**Abstract**

This study describes the experiences on geriatric palliative care of 12 caregivers in Metro Manila. This study looks on the variation of experiences on motivation and social support in caregiving. This study used a qualitative-descriptive research design and involved key informant interviews of caregivers as a research method. Informants were selected through a non-probability sampling technique specifically through a purposive-convenient sampling. Caregivers cite several of motivations for caregiving. Reasons mentioned are identified to be either intrinsic motivation or extrinsic motivation. Intrinsic motivation being cited are emphatic reasons which include framing patient as family; emotional reasons such as emotional attachment; and cognitive reasons which refers to gaining knowledge in caregiving. Extrinsic motivations by caregivers are incentive reasons which include monetary gains; and negative reinforcements such as institutional punishments. In terms of social support received, caregivers mentioned different sources and functions of support they receive. Caregivers cite two types of social support structure or sources, proximal social support and institution based support. For social support function, responses are categorized into intangible and tangible support.

**Keywords:** geriatric healthcare and management, geriatric palliative caregiving, motivation, social support structure, social support function

### **1. Introduction**

In the past decade, the caregiving profession is known to continue to increase because of the fast growth of the aging population [1]. In that sense, caregivers are high in demand because of the present global situation most especially those who are formal or professional workers and volunteers under long term facilities. Caregivers are individuals who tend to express caregiving behaviors that are required in their job description. Moreover, caregiving is a phenomenon that is increasingly studied by the medical and social sciences field [2]. Caregiving is an act of tending and caring for other individual with a problematic health condition or impairment in a daily basis.

Caregivers experience different situations doing geriatric palliative care. In the past literatures, various studies found different factors that may influence doing palliative care to elderly individuals. A study by Pearlin and Schooler [3], found that personal control and mastery has been a significant factor that shapes the caregiver's experience in doing caregiving. With personal mastery, an individual has the

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*Update in Geriatrics*

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capability to manipulate their actions hence overcomes different challenges. In the caregiver's perspective, they may be able to experience more positive experiences because they can control and manipulate their actions [4, 5].

In sociology, focuses on the global perspective of the concept of caregiving through caregivers, caregiver roles, and characteristics of caregivers as well as their motivations and social networks. Also, caregiving is studied through groups of caregivers or health care professionals tending to individuals who are in need of care. Caregiving in the field of sociology is studied through the experiences of caregivers from groups and organizations such as family, neighbors, health care institutions, as well as individuals affiliated with religious institutions [6]. All in all, sociologists focus on the influences of behaviors such as motivation as well as social networks of caregivers.

In recent studies, it is found that motivation plays a vital role among caregivers in doing palliative care towards elderly patients. Motivation is defined to be reinforcements for an individual to express a certain kind of behavior [7]. In the past, motivation is studied in the field of social psychology. Various theories explained with certain motivations, individuals manifest a particular behavior. Motivations are divided into two types: intrinsic and extrinsic motivation. Intrinsic motivations are reinforcements that are internal in nature. One example of intrinsic reinforcement is having altruistic motivation. According to a study by Hyde, Harris, and Boaden [8], health care workers manifest altruism in dealing with their patients. Altruistic motivation is having a voluntary mindset intended to help and increase another's welfare because the attitude of being concerned for others [9]. Moreover, it is a motivation that seeks to overcome the feeling of sympathy towards individuals who needs help [10]. According to a study by Bhatti and Qureshi [11], health care workers are motivated by the desire to help and take on a useful activity. In the case of geriatric palliative caregiving, caregivers feel the sense of helping their elderly patients without any compensation in return. This is mostly seen among voluntary workers in nursing homes run by religious organizations.

Another theory to explain the intrinsic motivations of doing geriatric palliative caregiving is Selective Investment Theory (SIL). This theory talks about social bonds or close relationship provides motivation that makes individuals suppress their own personal goals if need to prioritize the overall well-being of the other [7]. Moreover, the theory gives emphasis on the role of having close relationships in meeting the needs of other individuals. In recent literatures, caregivers' witness their patients' life at nursing homes hence makes them attached. With attachment, caregivers tend to care more and give more importance to their patients rather than their personal life.

Emotional motivation is also found to be an effective reinforcement for individuals. In a study by Carlo and Randall [10], the feeling of empathy triggers an individual to act or behave in a certain way because of strong emotions. It evokes mostly individuals who are easily affected by people who manifest emotional behaviors. For health care workers, a feeling of empathy urges them to work hard to do pain management on their elderly patients.

