Role Of Socioeconomics, Psychological State, and Attitude Toward Care Giving on Quality of Life of Dependent Patients’ Caregivers in the Northeast of Thailand

1. INTRODUCTION

The world is evolving toward a transitional society right now. The most prominent example of this pheno- menon has been seen in Thailand, which is anticipated to become “A completely aging society.” It has been in the top 10 Asian countries (Aged Society) since 2000, with 10% of the population being 60 years of age or older. By 2022, this percentage increased to 20% of the total population, and by 2037, it is expected to become a “super-aged society,” with 28% of the population being 60 years of age or older. Thailand's population aged sixty and over increased significantly from 2000 onwards. By 2022, twenty percent of the population was in this age bracket.It is expected to transform into a “super-aged society” by 2037, with 28% of its people being 60 years of age or older. The population of Thailand, which is 60 years of age and older, has increased significantly since 2000. The percentage of people in this age range by 2022 was 20%. Forecasts indicate that by 2037, 28% of Thais will be 60 years of age or older, making the country an aging society.

According to the Mahidol University Institute for Population and Social Research (2022), an increasing number of people worldwide are dealing with chronic health problems because of scientific developments and longer life expectancies. The emphasis on the family members and caregivers of dependent patients has grown because of this shift in the population. Conditions that last a year or more and require continuous medical care limit everyday activities, or both are referred to as chronic illnesses. The following ailments are categorized as chronic diseases by the Centers for Disease Control and Prevention (CDC): arthritis, type 2 diabetes, cancer, heart disease, stroke, and obesity [1].

The World Health Organization (WHO) has released recommendations intended to help caregivers in their efforts to manage the requirements of people with chronic illnesses properly. The organization recognizes the urgency with which the healthcare system must be mobilized. In order to improve the general well-being and quality of life of people with chronic health issues, caregivers should make sure they have the necessary tools and methods to offer them high-quality care and support [2].

People who are chronically sick frequently have one or more chronic diseases that restrict their abilities, leading to functional reliance. As a result, people with disabilities typically require greater help with everyday tasks2. According to data from Thailand's National Statistical Office, 417,000 individuals were dependent in 2016, making up 3.8% of the country's aged population overall. It is projected that 1,336,000 senior people—or 6.7% of the entire elderly population—will be unable to carry out everyday tasks in 2037 due to chronic illness (The Thailand National Statistical Office, 2016). These dependent people require caregivers to help with both their daily life activities and medical needs. Informal carers, also known as informal caregivers, are unpaid family members who help people who require assistance with daily living tasks, support, and care. Family caregivers are the backbone of systems for providing long-term care and are essential in helping patients who are reliant on them [3].

It is generally accepted that the complex and multifaceted elements impacting caregiver strain are indicators of the need for Long-Term Care (LTC). As of 2019, the National Health Commission Office in Thailand identified the caregiving setting, social context, expec- tations, and resources as important factors.Due to the fact that family caregivers' experiences along the course of the disease and the needs of their care vary, the perception of burden is subjective. The time, energy, and effort demands placed on caregivers are complex and involve a multitude of tasks. These put a lot of strain on the family members, who seem to be the major informal caregivers at the moment. Caregiver load, according to earlier research, is the term used to describe the emotional, psychological, and financial difficulties associated with providing care for a loved one—typically a family member who is ill. Negative health effects, such as higher levels of anxiety and depression, less healthy behaviour, and stress, are directly linked to caregiver load. According to Katsarou, Intas, and Pierrakos [4], caregivers who live with chronically sick individuals feel stress in their personal lives, social isolation, financial hardship, and intrinsic reward. Moreover, international studies demonstrate the inter- dependence between caregivers and the patients they support, as well as the impact that the patient’s level of functioning and course has on the caregiver’s mental health [5-8]. The duration of the care is also an important factor for the caregiver’s burden, i.e., the longer the care, the greater the caregiver’s burden and burnout; all of these indicate a poor quality of life for the patient's caregivers.

