Family Living Focus: Caregiver Health – A Population at Risk

Gail Gilman, Family Life Consultant, M.Ed., C.F.C.S. and Professor Emeritus, University of Minnesota  

Millions of Americans age 18 and older provide unpaid assistance and support to older people and adults with disabilities who live in the community.  The value of this unpaid labor force is estimated to be billions of dollars annually and is estimated to be greater than the combined costs of home health care and the care provided in assisted and long-term care facilities.

Evidence shows that most caregivers are ill-prepared for their role and provide care with little or no support, yet more than one-third of caregivers continue to provide intense care to others while suffering from poor health themselves.  Studies have shown that an influential factor in a caregiver’s decision to place an impaired relative in a long-term care facility is the family caregiver’s own physical health.

Research shows that family members who provide care to individuals with chronic or disabling conditions are themselves at risk.  Emotional, mental, and physical health problems arise from complex caregiving situations and the strains of caring for frail or disabled relatives.

 Impact of Caregiving on Caregiver Mental and Emotional Health

The psychological health of the family caregiver is negatively affected by providing care.  Higher levels of stress, anxiety, depression, and other mental health effects are common among family members who care for an older relative or friend.

 Caregivers show higher levels of depression.

• Studies consistently report higher levels of depressive symptoms and mental health problems among caregivers than among their noncaregiving peers.
• Estimates show that between 40 – 70% of caregivers have clinically significant symptoms of depression, with approximately one quarter to one half of these caregivers meeting the diagnostic criteria for major depression^.
• Both caregiver depression and perceived burden increase as the care receiver’s functional status declines.  Thus, higher levels of clinical depression are attributed to people caring for individuals with dementia.  Studies show that 30 – 40% of dementia caregivers suffer from depression and emotional stress.
• Depression and anxiety disorders found in caregivers persist and can even worsen after the placement of the patient in a nursing home.  Many caregivers who institutionalize their relative report depressive symptoms and anxiety to be as high as it was when care was in the home.
• Depressed caregivers are more likely to have coexisting anxiety disorders, substance abuse or dependence, and chronic disease.  Depression is also one of the most common conditions associated with suicide attempts.

 Caregivers suffer from high levels of stress and frustration.

 Caregivers have higher levels of stress than noncaregivers.  They also describe feeling frustrated, angry, drained, guilty, or helpless as a result of providing care.

• An estimated 16% of caregivers feel emotionally strained and 26% say taking care of the care recipient is hard on them emotionally.  An additional 13% of caregivers feel frustrated with the lack of progress made with the care recipients.
• Caregiving can also result in feeling a loss of self identity, lower levels of self esteem, constant worry, or feelings of uncertainty.  Caregivers have less self-acceptance and feel less effective and less in control of their lives than noncaregivers.
• More than one-fifth of caregivers are exhausted when they go to bed at night, and many feel they cannot handle all their caregiving responsibilities.

 Stressful caregiving situations may lead to harmful behaviors.

 As a response to increased stress, caregivers are shown to have increased alcohol and other substance use.  Several studies have shown that caregivers use prescription and psychotropic drugs more than noncaregivers.

• Family caregivers are at greater risk for higher levels of hostility than noncaregivers.
• Spousal caregivers who are at risk of clinical depression and are caring for a spouse with significant cognitive impairment and/or physical care needs are more likely to engage in harmful behavior toward their loved one.

If you are a caregiver identify the resources in your community that provide assistance for caregivers and services for your care recipient.  Contact your local health and human services agency for more information.

If you would like more information on “Caregiver Health – A Population at Risk” feel free to contact Gail Gilman, Family Life Consultant, M.Ed., C.F.C.S. and Professor Emeritus – University of Minnesota at waldn001@umn.edu.  Be sure to watch for more Family Living Focus™ information in next week’s paper.