Grupos de cuidadores familiares de idosos frágeis: porta aberta para o serviço, janela para o cuidado

Abstract

The Brazilian population is aging in a fast and heterogeneous manner, marked by the prevalence of chronic diseases, which makes elderly care not only a matter of Public Health but also an object of specific public politics. Care refers to the way of acting, to the attention, responsibility, citizenship and meeting the needs of the cared-for person, with guarantee of a worthy care, receptiveness and bonding, respecting the singularity of each individual. In the case of a fragile elderly, the functional disability determines the need of a caregiver, usually a female family person, wife or daughter, who takes care lonely, with no help. Despite the close relationship between the caregiver and the staff responsible for the elderlys care at the health services, attention is limited to the elderly, whereas the caregiver is disregarded. The lack of technical and emotional support to the familial caregiver reflects on his/her life and health and compromises the quality of the care given, as well as enables the aggravation of diseases that leads to the elderlys institutionalization. Thus, the government of Belo Horizonte implanted in 2009 the Qualification of Care for the Fragile Elderly Project (QCFEP), aimed at enabling professionals on aging and care matters, besides the formation of caregiver groups at the citys Basic Health Units (BHU) for caregiver support. The group work methodology was chosen because it makes the listening easier, enables the feeling of inclusion, valorization, belonging and the exchange of information between the participants. Between the years 2009 and 2013, 4,305 professionals were enabled and 121 groups were formed in 104 of the 147 BHUs of Belo Horizonte. This study aimed at acknowledging the perception of the fragile elderlys familial caregiver on care and his/her participation on the groups. This was an exploratory descriptive study, with a quantitative and qualitative approach. In 2013, 6 groups were formed, with 91 individuals, of which 37 were familial caregivers who met the studys inclusion criteria. On the quantitative stage, all the selected caregivers answered a questionnaire, which allowed the definition of the sociodemographic profile of the group. On the second stage, individual interviews were performed in order to acknowledge the perception of the familial caregivers on care and their participation on the groups. A total of 14 caregivers were selected, considering the multiple voices of gender, age, degree of relationship with the cared person, place of residence and time of care. The sample size was defined by the saturation criteria. The results showed that the caregivers profile is similar to that shown on other studies, that is, a family member, usually a woman (94.6%), with average age of 59 years (± 13 years). The family income varied between 2 and 3 minimum salaries (51.4%); 75.7% of the caregivers had their own income, which came from retirement. More than 75% of them lived with the elderly, at their own house with 2 to 5 people or more (94.5%) or close to the elderly. The family member cares for the elderly for 24 hours per day (45.9%), for several years, abandoning or reducing work, social and leisure activities, due to lack of help (32.4%). A total of 97.3% declared not having received any type of training for the care. As to social and leisure activities, 62.2% do not go to public places or community activities because they feel overloaded, they are not interested or because they dont have anyone to replace them in the care of the elderly. Caring means attending to the elderly persons needs and expresses reciprocity of attention at the family scope. However, it brings ambivalent feelings, such as well-being, a sense of accomplished duty, satisfaction, fatigue, love, impatience, and obligation. The caregivers considered the groups an important support, since they provided a feeling of inclusion, valorization, and safety and allowed the exchange of experiences and knowledge, positively reflecting on care and on a higher bonding with the health service. The activities in which they went through situations experienced by the elderly, as well as the availability of the staff, time, place and time of duration of the meetings (between 60 and 90 minutes) were described as positive. As for the gaps, they mentioned the absence of certain themes, such as nutrition and institutionalization and also the difficulty to leave the house. In order to make the participation in future activities possible, the caregivers suggested that the health system concedes substitute caregivers, during the time they are absent. According to the participants, groups of caregivers conducted by primary health care professionals open the doors to the service, work as a possibility to learn new abilities, to exchange experiences and positive changes on care. The groups allow the caregivers to understand the aging process, self-care and care for others. As a conclusion, it was observed that the support to the caregiver, despite being a legal recommendation, is still performed in an incipient manner. Thus, it is essential that the public managers recognize the potentiality of actions such as the QCFEP as strategies to strengthen the bonding, to optimize the resources of the attention and care network to a population that was, up to that point, invisible to the service: the familial caregivers.