Caregivers bew-are! The
impacts of caregiver stress
By Sheila Goodman
I am a medical social worker for a hospice agency. As I
walked into a patient's home for my weekly hospice visit, I called out to her
caregiver but there was no response. Entering the family room, I saw my hospice
patient resting comfortably on the couch. But slumped nearby in an easy chair
was her caregiver, unconscious. I called 911. The paramedics arrived quickly
and loaded into the ambulance the last person I had imagined would need help.
The caregiver was hospitalized and treated for a probable heart attack.
Later, after he had returned
home, I asked what had happened. Apparently, he hadn't felt well for days but
didn't tell his family because he thought no one could take care of his
mother-in-law as well as he could.
Caregiver Stress a Mortality Risk
Unfortunately, for those who work with clients nearing the
end of life, caregiver illness is a common situation and the number of
caregivers experiencing detrimental effects is growing. Caregivers develop
physical and emotional health problems due to the stress of caregiving, which
then lead to increased mortality risk. According to Schulz and Beach in their
1999 prospective population-based cohort study published in JAMA (282:23; http://goo.gl/KdNJlQ) , primary caregivers have
a 63 percent increased risk of dying; compared with non-caregivers. Prolonged
caregiver stress not only endangers the caregiver's health, but also the health
of the care recipient.
The medical system as we know'" it cannot meet all of a
patient's needs, thus more and more family members are taking on the role of
primary caregivers for their dying family members, and enrolling them in
hospice care. In 1982, hospice served approximately 25,000 patients.
By 2008, this number had increased to 14.5 million patients,
according to the National Hospice and Palliative Care Organization (http://goo.gl/OCMN6c), and is expected to
consistently increase as the baby boomers age.
'Primary caregivers have a 63 percent increased risk of dying.'
According to the National Alliance for Caregiving, in 2009
there were 43.5 million caregivers nationwide, and this number is climbing
(http//goo.gVKd9Lby). The growing number of caregivers for terminally ill
patients, and the related threat to caregivers' health, requires professionals,
especially social workers, to teach caregivers the best practices possible to protect
themselves while caregiving.
Patients on hospice care live longer, according to Meyers and Grey in Oncology Nurse Forum
(28:73, 2001), so family caregivers are spending more time than expected in a
caregiver role and reporting a decreased quality of life. According to Bialon
and Coke in the American Journal of
Hospice & Palliative Medicine (19:3, 2012; http://goo.gl/isccpB),
caregiver and physical reaction to the imbalance of demands placed on the
caregiver by various factors, including personal time, multiple roles, physical
and emotional states, financial resources, and formal care resources."
In addition, caregivers tend to engage in unhealthy
behaviors-poor diet, substance abuse and decreased self-care; these take a toll
on caregivers' physical and emotional well-being, according to Newell and
colleagues in the Journal of
Gerontological Nursing (38:19, 2012).
Tired, anxious or frustrated caregivers also may treat their
loved ones with less patience and compassion. A chronically stressed caregiver
can contribute to their charge's declining health-and sometimes even premature
institutionalization.
Minimizing Caregiver Burden
How can social workers minimize care-giver burden?
Qualitative research studies have identified four ways.
First, when hospice social workers perform an initial
assessment of newly admitted patients, they must educate the caregiver about
preventive measures for avoiding personal health issues. Such measures include
a eating a healthy diet, exercising, participating in a support system, maintaining
a spiritual connection and seeking outside assistance (e.g., respite care) when
needed.
Second, the social worker must inform caregivers that
research has substantiated that caregivers' conflict about this role and
caregiving's effects on other relationships serve as stressors impacting caregivers'
quality of life. Social workers need to help caregivers identify the
appropriate available resources to maintain their important roles.
Caregivers need information, education and training on preventing and
ameliorating stress.
Third, research shows that caregivers are concerned about
their lack of knowledge around how to physically care for their care recipient.
Caregivers need training on lifting patients (e.g., body mechanics), performing
personal hygiene tasks, dispensing medication and managing symptoms.
Last, research has indicated that many caregivers lack a
spiritual connection. Those having a spiritual connection experienced lower
levels of stress and a deeper sense of meaning in their caregiver role.
Social workers treating end-of-life clients must educate and
assist caregivers in managing caregiver stress and minimizing caregiver burden.
They also should inform other professionals who work with caregivers providing
end-of-life care about these four empirically identified areas.
Fortunately, my client's caregiver received medical
treatment and was fine, however, with specific education and support, his
chances of a recurring health scare can be minimized. •
Sheila Goodman is an
M.S.W. candidate at the USC School of Social Work in Los Angeles, Calif, and a
hospice worker for Cadence Hospital in Orange, Calif
Reprinted from: Aging
Today March-April 2016 issue
