A STUDY ON THE CHALLENGES FACED BY NURSING CAREGIVERS CARING FOR DEMENTIA PATIENTS IN NURSING HOMES IN LAGOS STATE

CHAPTER ONE INTRODUCTION 1.1 Background of the Study Dementia, characterized primarily by cognitive decline, is an acquired intellectual impairment that severely affects mental functioning. According to the World Health Organization, over 55 million people worldwide currently live with dementia, with projections estimating this number will surge to approximately 152.8 million by the year 2050 (DFC, 2019). Age remains the most significant risk factor for developing dementia, and with global populations aging, the prevalence of this condition continues to rise steadily. Research by Gao et al. (2023) highlights that both the prevalence and mortality rates associated with dementia are markedly higher among individuals aged 60 and above. This growing number of dementia cases places a tremendous financial and health-related strain on families and society at large (Gao et al., 2023). Dementia poses a major global public health challenge due to its substantial impact on healthcare systems worldwide. It is defined as a progressive, chronic disorder that impairs one or more cognitive domains such as language, learning and memory, executive function, complex attention, and perceptual-motor skills. Tahami et al. (2023) explain that dementia leads to significant disability, increases dependence, and disrupts everyday activities. The high dependency of dementia patients makes caregiving by family members particularly challenging and burdensome. Moreover, family caregivers often lack professional training, endure intense physical and psychological stress due to prolonged caregiving, and suffer from insufficient social support and assistance (Tahami et al., 2023). As a result, there is a growing trend in Nigeria for families to place elderly relatives with dementia into nursing homes compared to previous decades (Tahami et al., 2023). Nursing homes undertake comprehensive caregiving responsibilities that include 24-hour nursing care, regular health monitoring, and support with daily living activities for dementia patients. However, the high caregiving burden on hired staff negatively influences both the prognosis of patients and the quality of care delivered (Seidel & Thyrian, 2019). While much prior research on caregiver burden has focused on family caregivers, few studies have explored the factors that affect the burden experienced by caregivers working in nursing homes (Seidel & Thyrian, 2019). Past studies have identified several factors influencing caregiver burden, including patient characteristics such as behavioral and psychological symptoms of dementia (BPSD), caregivers’ training, skills, gender, literacy level, and the amount of daily care provided (Reuben, Romero, Evertson & Jennings, 2022). Consequently, this study aims to explore the challenges faced by nursing caregivers who care for dementia patients residing in nursing homes in Lagos State. 1.2 Statement of the Problem The increasing global prevalence of dementia has significantly increased the workload for nursing caregivers, especially those working in assisted living and nursing facilities. The World Health Organization (2020) estimates that around 50 million people worldwide are affected by dementia, a figure expected to quadruple by 2050. Nursing caregivers play a vital role in managing dementia patients who require specialized care due to their cognitive decline, memory loss, and behavioral disturbances. However, these caregivers face numerous challenges that impact both the quality of care they provide and their own emotional and physical well-being. One of the major issues is the intense emotional and psychological strain associated with dementia care. Research has shown that caregiving for dementia patients often leads to caregiver burnout, depression, and anxiety (Brodaty & Donkin, 2009). The unpredictable behaviors of patients and their limited ability to communicate exacerbate caregiver stress. Additionally, the physical demands of caregiving—such as assisting patients with eating, hygiene, and mobility—contribute to fatigue and exhaustion (Alzheimer's Association, 2022). Compounding these challenges is the frequent shortage of staff in nursing homes, which increases the workload and pressure on available caregivers. Many facilities lack adequate personnel, limiting the time caregivers can dedicate to providing personalized care to dementia patients (Harrington et al., 2016). This situation often leads to poor patient outcomes including increased risks of falls, malnutrition, and a general decline in health. These challenges emphasize the urgent need to improve support systems for nursing caregivers, including adequate staffing, specialized dementia care training, and access to mental health resources. Without such interventions, both caregiver well-being and the quality of dementia care in nursing homes are likely to deteriorate. Hence, this study investigates the challenges faced by nursing caregivers attending to dementia patients in nursing homes located in Lagos State. 1.3 Objectives of the Study The general aim of this study is to examine the challenges experienced by nursing caregivers who provide care for dementia patients in nursing homes within Lagos State. The specific objectives are: i. To identify the behavioral disturbances in dementia patients that present difficulties for nursing caregivers. ii. To assess the physical demands placed on nursing caregivers during the daily care of dementia patients. iii. To evaluate the coping strategies employed by nursing caregivers in managing the challenges of dementia care. iv. To recommend practical strategies that could enhance the well-being of nursing caregivers and improve the quality of dementia care in nursing homes. 1.4 Research Questions The following questions will guide the study: i. What behavioral disturbances in dementia patients create challenges for nursing caregivers? ii. What physical demands are placed on nursing caregivers in the daily care of dementia patients? iii. What coping mechanisms do nursing caregivers use to manage the challenges associated with dementia care? iv. What strategies can be recommended to improve the well-being of nursing caregivers and the quality of care provided to dementia patients in nursing homes? 1.5 Significance of the Study The results of this research could inform policy decisions related to staffing levels, caregiver education, and the allocation of resources within nursing homes. Ensuring sufficient staffing and providing specialized training for caregivers are crucial for enhancing the quality of care for dementia patients. Policymakers can utilize the findings to advocate for increased funding and improved support systems for caregivers working in nursing facilities. Additionally, this study will be valuable to the academic community by contributing to existing literature, expanding library resources, and serving as a reference for future research in this field. 1.6 Scope of the Study This study focuses specifically on the challenges experienced by nursing caregivers providing care for dementia patients in nursing homes located in Lagos State. Empirically, it will examine the behavioral disturbances in dementia patients that affect caregivers, the physical demands placed on caregivers, the coping strategies used by caregivers, and will propose recommendations to improve caregiver well-being and the quality of dementia care in nursing homes. Geographically, the study is confined to nursing homes within Lagos State. 1.7 Limitations of the Study As with all research, this study faced certain limitations. Notable constraints include: Time: The researcher was limited by time as this study was conducted alongside other academic commitments, including lectures and other educational activities. Finance: The research required significant financial expenditure, including costs for typesetting, printing, sourcing materials and literature, and data collection processes. Availability of Materials: There was difficulty in obtaining sufficient literature on this subject, due to the relatively limited availability of resources specific to this area, which posed a challenge for the study. 1.8 Definition of Terms Dementia: A collection of symptoms that affect memory, cognitive function, and social abilities to such an extent that they interfere with daily living. It results from brain cell damage which disrupts communication between cells, causing symptoms like memory loss, confusion, and behavioral changes. Nursing Caregivers: Healthcare professionals, including nurses and certified nursing assistants, responsible for providing daily care and support to patients with chronic illnesses such as dementia, in settings like nursing homes. Nursing Homes: Residential facilities that provide 24-hour care and supervision for elderly or disabled individuals who require assistance with daily living activities, including those with dementia. Caregiver Burnout: A state of emotional, physical, and mental exhaustion experienced by caregivers overwhelmed by the demands of caregiving, especially in dementia care, leading to reduced quality of care and negative effects on caregivers’ mental health. Understaffing: A situation where healthcare facilities have insufficient numbers of nurses or caregivers to adequately meet patient care needs, resulting in increased workloads, stress, and lowered care quality.