Which of the Following Is Not True of Family Caregivers in General?
Am Fam Physician. 2000 Dec 15;62(12):2613-2620.
Encounter related patient information handout on coping tips for caregivers, written by the authors of this article.
Related Editorial
Article Sections
- Abstruse
- Caregiver Burden
- Health Problems of Caregivers
- An Office-Based Approach
- Anticipatory Guidance
- Final Annotate
- References
Patients who provide care to family members or friends with dementia are likely to be in a family unit physician's practice. The caregiver role tin can exist stressful, and identifying these patients can give the family unit dr. opportunities to help patients cope with the challenges of the caregiver role. Family physicians have a systematic approach for assessing the degree of caregiver brunt in these patients. Considering caregivers are at increased risk for depression and feet, screening should be done to exclude the presence of either disorder. The caregiver's skill in managing behavioral problems in the family unit member with dementia should be assessed. If there are issues, family physicians should provide applied counseling about mutual caregiving stresses and nearly resources that do good caregivers. Helping the caregiver larn strategies for coping with difficulties may help reduce some of the stress the caregiver is experiencing.
By the twelvemonth 2030, an estimated 20 percent of the U.Due south. population will be 65 years or older.1 As the American population ages, a growing number of people will be serving equally caregivers for family unit members affected by dementia and other types of functional harm. Dementia is present in x per centum of individuals older than 65 years and in 47 percent of those older than 85 years.2 As many as 80 percent of persons with dementia are cared for in their homes by family members.3 In day-to-twenty-four hour period exercise, family unit physicians are likely to see patients who serve as caregivers. In fact, ane study of patients in a family practise demonstrated that 21 percent of the patients had caregiving responsibilities for persons with chronic medical conditions.four
Caring for someone with dementia is associated with a higher level of stress than caring for someone with functional impairment from another type of chronic illness.5 One survey revealed that persons with Alzheimer'southward disease required an boilerplate of seventy hours of care per week, with 62 of those hours provided by the primary caregiver. By 1990 dollar amounts, it was calculated that a caregiver provided $34,517 of care annually.6
While the issues faced past caregivers of patients with dementia are emphasized in this article, the bones principles utilise to other illnesses equally well. Knowledge of these principles can help family physicians teach their patients who are caregivers new coping strategies and brand appropriate interventions for those caregivers who are overwhelmed.
Caregiver Burden
- Abstract
- Caregiver Burden
- Health Problems of Caregivers
- An Office-Based Arroyo
- Anticipatory Guidance
- Final Comment
- References
Caregiver burden is an all-encompassing term used to describe the physical, emotional and financial price of providing care.7 Numerous questionnaires take been developed to quantify the largely subjective domain of caregiver burden, but the Zarit Burden Interview is the most widely referenced calibration in studies of caregiver burden (Figure 1).8
The Zarit Burden Interview
Figure 1.
Questions in the Zarit Burden Interview. While this questionnaire was non designed for use in practice, it demonstrates the telescopic of problems to consider when assessing caregiver burden. Copyright© 1983 Steven Zarit. Used with permission.
Surprisingly, research has shown that the level of burden perceived by the caregiver does not correlate with the elapsing of time spent as a caregiver or the progression of memory loss in the family unit member who is receiving care.nine,10 Studies as well suggest that the caste of functional impairment in the person receiving care does not correlate with caregiver burden.11 The degree of behavioral problems in patients with dementia, however, does contribute to caregiver burden.x When patients with dementia have depression, their caregivers report college levels of burden.12
Characteristics of the caregiver'due south skills are directly related to caregiver burden. For case, active coping skills and management strategies are associated with lower levels of caregiver burden. Active strategies include "amalgam a larger sense of the disease" and being firm in directing a relative's behavior.thirteen According to Saad and colleagues,13 a caregiver may develop a larger sense of the affliction past making sense of the illness, praying for strength to keep going and reminding himself or herself that this is something to await with aging. Family support, specifically frequent visits by other family members, and the presence of a strong social network represent with lower levels of caregiver brunt.8,xi
The consequences of a high caregiver burden include an increased risk of the need to place the family fellow member in a long-term care facility as well every bit increased use of formal in-home services.14 The societal and economic benefits of reducing the corporeality of caregiver burden are evident. In addition, higher levels of burden may correlate with increased morbidity and mortality in caregivers.15 Multiple studies10,16–twenty take shown that the incidence of low in caregivers is loftier, ranging from xviii to 47 percent, and caregivers who are depressed feel higher degrees of burden.21
Wellness Problems of Caregivers
- Abstruse
- Caregiver Brunt
- Wellness Problems of Caregivers
- An Office-Based Approach
- Anticipatory Guidance
- Final Comment
- References
Most of the enquiry on the health of caregivers has focused on psychologic well-being. Low is the most heavily researched expanse in caregiver health. Ane study22 revealed that feet was present in 17.v percent of caregivers, compared with 10.ix percentage of subjects in a matched command group. An increased incidence of feet correlates with research that has documented a higher amount of psychotropic drug employ among caregivers.23 The incidence of booze use among caregivers is uncertain. One study10 showed less alcohol use among caregivers than the general population, and another study24 showed no difference in the amount of alcohol use by caregivers and the general population.
