Vital statistics. Name, address, date of birth. Let’s look again at that last one … date of birth. Age. As health care professionals, how many of us ask our younger adult patients if they are responsible for the care of an elderly or ill family member?
The CDC and the Department of Health and Human Services estimate that more than 65 million people, or 29% of the U.S. population, provide care for a chronically ill, disabled, or aged family member for an average of 20 hours per week. Aside from the lifestyle adaptations that these scenarios indicate, research shows that the caregiver, and often not the person being cared for, is most at risk for unintended illness. More than 60% of caregivers report having poor eating habits, compared with noncaregivers, nearly three-quarters of family caregivers report that they do not seek basic health care themselves as often as they should, and 58% indicate that they have worse exercise habits than before they assumed caregiving responsibilities.
Physical stress is often the first problem that becomes obvious, especially for those who see the caregiver frequently. It may be as simple as being run down or getting sick more often. Mental or emotional stressors are frequently underassessed because most caregivers are not specifically asked about these problems. Depression, financial stressors, and other anxiety-related conditions such as inadequate sleep are common. Caregivers for persons with dementia have been found to have weakened immune systems, with an increased chance of developing a chronic illness. Caregivers experience serious chronic health conditions at nearly twice the rate of noncaregivers.
The value of the services that family caregivers provide for “free” when caring for older adults is estimated to be $375 billion a year. That is almost twice as much as the amount spent on home care and nursing home services combined ($158 billion).
An estimated 1.4 million children aged 8 to 18 provide care for an adult relative; nearly three-fourths of these are caring for a parent or grandparent. Also, caregiving for a family member is far from the shift work to which we are accustomed. There is usually no time set to “clock in,” and definitely no time to “clock out.” About 64% of caregivers live in the same household as their care recipient. We know that the financial toll is high, but perhaps the more important cost is the physical and mental health of the caregivers.
Ultimately, patients deal with these stressors in different ways. As health care providers, we should not only assess for caregiver stress in our patients, but also have some idea of what resources are available to offer the patient. A current listing of community organizations, religious groups, and other support groups should be compiled and offered to the caregiver/patient. Advise your patients to compile a notebook to keep resource information, as well as an ongoing documentation of their loved ones’ medical and financial information. Urge them to take the notebook with them for every health care appointment. Being able to write down questions before the visit and then take notes of the recommendations often improves the continuity of care and reduces stress.
Often, local and county health departments provide homemaker services. If other family or friends are not options, suggesting an appointment with agencies such as Social Security can be useful. Many caregivers are so consumed with their day-to-day tasks, and they (or their ill loved one) may be eligible for assistance but not be aware of it. Let’s try harder to make sure that the caregiver does not become the patient.
Sherril Sego, DNP, FAANP, is an independent consultant in Kansas City, Mo.