Caregiver Stress: Hazardous to Your Health

By Anne Pagnoni
UNDERSTANDING CAREGIVER STRESS
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.
Stress can be defined as a physiological reaction to a threat. The greater the threat -- the greater the level of stress. A threat is a real or perceived action against our person. Threats may include the anticipated possibility of death or injury but may also include challenges to our self-esteem, social standing or relationships to others or a threat may simply be a potential or real disruption of our established routines. What is stressful to one person may not be to another. For example, bumper-to-bumper traffic might be stressful to the woman executive who is late for an important meeting but to the delivery man who has no deadline and is being paid by the hour, it may be a welcome respite to relax and listen to the radio.
Stress produces real physical changes. In some unknown way the fears in our mind, both conscious and unconscious, cause the hypothalamus and pituitary glands, deep in our brain, to initiate a cascade of hormones and immune system proteins that temporarily alter our physical body. This is a normal human physiological response inherent to the human body when a threat is perceived--real or not. It is often called the "fight-or-flight response" or the "stress response". The purpose is to give us clearer thought and increased strength as well as to activate the immune system to deal with potential injury and to repair potential wounds. When the perceived threat is removed, assuming no damage is done, the body returns to normal.
A team of researchers at Ohio State University Medical Center has found a chemical marker in the blood that shows a significant increase under chronic stress and is linked to an impaired immune system response in aging adults. The team, led by Dr. Janice Kiecolt-Glaser, reports in the June 30, 2003 issue of Proceedings of the National Academy of Sciences on a 6-year study of elderly people caring for spouses with Alzheimer's Disease. With the caregivers, the team found a four-fold increase in an immune system protein -- interleukin 6 (IL-6) -- as compared to an identically matched control group of non-caregivers. Only the stress of caregiving correlated to the marked increase of IL-6 in the caregiver group. All other factors, including age, were not significant to the outcome. Even the younger caregivers saw an increase in IL-6.
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.
IL-6 is only one cytokine--an immune system mediator protein--in a cascade of endocrine hormones and cytokines that are released when the brain signals a person is threatened with harm, injury, undue mental or physical stress or death. The hormones prepare the body to react quickly by increasing heart rate, making muscles more reactive, stimulating thought, altering sugar metabolism and producing many more changes that result in the "rush" people experience when they think they may be harmed.
The cytokine release is mediated by IL-6, which takes the role of directing the immune system to gear up to prevent infection, promote wound healing and repair organs and muscles from any injury that may result from the imminent danger. The release of cytokines such as IL-1, IL-6, IL-8, TNF and other proteins such as CRP (C reactive protein) also promote development of inflammation, which is essential for blood cells to home in on injury or infection. In addition, these chemicals promote development of various types of immune system blood cells in bone marrow. This response to harm -- either real or perceived -- is an important and beneficial life-saving activity of a normally functioning body.
The problem is if this response is initiated over and over again, frequently, and over a long period; it can have a dangerous effect on the body. This constant initiation of the stress response is common among caregivers -- especially those caring for loved ones with dementia. Providing supervision or physical assistance many hours a week and over a period of years turns out to be extremely stressful. This type of stress is often unrelenting, occurring day after day and week after week. And the long-term effects of this stress are more pronounced in middle-aged and older people who are precisely the group most likely offering long term care to loved ones.