When compared with persons who are not in a caregiving role, caregivers perceive their own health status to exist lower.23 More just perception, the immune function of caregivers may be reduced. Research24 has shown that viral illnesses last longer in caregivers than in control subjects. In addition, three measures of cellular immunity have been shown to be lower in caregivers than in control subjects.24
A landmark study15 of caregiver health revealed that elderly spousal caregivers who experienced caregiver strain had a mortality risk that was 63 percent higher than that in control subjects. The implications of this report brand early identification of caregiver brunt and appropriate intervention fifty-fifty more disquisitional.
An Role-Based Approach
- Abstract
- Caregiver Burden
- Health Problems of Caregivers
- An Office-Based Approach
- Anticipatory Guidance
- Concluding Comment
- References
Caregivers have been described as "hidden patients."4 Family physicians should identify their patients who are caregivers through a detailed family and social history. Caregivers should be assessed for their level of perceived burden and for the presence of melancholia disorders such as depression and feet. In addition, family physicians should assist caregivers with coping strategies, counseling them almost means to handle behavioral management bug that arise during the course of dementia.
The degree of caregiver brunt should be assessed systematically. Questionnaires designed to quantify caregiver burden are not intended for employ during routine office assessments. In the office setting, request the patient a few questions can requite a measure of the patient's caregiver burden (Table 1).
TABLE 1
Suggested Questions for Assessing Caregiver Burden During an Office Visit
| Screening question | Area of concern |
|---|---|
| Do you feel that you are currently under a lot of stress? What aspects of your day are the most stressful? | Mental health |
| Accept you been feeling down or blue lately? | Mental health |
| Have y'all been feeling more anxious and irritable lately? | Mental health |
| Do your family and friends visit frequently? Exercise they phone often? | Social support |
| Do your friends and family lookout your relative for yous so that you have fourth dimension for yourself? | Social back up |
| Practice you have any exterior help? | Resources |
| Is your relative with dementia having any behaviors, such every bit wandering, that are difficult to manage? | Behavioral management |
| What do yous do to relieve your stress and tension? | Coping |
Mental wellness issues are a pregnant area of concern. Considering depression is the most common health problem in caregivers, information technology should be screened for routinely. Family and individual counseling may be considered for patients with affective disorders or a high level of caregiver brunt.
Social support and resources should exist explored if the patient's answers to screening questions suggest a need for outside assist. The clinician should ask specifically about the number of visits each week by family unit members and friends. The patient also may be asked, "Accept your family or friends offered to help?" or "Take you accepted the offer?"
RESPITE Intendance
If the caregiver does not receive respite regularly, physicians should give them permission to ask for help and assist them in finding sources for aid. Ways to advise sources include stating something like "You might desire to remember about contacting your church/synagogue for some help with your mom. They often accept sitting services bachelor." Another approach might exist to say, "Getting exterior assist may be a way for yous to get regular time outside the house. I'm going to give y'all a phone number so you can contact your local office on aging. It is a good resource for you."
Adult day services are an first-class source of respite for the caregiver and provide engaging activities for persons with dementia. The local Area Bureau on Aging tin provide the caregiver with a list of nearby facilities. In i study,25 caregivers gave respite services a rating of loftier overall satisfaction. Although formal and breezy respite care has been shown to delay institutionalization, respite care has a varied bear on on caregiver burden.25,26
Family problems oftentimes surface when discussing the specifics of respite care. Numerous and varied family stresses develop effectually providing care to the family member. The primary caregiver can have difficulty accepting other family members' support while at the same fourth dimension resenting a perceived lack of back up.
