Mental Health and Carers

Abstract

Current demographic changes, with ageing societies, pose new challenges, mainly due to the increasing prevalence of chronic conditions including dementia, chronic mental disease, intellectual disability as well as comorbid physical illness. All of these conditions are correlated with negative outcomes such as the burden on families and caregivers, a worse quality of life and early elderly institutionalization, with inevitably more morbidity and mortality. Health care systems are not prepared to cope with the diversity and uniqueness of these complex combinations of diseases in the elderly and their care needs in an effective way, where the role of families and carers cannot be ignored when finding the solution to these problems. Families and carers provide an important and necessary force and form part of the mental health systems worldwide, reducing the need for formal care and the burden on the healthcare and the social systems. The present chapter aims to be a contribution to acknowledge of the importance of all these carers of chronic disease patients, pinpointing some of the strategies to reduce elderly negative consequences, as well as an approach to fundamental interventions to give support to these families and caregivers in order to promote global mental health.

Take Away Messages

Carers form a highly mixed group, caring for all manner of disabilities. The challenges imposed by the ageing population with dementia , chronic mental disease, intellectual disability as well as comorbid physical illnesses comprising different specificities must be addressed with new policies with effective social and health interventions in order to promote mental health in the elderly , their carers and families.

In particular, some interventions, directed to both caregivers and elderly, have been proven to be effective (Sörensen et al. 2006; Pinquart and Sörensen 2007):

• Consultation or Case Management (including advice, information and referrals) (Roberts et al. 1999)

• Psychotherapy (individual or group-based, mostly cognitive-behavioural) (Vernooij-Dassen et al. 2011; Chien et al. 2011)

• Family Therapy (Benbow and Sharman 2014)

• Psychoeducational Programmes (structured information, behaviour and stress management) (Bourgeois et al. 2002; Fernandes 2012; Jensen et al. 2013)

• Support Groups (dealing with personal feelings, emotions and social isolation) (Gonyea and Silverstein 1991; Brodaty et al. 2003)

• Respite Offers (relief of the carer in day-care, home or institutions) (Gottlieb and Johnson 2000)

• Training for the patients (to improve social and everyday competence) (Quayhagen and Quayhagen 1989)

• Pharmacotherapy for the patients (particularly for behavioural problems and stabilization of cognitive impairment) and for carers (e.g. for depression, anxiety and insomnia) (Lingler et al. 2005; Sleath et al. 2005)

• Multicomponent Interventions (combining education, support and respite) (Dröes et al. 2004)

• Others such as patients and family associations, new technologies,¹ telephone support and some approaches such as yoga (Beauchamp et al. 2005; Bank et al. 2006; Waelde et al. 2004).

In the near future, and supported by the development of new heath care polices, families, carers , clinicians and researchers must address their actions to the development of more effective and preventive interventions (Sörensen et al. 2006). Early diagnosis and customized interventions based on a timely needs assessment (Orrell and Hancock 2004; Sörensen et al. 2006) will be much more cost-effective than the usual solution based only on institutionalization, which has proved to be an adverse and expensive outcome for elderly , families, carers and community.