Is Caregiving Hazardous To Your Health?

     I've been spending some time reading the blogs of three women who care for parents with dementia:

• The Yellow Wallpaper
• Dementia Blues
• Mom and Me Too.

   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.

Comments

[Paula Martinac]

Mona - Thanks for this important post. My sister, who is my co-caretaker, and I struggle to watch our own health because of the potential danger to our immune systems. I have read many horror stories of women in their 40s and 50s who are caring for a parent and end up in the hospital themselves... After a long bout (4 nonstop months) of "crisis management" with our folks, we're both better able to keep up with daily health maintenance.

One problem for me in getting care for myself - and that I'm sure affects other caregivers as well - has been health insurance. I have suffered from periods of deep depression during my caretaking time, but because I'm self-employed, I have rudimentary health coverage that doesn't include psychotherapy. So I've compensated by (1) blogging (!) and (2) talking to friends who have been through the same or similar situations. So far, that's helped, but I know that at some point, I may need to pay for therapy myself.

[peter vitaliano]

Paula - thanks for the important comments. Ironically, when illnesses progress and uninsured persons are hospitalized, the government ends up paying anyway. So, why not eliminate all the heartache and just provide health care for all Americans whether they are unemployed or self-employed. The problems for society are even further exacerbated when caregivers are left to fend for themselves, because when they get sick who will take care of them, and who will take care of their loved ones? I am going to Italy in October to give some lectures and to meet with officials there who have a universal government program that actually pays caregivers who take care of their loved ones in their homes. I hope to learn enough so that I can write about it when I come back. Thanks for your great comments.

[Deb Peterson]

Mona--I was talking to a co-worker today who is also caring for her elderly parents, and after we compared notes about the pace of our lives now that we have so much responsibility, we talked a bit about what we will then have to face once our parents die. Aside from the expected grief, we will probably also have to face a very abrupt change in focus, and may have to re-learn our old lives! I've been living "temporarily" with my mother for a year and a half now, and occasionally I return to my own home for a spell--but I can't relax. I have to be either in her world or mine, and travel between the two is not easy!

I've had very similar experiences to Paula's and have just now started therapy for myself. And it goes without saying that being able to talk to you and Paula and Gail is a crucial part of my coping.

[Mona Johnson]

Deb,

I'm almost feeling guilty that I'm not a caregiver! I hope that by asking what causes dementia (if not finding any quick answers) I can help you, Paula, Gail Rae and others make some sense of what you're going through.

I went to a writer's conference recently, and noticed that there were a lot of women there who had been caregivers until a short time ago. I think that somehow they're using writing to assess their former lives and find paths to new lives. Maybe that's how we're all using our blogs.