Introduction

Pegar texto In 2017, the World Health Organization (WHO) estimated that the proportion of adults over 60 years of age will double from 605 million to 2000 million by 2050 ¹. Aging as a result of demographic transformation has become a public health problem. Therefore, older people are more prone to develop functional disorders such as loss of autonomy, adaptability and motor dysfunction, a consequence of multiple health problems that affect them ^2,3. Currently, in the presence of the COVID-19 pandemic, health systems face a massive burden of care for people infected by this virus, which puts at risk the follow-up given to people with chronic pathologies. In addition, the health measures imposed by the government to remain in confinement limit the care of people with type 2 diabetes mellitus (T2DM), thus generating conditioning and logistical difficulties to provide care at home. This condition causes the elderly to be dependent on care provided by informal caregivers ⁴.

The care of a person with T2DM mainly falls on family members, who most of the time do not have the skills required to provide proper care, despite this they assume the responsibility by committing to perform the activities for a long period of time ^5,6. These activities have an impact on the caregiver's health, as they assume care of minimal complexity, but on many occasions they also provide care of greater complexity, which requires follow-up or close monitoring, such as the administration of medications, including insulin, which implies dependence or loss of autonomy on the part of the caregiver ^7,8.

The caregiver fulfills various roles in the family, invests time and resources in carrying out the various actions for the care of the person, becoming an essential element that favors autonomy and satisfies the needs of care ^9,10. It is currently recognized that caregiving is an important element for caregivers, since they are very prone to manifest disorders in their physical and mental health caused by the overload of activities ¹¹. To date, no studies have been found that report the experiences or opinions of this population group during the COVID-19 pandemic, so the results will allow us to acquire relevant information. The aim of the study was to identify the experiences of caregivers of elderly adults with T2DM during the COVID-19 pandemic.

Methodology

Qualitative research that allowed understanding the phenomenon being lived in terms of the experience and perceptions of caregivers of people with a chronic disease such as T2DM. The study was supported by Martin Heidegger's concept of phenomenology since it seeks, without prejudice or theories, to investigate, understand and interpret the being and/or person as a concrete experience and as a conscious subject ^12,13. The study was carried out with the participation of seven caregivers selected by convenience and contacted through family members and acquaintances referred by them; caregivers over 18 years of age residing in Chilpancingo, Guerrero, Mexico, who reported being in charge of the care of elderly persons with T2DM and who agreed to participate voluntarily, participated in the study. Data collection was carried out by means of a data questionnaire that was collected by the interviewer and a structured interview comprising six open-ended questions was conducted by telephone due to the confinement, lasting approximately 30 to 40 minutes and with prior informed consent.

In order to maintain the confidentiality of the participants, a code was assigned that was used in the transcriptions and in the corresponding results. The interviews were recorded and transcribed verbatim in Word format, added and analyzed in the program Atlas Ti version 7.0. The qualitative analysis of the data was developed by constructing an inductive taxonomy of the findings by reducing the descriptor codes to nominals and these in turn to categories by means of content analysis techniques. The content of the transcripts was presented in the form of clippings in order to respond to the main categories. The main dimensions were identified and the data analysis by categories was executed. The main themes identified were: a) Lack of knowledge and information management, b) Negative experience of caregiving in times of pandemic, c) Concern about confinement in the face of pandemic, d) Lifestyle changes during pandemic, e) Mental disorders in caregivers, and f) Feelings of satisfaction in caregiving.

The study adhered to the provisions set forth by the General Health Law on Health Research, which establishes the guidelines and general principles that all scientific research involving human beings must follow and establishes the ethical guidelines for the development of research in the area of health, in order to guarantee human dignity, the rights and well-being of the individual ¹⁴.

