. This aids in increasing prevalence of chronic diseases and multi-morbidity among elderly to the extent that 85% of elderly has one chronic disease and 60% has two or more chronic diseases.
Chronic diseases are the greatest determinant of functional capacity of elderly. Functional capacity is assessed by the ability to perform ADLs independently. Inability to perform one or more of the ADLs make the elderly dependent and need daily help to live.
With the increase in disability prevalence among elderly, the number of family caregivers is greatly increasing. Family/informal caregivers are those who give unpaid care for the dependent person based on a complex social relation between them. In the USA, there are 56.4 million family caregivers in 2021.
Informal caregivers provide the majority of long-term care for older adults. They are responsible for a variety of tasks, ranging from household chores to personal care and complex medical regimens.
It is the family of dependent elderly who takes the responsibility of the caregiving in a process which is described as long, painful and distressing journey because of the persistent physically demanding and financially stressing caregiving tasks and the emotional toll of caring for a loved one with debilitating illness.
Family caregivers are considered as forgotten patients. They are at risk for higher mortality rates, chronic diseases, poor sleep quality, caregiver burden and impaired HRQoL. Caregiver burden is a multidimensional differently perceived experience of physical, psychological, social and financial demands of caregivers.
In the research between our hands, we studied 1499 elderly 60 years or older with chronic diseases and their family caregivers attending outpatient and inpatient wards of Sohag University Hospitals in a cross sectional method. Caregivers of dependent elderly were studied to identify determinants of burden and HRQoL using validated Arabic versions of ZBI and SF-36 respectively.
To determine functional disability among elderly, Katz index of independence in activities of daily living was used. Caregivers of dependent elderly were studied to identify determinants of burden and HRQoL using validated Arabic versions of ZBI and SF-36 respectively.
The results were as follow:
Among the studied elderly, it was found that 37% (554 cases) of the studied elderly with chronic diseases are dependent.
The mean perceived burden score reported by the caregivers is 40±18.64. Those with mild to moderate burden represented 31.6%, followed by those with moderate to severe burden represented 30.7%. At last, those with severe burden represented 17.5%.
Results of multiple linear regression tests showed that low income elderly, elderly with mixed diseases, those with severe dependence and those with more chronic diseases their caregivers perceived higher burden scores with significant differences. Moreover, in law caregivers, those living with elderly in the same home and those rendering care for more hours reported higher burden scores with significant differences.
Regarding HRQoL, the studied caregivers reported higher scores in the physical component summary (mean ± SD: 48.1±12.6) compared to mental component summary (mean ± SD: 34.9±13.1). There are significant negative correlation between burden score and all HRQoL domains.
Moreover, HRQoL scores were significantly determined by socio-demographic and clinical characteristics of elderly as income, functional ability, number and duration of chronic diseases. In addition, HRQoL scores were significantly higher among male, educated, single caregivers, those with no chronic illnesses, caregivers having other assistant ones and those spending less daily hours in care.
Depending upon our research, we recommend to manage chronic diseases of elderly properly to decrease level of dependence. In addition, we recommend to give a hand to family caregivers by improving their economic level, providing more suitable work conditions, providing information and education programs about caregiving, providing psychological support programs and follow them frequently to catch stressed ones and to try to solve their problems early. This should be done to guarantee to keep their effective role in the society as community members before being caregivers and not to transform them to diseased ones.