In most younger people, when the threat lessens or disappears, the body reacts fairly quickly to shut down the stress response and return things to normal. But numerous studies have shown, as people age, the chemical cascade from stress lingers. Over a period of time, this constant chemical stimulus impairs the immune system and results in early aging, development of debilitating disease and early death. In this altered state, the body maintains high, potentially harmful levels of IL-6. The body does not return to normal without intervention.
Prolonged high levels of IL-6 and the accompanying hormones and cytokines have been linked to: cardiovascular disease, type II diabetes, frequent viral infections, intestinal, stomach and colon disorders, osteoporosis, periodontal disease, various cancers and auto immune disorders such as lupus, rheumatoid arthritis and multiple sclerosis. Alzheimer's, dementia, nerve damage and mental problems are also linked to high IL-6. Wounds heal slower, vaccinations are less likely to take and recovery from infectious disease is impaired. People who have depression also have high levels of IL-6. Depression in caregivers is about 8 times higher than the non-cargiving population.
This debilitating response to chronic stress is not unique to humans. Animals are affected as well. A 2004 PBS Scientific American Frontiers Special entitled "Worried Sick", explored the effect of chronic stress on animals. Observations in the field and experiments on animals exposed to chronic stress, uncovered the same phenomenon of debilitating disease and early death found in humans. Blood tests on the affected animals confirmed high levels of IL-6. The work of Dr. Janice Kiecolt-Glaser's team was also followed in the Special.

STRATEGIES TO REDUCE 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.
A number of organizations and private companies will give you advice and guidance -- many for free. If your care recipient has a very low income, you might get free help from your local Area Agency on Aging. A lot depends on available funds. Go to http://www.longtermcarelink.net/eldercare/ref_state_aging_services.htm for statewide lists of agencies.
A good source of free professional advice is the rapidly growing business of non-medical home care companies. Most will offer free consultations and these companies will also provide paid aides to help you with your loved-one…such things as bathing, dressing, shopping, household chores, transportation, companionship and much more. These people may also help you coordinate adult daycare or other community services. Go to http://www.longtermcarelink.net/a7homecare.htm for a nationwide list.

You may wish to pay for a formal assessment and care plan from a professional geriatric care manager. Go to http://www.longtermcarelink.net/a2bfindmanager.htm for a nationwide list of these valuable care specialists. 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. To learn all about long term care insurance and reverse mortgages go to www.longtermcarelink.net.
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. Go to www.longtermcarelink.net for more information.
FINDING RESOURCES FOR CAREGIVERS
The free resources of www.longtermcarelink.net are designed to provide you with government provider lists, free care assessments, information and care provider lists for reducing your eldercare burden and the attending stress. The site is a non-commercial source of help. It is the largest and most comprehensive free source of long term care information on the Internet. There are no ads or solicitations or pop-ups. A related site for the veterans aid and attendance benefit is found at www.veteransaidbenefit.org. This is a benefit that could be available to up to one third of all US residents over the age of 65 under certain conditions. It could provide an additional monthly income of up to $1,843 a month for qualifying veterans households.
Stay tuned for additional options that are available to managing caregiver stress!

Happy Holidays?

By Anne Pagnoni

Getting together and celebrating a special occasion with the family can be a wonderful time. It can also be a time when you begin noticing changes in your aging loved one. Perhaps as you celebrated the recent holidays, you noticed that your mother's hygiene isn't what it used to be. You may have noticed that her short term memory is declining or that she has been losing weight. Perhaps she mentioned being lonely during the day but being unable to get out of the house on her own due to physical ailments. You are working and taking care of your own busy family and can't imagine taking on additional caregiving responsibilities even though you want to. So what do you do? Now is the time to call Home Care Assistance.

Home Care Assistance is a full service home care agency offering hourly services but with a specialty in live-in caregivers. Our caregivers are specifically trained in our exclusive Balanced Care Method^TM . Focusing on lifestyle and dietary choices, the Balanced Care Method^TM promotes healthy activity, stress reduction, and social interaction to help seniors live their best possible lives – in the comfort of home. But, what exactly does this mean for your mother?

1. When it comes to physical hygiene, our caregivers are able to provide assistance with bathing, dressing, and grooming. A little help here can go a long way in improving your mom's willingness to interact with others and her own self-image.
   
2. From planning the menu to preparing the meal, the caregiver will ensure that your mother is eating three, well balanced meals per day. If your mother has food preferences or enjoys cooking, then she and her caregiver will enjoy doing this together.
   
3. Exercise. Not a word that most of us like to think about, but it's a necessity nonetheless. Your mom isn't going to be training for a marathon by any stretch, but the caregiver will work to improve her physical stamina. From simply doing stretches and chair exercises to walking to the mailbox or around the block, she won't be sitting in her favorite chair all day long anymore!
   
