ElderLaw News

ElderLaw News is a weekly e-newsletter that brings you reports of legal developments and other trends of vital interest to seniors and their advocates. This newsletter is brought to you by The Estate Planning & Elder Law Firm, P.C., William S. Fralin, Esq., President.

Understanding Caregiver Stress

The National Care Planning Council recently published an article on caregiver stress.

A 2003 study of caregivers by a research team at the Ohio State University has proven that the off-repeated adage "stress can kill you" is true. The focus of the investigation was the effect that the stress of caregiving had on caregivers. The team, led by Janice Kiecolt-Glaser, Ph.D., reports on a six-year study of elderly people caring for spouses with Alzheimer's disease. The study not only found a significant deterioration in the health of caregivers when compared to a similar group of non-caregivers, but it also found that the caregivers had a 63% higher death rate than the control group.

The demands on a caregiver result in a great deal of stress. It is often observed in publications about the elderly that stress can induce illness and depression. The resulting poor health can further decrease the effectiveness of the caregiver and in some cases, as proven by the study mentioned above, even cause premature death.

Stress can be defined as a physiological reaction to a threat. The greater the threat - the greater the level of stress. A threat is a real or perceived action against our person. Threats may include the anticipated possibility of death or injury but may also include challenges to our self-esteem, social standing or relationships to others, or a threat may simply be a potential or real disruption of our established routines. What is stressful to one person may not be to another. For example, bumper-to-bumper traffic might be stressful to the executive who is late for an important meeting, but to the delivery driver who has no deadline and is being paid by the hour, it may be a welcome respite to relax and listen to the radio.

Stress produces real physical changes. In some unknown way the fears in an individual’s mind, both conscious and subconscious, cause the hypothalamus and pituitary glands, deep in the brain, to initiate a cascade of hormones and immune system proteins that temporarily alter the body. This is a normal human physiological response inherent to the human body when a threat is perceived – real or not. It is often called the "fight-or-flight response" or the "stress response". The purpose is to give us clearer thought and increased strength as well as to activate the immune system to deal with potential injury and to repair potential wounds. When the perceived threat is removed, assuming no damage is done, the body returns to normal.

A team of researchers at the Ohio State University Medical Center has found a chemical marker in the blood that shows a significant increase under chronic stress and is linked to an impaired immune system response in aging adults. The team, led by Dr. Janice Kiecolt-Glaser, reports in the June 30, 2003, issue of Proceedings of the National Academy of Sciences on a six-year study of elderly people caring for spouses with Alzheimer's Disease. With the caregivers, the team found a four-fold increase in an immune system protein – interleukin 6 (IL-6) – as compared to an identically matched control group of non-caregivers. Only the stress of caregiving correlated to the marked increase of IL-6 in the caregiver group. All other factors, including age, were not significant to the outcome. Even the younger caregivers saw an increase in IL-6.

The study also found that the caregivers had a 63% higher death rate than the control group. About 70% of the caregivers died before the end of the study and had to be replaced by new subjects. Another surprising result was that high levels of IL-6 continued even three years after the caregiving stopped. Dr. Glaser proposes the prolonged stress may have triggered a permanent abnormality of the immune system.

IL-6 is only one cytokine – an immune system mediator protein – in a cascade of endocrine hormones and cytokines that are released when the brain signals a person is threatened with harm, injury, undue mental or physical stress or death. The hormones prepare the body to react quickly by increasing heart rate, making muscles more reactive, stimulating thought, altering sugar metabolism, and producing many more changes that result in the "rush" people experience when they think they may be harmed.

The problem is if this response is initiated frequently and over a long period, then it can have a dangerous effect on the body. This constant initiation of the stress response is common among caregivers – especially those caring for loved ones with dementia. Providing supervision or physical assistance many hours a week and over a period of years turns out to be extremely stressful. This type of stress is often unrelenting, occurring day after day and week after week. And the long-term effects of this stress are more pronounced in middle-aged and older people who are precisely the group most likely offering long-term care to loved ones.

