Stress of full-time caregiving increasingly referred to
as "caregiver syndrome" Symptoms: Depression, anxiety, anger, declining health
Many don't realize they have a recognizable condition, don't
seek help By Andree LeRoy, M.D. Special to CNN BOSTON, Massachusetts
(CNN) -- Do you take care of someone in your family with a
chronic medical illness or dementia? Have you felt depression,
anger or guilt? Has your health deteriorated since taking
on the responsibility of caregiving? If your answer is yes
to any one of these, you may be suffering from caregiver stress.
This condition is increasingly being referred to as "caregiver
syndrome" by the medical community because of its numerous
consistent signs and symptoms. In the pamphlet, "Caring
for Persons with Dementia," Dr. Jean Posner, a neuropsychiatrist
in Baltimore, Maryland, referred to caregiver syndrome as,
"a debilitating condition brought on by unrelieved, constant
caring for a person with a chronic illness or dementia."
An increasing number of Americans are finding themselves taking
care of someone who's aging or ill or both. According to the
American Academy of Geriatric Psychiatrists, one out of every
four American families cares for someone over the age of 50.
As America's population ages, that number is expected to skyrocket.
In 2000, the Census Bureau reported, just under 35 million
Americans were 65 or over; by 2030, the number is projected
to more than double, to more than 71 million. Many exhausted,
ill caregivers today don't seek help because they don't realize
that they have a recognizable condition.
According to a report from the National Consensus Development
Conference on Caregiving, the most common psychological symptoms
of caregiver syndrome are depression, anxiety and anger. Peter
Vitaliano, a professor of geriatric psychiatry at the University
of Washington and an expert on caregiving, said that the chronic
stress of caring for someone can lead to high blood pressure,
diabetes and a compromised immune system. In severe cases,
caregivers can take on the symptoms of the person that they
care for, he said. For example, a person caring for someone
with dementia may develop progressive memory loss. Worse still,
this syndrome can lead to death.
Elderly caregivers are at a 63 percent higher risk of mortality
than noncaregivers in the same age group, according to a study
by University of Pittsburgh researchers Richard Schulz and
Scott Beach reported in the Journal of the American Medical
Association in December 1999. Vitaliano suggests that the
physical symptoms are a result of a prolonged and elevated
level of stress hormones circulating in the body. He likened
exhausted caregivers' stress hormone levels to those suffering
from post traumatic stress disorder. Caregivers are usually
so immersed in their role that they neglect their own care,
said Vitaliano. The stress is not only related to the daunting
work of caregiving, but also the grief associated with the
decline in the health of their loved ones. The majority of
caregivers go through a period of shock followed by a major
adjustment in their roles. Such emotions are reflected in
online discussions among caregivers such as one at the Alzheimer's
Association Online Community. A number of spouses described
their role slowly evolving from partnership into a nurse-patient
relationship. The caregivers described the difficulty of the
change and talked about feeling anger, resentment and guilt.
They also suggested that in such an emotional state, it's
difficult to provide high- quality care to their loved ones.
Physicians, too, are not always certain how to approach the
issues raised by long-term caregiving. Although the term "caregiver
syndrome" is widely used among allied health professionals
such as hospice workers and nursing home assistants, the syndrome
is not yet recognized in American medical literature. Without
that official validation, it's not surprising that this problem
is not addressed more by physicians. A survey in the American
Academy of Family Physicians found that fewer than half of
caregivers were asked by their doctors whether they had caregiver
stress. Vitaliano believes that more research should be done
to help spread awareness. But Vitaliano isn't sure giving
caregiver syndrome the status of an official diagnosis would
be a good thing. He argues that if "caregiver syndrome"
were listed in the Diagnostic and Statistical Manual of Mental
Disorders (a text published by the American Psychiatric Association
that defines all mental health disorders) it could stigmatize
those that have it. "Caregiver stress is directly related
to the way our society views the elderly and the people who
care for them,"Vitaliano says. Today, caregiving is viewed
largely as a burden in this county.
If it were viewed as more of a societal expectation and
people were willing to offer more support, fewer caregivers
would suffer in isolation, he says. Others think giving caregiver
syndrome an official name would be helpful. Kathryn Anderson,
a researcher in families and chronic illness at Florida International
University, argues that caregiver stress should be named a
syndrome because it would help caregivers seek the help and
resources they need. Naming it a syndrome would encourage
health professionals to develop better treatment strategies
and require health insurers to pay for treatment, she believes.
For now, the American Academy of Family Physicians and the
National Center on Caregiving call for every caregiver to
be screened for stress and depression. Caregivers who show
signs of hostility, anxiety and a loss of interest in activities
they used to enjoy are urged to talk to their doctors. Experts
agree that expanding the caregiver support system, finding
sources of help for caregiver tasks and educating caregivers
can significantly decrease the occurrence of this syndrome.
Andree LeRoy, M.D., a 2006 graduate of the University of Illinois
at Chicago College of Medicine, was an intern with CNN Medical
News this summer. She is now in residency at Spaulding Rehabilitation
Hospital, in Boston, Massachusetts.
August 16, 2007 |
