AN INVESTIGATION INTO THE CHALLENGES  OF  NURSING  CAREGIVER FOR PATIENTS WITH DEMENTIA RESIDING IN NURSING HOMES IN LAGOS STATE

CHAPTER ONE

INTRODUCTION

Background of the study

The primary symptom of dementia, an acquired intellectual impairment, is cognitive failure. The World Health Organisation reports that over 55 million individuals globally have been diagnosed with dementia, and by 2050, that number is predicted to rise to 152.8 million [DFC, 2019]. Age is a key factor in the onset of dementia, and as the population ages, dementia prevalence has been steadily rising. Notably, dementia prevalence and death rates are much greater among people 60 years of age and older [Gao, et al., 2023]. The significant financial and health burden that impacted families and society as a whole bear as a result of this sharp increase is the cause [Gao et al., 2023]. Dementia is a global public health concern due to its immense influence on the healthcare system. Dementia is defined as a progressive chronic illness that impairs one or more cognitive domains, such as language, learning and memory, executive functioning, complex attention, and perceptual-motor functioning. According to Tahami et al. (2023), this causes significant disability, high reliance, and interference with everyday life activities. Because dementia patients have a high degree of reliance, caring for them as family members can be difficult and burdensome. Furthermore, the efficacy of family members' care is diminished by their lack of professional competence, the significant psychophysical stress of long-term care, and the absence of social support and help [Tahami et al., 2023]. As a result, compared to a few decades earlier, more Nigerian families are sending their elderly relatives who suffer from dementia to nursing facilities [Tahami et al, 2023]. A large carer load is created by the comprehensive care that nursing homes engage carers to offer to patients with dementia, including 24-hour nursing care, daily health monitoring, and daily living support. The prognosis of dementia patients and the quality of care they get are negatively impacted by the high burden of hired carers [Seidel & Thyrian, 2019]. Few studies have examined the factors influencing the load of carers engaged in nursing homes; the majority of prior research on carer burden concentrated on family carers [Seidel & Thyrian, 2019]. Based on previous research, the concept of carer burden necessitates careful consideration of the patient characteristics being cared for, such as the presence of behavioural and psychological symptoms of dementia (BPSD), training experience, caring ability, gender and literacy of carers, and the daily duration of care provided [Reuben, Romero, Evertson & Jennings, 2022]. Therefore, the researcher sought to investigate the challenges  of  nursing  caregiver for patients with dementia residing in nursing homes in Lagos State.

Statement of the problem

The growing global incidence of dementia has resulted in a substantial workload for nursing carers, particularly those employed in assisted living facilities. According to the World Health Organization (2020), approximately 50 million people globally suffer from dementia, and this figure is anticipated to quadruple by 2050. When it comes to caring for people with dementia, who need specialised care because of cognitive decline, memory loss, and behavioural disorders, nursing carers are essential. Nevertheless, these carers deal with a variety of issues that may have an impact on the kind of care they offer as well as their own emotional and physical health. The intense emotional and psychological strain that comes with caring for dementia sufferers is one of the main obstacles. Studies have indicated that the stressful nature of dementia care frequently leads to burnout, depression, and anxiety among nursing carers (Brodaty & Donkin, 2009). The unpredictability of patients' behaviour and their poor communication skills make carers' stress levels worse. Carer tiredness is further exacerbated by the physical demands of the role, which include helping with everyday tasks including eating, washing, and movement (Alzheimer's Association, 2022). Furthermore, there is sometimes a lack of workers in nursing homes, which puts more strain on carers' schedules and workloads. Many facilities have insufficient personnel, which means that carers might not have the time to offer dementia patients the individualised care that they need (Harrington et al., 2016). This condition can result in poor patient outcomes, including an increased risk of falls, malnutrition, and general decrease in health. 

