This page contains two articles on caregiving that were previously published in our newsletter, Aging Upbeat.

Caregiving Can Be Stressful how to handle caregiver stress written by Mark Miller, M.D. Providing care for a family member with a chronic illness or disability of any kind can be very stressful, and more people are in the position of being a caretaker than ever before. Statistics show that, in the new millennium, Americans as a group are living longer. The average lifespan is now approaching 80 years of age. This is a 30 year increase since the beginning of the last century, and this is partly due to treatments and medical advances.

The result is that many elders are living through medical events that they may not have survived in the past. Although many elders are living longer, many are doing so while also facing some kind of chronic disability, and these disabilities often require care from a family member. The most common chronic conditions afflicting older Americans are pain from arthritis, difficulties with walking or balance, and declining hearing or vision, all of which require help to get through a normal day.

Alzheimer’s disease and other forms of dementia and memory loss also can produce a great deal of caregiver burden. It is quite stressful to be faced with re-answering a loved one’s repeated questions, as well as dealing with uncooperativeness, wandering and incontinence. Many of these patients cannot be left alone without becoming a danger to themselves or others. As a result, caregivers are often faced with the difficult decision of placing a loved one in a nursing home. All of these stressors can result in depression for the person trying to care for another.

How can a caregiver handle stress better? The following are some tips that we have learned over the years from our experience of working with elderly patients and their families:

Take care of yourself. Make sure to see your doctor for regular check ups. Commonly, we see caregivers neglect their own health problems because they are so absorbed with the care of their loved ones. Caregivers cannot provide care to others if they become sick or run down themselves.

Get help for depression. The stress of caregiving can lead to depression. It can be exhausting, life changing and can interfere with sleep. Joining a support group is helpful for some caregivers. For others, being evaluated and treated for depression can help someone to cope better.

Get additional help with the caregiving. Many people feel they should carry the burden of caregiving all on their own, that only they can "do it right," or it is their duty alone. However, often other family members are quite willing to "take a turn" so that the caregiver can have a few hours off during the week to relax, shop, catch up on errands or visit friends. There are also many community agencies that can provide help with daily needs of elderly patients. Another possible avenue for additional help is respite care. This is a program where chronically ill or disabled family members can stay for a week or a month to allow caregivers to have some extended time off and come back refreshed. Adult day care is another solution to help with a caregivers worry. It can offer a friendly and safe environment with plenty of activities.

Watch that alcohol! Many caregivers are tempted to use alcohol more than they would normally in order to cope with the stress of caregiving. However, the effects of drinking more will make it harder for you to cope in the long run. If you feel that your drinking may be out of control, there is help available; ask your doctor.

Know your limits. One person can only do so much, particularly if you are feeling your own age or suffering from your own medical problems. There may come a time when you can’t continue to manage in the same way anymore. As a caregiver, you might consider other options such as getting help from new sources, moving to an easier to manage living arrangement or placing your loved one in a nursing home. A good social worker will be able to inform you about services that are available in your community.

In summary: Caregiving can be stressful. It is work. It requires vigilance. It can interfere with sleep. It limits your free time. It can drive you to drink. Take care of yourself. Admit it when you need more help or feel overwhelmed. If caregiving leads to depression, you may benefit from professional help from a counselor or psychiatrist.

Remember: As a caregiver, you must take care of yourself and your own health first!

written by Lynn Martire, Ph.D., and Rich Schulz, Ph.D.

One of our society’s great assets is the many family members who provide care to ill or disabled relatives. By some estimates, more than 15 million adults currently provide care to relatives with chronic illness or disability, saving the formal health care system billions of dollars annually.

Over the past 15 years researchers at the University of Pittsburgh have looked at the long-term consequences for family members of providing care to an ill or impaired older relative who is struggling with physical illness or mental health problems. Family caregiving often includes assistance with personal care activities, such as bathing, dressing and getting around, as well as other activities such as shopping, preparing meals, and driving. In addition, some family caregivers find themselves assisting their relative with managing finances, making decisions about their health care, and providing emotional support for dealing with illness.

"Due to increased longevity and improvements in the health of our populations, it is more common for older individuals to be a caregiver..."

The majority of family caregivers are either middle-aged individuals who provide care to a parent, or older individuals who provide care to a spouse. Due to increased longevity and improvements in the health of our population, it is becoming more common for older individuals to be a caregiver to an ill or impaired parent. Older adults who provide care to a spouse or parent are a special concern to researchers because these individuals are often dealing with health problems of their own. As a result, they may have fewer resources available to them and may be more negatively affected by caregiving than other types of caregivers.

It is important to note that not all caregivers feel burdened by their responsibilities. In one recent study carried out at the University of Pittsburgh we found that 35% of spousal caregivers reported no strain associated with caregiving. Indeed, a number of studies have shown that caregiving has numerous positive effects. It enables people to feel useful, needed, appreciated, and important. The experience of caregiving can also bring families closer together and cause people to appreciate life more. Adult children who are caregivers to elderly parents report that they find caregiving gratifying because they can "pay back" the care which their parent provided to them when they were young.

"One of the most common negative consequences of caregiving can be depressive symptoms..."

However, one of the most common negative consequences of family caregiving can be the onset of depressive symptoms such as feelings of sadness, hopelessness about the future, and difficulty concentrating. It is often the case that symptoms of depression develop over time in response to the difficult or stressful aspects of providing ongoing care to a family member. One can begin to feel overwhelmed, irritable and then guilty about these negative feelings. Caregivers have reported that some of the most difficult aspects of providing care stem from the unpredictable nature of an illness, dealing with memory or behavior problems of the care-recipient, and having less time for other activities or interests. Caregivers who are at greatest risk for depression are those who provide care to an individual who has memory problems.

"A recent study showed that caregivers are at higher risk of mortality than non-caregivers."

Many family caregivers report experiencing moderate to high levels of burden and distress as well as moderate to high levels of depression. One recent study showed that caregivers are at higher risk of mortality than non-caregivers. University of Pittsburgh researchers have been particularly interested in identifying individuals who are at risk for negative health outcomes and in developing programs that might alleviate some of the burdens associated with caregiving.

"Identifying and treating depression in caregivers is important not only for the well-being of the caregiver, but also for the quality of care provided..."

Identifying and treating symptoms of depression in family caregivers is important not only for the overall well-being of the caregiver but also for the quality of care provided to the care-recipient. Such treatment usually includes psychotherapy and/or antidepressant medications and is offered at the Late Life Depression Evaluation and Treatment Center.

Other strategies that have been shown to be beneficial include providing information about local resources that may lessen the burden of care, and teaching caregivers specific skills for dealing with functional or memory problems. These strategies and other approaches may reduce the burden of caregiving and help an individual to better experience the rewards of caregiving. Family caregivers are a valuable asset to our society, and their needs continue to be an important area of research at the University of Pittsburgh. 

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