BEHAVIORAL Bug
The caregiver's skills in managing behavioral issues should be explored in more than particular if the screening questions signal issues in this area. When assessing the caregiver's skills in dealing with behavioral problems, the physician should requite examples of situations, such equally "How would you respond to your mother's request the same question repeatedly, such equally, 'Where is John?'" Studies13 suggest that caregivers who are firm and directive tend to take less depression. Physicians should tell caregivers to be more than directive, as opposed to passive, in their strategies for dealing with hard behaviors. For example, a direct response would exist, "Mom, John is non here right now, so let's get-go getting lunch gear up."
Physicians should also encourage the caregiver to appoint the family member in activities. For example, the caregiver can be asked, "Does your married man assist with household tasks?" In this case, the caregiver should be encouraged to involve her married man in unproblematic tasks such as folding the laundry.
STRATEGIES FOR STRESS RELIEF
If the caregiver has trouble list his or her strategies for stress relief, this is an area for further questioning. Coping strategies can be divided into emotion-focused and trouble-focused. Examples of emotion-focused strategies are worrying and self-accusation. Caregivers who apply problem-focused strategies, such as against issues and seeking information take less exhaustion.26 Physicians should explore these strategies with their patients. A sample question for caregivers would be, "When something goes wrong with your blood brother's intendance, for case, if he loses control of his bladder, how would you react?" Emotion-focused responses are "I'd cry" or "I'd put him in a home." A problem-focused response is, "I'd call the dr. and find out what'southward happening." A tendency to utilise emotion-focused responses should alert the physician to an increased risk of burnout in the caregiver.
Agile coping strategies, such as constructing a larger sense of the illness, are associated with a lower incidence of depression among caregivers.13 The caregiver tin can be guided toward seeing the bigger movie by stating, for example, "I know this time has been challenging for you. What practise you lot see yourself doing when you are no longer a caregiver?"
Support groups are pop outlets for caregivers. One study3 revealed that educational support was most benign to caregivers when it was trouble-focused, such as on behavioral management. In another report,28 combination intervention that included individual and family counseling sessions as well equally mandatory participation in support groups was found to filibuster the need for nursing home placement. Institutionalization of dementia patients was delayed by 329 days in the intervention group of caregivers, compared with the group of caregivers who did not receive counseling and other forms of support.
For many caregivers, much of their burden is related to feelings of loneliness or isolation. Specific groups such equally the Breakaway program26 are designed to supplement traditional support groups by providing informal recreational and social activities with a peer group of caregivers who are experiencing similar stresses. Table ii summarizes some coping tips for caregivers.
TABLE ii
Coping Tips for Caregivers
| Educate yourself near the disease your family member is facing and how it may touch on his or her behavior, pain level, etc. |
| Find sources of help for caregiver tasks. Contact family unit, friends, neighbors, church building/synagogue, workplace, Area Bureau on Crumbling or other organizations. Keep looking! |
| Protect your personal time for something y'all enjoy or something you need to get done. |
| Try to find time for practice, eating well and sleeping plenty. |
| Apply your personal network of friends and family for support or notice a support grouping for caregivers of dementia patients in your area. |
| Watch out for symptoms of depression (such as crying more, sleeping more or less than usual, increased or decreased appetite or lack of involvement in usual activities). Notify your doctor if symptoms of depression are present. |
| Consider how yous will feel and what you will do after the caregiving ends. |
ELDER ABUSE
After the caregiver's behavioral management and coping strategies are assessed, it is of import to consider the issue of elderberry abuse. Although the incidence of abuse in the dyad of a dementia patient and a family caregiver is non very high, caregivers with a college burden may have an increased potential for mistreating the family member.29 If abuse is suspected, physicians can contact the appropriate local authorities through the National Hotline for Physician Reporting of Elder Corruption or Neglect at 800-490-8505. Mandatory reporting laws vary past state.
PATIENT Educational activity
Because a lack of understanding about the family fellow member's disease process may worsen caregiver stress, the caregiver's noesis about the dementing illness and bachelor resource should be explored and additional information provided when needed. Caregivers may be given written educational materials regarding dementia. Resources such as those in Table 3 should also exist fabricated available to caregivers.
