Caregiving & Alzheimer's disease.

Even though Andee Kaluzna's brother lived just a few miles away from their father when the older man was diagnosed with Alzheimer's disease, the 48-year-old woman became their father's primary caregiver. Why? "Because," she says, "I have two X chromosomes."

Indeed, the Family Caregiving Alliance notes that the typical caregiver is a 46-year-old woman, married and working outside the home. Overall, she spends as much as 50 percent more time giving care than male caregivers, providing an estimated $148 to $188 billion in unpaid care annually. (11)

This is not a benign task. "We've learned from the research that there are real health risks for the women who take on this type of caregiving," says Lisa P. Gwyther, MSW, LCSW, associate clinical professor and education director of the Bryan Alzheimer's Disease Research Center at Duke University Medical Center in Durham, NC. For instance, studies find that middle-aged and older women who provided care for an ill or disabled spouse are six times as likely to suffer depressive or anxious symptoms as those who had no caregiving responsibilities. (7)

Additionally, the chronic stress of caregiving can weaken the caregiver's immune system, more than double her risk of cardiovascular disease, result in an increased risk of developing hypertension, a lower perceived health status, slower wound healing and contribute to an overall increased risk of death. (13), (14)

"Caregiving may be a risk factor for early mortality," says Ms. Gwyther, "perhaps because of the effects of chronic stress, because women don't take care of their own health, or because the caregiving may worsen the family caregiver's previous chronic illnesses."

Plus, the effects on a woman's health don't end when direct caregiving does, she says. Studies find that the changes in a woman's immune functioning may continue for up to two years after the person they were caring for dies. Even moving the family member with Alzheimer's disease into a nursing home does not relieve stress on the primary family caregiver, she says. One recent study found no difference in depression, anxiety and the overall burden on families during or after the transition to a long-term care setting.

That's why, she says, "caregiving is a public health issue, not just a social concern. We're going to end up prematurely paying for the care of these women after they've cared for everyone else in their families."

There are ways to manage the stress of caregiving so you don't get sick, as Ms. Kaluzna learned. "I went to a support group religiously," she says. The support group gave her a "crystal ball" into the probable course of her father's illness. It also served as a place to get information, education and referrals, and as a sounding board where she could address her own issues around her father's illness.

Additionally, she carved out time for physical exercise. "I'm an ice dancer, and I called it my 'ice therapy,'" she recalls. Her time on the ice served as a mental vacation, she said, because she had to focus on so many things involved with the skating that she couldn't think about her father.

Today, Ms. Kaluzna leads caregiver support groups for the local chapter of the Alzheimer's Association in Chicago. "I strongly feel that, as a caregiver, there are four components to feeling comfortable and that you can rise above the chores of caregiving," she says. They are:

1. Have everything in order for your loved ones in terms of legal, financial and medical issues.

2. Anticipate end-of-life needs.

3. Take care of the family relationships so the family can come together to make decisions.

4. Find what it is that gives you solace and peace so you can cope.

References

(7) Brain Imaging Techniques Sharpen Focus on Alzheimer's [press release] Alzheimer's Association. July 20, 2004.

(11) Fact Sheet: Women and Caregiving. Family Caregiving Alliance. Available at: http://www.caregiver.org/caregiver

(12) Cannuscio CC, Jones C, Kawachi l, Colditz GA, et al. Reverberations of family illness; a longitudinal assessment of informal caregiving and mental health status in the Nurses' Health Study. Am J Public Health. 2002;92(8):1305-11

(13) Glaser R, Sheridan J, Malarkey WB, et al. Chronic stress modulates the immune response to a pneumococcal pneumonia vaccine. Psychosom Med. 2000;62(6):804-7.

(14) Lee, S. L., Colditz, G. A., Berkman, L. F., et al. (2003). Caregiving and risk of coronary heart disease in U.S. women: A prospective study. American Journal of Preventive Medicine, 24(2), 113-119.

RELATED ARTICLE: Caregivers: Avoiding Burnout 

Besides regular physical exercise and attending a support group, there are other steps you can take to prevent caregiver burnout, says Lisa P. Gwyther, MSW, LCSW. These include:

* Be tolerant of imperfections-yours and others.

* Structure daily routines for your loved one.

* Be gentle with yourself: you are living with a situation you didn't create and your choices may be limited by circumstances beyond your control.

* Cope, adapt, or accept what you can't change. Your relative will become less able to change his/her behavior. Adapting will be up to you.

* Learn about the disease and about caregiving.

* Keep up valued relationships.

* Ask for and accept help.