Family Caregiving for Older Adults: Health Effects and Interventions

Transcript

• 00:00I'm going to be talking about
• 00:02family caregiving for older adults,
• 00:04health effects, and interventions.
• 00:06My name is Joan Monnon and I'm an associate
• 00:10professor of Public Health in the Department
• 00:13of Social and Behavioral Sciences.
• 00:15My research examines how emotional processes
• 00:18affect health and older adult relationships.
• 00:22I examine both survey methods and laboratory
• 00:26experiments to understand the mechanisms,
• 00:29things like emotional contagion,
• 00:32cardiovascular reactivity,
• 00:34and moderators like gender and
• 00:37individual differences and attachment
• 00:39involved in these processes.
• 00:41And currently my research focuses on
• 00:44understanding how caregivers and care
• 00:47recipients support one another in
• 00:49the context of early stage dementia.
• 00:52The content provided in this program does
• 00:55not provide medical or clinical advice.
• 00:58The content is for general informational
• 01:00purposes only and the information
• 01:02provided herein is not intended to be a
• 01:06substitute for professional medical advice,
• 01:08diagnosis, or treatment.
• 01:10Always seek the advice of your
• 01:12healthcare provider with any questions
• 01:14you have regarding a medical condition.
• 01:17Never disregard professional medical
• 01:19advice or delay seeking it because of
• 01:23something you have seen in this program.
• 01:26I'll start with the definition
• 01:27of family caregiving so broadly,
• 01:29family caregivers are relatives,
• 01:32friends, partners,
• 01:33or neighbors who provide assistance,
• 01:36typically unpaid,
• 01:37to someone who has limitations
• 01:39in their physical, mental,
• 01:41or cognitive functioning.
• 01:44And family caregiving is not a new thing.
• 01:47It's a part of our daily lives
• 01:48and we've been doing it since
• 01:50the beginning of families,
• 01:52and it's really something that is
• 01:54a sign of love and care in our
• 01:58families and culture across the world.
• 02:01But caregiving in the US in terms of
• 02:04taking care of older adults with health
• 02:07or functional needs has really grown.
• 02:09So in 2015 there were 43.5 million Americans
• 02:14acting as caregivers for their loved ones,
• 02:18and then in 2020 it went up to 53,000,000.
• 02:24And the caregiving journey can
• 02:27can have many parts to it.
• 02:29So from the beginning it often
• 02:32starts with sporadic care,
• 02:34like accompanying a loved one to the
• 02:37physician's appointments of light errands,
• 02:40checking in on the family member,
• 02:42or communicating with health providers.
• 02:45And then it often goes up to more
• 02:49household tasks or monitoring
• 02:51symptoms and medications,
• 02:53managing finances,
• 02:54maybe hiring care providers that
• 02:58are professional care providers,
• 03:01and then also coordinating care and
• 03:04providing more emotional support.
• 03:06And then sometimes caregivers move up
• 03:08to the stage of more personal care,
• 03:11so things like more complex medical
• 03:14tasks that have to be done or
• 03:18dealing with insurance issues or
• 03:21monitoring behaviors and locations
• 03:23of that family member.
• 03:26And then sometimes caregivers are
• 03:28there at the end of life and have to
• 03:31do advanced care planning or minimize
• 03:34suffering or symptoms of their loved one,
• 03:37and then all the way to bereavement
• 03:41when the loved one passes.
• 03:44So what's the impact of
• 03:47caregiving on caregivers?
• 03:49So there can often be psychological distress,
• 03:54physical health problems.
• 03:57There can be effects on biomarkers,
• 04:00such as cardiovascular
• 04:03reactivity and blood pressure,
• 04:07and other kinds of immune markers
• 04:10that are measured in studies that
• 04:13correlate with actual disease outcomes.
• 04:16It can have negative effects on
• 04:19social relationships, on work,
• 04:22and sometimes caregiving can lead to
• 04:26elder mistreatment or abuse situations.
• 04:29But what are the risk factors for
• 04:32some of these adverse outcomes?
• 04:34Well,
• 04:35things like sociodemographic factors
• 04:38like having financial problems
• 04:40or high intensity caregiving,
• 04:43such as providing more hours of care.
• 04:47And also things like not believing that
• 04:50you had a choice and becoming a caregiver.
• 04:55And especially important characteristic
• 04:57is perceiving that your care recipient
• 05:01is suffering and that there's
• 05:02not much you can do about that.
• 05:05And then if the caregiver also
• 05:07had poor health to start with.
• 05:09Providing care can also exacerbate
• 05:13the health effects on caregivers.
• 05:16Having limited support from ones
• 05:19friends and family and other
• 05:21people that might be professional
• 05:24providers can also put one at risk.
