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Rapid Responses: Rapid Responses published:
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Disabled stroke survivors, training of care givers and mood disorders!
- Dr. Naseem A. Qureshi (13 May 2004)
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The Carer's point of view
- Heather E Thelwall (17 May 2004)
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Caregivers murder the frail elderly in Japan
- Takashi Ohrui, Mei He, Naoki Tomita, and Hidetada Sasaki (4 June 2004)
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Dr. Naseem A. Qureshi, Medical Director [A], Director, CME&R Buraidah Mental Health Hospital, Postcode.2292, Saudi Arabia
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Dear Sir: Stroke cripples the patient, who needs almost all types of helps as editorialised by Hankey [1] in response to two empirical studies [2,3] by a group of distingushed researchers. Overall revealed findings are that adequately trained care givers-family members or substitutes-of disabled stroke survivors provide them better services and all types of supports and in doing so all three integrated partners-stroke patients, care givers and health managers benfit, simply from all perspectives including emotional, financial and service delivery. Therefore, care givers of stroke survivors should receive proper training in order to provide more confidently the cost-effective services to them. There is an emerging, research evidence that stroke patients usually develop moderate to severe mood disturbances mostly depression. Some of them may also manifest signs of mania. In addition, a proportion of stroke patients are reported to be suffering from depression before they are struck by cerebrovascular accident. From psychiatric perspectives, both comorbid conditions require proper psychiatric assessment, diagnosis and appropriate intervention in order to improve the overall outcome of patients with stroke. References: 1. Graeme J Hankey. Informal care giving for disabled stroke survivors. BMJ 2004; 328: 1085-1086 2. Lalit Kalra, Andrew Evans, Inigo Perez, Anne Melbourn, Anita Patel, Martin Knapp, and Nora Donaldson. Training carers of stroke patients: randomised controlled trial. BMJ 2004 328: 1099-0. 3. Anita Patel, Martin Knapp, Andrew Evans, Inigo Perez, and Lalit Kalra. Training care givers of stroke patients: economic evaluation. BMJ 2004 328: 1102-0. Competing interests: From daily multiple services perspective, we effectively trained mothers of handicapped children and this study was published in Saudi Med J 1996; 17: 333-338. |
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Heather E Thelwall, carer home BS8 2SH
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How reassuring that the un(der)paid role of the carer has received some attention in the BMJ. Following my husband's stroke in September 2001, I have been plunged into the bewildering world where you can go neither forwards or backwards - no cure, no carefree pre-stroke life. I am struck that the push towards "Care in the community", which in Bristol means the restructuring of stroke services with the closure of the old General Hospital really means "Care by a Carer" - with unspecified and inadequate support. In any civilised society worthy of that name, relatives and friends accept that they will play their part in the care of those close to them as circumstances dictate. But the carer may well find themselves doing things that "professionals" are forbidden to do - like lifting and washing soiled clothing. Does this mean they are immune from consequent dangers and do not deserve protection? The best training for Carers I have found is to go to the OT, physio and speech sessions, be interested and learn from the experts - and I have found all the therapists more than happy to explain and discuss. But to do so means a full time caring role, and that is a very tough decision. Competing interests: None declared |
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Takashi Ohrui, associate professor Tohoku University School of Medicine, 1-1Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan, Mei He, Naoki Tomita, and Hidetada Sasaki
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EDITOR-Because of the prevalence and seriousness of the problem of caregiver burden and stress, several attempts have been made to develop strategies of reducing the burden of informal care giving for frail elderly people (1, 2). Japan launched a long-term care (LTC) insurance system in a courageous attempt to reduce burden of care for frail older people in April 2000 (3). To assess the efficacy of this new insurance system, we investigated the prevalence of caregivers murdering frail older recipients because of exhaustion from the care burden before and after the inception of this system. Eligible recipients were disabled persons who were aged 40 years and older receiving aid from the LTC insurance system, living with their caregivers in their own home, and were killed by their caregivers because of exhaustion associated with the care burden (confirmed by police records). Cases were excluded if caregivers were drug abusers or had psychological disorders. We surveyed and found 131 eligible cases between January 1997 to December 2003, using a computerized surveillance system (http://www.asahi.com/) provided by a major Japanese Newspaper, the Asahi Shinbun. The mean age of the caregivers was 66.3 } 13.4 (SD) years and that of the recipients was 72.5 } 11.9 years. The most frequent cases were murder between a son or daughter and their parents (50%), followed by that of between a husband and wife (47%) and others (3%). The annual prevalence of caregiver murder was 13, 12, 17, 17, 21, 26 and 25 cases per year in 1997, 1998, 1999, 2000, 2001, 2002 and 2003, respectively. The recipients' principal physical conditions were dementia (57%), bedridden condition due to stroke with or without dementia (40%) and others (3%). The murders were by strangulation (68%), stabbing (13%), striking (9%) and others (10%). We demonstrated that the prevalence of murder by exhausted caregivers to the frail older recipients was increasing after the inception of the new LTC insurance system in 2000. Although services are allocated based on the Government-Certified Disability Index (4, 5), recent reports describe that the needs of demented elderly are often underestimated under the current system (4, 5). This system should be urgently improved in order to lighten the caregiver's burden, especially in caring for demented people. References 1 Hankey GJ. Informal care giving for disabled stroke survivors. BMJ 2004; 328:1085-6. (8 May.) 2 Kalra L, Evans A, Perez I, Melbourn A, Patel A, Knapp M, Donaldson N. Training care givers of stroke patients: randomized controlled trial. BMJ 2004;328:1099-101. (8 May.) 3 Arai Y. Japanfs new long-term care insurance. Lancet 2001;357:1713. 4 Campbell JC, Ikegami N. Long-term care insurance comes to Japan: a major departure for Japan, this new program aims to be a comprehensive solution to the problem of caring for frail older people. Health Aff 2000;19: 26-38. 5 Arai Y, Zarit SH, Kumamoto K, Takeda A. Are there inequities in the assessment of dementia under Japanfs LTC insurance system? Int J Geriatr Psychiatry 2003;18:346-52. Competing interests: None declared |
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