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Caring for older people at home

Ageing populations in industrialized countries where older people will live longer will require care to manage long-term conditions and disability to continue living in their own homes or communities. Care of older people at home is generally provided by their spouse or family and what it involves can vary in different parts of the world according to health and social care policies. Early studies have tended to focus on the burden and stress of caregiving. In this issue of JAN,del-Pino-Casado et al. (2011) report on a systematic review of quantitative studies of coping and subjective burden in carers of older relatives. They identified four coping strategies. Of note, were the positive associations between avoidance coping in carers at home of people with cognitive impairment (with or without dementia). Avoidance coping was ineffective and may mediate or moderate subjective burden and its outcomes or precede subjective burden. There were few studies on emotional coping and heterogeneous results for other coping strategies. This review makes an important contribution to the evidence on caregiving by family and older people.

The quality of care-giving relationships on carers and outcomes is also important. Shim et al. (2011) investigated the correlates of care relationship mutuality among family carers and people with Alzheimer and Parkinson disease. Those carers with lower perceived mutuality in their relationship had less care-giving experience, cared for people with lower functional ability, had more depressive symptoms and were more likely to terminate caring. Rest from caregiving and respite for carers are important (de la cuesta-Benjumea 2011). These studies and those included by del Pino-Casado et al. illustrate that there is more to research on carers than a narrow focus on coping and burden. The nature of relationships and duration of caring are ameliorated by feelings of mutuality and reciprocity and carer-support networks which can protect health status, quality of life and well-being (McMunn et al. 2009, Tolkacheva et al. 2011). Future research needs to focus on the full range of caregiving and related factors: people cared for, duration, relationships, gender, benefits, burden, employment, support and support networks using mixed methods, designs and longitudinal international studies.

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