Tabular array three
Resource for Obtaining Data Almost Caregiving
| Alzheimer'due south Association | |
| Phone: 800-272-3900 | |
| Web accost: http://world wide web.alz.org | |
| National Data Center of the U.S. Administration on Aging | |
| Telephone: 202-619-7501 | |
| American Association of Retired Persons; a free caregiver resource kit is available (No. D15267) | |
| Telephone: 800-424-3410 | |
| National Counsel on the Aging | |
| Telephone: 202-479-1200 | |
| Children of Aging Parents | |
| Telephone: 800-227-7294 | |
| Telephone: 215-945-6900 | |
| Web accost: http://www.caps4caregivers.org | |
| National Family Caregivers Clan | |
| Telephone: 800-896-3650 | |
| Web accost: http://www.nfcacares.org | |
| The Well Spouse Foundation | |
| Telephone: 800-838-0879 | |
| Telephone: 202-685-8815 | |
| Spider web accost: http://www.wellspouse.org | |
| National Hotline for Doc Reporting of Elderberry Abuse and Neglect | |
| Telephone: 800-490-8505 | |
| Eldercare Locator (A nationwide service for locating surface area agencies on aging) | |
| Phone: 800-677-1116 | |
| Administration on Crumbling | |
| Spider web address: http://world wide web.aoa.gov | |
| Caregiving Online (Online support service through a caregiving newsletter) | |
| Web address: http://www.caregiving.com | |
| Alzheimer's Illness Educational activity and Referral Heart, National Establish on Aging (This Web site includes information about ongoing studies.) | |
| Web address: http://www.alzheimers.org | |
| CareGuide.com (A personal caregiving resource) | |
| Web address: http://www.careguide.net | |
| Caregiverzone.com (A Web site for family unit persons) | |
| Web address: http://www.caregiverzone.com | |
Anticipatory Guidance
- Abstruse
- Caregiver Brunt
- Wellness Issues of Caregivers
- An Function-Based Approach
- Anticipatory Guidance
- Final Annotate
- References
The menses following the expiry of the intendance recipient tin can be a difficult transition for some caregivers. One study30 suggests that caregivers who experience high levels of burden during the caregiving role tend to accept more difficulty with the bereavement process. Later identifying caregivers with higher levels of burden, family physicians should help set up these patients for the emotional challenges ahead.
Last Annotate
- Abstract
- Caregiver Burden
- Health Problems of Caregivers
- An Role-Based Approach
- Anticipatory Guidance
- Terminal Comment
- References
Family physicians can accept a significant impact on the health and well-being of caregivers. By assessing the caregiver's level of burden, including the issue of low, the medico tin identify caregivers who are at high risk for physical and emotional issues. Family unit physicians can educate caregivers on behavioral direction techniques and coping strategies. Past providing the holistic approach to treat caregivers, family physicians can help fix them for the many phases of this challenging part.
To see the full article, log in or buy access.
REFERENCES
testify all references
i. Koizumi LS, et al, ed. The public health. In: 1998 wellness care almanac and yearbook. New York: Faulkner and Grayness, 1998:263. ...
2. Evans DA, Funkenstein HH, Albert MS, Scherr PA, Melt NR, Chown MJ, et al. Prevalence of Alzheimer's disease in a community population of older persons. JAMA. 1989;262:2551–6.
iii. Haley Nosotros. The family caregiver's office in Alzheimer'due south disease. Neurology. 1997;48(suppl 6):S25–S29.
4. Andolsek KM, Clapp-Channing NE, Gehlbach SH, Moore I, Proffitt VS, Sigmon A, et al. Caregivers and elderly relatives: the prevalence of caregiving in a family practice. Arch Intern Med. 1988;148:2177–80.
5. Clipp EC, George LK. Dementia and cancer: A comparison of spouse caregivers. Gerontologist. 1993;33:534–41.
vi. Max Westward, Webber P, Fox P. Alzheimer's disease: the unpaid burden of caring. J Aging Health. 1995;vii:179–99.
7. George LK, Gwyther LP. Caregiver well-beingness: a multidimensional test of family caregivers of demented adults. Gerontologist. 1986;26:253–nine.
eight. Zarit SH, Reever KE, Bach-Peterson J. Relatives of the dumb elderly: correlates of feelings of burden. Gerontologist. 1980;20:649–55.
