UA Study Sheds Light on Health Consequences of Caregiving

FAYETTEVILLE, Ark. - Researchers at the University of Arkansas who have been studying the effects of stress on caregivers' health have found a surprising link between the type of assistance caregivers provide and the amount of stress they report.

"It came as no surprise to us that caregivers are under stress," remarked Barbara Shadden, director of the program in communication disorders, who, with fellow researcher Ro DiBrezzo, director of the UA Human Performance Lab, serves as co-director of the UA Office for Studies on Aging, where the study originated. "What we did find striking is that not all forms of caregiving cause the same amount of stress."

Their results have shed new light on the causes of caregiver stress, as well as the kind of support caregivers need to help them cope.

Approximately 45 million people in the United States devote a large portion of their lives to caring for an aging or disabled relative. Combine that with the demands of jobs, children and marriage, and the product is a tailor-made recipe for stress.

In looking at the causes of caregiver stress, the researchers found that caregivers who provided more assistance with tasks such as managing money and medications reported more stress than those who were involved primarily in assisting with physical needs.

"We believe the reason for this is because these responsibilities are related to the loved one's cognitive function," Shadden explained. "To watch someone, particularly a parent, lose cognitive abilities so that they cannot do the 'thinking' tasks that they used to, is very hard on the caregiver emotionally-and often is actually more stressful than assisting with the more physically demanding tasks such as bathing or cleaning."

Not surprisingly, women caregivers tended to provide more assistance with basic physical needs, while men were more likely to help with activities such as managing finances. However, both men and women respondents reported that dealing with a care recipient's cognitive and emotional difficulties is harder than dealing with physical challenges.

All forms of caregiving, though, take both a physical and emotional toll on caregivers. According to their study, Shadden and DiBrezzo found that caregivers reported lower ratings of overall health, higher levels of stress and lower overall health satisfaction than non-caregivers.

"That didn't come as much of a surprise," said DiBrezzo. "But it's still cause for concern, particularly since chronic stress has been linked to several major illnesses-from heart disease to cancer."

In addition to the physical problems, the emotional impact can be just as bad. Shadden and DiBrezzo found that many caregivers are subject to feelings of increased sadness, irritability, fatigue and guilt. These feelings, if left unaddressed, can lead to chronic depression.

What then are the best solutions to help caregivers cope with their situations? When questioned, most respondents listed needs such as access to more information and education, the availability of professional resources and the option of family leave time from employers. Psychological counseling, group therapy and support groups were typically the least-favored options by both male and female caregivers. As DiBrezzo and Shadden noted, this points to the need for practical, real-world assistance to help caregivers better manage their situations.

Ironically, many of these resources are already available, but caregivers simply do not know that they are out there, so they don't take advantage of them. It's important, then, not only for the resources to be available but for employers and agencies who offer these services to make sure that caregivers are aware of them, the researchers said.

DiBrezzo and Shadden recommend that caregivers contact their local Area Agency on Aging (AAA) for more information on support services (www.aaanwar.org). This private, non-profit organization, established by the Older American's Act, has branches in every state and offers access to a wide variety of resources for caregivers, such as information and referrals, case management, in-home care, home-delivered assistance devices and personal emergency response systems. They also provide access to adult day care, home delivered meals, senior activity centers and caregiver training programs. As Sara Tepfer, director of case management for the Northwest Arkansas AAA notes: "Our services are geared to help lighten the burden on caregivers. We provide caregivers with training and education, support, counseling, assistance with respite care and supplemental services to help ease the caregiving role."

This autumn, DiBrezzo and Shadden plan to continue their study. They will be taking measurements from participants of a number of biological stress indicators, such as cortisol and IL-6 levels, which have been linked to heart disease and other health problems. They can then determine precisely what physical effects the stress of caregiving has on the body.

"Because our definitions of what constitutes stress are fairly subjective, some people may be under great stress and not really be conscious of it, so they may not report being stressed when asked in a survey," DiBrezzo noted. "The biological markers, though, will still show up. That's why this phase of quantitative analysis is so important."

Few studies have used quantitative analysis to measure the stress impact related to caregiving. Researchers know that caregivers experience stress. They know that caregivers feel less healthy. Shadden and DiBrezzo's next step is to determine exactly what's going on in their bodies because of that stress and how it is impacting them.

"When this whole study is complete, we should have a better understanding of exactly what caregivers need and how we can help them cope," Shadden explained. "This is really exciting research linked to quality of life. It should prove to be a major initiative."