To manage these challenges, Thailand's Ministry of Public Health has promoted home-based care, training family members to assist with daily activities and health management. Despite this, caregivers often face fatigue, stress, physical health issues, and mental health challenges exacerbated by the lack of a designated primary caregiver. Social capital, including social networks and perceived support, plays a crucial role in improving health outcomes and quality of life. However, there is limited research on the quality of life of caregivers in Thailand, particularly in the Northeast region. This study aimed to determine the prevalence of quality of life among caregivers and its related factors to fill this gap and provide insights for developing strategies to enhance caregiver well-being and improve hospital-community cooperation.

2. METHODS

2.2. Sample Size Calculation and Sampling Method

The sample size for this study was calculated using a formula for sample size determination in multivariable analysis, specifically using multiple logistic regression statistics. The data was derived from a study on previous literature on stroke caregiver (Narissara Wongsombat, 2016). The variable of interest was the quality of life of caregivers for patients with dependency. Using the Hsieh, Bloch and Larson (1998). Formula for multivariate analysis in multiple logistic regression:

n= 600.978

The influence of the relationship between independent variables must be adjusted with the Variance Inflation Factor (VIF) value. The researcher selected ρ=0.55 as the minimum sample size for the study because it has a VIF value of 2.22, and the total sample size was 1,335.

Multistage sampling was used. Health regions were the primary sampling unit. Twenty provinces were randomly selected in the second step. Subsequently, district and subdistrict were randomly selected step by step to reach all of the samples.

3. RESULTS

As shown in Table 1, demographic and socioeconomic distribution among dependent patients’ caregivers in the northeastern region of Thailand among 1,335 dependent patients’ caregivers, the majority of the respondents were female (73.26%), 46.44% of them aged between 31–45 years, 54.76% had Primary /equivalent education, 97.53% were Buddhist, 57.83% married, 44.12% were farmers, 44.12% of their average family size was 5 – 6 persons (Tables 1 and 2).

The prevalence of QOL among caregivers of dependent patients. The examination of data from 1,335 caregivers of dependent patients in Thailand's Northeastern area revealed that 58.05 percent of caregivers of dependent patients had a low quality of life (Table 3).

4. DISCUSSION

The study identifies several critical factors that significantly affect the Quality Of Life (QOL) of caregivers for dependent patients in Northeastern Thailand. These factors include age, economic status, monthly caregiving expenses, caregiving knowledge level, caregiving perception level, and mental health status. Here is a detailed discussion of each factor (Tables 4-6):

It has been found that caregivers aged 45-59 of dependent patients have a higher likelihood of experiencing poor quality of life compared to other age groups. This finding is consistent with previous studies, both internationally and in Thailand, which have identified age as a significant predictor of caregiver burden. According to Adelman et al. (2014) [9], age is a primary factor in predicting caregiver burden and related distress. Nearly half of the caregivers are working-age individuals whose health deteriorates with age. This aligns with Orem's (1991) [10] concept that age indicates maturity or the ability to manage the environment, mental state, and perception. Age influences a person's self-care ability, which increases until adulthood and may decline in old age. Similarly, a study by Prachuntaen (2018) [11] found that age significantly affects the physical quality of life of elderly caregivers. Factors considered include physical strength, daily caregiving capacity, and significant bodily changes at a 0.05 statistical significance level. The most impactful factor on physical quality of life is daily caregiving capacity. This research indicates that age is a crucial determinant of caregiving ability, decision-making, and overall caregiving capacity, which diminishes with age. Consequently, as caregivers age, their caregiving burden increases, leading to a decline in quality of life and increased difficulty in caregiving.

People with higher incomes are generally able to plan their lives better and choose the four basic necessities of life to meet their needs with higher quality compared to those with lower incomes. Economic and social issues, as well as financial problems or poverty, contribute to stress and anxiety, which in turn affect the quality of life. Moreover, income is an indicator of financial stability. Caregivers must be prepared to cover medical expenses and related activities for dependents. Those with higher incomes who can adequately meet necessary expenses will have a better quality of life compared to caregivers with lower and insufficient incomes. This is consistent with the study by Suttasri et al., which found a moderate positive correlation between income and the quality of life of caregivers of chronic patients with dependencies [12].

