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Caregiver Stress:  Causes and Treatment


Lee Willis, Ph.D.


Clinical Psychologist, Southern California Alzheimer's Disease Diagnostic 
	and Treatment Center


Rancho Los Amigos Medical Center






Shirle Gottlieb


Caregiver and Theater Critic

__________________


Caregiver Stress and Health 



Willis: The following is a brief synopsis of research recently
conducted at Rancho Los Amigos Medical Center. It is not a
transcription of my presentation at the workshop. As a resource I have
included an extensive bibliography on caregiving.

Caring for a physically disabled spouse or other relative can be
physically and emotionally stressful, placing the caregiver at
heightened risk of illness and chronic disease onset.  Although an
abundance of research has focused on the adverse emotional and social
effects of caregiving, there have been few studies of the physical
health consequences for this group. The purpose of the study being
reported was to investigate (1) health consequences of caregiving, and
(2) relationships between physical health and psycho-social
characteristics of caregivers.

Our sample included 24 primary caregivers (CG) and 31 non-caregivers
(NCG) ranging from 55 to 78 years of age. All participants received
complete physical examinations, including evaluation of
cardiovascular, respiratory, musculoskeletal, sensory, and
neurological systems. Combined, these physical health measures
produced a continuous morbidity (or illness) scale with 110 individual
variables. Where appropriate, individual morbidity scores were
adjusted for age and gender. Participants also completed scales
evaluating personality, social support, locus of control, perceived
stress, psychological distress, and problem behaviors of the disabled
spouse.

Analysis of the resulting data showed no significant differences
between caregivers and non-caregivers in terms of age, education, or
gender. There were, however, significant differences in morbidity,
with caregivers demonstrating greater incidence of illness. For
example, caregivers had higher blood pressure and more acute health
conditions.

Caregivers also reported significantly more psycho-social problems
including psychological distress, inadequate social attachments, and
health perceived not to be in their own control, as well as more
behavioral problems attributed to the disabled spouse.

The best predictors, accounting for up to 69% of the differences
between caregivers and non-caregivers, were: their total illness
score, the number and severity of daily hassles they experienced,
their perception that their health was not in their own control, and
their having a dependent personality style.

The results of this study offer evidence that in providing primary
care for a disabled spouse, a person encounters a potential risk to
his or her own physical health. The effect is detectable on routine
physical examination, not requiring expensive and intrusive
procedures. Elevated blood pressure was a particularly salient feature
for caregivers.



__________________


Resources:  

Beach Center on Families and Disability, University of Kansas, 3111
Hayworth Hall, Lawrence, KS 66045. (913) 864-7600.

The Family Survival Project, 425 Bush Street, Suite 500, San
Francisco, CA 94108. (415) 434-3388.

Bibliography:

Anthony-Bergstone C, Zarit S, Gatz M (1988). Symptoms of psychological
distress among caregivers of dementia patients.  Psychology and Aging,
3:245-248.

Aronson MK, Lipkowitz R (1981). Senile dementia, Alzheimer's type: The
family and the health care delivery system. Journal of the American
Geriatrics Society, 29:568-571.

Baile V, Norbeck JS, Barnes LE (1988). Stress, social support, and
psychological distress of family caregivers of the elderly. Nursing
Research, 37:217-222.

Barusch AS, Spaid WM (1988). Gender differences in caregiving: Why do
wives report greater burden? The Gerontologist, 29:667-676.

Bishop DS, Epstein NB, Leitner GI, Miller IW, Srinivasan SV (1986).
Stroke: Morale, family functioning, health status, and functional
capacity. Archives of Physical Medicine and Rehabilitation, 67:84-87.

Brane G (1986). Normal aging and dementia disorders -- Coping and
crisis in the family. Progress in Neuropsychopharmacology and
Biological Psychiatry, 10:287-295.

Brody EM (1985). Parent care as a normative family stress. The
Gerontologist, 25:19-29.

Brody SJ, Poulshock SW, Masciocchi CF (1978). The family caring unit:
A major consideration in the long-term support system. The
Gerontologist, 18:556-561.

Bunting SM (1989). Stress on caregivers of the elderly.  Advances in
Nursing Science, 11:63-73.

Cantor, MH (1983). Strain among caregivers: A study of experience in
the United States. The Gerontologist, 23:597-604.

Chenoweth B, Spencer B (1986). Dementia: The experience of family
caregivers. The Gerontologist, 26:267-271.

Chiriboga DA, Weiler PG, Nielsen K (1989). The stress of caregiving.
Journal of Applied Social Sciences, 13:119-141.

Cleary BL (1987). Alzheimer's disease: Specific stressors and
strategies associated with caregiving. The Southwestern: The Journal
for Aging in the Southwest, 4:36-47.

Cohen D, Eisdorfer C (1988). Depression and family members caring for
a relative with Alzheimer's disease. Journal of the American Geriatric
Society, 36:885-889.

Coppel DB, Burton C, Becker J, Fiore J (1985). Relationships of
cognitions associated with coping reactions to depression in spousal
caregivers of Alzheimer's disease patients.  Cognitive Therapy and
Research, 9:253-266.

