Caregiver stress: The crucial, often unrecognized byproduct of chronic disease
September 11, 2019
Science Daily/Elsevier
There is growing evidence that caregivers of patients with cardiovascular disease (CVD) are vulnerable to developing their own poor cardiovascular health. Investigators report in the Canadian Journal of Cardiology, published by Elsevier, on a proof-of-concept couples-based intervention in a cardiac rehabilitation setting. This intervention has shown potential for reducing caregiver distress, and future studies are evaluating its impact on both caregivers' and patients' cardiovascular health.
Nearly half of Canadians have been in caregiving roles to family and friends, with similar figures in the United States and Europe. A caregiver is broadly defined as someone who provides informal or unpaid work to a family member or friend with a chronic condition or disability. Caregivers provide crucial, rarely remunerated support to sick family members or friends. About 40 per cent of caregivers, of whom more than half are women, report high psychological, emotional, physical, social, and financial stresses imposed by the caregiving role. These factors can contribute to a higher risk of CVD among caregivers themselves. However, despite an appreciation of these issues, few approaches have been effective in reducing caregiver stress. This need is expected to increase because pressures on "cardiac" caregivers are projected to rise in the next decade as the population ages, length of hospital stays decline, and CVD and associated risk factors continue to increase.
"It is abundantly clear that caregivers need to be better supported!" said lead investigator Heather Tulloch, PhD, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute (UOHI), and University of Ottawa, Ottawa, ON, Canada. First author, Karen Bouchard, PhD, postdoctoral fellow in behavioral medicine at UOHI added, "Caregivers are critical for patients' cardiovascular health management and are an invaluable healthcare resource, contributing enormously to the Canadian healthcare system. Individuals who care for their partners may experience additional cardiovascular risk -- a risk that should be recognized and to which we should respond."
In this narrative review, investigators look at evidence from the fields of health psychology and relationship science and highlight the direct (e.g., physiological) and indirect (e.g., behavioral, emotional) factors that link caregiver distress with caregivers' own cardiovascular risk. For example, caregivers are more likely to continue to smoke and less likely to be physically active than individuals who provide no or low levels of care; their diets tend to be high in saturated fat intake leading to greater body mass indexes; they spend less time engaging in self-care activities and report poor preventive health behaviors; they experience less or disordered sleep; and demonstrate poor adherence to medication. Spousal caregivers have higher levels of depressive symptoms, physical and financial burden, relationship strain, and lower levels of positive psychological wellbeing compared to adult children caregivers, for example.
The researchers report that the risk of hypertension and metabolic syndrome may be directly related to high-intensity caregiving, defined as providing more than 14 hours of caregiving per week over two consecutive years. They also report findings that estimate the economic contribution of caregivers' unpaid labor to be $26 billion annually in Canada, which is projected to increase to $128 billion by 2035 (likely translating to over a trillion dollars each in the USA and Europe).
The investigators contend that the cardiovascular health of both patient and caregiver could be improved by enhancing the quality of the patient-caregiver relationship. They describe a proof of concept testing of Healing Hearts Together, a relationship-enhancement and educational program for patients and partners. Based on attachment theory, which states that close emotional bonds are essential when faced with a threat such as a cardiac event, the program guides couples through conversations in which they review information on heart health and attachment; share their unique experiences with heart disease with partners and peers; and learn to clearly communicate their need for connection and reassurance. This connection enhances couple satisfaction and problem solving. Participants reported improvements in relationship quality, mental health, and select quality of life measures. A controlled evaluation of the impact of the program on cardiovascular risk factors is underway.
"The aim of Healing Hearts Together is to increase emotional accessibility and responsiveness in couples facing CVD," explained Dr. Tulloch. "Taken together, couples-based interventions in a cardiac rehabilitation setting may be a timely and appropriate approach to reduce caregiver distress and enhance caregivers' comprehensive health outcomes. There is an emerging opportunity to care for those who care for their partners and enhance the health of both. It is important that healthcare professionals recognize the burden of caregiving and act sensitively and strategically to address these challenges."
