Obesity is a global epidemic. It creates a major public health problem. The rising trend is primarily a result of low levels of physical activity and high caloric diets. Obesity is both a complication of and risk factor for serious co-morbidities. Furthermore, it is a disease entity in itself. This pathway aims to provide care physicians with a stepwise approach to the diagnosis and management of obesity among adult Asian patients.
Male ; Female ; Aged ; Middle Aged ; Adult ; OBESITY ; CRITICAL PATHWAYS

BACKGROUND: Caregivers who are most prone to strain are those taking care of patients suffering from chronic, debilitating or life-threatening illnesses. Implementing effective methods to address caregivers' needs would not only promote their physical and psycho-emotional well being but also lead to better provision of care for the patient.

OBJECTIVE: This study aimed to determine the effect of standard Supportive, Palliative and Hospice Medicine (SPHM) interventions on caregiver strain among primary caregivers of adult patients with a debilitating chronic or life-threatening illness admitted at the charity wards of the Philippine General Hospital.

METHODS: This was a non-controlled before and after study. Thirty-two primary caregivers of adult patients admitted at the PGH charity wards were interviewed from July to September 2010 within 48 hours of referral to SPHM. Using cut-off score of 23 on the Filipino version of the Modified Caregiver Strain Index, caregivers were classified into two groups, those with strain and those without strain. The SPHM team in charge of each patient/caregiver was blinded for the results of this initial assessment. Baseline characteristics of caregivers prior to SPHM intervention were compared between the two groups. After two weeks, a follow-up interview was done with these same caregivers using the same assessment tool for caregiver strain. Only 17 caregivers were able to complete follow-up. Twelve index patients died prior to completion of the two-week follow-up period, and 3 caregivers were inaccessible at the time of follow-up. Those caregivers who completed follow-up were re-assessed for any change in caregiver strain status.

RESULTS: Of the 32 caregivers, 21 (66%)were found to have caregiver strain. The mean ages of caregivers were 40+11 and 44+17 among those strain and without strain, respectively. Majority of the caregivers were females in both groups. Caregiver strain was significantly associated with the average number of hours per day spent in caregiving (Fisher's exact test p=0.0245). Among those who completed follow-up, 3 (18%) caregivers who were initially classified to have strain had no strain after SPHM intervention. There was one (6%) caregiver who initially had no strain but was assessed to have caregiver strain after two weeks. However, those observed changes in caregiver strain status after SPHM intervention was not statistically significant with a McNemar exact probability of 0.625.

CONCLUSION: There is a high proportion of primary caregivers of adult patients with debilitating chronic or life threatening illnesses who have caregiver strain. Strain is significantly associated with the usual number of hours per day spent in caregiving. There is no sufficient evidence to attribute the observed positive change in caregiver strain (from "with strain" to "without strain") to SPHM interventions.