Issues and risks in caregiving
In addition to taking on the household chores, shopping, transportation, and personal care, 37 percent of caregivers are involved in giving medications, injections, and medical treatments to the person for whom they are providing care. Seventy-seven percent of those caregivers report the need to ask for advice about the medications and medical treatments, and the person they usually turn to is their physician. While they talk to the physician about their loved one's health, they don't talk about their own. This is a population at increased risk of morbidity and mortality. Yet we and they often ignore these health risks.
Reliance on family support networks is a major part of national health policy, and demographic trends and changes in the health care delivery system suggest an increased reliance on family caregivers in the future. It is estimated that 80 percent of community care is provided by family caregivers, at an approximate economic value of $200 billion annually.1,2
The research literature is replete with findings that family caregivers face inevitable stresses and burdens. The role of caregiving is potentially an occupational hazard, and its demands place caregivers at risk for psychological and physical problems. These include increased morbidity and mortality,3 chronic stress, family conflicts, and failure to meet one’s personal and emotional needs.4,5 manifestations of caregiver stress and burden include burnout, self-neglect, excessive use of drugs or alcohol, depression, and neglect, abuse, and premature institutional placement of the patient.6
Primary care physicians can provide a strong model to guide relationships with family caregivers. An effective relationship model acknowledges the key linkage role of the primary care physician and recognizes that caregivers and patients form interdependent units. It also considers the caregiver as a partner with the physician in the care of the patient. The physician demonstrates concern for and carries out periodic assessment of the caregiver as well as the patient and validates the role of the caregiver.7
- Doty P. Family care of the elderly: the role of public policy. Milbank Q . 1986;64:34-75.
- Arno PS, Levine C, Memmott M. The economic value of informal caregiving. Health Affairs . 1999;18:182-188
- Schulz R, Beach SR. Caregiving as a risk factor for mortality: The caregiver health effects study. JAMA . 1999:282: 2215-2219.
- The loneliness of the long-term caregiver. N Engl J Med . 1999;340:1587-1590.
- Thompson C, Briggs M. Support for carers of people with Alzheimer’s type dementia. Cochrane Database Syst Rev . 200;2:CD000454
- Newman SJ, Struyk R, Wright P, Rice M. Overwhelming odds: Caregiving and the risk of institutionalization. J Gerontol Soc Sci . 1990;45:S173-S183.
- Council on Scientific Affairs, American Medical Association. Physicians and family caregivers: a model for partnership. JAMA. 1993;269:1282-1284.
The invisible caregiver: How can doctors care for them too? American Medical News, Sept. 17, 2001
Mortality Risk Among Elderly Spousal Caregivers JAMA Volume 28, No. 23, Dec. 15, 1999