4. You know the old saying, use it or lose it. It applies to short term memory, too! While our caregivers can't reverse memory loss associated with dementia and Alzheimer's Disease, they can provide social interaction, which has been shown to improve cognitive function. A game of cards, anyone?
   

When it comes to caring for your aging loved one, accept help from the professionals. While this is new to you, it isn't new to us. For more information about Home Care Assistance, please visit our website at www.homecareassistance.com. To be directed to your local Home Care Assistance office, please call 1-866-4-LIVEIN.

Difficulties Facing Stressed & Overwhelmed Family Caregivers

by Anne Pagnoni

Many family caregivers find themselves unprepared for the physical and emotional demands of caring for a loved one and quickly become stressed and overloaded. When this occurs many caregivers find themselves unable to provide the level of care necessary to nurture their loved one at home.

Situation One: The care receiver lives with the care provider

If the caregiver is working outside of the home or has a very active social calendar, then the care receiver often finds him or herself at home alone for the greater part of the day. As a result the care receiver quite often becomes imprisoned by the home environment due to functional limitation. Receiving little or no social stimulus, the care recipient spends day after day sleeping and watching television. Physical exercise consists of moving to or from the bathroom. The care receiver typically will not prepare a meal. Many times drinking and eating are deliberately avoided to lessen trips to the bathroom. When the care receiver lacks adequate food and fluid intake the result is malnutrition and dehydration both of which result in poor mental reasoning and stupor; hence, the cycle of sleeping and television watching continues.

Solution: A home health aide is a great option if you wish to have your loved one remain in your home while being properly care for during your daily absences. In addition to a home health aide, consider having your loved one attend an adult day care center either daily or several times per week. An assisted living community is another viable option if you feel that your home is no longer an appropriate setting for your loved one.

Situation Two: The care receiver lives alone

Care recipients who live alone can be guilty of self-neglect. Self-neglect is when the care recipient is not interested or is incapable of taking care of his or her own needs. Examples of self-neglect include not eating or drinking enough; not tending to personal hygiene including bathing and grooming; allowing garbage to accumulate within the home; having unattended pets, which urinate and defecate in living spaces; and refusing assistance. When a caregiver is providing care to a care recipient who lives alone, it is imperative that the caregiver work to provide a stimulating environment for the care receiver. Self-neglect with or without a caregiver is a form of elder abuse and in some states it is required by law that its existence be reported. A caregiver allowing self-neglect to happen could be criminally charged.

Solution: A home health aide can assist your loved one with meal preparation, bathing, dressing, grooming, and housekeeping. Many live-in caregivers will tend to family pets. For social interaction have your loved one attend an adult day care center or senior center. Seek out the services of a Geriatric Care Manager for guidance on how to make your loved one safe at home.

Situation Three: Failure to bring in outside help

The biggest mistake made by caregivers is not asking for help. The reasons for this vary. Sometimes the caregiver is a child, who is a long distance caregiver, and doesn't fully appreciate the severity of the situation. Other times money can be the big motivator. Stressed and overwhelmed caregivers become so involved with their loved one that they isolate themselves from others. This isolation makes them reluctant to contact those who can help. Regardless of the cause, failure to ask for help or to hire help can have dire consequences on the welfare of the care recipient and the caregiver.

Solution: Ask for help!! Talk to a local home care agency about available options. While you may think that home care services aren't affordable, you may find yourself pleasantly surprised. Contact your local area agency on aging. If you are a long distance caregiver, then enlist the services of a Geriatric Care Manager so that there is someone locally managing your loved one's care.

If you are the primary caregiver for another individual, then please do not allow yourself and your loved one to fall into one of the situations described above. Ask for help. Be involved. Know your options.

Please direct comments or questions on this post to apagnoni@homecareassistance.com. For more information on Home Care Assistance, please visit us at http://www.homecareassistance.com/ or call 1-866-4-LIVEIN.