I've been spending some time reading the blogs of three women who care for parents with dementia:
I noticed how carefully they monitor the details of their parents' conditions (see the Daily Tests section of Mom and Me Too for an example). But do they monitor their own health so carefully? Probably not.
Jane Cziborra at Alzheimer's Disease International pointed out an interesting article about caregiver health in the June 2006 issue of Psychiatric Times. The article was written by Peter Vitaliano and Wayne Katon, both professors in the Department of Psychiatry and Behavioral Sciences at the University of Washington in Seattle. Their article emphasizes the physical and emotional costs of caregiving, and summarizes the research in this area.
I'm not surprised that the article reports caregivers of dementia patients suffer from high levels of depression. One study mentioned in the article found that 46% of caregivers who asked for help in improving their coping skills were depressed, as were 18% of those who did not ask for help.
But I didn't know the extent of the measurable health problems that caregivers tend to develop. In a 2003 meta-analysis of 23 studies, Dr. Vitaliano found that caregivers had an average of 15% lower antibody responses [indicating immune system problems] and 23% higher levels of stress hormones than non-caregivers.
I talked with Dr. Vitaliano to get some details on his work. "Repeated studies have shown that high blood pressure, high cholesterol and lowered immune function are all connected to stress," he told me. "But the insulin/blood sugar connection in the caregivers we've studied knocks your socks off! Stress, independent of body fat, causes higher insulin and glucose levels, and these problems are linked to diabetes and heart disease."
Dr. Peter Vitaliano
Dr. Vitaliano and his colleagues have also found increased gum disease in caregivers. Several studies link gum disease to heart problems.
"But the tragic irony is that caregivers can develop cognitive problems," Dr. Vitaliano says. "Even when you control for age, gender, education, income and race, caregivers score significantly lower on memory tests than non-caregivers. We know that this is one of the physiological symptoms that can accompany depression. How can you take care of someone else when you're having your own cognitive problems?"
Results of these studies support the conclusions of research by University of Pittsburgh scientists published in The Journal of the American Medical Association [register for free access]. That study found older caregivers have a 63% higher risk of death than non-caregivers in the same age group.
"Men seem to be more susceptible to the physiological problems associated with caregiving," Dr. Vitaliano notes. "Women caregivers report high levels of depression and anxiety, but when you look at their blood and urine, their results aren't as bad as those of the male caregivers."
Whether caregivers are male or female, Drs. Vitaliano and Katon recommend that psychiatrists who treat patients for dementia also monitor the caregivers. In an ideal world, psychiatrists would work carefully with primary care providers to monitor and treat the mental and physical health problems associated with caregiving. The practical aspects of caring for the caregivers are complex - I'll talk about that in my next post.