The knowledge in caregiving reveals that caregivers with a low level of knowledge tend to have a poor quality of life. The knowledge of patient health care negatively impacts the health care of those who are dependent on the caregiver’s health. This can be explained by the fact that caregivers who provide excellent care for those with health dependency have gained caregiving experience from various media, other individuals, and access to health care services related to patient care. This aligns with Green's concept, which states that knowledge is a fundamental factor that motivates an individual's actions and can lead to personal satisfaction derived from learning experiences. This is also consistent with studies by Ahmed and Ghaith (2018) [13]. which found that internal factors affecting the performance of caregivers for dependent elderly are knowledge of elderly care. This knowledge promotes efficient caregiving, enhances the self-help capacity of those with depen- dencies, and maintains a good quality of life for caregivers.

Perception in caregiving studies shows that moderate perception is associated with a poorer quality of life. This is consistent with the study by Turnbull et al., [14] which examined factors related to caregiving for homebound elderly. They found that perceptions and attitudes towards elderly care were at a moderate level. Additionally, it aligns with the study by Purimat et al. [15], which investigated factors influencing the quality of life of caregivers for dependent elderly in Chanthaburi Province. They found that per- ceptions of elderly care could predict 58.1% of the quality of life of caregivers for dependent elderly. However, this contrasts with the study by Promtingkarn et al.(2019) [16], which found that a positive attitude had the greatest impact on elderly care in the health service system. This study shows that perception in caregiving reflects gratitude and repayment of kindness towards parents, spouses, and others. Haley et al. (2009) [17] found that caregivers feel valued when caring for patients. Factors influencing and predicting the quality of life of caregivers for dependent elderly include the attitude towards elderly care, with self-esteem being the most significant predictor. This can be explained by the fact that caregivers' self-worth and gratitude contribute to their sense of value, and if they are confident in their capabilities and have strong motivation, they can face various challenges and achieve a good quality of life. This is consistent with the study by Saban et al., which found that the perception of self-worth was the most significant predictor of caregivers' quality of life [18].

Mental health of caregivers: Studies have found that depression is associated with a poorer quality of life, which studied the factors predicting stress coping in caregivers of spinal cord injury patients. It found that participants who received correct caregiving information were better able to make appropriate problem-solving decisions, leading to more effective stress coping. Additionally, previous studies have found that caregiver role stress and caregiver attitudes significantly explain the variance in caregiver readiness for caring for dependent elderly. Considering the weight and direction of caregiver role stress, it was found that lower caregiver role stress is associated with higher readiness to care for dependent elderly. Caregiver role stress is the most influential factor in predicting caregiver readiness to care for dependent elderly, leading to mental health problems, depression, and poor quality of life [19].

The burden on primary caregivers is related to the progression of psychiatric disorders and mental health. Common mental health problems in caregivers include anxiety (95%) and depression (45%). Symptoms of severe mental conditions (post-traumatic stress disorder) and psychological distress include feelings of helplessness, uncertainty, hopelessness, loss of dignity, guilt, and impaired quality of life [20].

CONCLUSION

The findings from this study have important implications for healthcare practice and policy. Interventions aimed at improving the QOL of caregivers should focus on:

1. Providing financial support or subsidies to alleviate the economic burden of caregiving.

2. Offering training and educational programs to enhance caregiving knowledge and skills.

3. Promoting positive perceptions of caregiving through counseling and support groups.

4. Ensuring access to mental health services to address and prevent depression among caregivers.

By addressing these factors, it is possible to improve the overall well-being and QOL of caregivers, which in turn can positively impact the care they provide to dependent patients. Future research should continue to understand the impact of diversity on caregivers’ needs for support. It should also continue to develop and evaluate alternative models of care. Family-centered care may be the way forward to optimize care systems’ abilities to meet the heterogeneous needs of family caregivers. Ultimately, caregivers must be supported as they are essential to the well-being of those they care for and to the QOL of them.

REFERENCES