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|Year : 2014 | Volume
| Issue : 4 | Page : 355-356
Family caregiving in India: Importance of need-based support and intervention in acute care settings
Department of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samasthana (SVYASA), Bengaluru, Karnataka, India
|Date of Web Publication||5-Nov-2014|
Dr. A Jagannathan
Department of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samasthana (SVYASA), Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jagannathan A. Family caregiving in India: Importance of need-based support and intervention in acute care settings. J Postgrad Med 2014;60:355-6
Bhalla et al., in this issue, have detailed the profile and tasks undertaken by family caregivers in India and indicated the potential support required by them in taking care of their relatives in an acute care setting.  As rightly pointed out by the authors, the aspect of caregiving in India by the family members (informal caregiving) is unique as compared to the developed world, where caregiving is most often equivalent to formal or paid care. It is noted that caregivers who were in "high contact" with the patients with mental illness in their daily life, often face the highest burden.  In case of family caregivers the aspect of great emotional involvement along with the physical responsibility of caretaking, adds to the burden of care. In this aspect though, as health professionals, we should strongly advocate for the provision of support or intervention to family caregivers; we should also be careful in stressing the importance of need-based support or intervention to help ease their burden.
Burden can be defined as the extent to which caregivers perceive their emotional and physical health, social life and financial status as being affected as a result of caring for their relative.  It has two components: 1. Objective burden which refers to the quantifiable challenges faced by the family members in everyday life such as financial costs, loss of free time and altered social relationships and 2. Subjective burden refers to the abstract or emotional costs faced by the family as a result of the patient's illness. 
Researchers have opined that objective burden can be effectively handled by improving the perceived social support of the family caregivers,  whereas subjective burden may require individualized or family psychosocial intervention. A recently published study by Jagannathan et al depicted that perceived social support had a significant inverse correlation with total burden score-indicating that in acute care settings, in addition to symptom reduction and disability limitation, focus should be on enhancing social support in order to reduce caregiver burden among family caregivers. 
The needs of caregivers also vary across cultures and hence to develop any intervention or provide support to cater to caregivers, an in-depth assessment in a cultural context is essential.  In the Indian setting, most of the caregivers do not consider the caregiving process to be burdensome or stressful (as they considered it their responsibility); hence, studies have opined that interventions or support will be effective only for those caregivers who express a felt need for these interventions.  Further, the resilience of Indian caregivers could be higher than reported in western studies. A reason for this is the strong family and value system present in the country which helps the patient and caregivers cope with the the burden effectively. By providing interventions to all caregivers, we may be falsely assuming that they all are equally burdened by the caretaking process and have poor resilience.
In keeping with this argument, it is necessary to analyze whether it is early to introduce any psychosocial intervention to family caregivers admitted in a tertiary hospital in acute care settings to relieve their burden. Most caregivers in this situation are preoccupied with the recovery of their patient and many a times have to sacrifice their personal time to take care of their patient. In such a scenario, asking them to be part of an intervention could be as good as not providing any intervention or possibly adding to their burden, as they may not have the attitude or inclination to understand the procedure or benefits of the intervention being taught to them. Maybe for best results, any intervention for caregivers requires to be given either a. When their patient is out of the acute phase of the illness or b. As requested by the caregiver. Health professionals could alternatively help in improving the perceived social support of the family caregivers to help them deal with the burden of care, in such acute care scenarios.
| :: References|| |
Bhalla A, Suri V, Kaur P, Kaur S. Involvement of the family members in caring of patients in acute care setting. J Postgrad Med 2014;60:382-5.
Winefield HR, Harvey EJ. Needs of family caregivers in chronic schizophrenia. Schizophr Bull 1994;20:557-66.
Zarit SH, Todd PA, Zarit JM. Subjective burden of husbands and wives as caregivers: A longitudinal study. Gerontologist 1986;26:260-6.
Pillay U, Rao K. The structure and function of social support in relation to help-seeking behavior. Fam Ther 2002;29:153-67.
Jagannathan A, Thirthalli J, Hamza A, Nagendra HR, Gangadhar BN. Predictors of family caregiver burden in schizophrenia: Study from an in-patient tertiary care hospital in India. Asian J Psychiatr 2014;8:94-8.
Jagannathan A, Thirthalli J, Hamza A, Hariprasad VR, Nagendra HR, Gangadhar BN. A qualitative study on the needs of caregivers of inpatients with schizophrenia in India. Int J Soc Psychiatry 2011;57:180-94.
Jagannathan A, Hamza A, Thirthalli J, Nagendra HR, Kare M, Yadav M, et al.
Efficacy of yoga and psychosocial training programme for caregivers of persons with schizophrenia. National Journal of Professional Social Work 2012;13:3-15.
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