A caregiver is the person that provides physical, emotional, financial or other support to another person or persons. Women most often serve as caregivers and provide support most commonly for immediate family members (Sherwood 2006). The role of a caregiver is associated with many personal benefits. In fact, 80% of family caregivers report the experience as emotionally rewarding but caregivers are also at risk for chronic stresses associated with this task. Ironically, care giving can most certainly upset the body balance of a caregiver.

Caregiver strain is a term used when the emotional and/or physical health of a caregiver is compromised or when the demands of care giving are greater than the available resources (Given 1992). Over 15 million adults currently provide care for elderly relatives in the United States (Schulz 1998). The number of caregivers will likely continue to increase as the population lives longer. By 2030, 20% of the United States population will be 65 years or older (Koizumi 1998). Without this extensive network of caregivers, many cared for individuals will require permanent admission to institutions or health care facilities. The costs of these services are not covered by insurance in many cases. Therefore, many caregivers must provide this care at home. The average caregiver spends over 10% of their annual income on care giving expenses (Evercare 2007). Of caregivers that support an elderly person, 40% also simultaneously support children. Caregivers spend 23-41 hours per week on caregiver duties alone, with low-income caregivers reporting a greater time commitment (Evercare 2007). Given that 64% of all caretakers also work outside the home, the overall burden that the typical caretaker bears is enormous.

The cumulative burden of time commitment, prolonged stress, financial strain, and the physical requirements of care giving may increase the risk for physical health problems in caregivers. Elderly caregivers who report strain caused by care giving have a 63% higher mortality risk versus non-caregivers (Schultz 1999) as well as higher rates of depression, anxiety, and alcohol use. Furthermore, these caregivers are at greater risk of placing the family member in a long-term health care facility and using in-home services more often due to inability to cope with the strain of care giving (Brown 1990). The benefits of reducing caregiver strain are evident. Therefore, there is a strong need to identify factors that can lower caregiver strain and the complications associated with this strain.

Management of Caregiver Strain:

Maintain A Healthy Lifestyle

• Devote free time each day to exercise or participate in other activities that can help to reduce chronic stress. Exercise regularly for a minimum of 20 minutes at least 3 times a week. Choose an activity that you enjoy such as walking, dancing, swimming, etc. Yoga or tai-chi may be particularly beneficial for the caregiver because they teach relaxation techniques that can be used at any time throughout the day when faced with a stressful situation.

• Meditation is an effective method to reduce stress and requires little time. When stress is high, the caregiver can go to a quiet area, sit or lie still, breathe deeply, and clear the mind. Physiological and psychological benefits of meditation have been reported with as little of 5 minutes on most days of the week. Visualizing comforting scenes or memories or listening to easy music can aid with meditation.

• Eat nutritious balanced meals, limit caffeine and alcohol intake, do not smoke and try to get 6-8 hours of sleep each night. Occasional juicing can provide a quick shot of natures best liquid vitamins and can act as a natural phytonutrient supplement. Proper nutrition is vital for caregivers given their energy expenditure.

• See your personal physician if the chronic stress associated with care giving begins to feel overwhelming. Screening tools are useful to identify whether care giving stresses are excessive and may require intervention. The most common screening test is the Caregiver Strain Index test (Sullivan 2002), which can be found at http://www.consultgerirn.org/uploads/File/Caregiver%20Strain%20Index.pdf.

Take Scheduled Breaks

Caregivers often do not take regular breaks due to feelings of guilt. However, just like a regular job, breaks are needed in order to avoid undue stress. A support system consisting of family, friends and professional caregivers needs to be established and used regularly to allow the caregiver this much needed time.

Ask For Help

Ask for help when needed. About 75% of adults that provide care for an elderly family member do so with no additional help. When care giving stresses are great, the support system should be utilized.

Education

Caregiver stress may worsen due to a lack of understanding of a family member’s condition. The caregiver should attempt to educate him/herself and identify available resources available for the cared-for family member’s condition.

Attend A Caregiver Support Group

This group may help the caregiver understand that his/her feelings are normal. Furthermore, this group may offer practical advice on better ways to manage excessive caregiver stress and will allow opportunity to discuss issues, successes and feelings related to care giving.

Caregivers comprise a significant proportion of the United States population and help to reduce the financial burden associated with use of health care facilities. However, care giving is associated with a significant physical, psychological and financial burden to the caregiver. By incorporating some of these caregiver stress management recommendations, the caregiver can continue to provide optimum care while successfully managing stress. Ultimately, this will help the caregiver to maintain health thereby allowing him/her to provide optimum care for the person in need.

Dr. Linda Posch MS SLP ND

References

Brown LJ, Potter JF, & Foster BG. Caregiver burden should be evaluated during geriatric assessment. J Am Geriatr Soc 1990;38:455-60.

Evercare. (2007). Family Caregivers – What They Spend, What They Sacrifice. http://www.caregiving.org/data/Evercare_NAC_CaregiverCostStudyFINAL20111907.pdf

Given, C., Given, B., Stommel, M., Collins, C., King, S., & Franklin, S. (1992). The Caregiver Reaction Assessment (CRA) for caregivers to persons with chronic physical and mental impairments. Research in Nursing and Health. 15:271–283.

Koizumi LS, et al, ed. (1998). The public health. In: Health Care Almanac and Yearbook. New York: Faulkner and Gray:263.

Onega LL. (2008). Helping those who help others: the Modified Caregiver Strain Index. Am J Nurs 108:62-9.

Sherwood, P.R., Given, B.A., Given, C.W., Schiffman, R.F., Murman, D.L., Lovely, M., et al. (2006). Predictors of distress in caregivers of persons with a primary malignant brain tumor. Research in Nursing and Health. 29:105–120.

Schulz R & Beach SR. (1999). Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. JAMA 282:2215-9.

Schulz R & Quittner AL. (1998). Caregiving for children and adults with chronic conditions: introduction to the special issue. Health Psychol 17:107-111.

Sullivan MT. (2002). Caregiver Strain Index. J Gerontol Nurs 28:4-5.