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The Antidote for Caregiver Stress? Become Engaged

More than 5 million Americans today live with some form of dementia, and caring for those afflicted creates significant stress on family caregivers. Current figures place the number of family and friend caregivers at about 15.4 million (approximately 60% of these are women); these caregivers spend an estimated 17.5 billion hours of unpaid time at a cost of $216.4 billion annually.

Published: Oct 6, 2014

The Antidote for Caregiver Stress? Become Engaged

More than 5 million Americans today live with some form of dementia, and caring for those afflicted creates significant stress on family caregivers. Current figures place the number of family and friend caregivers at about 15.4 million (approximately 60% of these are women); these caregivers spend an estimated 17.5 billion hours of unpaid time at a cost of $216.4 billion annually. In addition to the time and cost impacts, caregivers suffer emotional, psychological, and social impacts as a result of their caregiving responsibilities.

Studies indicate that caregivers are more prone to suffer from depression and anxiety disorders, social isolation, sleep problems, and increased risk for prolonged infections and health problems. There is also data that indicate that higher levels of caregiver stress is a determining factor in nursing home admissions for dementia sufferers, and it is not uncommon for caregiver stress to contribute to familial conflicts and loss of work productivity. Given these statistics, preparing caregivers for and aiding them during their time caring for their loved ones plays an important role in diminishing the stress levels, and thereby the health impacts for both the caregivers and dementia sufferers.

For caregivers of seniors with dementia, stress levels can be further heightened by mood changes in the senior caused by the disease, which affects approximately 20 percent to 24 percent of seniors with dementia. Not surprisingly, the degree of stress in the caregiver is relative to the senior’s cognitive impairment and the severity of   the mood changes. This stress is amplified as well because caregivers often over- or underestimate the abilities of the person with dementia.

Intervention research has uncovered a number of techniques to reduce caregiver stress, including counseling, skills training, training in preventative health practices and medications for the dementia sufferer. A promising technique that benefits the dementia sufferer while decreasing the stress the caregiver experiences is the Tailored Activity Program (TAP) developed by a team of researchers led by Laura Gitlin at the Thomas Jefferson University’s Center for Applied Research on Aging and Health. The research showed that engaging seniors with dementia in activities they can do successfully reduces the incidence of aggressive behaviours and could be more effective than medications, which can carry serious side effects. Unlike other approaches that focus on patients living in an institutional setting, however, TAP targets seniors with dementia living within the community and involves the caregiver in the activity strategies.

As part of TAP, caregivers receive training on how to implement the activities through role playing and demonstrations to the senior with dementia. They also learn stress-reduction techniques, such as deep breathing, to allow them to maintain a controlled tone with the senior with dementia. As the senior masters each activity, the caregiver introduces another to continue engagement. The caregivers are also taught how to simplify the activities in preparation for the future cognitive decline the senior with dementia will experience. Thus, the caregivers are not only given strategies relevant for the moment, but are also prepared with strategies for the future.

TAP has been shown to be effective in reducing shadowing, repetitive questioning, and aggressive behavior, which have been shown to compel stressed caregivers into placing seniors with dementia in nursing homes. Researchers believe this decline in negative behaviours is due to the seniors experiencing a stronger self-identity by being able to perform activities and express themselves positively. Because the activities are tailored to the seniors’ abilities, they are able to successfully engage in and complete tasks rather than suffer frustration at their inabilities. Additionally, since the activities are simplified and presented at a pace that is comfortable for the seniors, they do not suffer from sensory overload, which often precipitates aggressive behaviours.

TAP has also been shown to provide positive effects for the caregivers. Caregivers experience the joy of seeing their loved ones’ moods and interest in life improve since the tailored activities provide pleasure rather than frustration. Caregivers are also able to better judge their loved ones’ capabilities so expectations are more realistic, which reduces the caregivers’ frustration as well as the seniors’ frustration, resulting in fewer instances of aggressive behaviours. Moreover, caregivers discovered that rather than requiring more work on their part, TAP’s targeted, structured activities are easy to implement and reduce the time required for daily care.

TAP programs and studies repeatedly show that engaging seniors with dementia in meaningful tasks tailored to their current cognitive abilities has a positive outcome for everyone involved. It enhances the quality of life for seniors suffering from dementia and improves interactions between the seniors and their caregivers. It also results in fewer hospitalizations and lower nursing home admissions for the seniors with dementia.

How Comfort Keepers® Can Help

Many Comfort Keepers® locations offer specialized dementia care and can also provide respite for caregivers. Interactive Caregiving™ is the unique way our caregivers, or Comfort Keepers®, deliver care to our clients. It centers on four interrelated aspects: mental engagement, physical activity, proper nutrition, and safety. As the TAP and other studies show, keeping dementia sufferers active and engaged in meaningful activities increases the quality of life for everyone involved.

Caregivers can also benefit from our respite services. Our Comfort Keepers can offer caregivers much-needed personal time so they can attend to family matters, personal appointments, or simply take some time off to relax. Contact your local Comfort Keepers office for more information on how we can help.

 

References

Alzheimer’s Association. (2013). 2013 Alzheimer’s Disease Facts and Figures, Alzheimer’s & Dementia, 9(2).

Brodaty, H. & Donkin, M. (2009). Family caregivers of people with dementia. Dialogues in Clinical Neuroscience, 11(2), 217-228.

Gitlin, L.N., Winter, L., Burke, J., Chernett, N., Dennis, M., & Hauck, W.W. (2008). Tailored activities to manage neuropsychiatric behaviors in persons with dementia and reduce caregiver burden: A randomized pilot study. Am J Geriatr Psychiatry, 16(3), 229–239. doi:10.1097/JGP.0b013e318160da72.

Kiecolt-Glaser, J.K., Preacher, K.J., MacCallum, R.C., Atkinson, C., Malarkey, W.B., & Glaser, R. (2003). Chronic stress and age-related increases in the proinflammatory cytokine IL-6. Proceedings of the National Academy of Sciences, USA, 100, 15, 9090-9095.

News Medical. New Tailored Activity Program to ease troublesome symptoms of dementia. (2013). Retrieved from http://www.news-medical.net/news/20130912/New-Tailored-Activity-Program-to-ease-troublesome-symptoms-of-dementia.aspx.

Schulz, R. & Matire, L. M. (2004). Family caregiving of persons with dementia: Prevalence, health effects, and support strategies. Am J Geriatr Psychiatry 12(3), 240-249.

Spillman, B. & Long, S.K. (2009). Does high caregiver stress predict nursing home entry? Inquiry, 46, 140–161.

 

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