Results

Seven interviews were conducted with caregivers of persons with T2DM, identifying a higher prevalence in males 57.1% and only 42.9% in females, 57.1% reported ages between 31 and 40 years and 42.9% were between 18 and 30 years old, in relation to schooling 42.9% studied high school and secondary school respectively and only 14.3% studied elementary school. In relation to schooling, 42.9% studied high school and junior high school respectively and only 14.3% studied elementary school, 57.1% of the people had been with T2DM for 1 to 10 years, 57.1% of the caregivers reported having cared for people with T2DM for 1 to 10 years, in relation to the role they had with the sick person, 57.1% reported being a son or daughter (Table 1).

The content analysis of the data acquired through the structured interview led to the identification of 6 categories.

Discussion

According to the objective of this study, caregivers mentioned limited or no knowledge about their disease, Scarton, et al. ¹⁵ identified that due to the stress generated in family members, the caregiver showed concern and psychological disorders in relation to the care of people with T2DM. In this regard, in a study ¹⁶ they identified that the process of adaptation to the disease was perceived as a complication in caregivers due to the care required by the person with T2DM, as well as to achieve health control. In addition, uncontrollable factors such as the pandemic affected this context, placing the caregiver as the main responsible for the health of the person, generating a greater demand on their psychosocial capacities ¹⁷.

Although the caregivers showed great psychological demands due to the large amount of time they invested, along with the fact that they did not have defense mechanisms against the stress that confinement generated in them, added to the concern about the fear of infecting themselves or the person with T2DM with the coronavirus, anyhow, they mentioned that living with more family members distracted them a little from the problems. Authors such as Baldwin, et al. ¹⁸ reported that when the care of the person with T2DM begins, the lifestyle is modified, adapting the family to the new situation and generating in them the search for solutions to compensate for the affectations in each member. It has been shown that caring for a family member with diabetes surrounded by relatives reduces stress levels in both the caregiver and the person. Navarro, et al. ¹⁹ found that living with other family members had positive effects on the medication behavior of people with diabetes, and also reduced stress, generating a change of mood in the caregiver.

In this study it was identified that less experienced caregivers turned to digital resources such as the Internet to resolve their doubts regarding the care they should provide to sick family members, in relation to this there is evidence ²⁰ which shows that caregivers recognize the importance of the development of their activities for the improvement of their family members. They also mentioned that they would like to receive support for the development of their activities since they did not know the care and did not receive training. In this regard, Cortés, et al. ² reported that the interactions of caregivers with health professionals and the proportion of strategic resources for the management of a chronic condition can be an opportunity for the emotional support of caregivers, as well as for the search for solutions that could reduce the challenges they faced ^21,22. However, there was evidence that caregivers complained that once the pandemic began, the health care system was reconverted, attempting to solve emerging health problems, neglecting people with chronic diseases and their care became the direct responsibility of the caregiver ²³. In addition to the above, the caregivers stated that on their own they looked for mechanisms to obtain information, including the Internet, this coincides with what was reported by Cántaro and Mayta-Tristán ^24,25 who reported that the Internet can be used as an alternative by caregivers of people with diabetes, and by the sick people themselves in both the dissemination and control of their disease.

The caregivers stated that although at times they felt frustrated, they looked for alternatives to improve their care and the fact of seeing their relatives improve made them forget their frustration, they were certain that no one cared for them better than they did, in accordance with Fajardo, et al, ²⁰ who showed that caregivers considered that their family member depended a lot on them, but they viewed it in a positive way since they considered that they were the people they could trust the most, due to the affection they showed them, which allowed them to provide more and better care than they should ²⁶.

Conclusions

Based on the objective established regarding the identification of the experiences of caregivers of elderly adults with T2DM during the COVID-19 pandemic, the results allowed us to identify a difficult experience in the caregivers of the ill persons. However, in the face of adversities such as the confinement generated by the pandemic, they continued to provide care. It is important to point out the need to provide support to this population through workshops or sessions in which they are provided with knowledge and updates on the care they should provide to patients with T2DM in their family environment. It is recommended to deepen the study phenomenon by considering the popular knowledge of caregivers of people with chronic diseases.

Conflict of interest

The authors stated that they have no conflicts of any kind.

Financing

This article did not receive any type of funding from any agency.