Cutler L (1985).  Counseling caregivers. The Gerontologist,
Fall:53-58.

Deimling GT, Bass DM (1986). Symptoms of mental impairment among
elderly adults and their effects on family caregivers.  Journal of
Gerontology, 41:778-784.

Drinka TJK, Smith JC, Drinka PJ (1987). Correlates of depression and
burden for informal caregivers of patients in a geriatrics referral
clinic. Journal of the American Geriatrics Society, 35:522-525.

Eagles JM, Graig A, Rawlinson F, Restall DB, Beattie JAG, Besson JAO
(1987). The psychological well-being of supporters of the demented
elderly. British Journal of Psychiatry, 150: 293-298.

Eisenberg MG, Sutkin LC, Jansen MA (1984). Chronic illness and
disability through the life span: Effects on self and family.  New
York: Springer Publishing.

Fengler AP, Goodrich N (1979). Wives of elderly disabled men: The
hidden patients. The Gerontologist, 19:175-183.

Fiore J, Becker J, Coppel DB (1983). Social network interactions: A
buffer or a stress. American Journal of Community Psychology,
11:423-439.

Fiore J, Coppel DB, Becker J, Cox GB (1986). Social support as a
multifaceted concept: Examination of important dimensions for
adjustment. American Journal of Community Psychology, 14:93-111.

Fitting M, Rabins P, Lucas MJ, Eastham J (1986). Caregivers for
dementia patients: A comparison of husbands and wives.  The
Gerontologist, 26:248-252.

Gallagher D, Rose J, Rivera P, Lovett S, Thompson LW (1989).
Prevalence of depression in family caregivers. The Gerontologist,
29:449-456.

Gaynor S (1989). When the caregiver becomes the patient.  Geriatric
Nursing, 10:121-123.

George KL, Gwyther L (1986). Caregiver well-being: A multidimensional
examination of family caregivers of demented adults. The
Gerontologist, 26:253-259.

Gilhooly MLM (1984). The impact of care-giving on caregivers: Factors
associated with the psychological well-being of people supporting a
dementing relative in the community. British Journal of Medical
Psychology, 57:35-44.

Given CW, Collins CE, Given BA (1988). Sources of stress among
families caring for relatives with Alzheimer's disease.  Nursing
Clinics of North America, 23:69-82.

Goldman LS, Luchins DJ (1984). Depression in the spouses of demented
patients. American Journal of Psychiatry, 141(11):1467-1468.

Goldstein MS, Hurwicz M (1989). Psychosocial distress and perceived
health status among elderly users of a health maintenance
organization. Journal of Gerontology, 44:154-156.

Grad J, Salinsbury P (1968). The effects that patients have on their
families in a community care and control psychiatric service -- A two
year follow-up. British Journal of Psychiatry, 114:265-278.

Grossman L, London C, Barry C (1981). Older women caring for disabled
spouses: A model for supportive services. The Gerontologist,
21:464-470.

Gwyther LP, George LK (1986). Symposium: Caregivers for dementia
patients: Complex determinants of well-being and burden. The
Gerontologist, 26:245-247.

Haley WW, Levine EG, Brown SL, Berry JW, Hughes GH (1987).
Psychological, social, and health consequences of caring for a
relative with senile dementia. Journal of the American Geriatrics
Society, 35:405-411.

Horowitz A (1985). Family caregiving to the frail elderly. In C
Eisdorfer (Ed.) Annual review of gerontology and geriatrics,
5:194-246. New York: Springer.

Horowitz A (1985). Sons and daughters as caregivers to older parents:
Differences in role performance and consequences.  The Gerontologist,
25:612-617.

Houlihan JP (1987). Families caring for frail and demented elderly: A
review and selected findings. Family Systems Medicine, 5:344-356.

Johnson CL, Catalano DJ (1983). A longitudinal study of family
supports to impaired elderly. The Gerontologist, 23:612-618.

Josephs, A (1992). Stroke: An owner's manual. The invaluable guide to
life after stroke. Long Beach, CA: Amadeus Press.

Kapust LR (1982). Living with dementia: The ongoing funeral.  Social
Work in Health Care, 7:79-90.

Liptzin GB, Grob MC, Eisen SV (1988). Family burden of demented and
depressed elderly psychiatric inpatients. The Gerontologist,
28:397-401.
 
Lyons W (1982). Coping with cognitive impairment: Some family dynamics
and helping roles. Journal of Gerontological Social Work, 4:3-20.

Maurer JR, Strasberg PD (1989). Building a new dream: A family guide
to coping with chronic illness and disability.  Reading, MA: Addison
Wesley, Inc.

Miller B (1987). Gender and control among spouses of the cognitively
impaired: A research note. The Gerontologist, 27:447-453.

Montgomery RJV, Gonyea JG, Hooyman NR (1985). Caregiving and the
experience of subjective and objective burden. Family Relations,
January:19-25.

Morris LW, Morris RG, Britton PG (1988). The relationship between
marital intimacy, perceived strain and depression in spouse caregivers
of dementia sufferers. British Journal of Medical Psychology,
61:231-236.

