Ask the Expert

A Physician's View of Caregiver Health

by Moira Fordyce, MB CHb, MD, FRCPE, AGSF

The following text was excerpted from the testimony given by Dr. Moira Fordyce at the Novemer 2005 legislative hearing before the Senate Subcommittee on Aging and Long-Term Care in Sacramento.

I have been a doctor for 43 years, and have practiced medicine in Scotland, England and the United States of America. When I came to America in 1976 after 14 years of practice in Britain I was an internal medicine specialist with training in geriatrics. Since at that time there were few geriatricians in the U.S., I was prevailed upon to practice and teach geriatrics, and I have done this with great satisfaction ever since.

I specialized in home visits, nursing home care, and hospice, and set up home care, hospice and geriatric programs for Kaiser Permanente in San Jose. Now my main focus is teaching, writing, research, committee work, medico-legal review and advocating for the elderly and caregivers. I have also joined the ranks of the "young-old."

Those are some of my medical credentials. I have also been a caregiver to my husband, three sons, and my mother.

The Effects of Caregiving on Caregiver Health

There is now a large and growing body of evidence that confirms that caring for a physically or mentally chronically sick person can have dire consequences for the caregiver. Caregiver health is becoming a public health issue, as the numbers of caregivers grow and the average duration of caregiving is four years. In many cases, even longer. Health effects can be physical, mental, emotional, or a combination of all three:

Physical Effects

Compared with noncaregivers, caregivers suffer from:

  • Diminished immune responses, which means more frequent infection and increased risk of cancers;
  • Slower wound healing;
  • Higher incidence of hospitalization;
  • Higher mortality rate;
  • Poorer general health;
  • Higher incidence of headaches, gastro-intestinal problems and insomnia; and
  • An increased risk of heart disease.

Mental Effects

Compared with noncaregivers, the following occur more often in caregivers:

  • Depression and anxiety disorders, and these can persist, even after the death of the patient or placement in a nursing home—guilt often adding to this sad picture.
  • Whenever we say "depression" the next thought must be "is suicide far behind?" and yes, there is a higher incidence of suicide among caregivers.
  • Alcohol and other substance use—this has serious implications for driving and operating machinery as well as damage to health.

Emotional Effects

  • Emotional exhaustion and caregiver stress is real and debilitating. Among signs of caregiver stress are anger at self and the patient; social withdrawal from friends and activities previously enjoyed; irritability leading to moodiness; negative thoughts and reactions; inability to concentrate; and errors at work—the wage-earning caregiver cannot afford this.
  • There is evidence now that emotional stress adversely affects longevity—this goes with the higher risk of mortality I have mentioned above.

Physical, mental and emotional damage, or a combination of all three? What a gloomy picture! But is it always like this? Does it need to be like this? I am happy to say the answer is "No!" it needn't be like this.

We can change it. Sick caregivers cannot effectively look after chronically sick patients so we must find ways to keep caregivers healthy. How might we do this? As well as the studies supporting the adverse effects on health I have described above, there are other studies that make it abundantly clear that access to a good social support network—family and friends, community resources, religious groups, volunteers—and respite care have a strongly positive effect on the mental, physical, and emotional health of the caregiver.

Respite care can range from a family member, friend, or volunteer coming in for a few hours each week to give the main caregiver a break, to having the care recipient attend a day care center, to admitting him or her to a nursing home for a few days to hiring in-home help. Respite care is caring for the caregiver.

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