Caring for the Caregiver: Part 2

June 15, 2015

Guest Blogger: Dr. Brent P. Forester, MSc., Geriatric Psychiatrist

October, 2014

Caring for the Caregiver: Part II

http://www.bridgesbyepoch.com/blog/dr-brent-forester/2014/10/08/caring-caregiver-part-ii

Last month we discussed the prevalence and impact of caregiver stress and the elevated risk of medical problems and emotional distress in caregivers. So what options are available for caregivers to help avoid or cope with the reality of living with a loved one suffering from dementia? Education, social support and attention to one’s needs are the foundation of what it takes to “care for the caregiver.”

Many caregivers have trouble understanding the nature of the common symptoms of dementia. For example, memory loss may be misinterpreted as purposeful if a spouse is unaware that damage to the brain’s hippocampus early in the course of Alzheimer’s disease is responsible for the loss of memory. Agitation, anxiety and even depression are common manifestations of the behavioral symptoms of dementia.  Once again, caregivers must understand that these symptoms do not represent willful behavior but rather reflect the underlying brain degeneration that is impairing the brain’s frontal lobes from suppressing bursts of mood swings and severe agitation.

Intellectual understanding of the causes of memory loss and behavioral outbursts is helpful but not sufficient to assist caregivers in the moments of frustration that inevitably occur. Social support is critical. Caregivers need others to help them in times of crisis: someone to lend an ear or to provide advice about how they might approach a challenging situation. Caregivers need to remember to take time to care for themselves. Easier said than done for spouse caregivers who are loyal after decades of marriage!  The Alzheimer’s Association is an excellent resource for caregivers. The Association provides individual family consultations, support groups and educational programs. Day programs for the individual with dementia not only provide a stimulating and structured environment for the person with dementia, but this also provides the caregiver with a precious commodity: Time. Caregivers can take advantage of time and give themselves a break, whether this includes a social outing, support group, exercise or just relaxing. Although this advice seems so simple, taking advantage of such opportunities provides caregivers with respite and allows for re-energizing.

One interesting study published a number of years ago demonstrated the power of caregiver support groups and caregiver counseling (Mittelman, Neurology. 2006). This study was a randomized controlled trial comparing an enhanced counseling and support intervention compared to usual care. Participants included 406 spouse caregivers of community-dwelling patients who had enrolled in the study over a 9.5-year period. The intervention consisted of six sessions of individual and family counseling, support group participation, and continuous availability of telephone counseling. Structured questionnaires were administered at baseline, every 4 months for the first year and every 6 months thereafter. Interestingly, the researchers discovered that patients whose spouses received the intervention experienced a 28.3% reduction in the rate of nursing home placement with a delay in the median time to nursing home placement of nearly 19 months. Improvements in caregivers’ satisfaction with social support, response to patient behavior problems, and symptoms of depression collectively accounted for a majority of the intervention’s beneficial impact on placement.

Caregivers need the support of family members and the community to help ease their distress, reduce their risk for depression and medical complications and improve the quality of life for their loved ones with dementia.