 Click On Any Category Below To Learn More How Caregiver Stress Is Measured Negative Effects Of Caregiving Stress Specific Health Effects Of Caregiving Stress HOW CAREGIVER STRESS IS MEASURED Caregiver stress has been exhaustively studied. Researchers use the term "caregiver burden" to describe this type of stress. Various tests have been designed to measure caregiver burden. The test discussed here is the Zarit Burden Interview (ZBI), designed by Professor Steven Zarit. The Zarit Burden Interview is one of the most widely used tests of caregiving burden. It is simple to use and score. If you receive a high score on the test, you may be at risk for the physical complications of caregiver stress. You can learn more about the Zarit Burden Interview Online.CLICK HERE Many factors influence the amount of caregiving burden felt. Caregivers who live with the one they care for have the highest burden scores. Caregivers with a loved one in a nursing home also have very high burden scores. Caregivers living away from their patient have the lowest burden scores . In general, wives who are caregivers, tend to have higher burden scores than caregiver husbands. Daughters living with a patient for whom they provide care have the highest burden scores of all. The lowest burden scores are experienced by husbands with wives in a nursing home and by daughters with a patient who lives elsewhere. Emotional and physical factors contribute to caregiving burden. Angry and resentful caregivers always report feeling more burdened than those not expressing anger. Caregivers who have previously provided care for other people feel less caregiver burden. Caregivers who themselves are in ill health, report higher perceived burden. Caregiver stress is also influenced by the attitudes of the caregiver toward the care recipient. Caregivers who attribute a patient's troubling behaviors to the patient's illness are less burdened than caregivers who attribute the patient's behavior to patient willfulness . Caregivers who see the patient as "emotionally demanding" or "dependent" feel a higher sense of burden than those who see the patient as "disturbed" or disabled". Caregivers caring for very forgetful patients perceive their burden as being higher than caregivers who care for patients with mild forgetfulness. The behaviors and attitudes expressed by the care recipient can influence caregiver stress. One study found that caregiver burden is increased in 63% of caregivers when patients constantly ask the caregiver questions. Some Alzheimer patients have the need to always be physically near the caregiver. In this type of situation, 40% of caregivers are burdened by the constant clinging of their patient. One study revealed which patient behaviors increase the sense of caregiver burden most often. The study reported that 67% of caregivers reported that the following stressors occurred almost daily: patient confusion, patient aggression, and finally, nighttime wandering. Caregivers reduce caregiver stress and burden in varied ways. Humor seems to help lighten the burden for caregivers when these stressors occur. One study found that how caregivers view a stressor may help to modify the amount of burden felt. Men and women who said during an interview, "I look for the silver lining," or "I count my blessings and appreciate what my spouse can still do" had less overall feelings of burden. Some caregivers reduce their burden by "trying to make sense of the illness" by relying on religious or philosophical beliefs. Those caregivers who experienced the highest burden were the ones who use "wishful thinking" such as believing that a miracle could happen to change the illness. Jarrett found that how couples related prior to dementia diagnosis determines later perceptions of caregiver burden. Those women and men who had been very affectionate with their spouse prior to the onset of dementia experienced less burden and less feelings of depression. NEGATIVE EFFECTS OF CAREGIVING STRESS Providing care to an alzheimer patient is extraordinarily stressful. The results of stress can affect caregivers in many ways. Some caregivers find their physical and mental well being under attack. Anxiety, depression, a diminished social life, loss of self-esteem, and a decline in job performance are some of the problems alzheimer caregivers find themselves struggling with. Caregivers generally experience two types of stress - primary and secondary. Primary stress is the stress felt from everyday caregiving duties. Secondary stress comes from sources other than direct caregiving duties. Some causes of primary caregiver stress include: planning and implementing daily care for the patient, restraining the patient for safety reasons, assisting the patient with bathing and toileting,and managing difficult patient behavior such as agitation and wandering. Some causes of secondary caregiver stress include: caregiver conflicts with other family members, economic hardships such as lost work wages, and limitations on personal leisure and social activities. Caregiving stress directly affects the health of caregivers. When caregivers are asked to rate to what degree the stress of caregiving has affected their health, close to 25% report that their health has suffered in some way as a result of their caregiving role. Interestingly, caregivers seem to spend less time in doctors' offices than non-caregivers. Data from the National Center for Health Statistics shows: caregivers average 4 doctor visits per year, while non-caregivers average 7 doctor visits per year. Male and female caregivers report about the same number of doctor visits yearly. Many caregivers feel anxious and depressed. Caregivers report more feelings of anxiety than non-caregivers. About one-third of all caregivers report some level of anxiety. Dee Jones studied wife and daughter caregivers. She found anxiety much more prevalent among daughter caregivers. This may occur because daughter caregivers have the combined stresses of maintaining their own family and working either full or part time while trying to care for an aged parent. Feelings of depression can become a serious problem for some caregivers. Ironically, many