Prolonged high levels of IL-6 and the accompanying hormones and cytokines have been linked to: cardiovascular disease, type II diabetes, frequent viral infections, intestinal, stomach and colon disorders, osteoporosis, periodontal disease, various cancers and auto immune disorders such as lupus, rheumatoid arthritis and multiple sclerosis. Alzheimer's, dementia, nerve damage and mental problems are also linked to high IL-6. Wounds heal slower, vaccinations are less likely to take and recovery from infectious disease is impaired. People who have depression also have high levels of IL-6. Depression in caregivers is about eight times higher than the non-caregiving population.

Ask for help. Most caregivers are thrust into their role without preparation because the need for care usually comes with little warning. Caregivers end up operating in a "crisis" mode – arranging medical care and living arrangements, scheduling care time, providing meals and household chores, etc. Because they are so stressed and burdened, they rarely take time to find out what resources are available to help them. Ironically, caregivers often sever ties with family, friends and support groups about this time just when help from these people is most needed.

As a caregiver you must ask for help. The stress of going it alone is dangerous to your health. If it's difficult for you to ask for help, then use an advocate – a sibling, a friend or a professional care manager – to arrange a meeting and get formal, written commitments from those people who are willing to help you. The extra help will give you breathing room to find all those resources that are there to help you.

Seek care management advice. A number of organizations and private companies will give you advice and guidance – many for free. If your care recipient has a low income, then you might get free help from your local Area Agency on Aging. A lot depends on available funds. Go to www.longtermcarelink.net/eldercare/ref_state_aging_services.htm for a list of agencies.

A good source of free professional advice is the rapidly growing business of non-medical home care companies. Most will offer free consultations, and these companies will also provide paid aides to help you in caring for your loved-one with such things as bathing, dressing, shopping, household chores, transportation, companionship and much more. These people may also help you coordinate adult daycare or other community services. Go to www.longtermcarelink.net/a7homecare.htm for a nationwide list.

You may want to pay for a formal assessment and care plan from a professional geriatric care manager. Go to www.longtermcarelink.net/a2bfindmanager.htm for a nationwide list of these valuable care specialists. Even though it may cost you a little money to hire a care manager, this could be the best money you will ever spend. Care managers are valuable in helping find supportive resources, providing respite, saving money from care providers, finding money to pay for care, making arrangements with family or government providers, and providing advice on issues with which you may be struggling.

Take time off – find temporary substitutes. Taking a break from caregiving is just as important as taking a break from work or taking that long-awaited vacation. A care manager may be of help in selecting the best temporary help in order to give you a break. Or you may make arrangements with family or friends to give you a break from caregiving.

Make plans for funding future care arrangements for a healthy parent. The analysis of data from three national surveys (Mature Market Institute, National Alliance for Caregiving, and LifePlans Inc.) points out that employees caring for disabled elders who have long-term care insurance are nearly two times more likely to be able to continue working than those caring for non-insured relatives. In addition, working caregivers of those with long-term care insurance said that they were less likely to experience some type of stress, such as having to give constant attention to the care recipient or having to provide care while not feeling well themselves. Also, the group with insurance devoted more "quality time" – more companionship and less hands-on assistance – than the group without insurance.

See if your healthy parent can still buy insurance. If this parent can't afford it, then see if other family members might contribute to premiums. Some strategies involve using a reverse mortgage to buy long-term care insurance and life insurance for your loved one. You should also consider insurance for yourself so if you need care someday, then it won't be so stressful on your caregivers. To learn all about long-term care insurance and reverse mortgages, go to www.longtermcarelink.net.

Use assistive technology. There are a number of technologies to make sure your loved-ones are safe while you're away. Such things as emergency alert bracelets and pendants, GPS tracking for wandering, remote video surveillance, telehomecare, sensory augmentation, and all sorts of assistive devices to help disabled people cope on their own. Go to www.longtermcarelink.net for more information.

Remove non-caregiving stress from your job or at home. If you can remove other stressors in your life, then you can cope better with the stress of caregiving, which you may not want to or can't remove. The Internet is your best resource here. Go to www.google.com, type in "work stress," and you can browse 3 million plus URL's. For home stress type in “home stress” and browse 4 million plus URL's.

Attend workshops or seminars to uncover additional strategies. The Utah Eldercare Planning Council offers worksite or community presentations on various eldercare issues. Community workshops like these are available across the country. These learning experiences are an opportunity to find help with your own caregiving situation. To learn more about the Utah Eldercare Planning Council please go to www.careUTAH.com.