Social desirability is a motivation that evokes individuals to behave in a certain way because of social pressure and norms [12]. Individuals are more likely to express caregiving behavior when being observed by their superiors. Also, caregivers feel pressure from their supervisors in order to accomplish their tasks and jobs in doing geriatric palliative caregiving. It is a norm that caregivers must do caregiving duties and nothing else. This reinforces caregivers to tend to their task and normal work. Also, health care workers are motivated to work harder when it is on the motive of desiring a gain of approval and respect from other people most especially their superiors [10].

For extrinsic kinds of motivation, the most frequently used in the health care sector is compensation and punishment. It is found that both are effective tools for reinforcing

#### *Motivation and Social Support Received in Elderly Care: The Case of Geriatric Palliative… DOI: http://dx.doi.org/10.5772/intechopen.93938*

individuals to comply with their job description. However according to Kreps [13], "providing extrinsic incentives for workers can be counterproductive, because it may destroy the workers' intrinsic motivation (p. 359)." In that sense, extrinsic motivation may not be truly effective in reinforcing individuals because it is found to be inefficient.

Access to social support is also a proximal factor that influences the experiences of caregivers in doing geriatric palliative caregiving. Social support is an available assistance from other people and it is also a coping resource used by individuals [14]. Moreover, it talks about received encouragement and assistance by individuals from other people. According to Albrecht and Adelman [15], social support is defined to be a "verbal and nonverbal communication between recipients and providers that reduces uncertainty about the situation, the self, the other, or the relationship, and functions to enhance a perception of personal control in one's life experience (p. 18)".

Social support can be a discourse between two entities. This concept is understood to be given or received. On one hand, social support is an act or behavior that an individual that is to be given to another individual. On the other hand, it is also an act that an individual receives from another individual [16]. Social support can be measured in two categories. One category is called structural support or social integration. It measures the quantity or the extent of which an individual is connected to a social network [17]. This category measures the size, frequency, or density of a social network of an individual [18]. Another category is called functional social support. This measures the quality or functional aspects of social support. It looks on the roles of the social network provides. Functions such as emotional support which focuses on the affect and emotional nurture provided by sources of social support; esteem support which focuses on bolstering an individual to handle a difficult situations; network support which focuses on the affirmation of an individual as a part of a social network; informational support which focuses on which focuses on a the communication that gives insightful information; and tangible support which focuses physical assistance and support [19].

According to Kaufman, Kosberg, Leeper, and Tang [20] having good social support causes positive behavior in doing health care management specifically in the spiritual aspect of geriatric palliative caregiving. Moreover, with good social support, the caregiving job becomes less challenging and burdensome because it is known as a coping resource used by caregivers [14]. However, the caregiving experience becomes challenging and burdensome because of factors such as lack of emotional support from colleagues and peers, social isolation, and inadequate social activities about coping [21].

Support also comes from different sources. It may come from colleagues, peers, and most especially family. Research found that lack of family support has been found to "correlate with high levels of physical as well as psychological exhaustion, with many caregivers reporting that their social support decreases over time" [14].

There may be a lot of studies about motivation and social support, however very limited studies were seen focusing on the variation of motivations and social support structure and functions of geriatric palliative caregivers in the Philippines. With that, the objective of this study is to describe various motivations and social support experiences of caregivers in geriatric palliative caregiving.

#### **2. Methodology**

This study used a qualitative-descriptive research design. This study describes the motivation and social support experiences of professional caregivers tending to elderly patients under intensive care. This study involved key informant interviews of caregivers as a research method. In addition, this involved a face-to-face interview as a research technique.

The population of this study involved professional caregivers employed in a private nursing home in Metro Manila. This study involved 12 key informants as sample. This study utilized a non-probability sampling technique. Key informants are chosen through a purposive-convenient sampling. To be eligible for the interview, the sample should fit the specific selection criteria: 1) Must have an experience doing geriatric palliative care; and 2) Has at least one to two years of experience in the caregiving profession.

The voice-recorded in-depth interviews were transcribed, and the data gathered were sorted according to the research problems they addressed. Content analysis was used as data evaluation through an evaluation of the interview transcriptions. The personal and work characteristics of the caregivers were tabulated to present the trends across these phenomena, and similar answers to the interview questions are grouped together. The information were analyzed and presented based on similarities and differences of the themes.