Morris RG, Morris LW, Britton PG (1988). Factors affecting the
emotional well-being of the caregivers of dementia sufferers.  British
Journal of Psychiatry, 153:147-156.

Morris LW, Morris RG, Britton PG (1989). Social support networks and
formal support as factors influencing the psychological adjustment of
spouse caregivers of dementia sufferers. International Journal of
Geriatric Psychiatry, 4:47-51.

Mortiz DJ, Kasl SV, Berkman LF (1989). The health impact of living
with a cognitively impaired elderly spouse: Depressive symptoms and
social functioning. Journal of Gerontology, 44:S17-27.

Motenko AK (1989). The frustrations, gratifications, and well-being of
dementia caregivers. The Gerontologist, 29:166-172.

Norris VK, Stephens-Parris MA, Kinny JM (1990). The impact of family
interactions on recovery from stroke: Help or hindrance? The
Gerontologist, 30:535-542.

Novak M, Guest C (1989). Caregiving response to Alzheimer's disease.
International Journal of Aging and Human Development, 28:67-79.

Pagel MD, Becker J (1987). Depressive thinking and depression:
Relations with personality and social resources. Journal of
Personality and Social Psychology, 52:1043-1052.

Pagel MD, Becker J, Coppel DB (1985). Loss of control, self-blame, and
depression: An investigation of spouse caregivers of Alzheimer's
disease patients. Journal of Abnormal Psychology, 94:169-182.

Pagel MD, Elderly WW, Becker J (1987). Social networks: We get help by
(and in spite of) a little help from our friends.  Journal of
Personality and Social Psychology, 53:793-804.

Pett MA, Caserta MS, Hutton AP, Lund DA (1988).  Intergenerational
conflict: Middle-aged women caring for demented older relatives.
American Journal of Orthopsychiatry, 85(3):405-417.

Petty D, Friss L (1987). A balancing act of working and caregiving.
Business and Health, October:22-24.

Poulshock SW, Deimling GT (1984). Families caring for elders in
residence: Issues in the measurement of burden. Journal of
Gerontology, 39:230-239.

Pratt C, Wright S, Schmall V (1987). Burden, coping and health status:
A comparison of family caregivers to community dwelling and
institutionalized Alzheimer's patients. Journal of Gerontological
Social Work, :99-113.

Pruchno RA, Potashnik SL (1989). Caregiving spouses. Journal of the
American Geriatrics Society, 37:697-705.

Pruchno RA, Resch NL (1989). Aberrant behaviors and Alzheimer's
disease mental health effects on spouse caregivers. Journal of
Gerontology, 44:S177-182.

Pruchno RA, Resch NL (1989). Husbands and wives as caregivers:
Antecedents of depression and burden. The Gerontologist, 29:159-165.

Quayhagen MP, Quayhagen M (1988). Alzheimer's stress: Coping with the
caregiving role. The Gerontologist, 28:391-396.

Rabins PV, Mace NL, Lucas MJ (1982). The impact of dementia on the
family. Journal of the American Medical Association, 248:333-335.

Schultz RS, Visintainer P, Williamson GM (1990). Psychiatric and
physical morbidity effects of caregiving. Journal of Gerontology,
45:181-191.

Shanas E (1979). The family as a social support system in old age. The
Gerontologist, 19:169-174.

Silliman RA, Sternberg J (1988). Family caregiving: Impact of patient
functioning and underlying causes of dependency. The Gerontologist,
28:377-382.

Soldo BJ, Myllyluoma J (1983). Caregivers who live with dependent
elderly: A national profile. The Gerontologist, 23:605-611.

Stone R, Cafferata GL, Sangl J (1987). Caregivers of the frail
elderly: A national profile. The Gerontologist, 27:616-626.

Toseland RW, Zarit SH (1989). Introduction to the symposium.  The
Gerontologist, 29:437.

When stroke strikes -- Information for the family. United Stroke
Foundation: The road back -- A resocialization program. Stroke
Association of Southern California, 2001 S. Barrington Ave., Suite
308, Los Angeles, CA 90025.

Whittick JE (1988). Dementia and mental handicap: Emotional distress
in carers. British Journal of Clinical Psychology, 27:167-172.

Winogrond IR, Fisk AA, Kirsling RA, Keyes B (1987). The relationship
of caregiver burden and morale to Alzheimer's disease patient function
in a therapeutic setting. The Gerontologist, 27:336-339.

Worchester MI, Quayhagen MP (1989). Correlates of caregiving
satisfaction: Prerequisites to elder care. Research in Nursing and
Health, 6:61-67.

Zarit SH, Toseland RW (1989). Current and future direction in family
caregiving research. The Gerontologist, 29:481-483.

Zarit SH, Reever KE, Bach-Peterson J (1980). Relatives of the impaired
elderly: Correlates of feelings of burden. The Gerontologist,
20:649-655.

Zarit SH, Todd PA, Zarit JM (1986). Subjective burden of husbands and
wives as caregivers: A longitudinal study. The Gerontologist,
26:260-266.

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