"Detrimental effects of the caregiving experience are greater among middle-aged caregivers, those known as the 'sandwich generation,' because they balance paid work commitments and interpersonal relationships with care delivery tasks for parents, children, and/or partners," commented Monica Parry, NP-Adult, MEd, MSc, PhD, University of Toronto, Toronto, ON, Canada, in an accompanying editorial. She points out that men and women deal differently with caregiving and, as the landscape of heart disease in women is changing, so must our approach and understanding of the caregiving experiences of men. For example, male caregivers may struggle with the societal views of caring; feel invisible at times; and may be unsure how to assimilate the caring role, masculinity, and accessing help for themselves. "We are facing an epidemic of caregiver burden. Caregivers cannot remain under-researched, under-diagnosed, under-treated and/or under-supported," she concluded.
https://www.sciencedaily.com/releases/2019/09/190911091400.htm
Mindfulness may help decrease stress in caregivers of veterans
April 29, 2019
Science Daily/University of Illinois at Urbana-Champaign, News Bureau
Mindfulness therapy may be an effective way of mitigating the stress experienced by spouses and other informal caregivers for military veterans, a new study by researchers at the University of Illinois suggests.
Kinesiology and community health professor Sandraluz Lara-Cinisomo led a pilot study that taught caregivers of veterans in central Illinois mindfulness-based cognitive therapy skills. The caregivers in the treatment group -- mostly women caring for their spouses -- reported significant decreases in their perceived levels of stress, anxiety and worry.
By contrast, the researchers found no significant changes in any of these symptoms among the participants assigned to the waitlist control group.
"This not only shows the feasibility but also the promise that mindfulness has for improving mental health outcomes in this vulnerable, hard-to-reach population," Lara-Cinisomo said. "Although the study population was small, it shows that there's interest in this type of programming."
The researchers reported their findings in a paper published in the journal Mindfulness and examined the feasibility of the intervention in another paper published in the Journal of Holistic Nursing.
About 5.5 million informal caregivers, usually family members, provide daily care and support for U.S. military veterans. While recent federal legislation sought to bolster the financial support and assistance provided to these caregivers by offering programs such as mentoring, support groups, respite care and sometimes stipends, these services may be limited to those caring for veterans with specific diagnoses or types of injuries.
Moreover, some programs are designed primarily to serve the care needs of the veterans and only incidentally address the caregivers' needs, the researchers wrote.
"While the Veterans Administration, the Dole Foundation and other organizations are providing services, there's research to suggest that some services often don't match caregivers' needs," Lara-Cinisomo said. "Furthermore, there's been little research that has evaluated the effectiveness of current caregiver services."
Lara-Cinisomo said that compared with caregivers in the general population, those caring for veterans experience higher levels of psychological distress, poorer overall health and increased "caregiver burden" -- which refers to the overall emotional, physical and financial strain associated with providing multiple forms of care.
Additionally, caregivers of veterans engage in twice as much highly stressful or physically demanding care, compared with other caregivers, according to the study.
The majority of caregivers in the study had been providing care for more than nine years and spent 21-30 hours solely attending to the veterans' needs, in addition to other family obligations, Lara-Cinisomo said.
A large proportion of the veterans they were caring for had combat-related injuries along with a wide variety of other health issues, including mental illness and post-traumatic stress disorder, diabetes, cancer, traumatic brain injury and Parkinson's disease, Lara-Cinisomo said.
To be eligible to participate in the eight-week intervention, caregivers had to be providing informal/unpaid care to a veteran, be at least 18 years old, able to walk or sit to perform the mindfulness activities and not have any mental health problems other than anxiety or depression.
Of the caregivers who met the screening criteria and enrolled in the study, 11 were randomly assigned to the mindfulness intervention and 12 to the waitlist control group. All of the participants completed the study, and those on the waitlist were offered the opportunity to go through the mindfulness training after the wait period.
Participants in the mindfulness intervention met weekly for two hours of instruction on the skills and how to apply them in stressful situations. These skills include focusing on body sensations to eliminate and reduce emotional activity, and concentrating on the present, as opposed to ruminating about their worries.
They were encouraged to practice these exercises at home for 30-40 minutes daily with the help of an audio CD. Participants reported that they spent an average of 19 minutes weekly engaging in the activities at home.
"Despite our small numbers, we were able to show that mindfulness helps and that it should be pursued not only by researchers, but by practitioners and those providing services to this population," said Lara-Cinisomo, who is currently working with colleagues at the RAND Corporation and Loyola University to build on these findings. "There also might be some additional benefits for the caregiver and the veteran, as well, that we should explore in future studies, such as improved sleep."
https://www.sciencedaily.com/releases/2019/04/190429154532.htm