9. Novak M, Guest C. Application of a multidimensional caregiver brunt inventory. Gerontologist. 1989;29:798–803.
10. Baumgarten Yard, Hanley JA, Infante-Rivard C, Battista RN, Becker R, Gauthier S. Wellness of family members caring for elderly persons with dementia. Ann Intern Med. 1994;120:126–32.
eleven. Dunkin JJ, Anderson-Hanley C. Dementia caregiver burden: a review of the literature and guidelines for cess and intervention. Neurology. 1998;51(suppl i):S53–S60.
12. Drinka TJ, Smith JC, Drinka PJ. Correlates of depression and burden for informal caregivers of patients in a geriatrics referral dispensary. J Am Geriatr Soc. 1987;35:522–5.
xiii. Saad K, Hartman J, Ballard C, Kurian Yard, Graham C, Wilcock Thou. Coping by the carers of dementia sufferers. Age Crumbling. 1995;24:495–eight.
14. Brown 50 J, Potter JF, Foster BG. Caregiver burden should be evaluated during geriatric cess. J Am Geriatr Soc. 1990;38:455–lx.
15. Schulz R, Beach SR. Caregiving every bit a adventure cistron for mortality. The Caregiver Health Effects Study. JAMA. 1999;282:2215–9.
16. Rosenthal CJ, Sulman J, Marshall Five W. Depressive symptoms in family unit caregivers of long-stay patients. Gerontologist. 1993;33:249–56.
17. Teri L, Truax P. Assessment of depression in dementia patients: clan of caregiver mood with low ratings. Gerontologist. 1994;34:231–four.
18. Gallagher D, Rose J, Rivera P, Lovett S, Thompson LW. Prevalence of depression in family unit caregivers. Gerontologist. 1989;29:449–56.
19. Williamson GM, Schultz R. Coping with specific stressors in Alzheimer'southward affliction caregiving. Gerontologist. 1993;33:747–55.
xx. Livingston Thousand, Manela M, Katona C. Low and other psychiatric morbidity in care of elderly people living at home. Br Med J. 1996;312:153–6.
21. Lawton MP, Moss M, Kleban MH, Glicksman A, Rovine M. A two-factor model of caregiving appraisal and psychological well-being. J Gerontol Psychol Sciences. 1991;46:181–nine.
22. Cochrane JJ, Goering PN, Rogers JM. The mental health of informal caregivers in Ontario: an epidemiological survey. Am J Public Health. 1997;87:2002–7.
23. Grafstrom One thousand, Fratiglioni L, Sandman PO, Winblad B. Wellness and social consequences for relatives of demented and non-demented elderly. A population-based study. J Clin Epidemiol. 1992;45:861–70.
24. Kiecolt-Glaser JK, Dura JR, Speicher CE, Trask OJ, Glaser R. Spousal caregivers of dementia victims: longitudinal changes in immunity and wellness. Psychosom Med. 1991;53:345–62.
25. Lawton MP, Brody EM, Saperstein AR. A controlled written report of respite service for caregivers of Alzheimer's patients. Gerontologist. 1989;29:8–xvi.
26. Forde OT, Pearlman South. Breakaway: A social supplement to caregivers' support groups. Am J Alz Dis. 1999;14:120–4.
27. Almberg B, Grafstrom M, Winblad B. Major strain and coping strategies as reported by family members who intendance for aged demented relatives. J Adv Nursing. 1997;26:683–91.
28. Mittelman MS, Ferris SH, Shulman E, Steinberg K, Levin B. A family intervention to filibuster nursing home placement of patients with Alzheimer's Disease: a randomized controlled trial. JAMA. 1996;276:1725–31.
29. McGuire P, Fulmer T. Elder abuse. In: Cassel CK, Cohen HJ, Larson EB, Meier DE, Resnick NM, Rubenstein LZ, et al, eds. Geriatric medicine. 3d ed. New York: Springer-Verlag 1997:855–64.
30. Bass DM, Bowman K. The transition from caregiving to bereavement: the human relationship of care-related strain and aligning to expiry. Gerontologist. 1990;thirty:35–42.
Copyright © 2000 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may brand ane printout of the cloth and may use that printout only for his or her personal, not-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether at present known or subsequently invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.
MOST RECENT Upshot
Feb 2022
Access the latest issue of American Family Doc
Read the Issue
Email Alerts
Don't miss a unmarried issue. Sign up for the complimentary AFP e-mail tabular array of contents.
Sign Up Now
Source: https://www.aafp.org/afp/2000/1215/p2613.html
0 Response to "Which of the Following Is Not True of Family Caregivers in General?"
Post a Comment