Caregiving - Hazardous to Your Health and Sometimes Deadly

Caregiver Burnout

Caregiving can be very stressful and demanding. In the case of a healthy spouse or a child living with the disabled person at home, caregiving can be a 24-hour, 7 day a week commitment. But even for the caregiver not living in the home, looking after a loved one or friend can consume all of the caregiver's free time.

Surveys and studies consistently show that depression is a major problem with full-time informal caregivers. This is typically brought on by stress and fatigue as well as social isolation from family and friends. If allowed to go on too long, the caregiver can sometimes break down and may end up needing long term care as well.

A typical pattern may unfold as follows:

• 1 to 18 months - the caregiver is confident, has everything under control and is coping well. Other friends and family are lending support.
• 20 to 36 months - the caregiver is taking medication to sleep and control mood swings. Outside help dwindles away and except for trips to the store or doctor, the caregiver has severed most social contacts. The caregiver feels alone and helpless.
• 38 to 50 months - Besides needing tranquilizers or antidepressants, the caregiver's physical health is beginning to deteriorate. Lack of focus and sheer fatigue cloud judgment and the caregiver is often unable to make rational decisions or ask for help. It is often at this stage that family or friends intercede and find other solutions for care. This may include respite care, hiring home health aides or putting the disabled loved one in a facility. Without intervention, the caregiver may become a candidate for long term care as well.

Since most people go into informal caregiving without training or counseling they often aren't aware of the possible outcome described above. It is therefore extremely important to receive counseling and to formulate a plan of action prior to making a caregiving commitment.

Caregiving Stress - Hazardous to Your Health and Sometimes Deadly

A 2003 study of caregivers by a research team at Ohio State University has proven the off-repeated adage "stress can kill you" is true. The focus of the investigation was the effect the stress of caregiving had on caregivers. The team, led by Dr. Janice Kiecolt-Glaser, reports on a 6-year study of elderly people caring for spouses with Alzheimer's Disease. The study not only found a significant deterioration in the health of caregivers when compared to a similar group of non-caregivers but also found the caregivers had a 63% higher death rate than the control group.

The demands on a caregiver result in a great deal of stress. It is often observed in aging publications that stress can induce illness and depression. The resulting poor health can further decrease the effectiveness of the caregiver and in some cases, as proven by the study mentioned above, even cause premature death.

The study also found that the caregivers had a 63% higher death rate than the control group. About 70% of the caregivers died before the end of the study and had to be replaced by new subjects. Another surprising result was that high levels of IL-6 continued even three years after the caregiving stopped. Dr. Glaser proposes the prolonged stress may have triggered a permanent abnormality of the immune system.

Strategies to Deal with Caregiver Stress

Ask for help.

Most caregivers are reluctantly thrust into their role without preparation because the need for care usually comes with little warning. Caregivers end up operating in a "crisis" mode - arranging medical care and living arrangements, scheduling care time, providing meals and household chores and so forth. Because they are so stressed and burdened, they rarely take time to find out what resources are available to help them. Ironically, caregivers often sever ties with family, friends and support groups about this time just when help from these people is most needed.

As a caregiver you must ask for help. The stress of going it alone is dangerous to your health. If it's difficult to ask for yourself, use an advocate - a sibling, friend or professional care manager - to arrange a meeting and get formal, written commitments from those people who are willing to help you. The extra help will give you breathing room to find all those resources that are there to help you.

Seek care management advice.

You should pay for a formal assessment and care plan from a professional geriatric care manager. Even though it may cost you a little money to hire a care manager, this could be the best money you will ever spend. Care managers are valuable in helping find supporting resources, providing respite, saving money from care providers, finding money to pay for care, making arrangements with family or government providers and providing advice on issues that you may be struggling with.

Take time off--find temporary substitutes.

Taking a break from caregiving is just as important as taking a break at work or taking that long-awaited vacation. A care manager may be of help in selecting the best temporary help to give you a break. Or you may make arrangements with family or friends to give you a break from caregiving.

Make plans for funding future care arrangements for you or for a healthy parent.

The analysis of data from three national surveys (Mature Market Institute, National Alliance for Caregiving and LifePlans, Inc) points out that employees caring for disabled elders who have long term care insurance (LTCI) are nearly two times more likely to be able to continue working than those caring for non-insured relatives. In addition, working caregivers of those with long term care insurance said that they were less likely to experience some type of stress, such as having to give constant attention to the care recipient or having to provide care while not feeling well themselves. Also, the group with insurance devoted more "quality time" - more companionship and less hands-on assistance - than the group without.

See if your healthy parent can still buy insurance. If he or she can't afford it, see if other family members might contribute to premiums. There are also useful strategies using a reverse mortgage to buy long term care insurance and life insurance for your loved ones. You should also consider insurance for yourself so when you need care someday, it won't be so stressful on your caregivers.

Use assistive technology.

There are a number of technologies to make sure your loved-ones are safe while you're away. Such things as emergency alert bracelets and pendants, GPS tracking for wandering, remote video surveillance, telehomecare, sensory augmentation and all sorts of assistive devices to help disabled people cope on their own.

Remove non-caregiving stress from your job or at home.

It's obvious if you can remove other stressors in your life, you can cope better with the stress of caregiving, which you may not want to or can't remove. The internet is your best resource here. Go to www.google.com, the most relevant non-commercial search engine on the net. Type in "work stress" and you can browse 3 million plus URL's. For home stress type in "home stress" and browse 4 million plus URL's. Everything you ever wanted to know is buried somewhere in those millions of pages.

Attend workshops or seminars to uncover additional strategies.

The Utah Eldercare Planning Council offers worksite or community presentations on various eldercare issues. Community workshops like these are available across the country. These learning experiences are an opportunity to find help with your own caregiving situation.

Exercise.

Exercise is a powerful and effective way to fight stress. It is recommended you do about 30 minutes of moderate exercise at least 3 days a week. Here are a few reasons why exercise works.

• Distraction -Exercise provides time away from the stresses of the day.
• Endorphins - Endorphins are opiate-like chemicals that the body produces naturally during periods of stress or physical exertion to relieve pain. Some evidence suggests that they may be involved in the regulation of mood.
• Neurotransmitters - During exercise, the body releases higher levels of dopamine. These hormones improve the thought process by facilitating transfer of information between neurons.
• Self-esteem - Exercise can be a gratifying and fulfilling activity for people. The act of doing something good for self can promote self-esteem.
• Reduces IL-6 - Although muscles temporarily produce IL-6 during heavy workouts, exercise tends to lower levels between workouts.

Do a better job of managing time.

In our modern world, one of the most prevalent threats to our well-being is the improper use of time. Not meeting deadlines may cost us a promotion or our career. Failure to make appointments or to meet obligations threatens our self-image or social standing. These and many more time-related threats cause stress. Finding help with managing your time would probably go a long way to relieving your stress.

Develop a support group and maintain social contacts.

Participating in a support group can help manage stress. Sharing coping strategies in a group setting lets you help others while helping yourself. It may also help you to realize that some problems have no solutions and that accepting the situation is reality. Social support has a huge impact on reducing stress. Many studies show that social support decreases the stress response hormones in our bodies. In his book, Love and Survival (Harper Perennial, 1998) Dr. Dean Ornish notes that people who have close relationships and a strong sense of connection and community enjoy better health and live longer than those who live in isolation or alienation. People who suffer alone, suffer a lot.