of those caregivers with the most severe depression do not know or recognize that they are depressed. Consequently, they often do not seek medical help for their condition. Caregivers are also stressed by restrictions on their social life. The caregiving experience often affects the social structure and activities of the family. Dee Jones studied how caregiving changes the family. More than 16% of caregivers say that caregiving has definitely impacted family integrity. (Integrity in this study was defined as being relatively free of conflict and turmoil.) Many daughters reported that they were unable to go out in the evening with their husbands because they were caring for a demented parent. Many daughters resented the lack of privacy brought about by the care of a demented parent. Caregiving also places limits on the caregiver's social life. More than 60% of caregivers say that socializing and participating in hobbies are curtailed by caregiving . Caregivers living with an Alzheimer patient have an even more restricted social life than those who do not live with the patient. For example, spouses who take care of an Alzheimer patient report that they: have fewer visits from friends and family, spend less time chatting on the telephone, spend less time in their house of worship, spend less time with their hobbies, and vacations often suffer for caregivers as well. Caregivers also suffer disruption of their employment. More than 11% of caregivers quit their jobs to care for a parent at home. Hours worked are reduced by 3%. Time off from work is required by 8% of caregivers to perform caregiving chores. Many caregivers tend to develop negative health behaviors, such as smoking,not exercising,and overeating. One study looked at exercise patterns of caregivers. Only 41% of caregivers perform vigorous aerobic exercise weekly, compared to 65% of non-caregivers. Caregivers also tend to limit their exercise sessions to a shorter amount of time per session. Caregivers average 1.4 hours of exercise each week as compared to non-caregivers who average 3.6 hours of exercise each week. Regular exercise helps to reduce stress. Caregivers who exercise regularly have less depression, less anxiety, less anger, less perceived stress, and generally have lower blood pressure than caregivers who do not exercise. SPECIFIC HEALTH EFFECTS OF CAREGIVING STRESS Surprisingly, alzheimer caregivers seem to maintain their health fairly well despite the enormous stress they work under. However, the strain of caregiving can aggravate certain diseases. Additionally, about 12% of caregivers become physically ill or injured as a result of caregiving. Caregivers of dementia patients tend to develop diabetes, anemia, ulcers, and hypertension. In particular, alzheimer caregivers are especially vulnerable to insomnia, diabetes, and hypertension. Caregivers of dementia patients tend to have more bad dreams, heart palpations,headaches,and excessive perspiration than non-caregivers. Females seem especially prone to these symptoms . Caregivers tend to drink alcohol more often than non-caregivers. They also tend to use more psychotropic drugs such as those that induce sleep or relaxation. About 30% of caregivers use psychotropic drugs, compared to 20% of non-caregivers . A note of caution: A problem arises for stressed caregivers when they accidentally combine alcohol with a relaxant drug. Combining drugs with alcohol is dangerous and should be avoided. Caregiving affects sleep patterns. Caregivers sleep a bit less than non-caregivers. In one study , caregivers reported 22.4 hours of sleep every three days. Non-caregivers reported about 23.7 hours of sleep every three days. Although the number of hours spent sleeping is not dramatically different between caregivers and non-caregivers, the quality of sleep may be less for caregivers. As noted previously, caregivers use relaxant and sleep-inducing drugs more often than non-caregivers. Drug-induced sleep is not as nourishing to the body as sleep that comes naturally. Weight gain can be a problem for caregivers. Some female caregivers are prone to weight gain. A major study finds that women who care for alzheimer patients tend to gain weight, but only if they are unable to control their anger. Women caregivers who find effective ways to control their anger do not gain weight. Diabetes can be aggravated by the stress of caregiving. During periods of stress, especially in diabetics, high levels of insulin are present in the bloodstream. Insulin normally binds to cells and increases the entry of sugar inside cells where it is used for fuel. Thus, insulin that floats in the bloodstream during stress is less efficient. Female alzheimer caregivers who report both a high number of caregiving "hassles" and who feel anger and hostility have higher insulin levels in their bloodstream. Male caregivers often have elevated blood insulin with a high number of daily caregiving hassles. But feelings of anger do not seem to raise insulin levels as much as in female caregivers. These findings indicate that diabetic caregivers,more than other caregivers, need to find a way to release stress and stay as calm as possible. They should especially try to avoid getting angry. Wound healing is affected by the stress of caregiving. One study found that wounds, such as cuts, take 24% longer to heal in alzheimer caregivers than in non-caregivers. The immune system is weakened by caregiver stress. The main defenders in our immune system are lymphocytes and natural killer cells. Natural killer cells are particularly important to ward off viruses. Stress can lower the activity of natural killer cells. Studies also show that alzheimer caregivers have lower natural killer cell activity. Consequently, caregivers are more prone to colds and infections because of deficient immune responses. Not all caregivers have lowered immune activities. It appears that alzheimer caregivers who have more social contacts seem to have more efficient immune system functioning . Thus, it is important for caregivers to maintain family and friends and talk problems out in a support group, in order to maintain optimum immune system functioning. |