These difficulties highlight the need for improved systems of support, such as sufficient staffing, dementia care expertise, and availability of mental health services, for nursing carers. The well-being of carers and the standard of care provided to dementia patients in nursing homes will both continue to decline in the absence of solutions to these problems. Hence, the study investigates  the challenges  of  nursing  caregiver for patients with dementia residing in nursing homes in Lagos State.

1.3 Objective of the study

The broad objective of the study is to investigate the challenges  of  nursing  caregiver for patients with dementia residing in nursing homes in Lagos State. The specific objectives is as follows

To identify the behavioral disturbances in dementia patients that pose challenges for nursing caregivers.

To assess the physical demands placed on nursing caregivers in providing daily care for dementia patients.

To evaluate the coping mechanisms employed by nursing caregivers to manage the  challenges of caring for dementia patients.

To recommend strategies aimed at improving the well-being of nursing caregivers and the quality of dementia care in nursing homes.

1.4 Research questions

The following questions have been prepared to guide the study

What are the behavioral disturbances in dementia patients that pose challenges for nursing caregivers?

What are the physical demands placed on nursing caregivers in providing daily care for dementia patients?

What are the coping mechanisms employed by nursing caregivers to manage the  challenges of caring for dementia patients?

What are the recommended strategies aimed at improving the well-being of nursing caregivers and the quality of dementia care in nursing homes?

1.5 Significance of the study

The findings of this study may inform policy recommendations on staffing levels, caregiver training, and resource allocation in nursing homes. Adequate staffing and specialized training are essential for improving the quality of care for dementia patients. Policymakers can use this study to advocate for increased funding and better support for nursing home caregivers. Findings of the study will also be significant to the academic community as it will contribute to the existing literature, add to library resources and serve as a guide to future academic researchers.

1.6 Scope of the study

The study focus on the challenges  of  nursing  caregiver for patients with dementia residing in nursing homes in Lagos State. Empirically, the study will identify the behavioral disturbances in dementia patients that pose challenges for nursing caregivers, assess the physical demands placed on nursing caregivers in providing daily care for dementia patients, evaluate the coping mechanisms employed by nursing caregivers to manage the  challenges of caring for dementia patients and recommend strategies aimed at improving the well-being of nursing caregivers and the quality of dementia care in nursing homes. 

Geographically, the study will be delimited to nursing homes in Lagos State.

1.7 Limitation of the study

Like in every human endeavour, the researchers encountered slight constraints while carrying out the study. The significant constraint are: 

Time: The researcher encountered time constraint as the researcher had to carry out this research along side other academic activities such as attending lectures and other educational activities required of her.

Finance: The researcher incurred more financial expenses in carrying out this study such as typesetting, printing, sourcing for relevant materials, literature, or information and in the data collection process.

Availability of Materials: The researcher encountered challenges in sourcing for literature in this study. The scarcity of literature on the subject due to the nature of the discourse was a limitation to this study.

1.8 Definition of terms

Dementia: A group of symptoms affecting memory, cognitive abilities, and social functioning severely enough to interfere with daily life. It is caused by damage to brain cells, which impairs communication between them, leading to symptoms such as memory loss, confusion, and behavioral changes.

Nursing Caregivers: Healthcare professionals, such as nurses or certified nursing assistants, who are responsible for providing day-to-day care and support to patients with chronic illnesses, including those with dementia, in various healthcare settings such as nursing homes.

Nursing Homes: Residential facilities designed to provide around-the-clock care for elderly or disabled individuals who require constant supervision and assistance with daily living activities, including those with dementia.

Caregiver Burnout: A state of physical, emotional, and mental exhaustion that can occur when caregivers are overwhelmed by the demands of caregiving, particularly when caring for dementia patients. Burnout can result in reduced quality of care and affect the caregiver’s mental health.

Understaffing: A condition in which there are not enough healthcare workers, such as nurses or caregivers, available to meet the needs of patients in a care facility. This issue often leads to overwork, stress, and decreased quality of care.

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