Did You Know 21% of US households are impacted by care giving responsibilities?

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Providers and Caregivers: Together on the Front Lines
By Rosemary Laird, MD, MHSA, AGSF
Today’s Geriatric Medicine
Vol. 8 No. 4 P. 24

Providing care to loved ones presents specialized challenges to family members. Physicians must familiarize themselves with basic information to offer caregivers who seek assistance and solutions.

Whether you’ve observed the increasing prevalence and you’re totally aware, or you haven’t noticed or given it much thought, you probably have a growing number of patients who have taken on the role of caregiver for a family member or friend.

The Centers for Disease Control and Prevention provides the following statistics:1

• Approximately 21% of US households are impacted by caregiving responsibilities.

• The typical caregiver is a 46-year-old woman with some college experience, who provides more than 20 hours of care per week to her mother.

• Many caregivers have reported difficulty finding time for themselves (35%); managing emotional and physical stress (29%); and balancing work with family responsibilities (29%).

That puts primary care providers and family caregivers together squarely on the front lines of caregiving. Despite their increasing ranks, family caregivers are generally an unrecognized and unsupported group. Life as a caregiver has been compared with life with a chronic stressful condition that can have immediate impacts on health, such as sleep deprivation, as well as long-term effects, such as immune system suppression.2

As a primary care provider, you likely feel more prepared to manage patients’ diabetes, hypertension, and preventive care needs than to help patients address the wide range of physical, emotional, and spiritual impacts caregiving can produce. It’s also likely that patients have come to you with a broad range of challenging questions about the specialized care of the family member who is the focus of their attention.

They may ask: How do we hire someone to help with Mom? Is it time for an assisted living facility? Should Dad continue to drive? Do we need to draw a power of attorney? Is it time for hospice?

It’s important for providers to familiarize themselves with basic information for caregivers, keep printed handouts available for distribution, and/or share with caregivers as it becomes clear you’re working with them within your practice. Unfortunately, family caregivers haven’t received training in caregiving. They will be immensely grateful for your input. A survey by AARP showed a high caregiver interest in receiving advice from physicians.

Among caregivers seeking information to assist in caring for loved ones, the top source of information would be a health or caregiving provider (36%), including a physician (22%).3

Caregiving Is Risky Business
As the medical provider for a family caregiver, one of the most important things to recognize is that caregivers will often ignore their own needs and desires in their efforts to care for a spouse, parent, or other family member. This selfless group, deservedly the focus of admiration for their devotion, commit their time and energy to caring for loved ones with chronic illnesses such as congestive heart failure, stroke, diabetes, or Alzheimer’s disease and may need assistance over many years, often with increasing needs over time.

The health implications, especially when long-term caregiving is required, can be serious. Keep in mind that some caregivers will be elderly spouses with their own increased risks for illness or age-related functional decline. Younger caregivers, such as adult children, may have the added complication of needing to balance the demands of their own work situations or family responsibilities with the needs of an ill parent.

Caregiving creates a chronic stress state, and the impact of chronic stress on the body, both physically and emotionally, is well documented. The emotional stresses of serving as a family caregiver can include grief, sadness, a sense of loss, anxiety, anger, and conflict. Aspects of physical stress include caregivers’ reports of physical strain, sleep deprivation, and fatigue.

Research into the impact of caregiving has proven even more worrisome. In the Caregiver Health Effects Study, researchers examined relative mortality rates between caregivers with strain and noncaregivers. Higher mortality risk has been shown among elderly caregivers when compared with noncaregivers.

After adjusting for sociodemographic and disease-related factors, researchers determined that participants providing care and experiencing caregiver strain had higher mortality risks: 63% higher than noncaregiving controls (relative risk 1.63; 95% confidence interval, 1.00-2.65).2

Taking Your Oxygen First
Flight attendants are right: When a crisis strikes, it’s vital for the most able-bodied to first secure themselves and ensure their own well-being. Only then can they effectively help those in need. If the family caregiver becomes ill, who will care for the patient? Remind caregivers often to first care for themselves. A full explanation of how and why family caregivers need to care for themselves appears in Take Your Oxygen First: Protecting Your Health and Happiness While Caring for a Loved One With Memory Loss. Although it is written about a family member facing Alzheimer’s disease and the associated caregiving concerns, the main message and many of the lessons in the book are universal. All caregivers can benefit from the book’s recommendations.

While encouraging family caregivers to “take their oxygen first,” consider the following strategies:

• Encourage an annual physical examination and preventive care update. Carefully review all necessary cancer screens.

• Advise caregivers to complete all appropriate vaccinations, especially the flu vaccine. Remind patients of the importance of receiving the flu vaccine as soon as it’s available each season. A study showed delayed immune response among caregivers compared with noncaregivers.4 Encourage caregivers to be at the front of the line each fall.

• If possible, identify family caregivers within your electronic medical record so you can provide annual reminders for their physical examinations. Make sure they are not giving their appointment time away to the family member for whom they are caring. Additionally, if the caregiver is hospitalized or in need of testing that may impact the ability to care, ask about the needs of the family member who requires care.

Private Pay Caregiving Assistance
For patients or families with financial resources, there are often local professionals such as aging life care professionals, case managers, or care managers, who can intervene and help to ease the burden of caregiving. These paid professionals’ activities typically include finding in-home providers, helping with medication management, choosing the right assisted living facility, arranging transportation, accompanying patients to medical appointments, helping to find specialists, and other activities geared toward patients’ particular needs.

In most communities, the independent professionals listed above can help. These professionals provide personalized assistance and help to arrange care according to specific needs. They are often registered nurses or social workers. In some situations, long term care insurance may include the services of a geriatric care manager or will allow funds to be used to cover associated costs. Find a professional by starting the search at www.aginglifecare.org.

It’s important to note that local hospitals may have employees whose titles are case or care mangers and who assist patients while they are in the hospital. Typically their services do not extend to the home setting.

Regardless of your patients’ caregiver circumstances, remain vigilant in identifying caregivers who can benefit from your support and encouragement.

— Rosemary Laird, MD, MHSA, AGSF, a geriatrician, is executive medical director of senior services for Florida Hospital at Winter Park, and past president of the Florida Geriatrics Society. She is a coauthor of Take Your Oxygen First: Protecting Your Health and Happiness While Caring for a Loved One With Memory Loss.

References
1. Family caregiving: the facts. Centers for Disease Control and Prevention website.http://www.cdc.gov/aging/caregiving/facts.htm

2. Schulz R, Beach SR. Caregiving as a risk factor for mortality: the Caregiver Health Effects Study.JAMA. 1999;282(23):2215-2219.

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Aging Information Network (AIN) is a multi-dimensional website providing information resources through listing of providers to care givers who may or may not have time to assist in daily care or locate services for their elderly loved ones.

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