Lifestyle Changes to Reduce Stress

-- Exercise. Exercise is a powerful and effective way to fight stress. It is recommended you do about 30 minutes of moderate exercise at least 3 days a week.

-- Develop a support group and maintain social contacts. Participating in a support group can help manage stress. Sharing coping strategies in a group setting lets you help others while helping yourself. It may also help you to realize that some problems have no solutions and that accepting the situation is reality. Social support has a huge impact on reducing stress. Many studies show that social support decreases the stress response hormones in our bodies.

-- Get adequate sleep. Sleep isn't a luxury; it's a necessity. Sleep restores the body and mind and helps us maintain our mental and physical health. Studies have shown that people who get seven to eight hours of sleep each night enjoy better health and live longer than people who get less sleep.

-- Pursue diversions, hobbies and relaxing activities. Go to a movie, a play, a sporting event, immerse yourself in a hobby, listen to some favorite music or take a walk. It cannot be emphasized enough how important it is as a caregiver you spend some quality time alone every week, doing exactly what it is you like to do.

Reduce Stress Through Proper Nutrition

-- Eating too much. Many people react to stress by overeating. Eating too much for a long period causes obesity. This causes your heart and lungs to work harder, overloads your organs and reduces stamina.

-- Not eating properly. Some people react to stress and stress-induced depression by not eating or eating poorly. If you eat a good, well-balanced diet, your body will be receiving all the nutrients it requires to function properly.

-- Coffee, tea, caffeinated soft drinks, and chocolate. Caffeine is a stimulant. One of the reasons you probably use it is to raise your level of activity. This chemical actually enhances the stress response and thus increases your existing stress. Small quantities probably do little harm, but large quantities over a long period produce excessive stress and lead to many of the physical ailments attributed to chronic stress.

-- Alcohol. Some people react to stress by imbibing in alcohol. In small amounts, alcohol may help you relax. In large amounts, alcohol may increase stress as it disrupts sleep.

-- Tobacco. In the short-term tobacco use seems to relax people, but the toxic effects of nicotine raise the heart rate and enhance the stress response. After the initial period of giving up smoking, most ex-smokers report feeling much calmer.

-- Sugar and refined flour. Sugar can be a stimulant for people experiencing stress and stress-induced depression. Sugar-rich foods (the starch in refined flour is also a form of sugar) can raise your energy level in the short-term. The problem is your body copes with high levels of sugar by secreting large amounts of insulin, which in turn, quickly reduces the excess amount of sugar in your blood stream often causing blood sugar levels to swing too low.

Controlling Stress With Mind and Body Calming Techniques

-- Music therapy. Listening to music does wonders to alleviate stress.

-- Laughter therapy. Numerous studies show that laughter has the uncanny ability to greatly reduce or eliminate stress.

-- Meditation. If you have ten free minutes a day, you can reduce stress, reduce insomnia, lessen anxiety and depression, and decrease your chances of developing cardiovascular disease.

-- Tai Chi, yoga, acupuncture, massage therapy, and aromatherapy. All help calm the body and mind.

-- Pet therapy. The saying, "A dog is man's best friend," is certainly true when it comes to dealing with your body's stress response. Many people feel more relaxed when companion animals are present. Several studies have shown that pets are good for us in numerous ways. For example, petting an animal is known to lower your heart rate, lower your blood pressure, and brighten your mood. Another study found that simply watching fish in an aquarium made patients waiting to undergo medical procedures less anxious. In fact, "pet therapy" is frequently used in hospitals and nursing homes to increase socialization and to reduce depression, loneliness, anger, and stress


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The Estate Planning & Elder Law Firm, P.C. is an elder law firm. We represent older persons, disabled persons, their families, and their advocates. The practice of elder law includes estate planning, estate and trust administration, powers of attorney, advance medical directives, titling of assets and designations of beneficiaries, guardianships, conservatorships, and public entitlements such as Medicaid, Medicare, Social Security, and SSI, disability planning, income tax planning and preparation, care management, and fiduciary services. For more information about The Estate Planning & Elder Law Firm, P.C., please visit our website at http://www.chroniccareadvocacy.com.

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