Structural-functional aspects of caring for elders in the home environment.

Abstract

The purpose of this study was to identify variables that facilitate lay caregivers in maintaining dependent elders in the home setting. Specifically, this study: (1) tested a deduced theory designed to explain home maintenance of a dependent elder; (2) examined the relationship between the following variables: Seriousness of an Elder's Illness, Caregiver Overload, Quality of Care, Learning State, Caregivers Maintenance Ability, Acceptance of the Maintenance Role and the Caregiver's Perception of Power; and (3) evaluated the reliability and validity of the instruments that measured the proposed variables. A descriptive correlational design with causal modeling methodology was used to assess a five stage theory. The convenience sample was comprised of 70 English speaking caregivers providing a minimum of five hours of direct care to a dependent elder in the home setting. Reliability and validity of the instruments used to evaluate the theoretical concepts were assessed by Cronbach's alpha, factor analysis and predictive model testing. Multiple regression statistics were used to evaluate the theory and residual analysis was used to assess violations of statistical and causal modeling assumptions. The findings supported two of the predicted relationships: Seriousness of Illness had a direct and positive relationship with Caregiver Overload (B =.60, R² =.35) and Learning State had a direct and positive influence on Acceptance of the Maintenance Role (B =.36, R² =.18). As the disabilities of the dependent elder became more acute, the caregivers' feelings of being overloaded with the burden of the caregiving responsibilities increased. However, when the caregivers had a positive perception of their abilities to implement prescribed health care instruction as well as felt positively about their caregiving role (Learning State), they spent a greater amount of time giving direct care to the dependent elder (Acceptance of Maintenance Role). Identification of learning needs as they relate to the caregivers' ability to understand and implement health care instruction as well as feel positively about their role, can assist nurses in developing appropriate teaching interventions. The expected outcome of these interventions is direct care provided by the caregiver to the dependent elder.