• 05:28And then having a physical home
• 05:32environment that includes stairs or
• 05:35the lack of things that facilitate care
• 05:38for that loved 1 can be risk factors.
• 05:42There's many interventions that
• 05:44we already have.
• 05:46So at least 50 systematic reviews,
• 05:50many of which include meta analysis,
• 05:52have been published since 2000.
• 05:56And so since 2014,
• 05:58five systematic reviews of systematic
• 06:01reviews have been published.
• 06:04So there's many, many interventions,
• 06:07and these interventions often
• 06:10target or measure things like
• 06:15psychological morbidity or problems,
• 06:19caregiver burden, stress,
• 06:23coping skills,
• 06:24social support,
• 06:25and then patient outcomes such as
• 06:29behaviors in the dementia context that are
• 06:33problems or challenging for caregivers,
• 06:37and then also institutional placement.
• 06:41So many of these interventions
• 06:43are psychosocial interventions,
• 06:44and they really target the main information
• 06:48needs of caregivers and care recipients.
• 06:51They equip caregivers with adaptive
• 06:54strategies and behaviors that they need
• 06:57to mitigate the impact of the care,
• 07:00recipients,
• 07:00illness and disability in their daily lives.
• 07:04Things like stress management,
• 07:06and they enhance communication skills between
• 07:10caregivers and care recipients and
• 07:13sometimes even the healthcare providers.
• 07:16And the also important part of these
• 07:19interventions is connecting caregivers
• 07:21to other resources or services and also
• 07:25providing them with social support.
• 07:28Many interventions are also
• 07:30meditative interventions,
• 07:31and the core features of these are an
• 07:34emphasis on and practice of meditation,
• 07:37recognizing, recognizing,
• 07:39and accepting that unpleasant cognitions,
• 07:42emotions, and sensations are a part of life,
• 07:46synthesizing change and acceptance
• 07:48and changes in the way that people
• 07:52relate to experiences and facilitate
• 07:54positive action in the face of life.
• 07:57Stressors, physical activity interventions
• 08:02are also really popular and many are
• 08:05designed to enhance caregiver physical
• 08:07activity by having them engage in
• 08:10lots of different activities,
• 08:12most notably brisk walking,
• 08:15stair climbing, dancing,
• 08:19gardening, stretching,
• 08:22strength training and yoga.
• 08:26And Tai chi tend to be the most popular
• 08:30interventions with physical activity and
• 08:32some include care recipients and some
• 08:35are just targeted towards caregivers.
• 08:38Cognitive behavioral therapy is also a
• 08:41very popular clinical type of therapy
• 08:44offered to caregivers that's been
• 08:47shown to be pretty efficacious for
• 08:50decreasing caregiver depression, anxiety,
• 08:53stress, and dysfunctional thoughts.
• 08:56So in a recent review of 12
• 08:59randomized control trials,
• 09:00we find these improvements for caregivers
• 09:04And then cognitive behavioral therapy
• 09:06also improves satisfaction with life,
• 09:09perceived self efficacy,
• 09:11behavioral activation and
• 09:14appraisal of problem behaviors.
• 09:17Respite and care coordination is
• 09:19also really popular and one recent
• 09:22systematic review of 104 studies shows
• 09:25that burden was reduced from two to
• 09:29six months follow-ups in single sample
• 09:32studies but not in randomized controlled
• 09:35Childs and quasi experimental studies.
• 09:38And we have also seen that daycare
• 09:41services are effective in decreasing
• 09:43caregiver burden and behavioral problems
• 09:45in persons with dementia specifically,
• 09:48but they also accelerated time
• 09:51to nursing home admissions.
• 09:54Technologybased interventions are growing.
• 09:56So this is really something
• 09:58to look for in the future.
• 10:00And over the past couple of years,
• 10:03they've really been essential to
• 10:05be able to reach many communities
• 10:08that haven't been able to come into
• 10:11universities or healthcare systems
• 10:13to get these caregiver interventions.
• 10:16We now have the National Institute
• 10:19on Aging Impact Collaboratory,
• 10:21which is this collaboratory that works
• 10:23to put some of these interventions
• 10:26in the healthcare system and measure
• 10:29them without actually doing studies
• 10:32by getting the data from healthcare
• 10:35systems to look at the outcomes.
• 10:37And so we're now piloting many of
• 10:41these interventions to see if we
• 10:44can get them to a larger group of
• 10:47caregivers that are connected to health
• 10:50systems and community organizations.
• 10:53There's also a great resource at
• 10:55Benjamin Rose Institute on E Jang,
• 10:57which is a database of all these
• 11:00caregiver interventions that have been
• 11:02have been shown to be beneficial.
• 11:04And it provides all the resources
• 11:06that you might need to put out one
• 11:09of these interventions if you have
• 11:11an organization targeted to help
• 11:13older adults in the community
• 11:15or in healthcare settings.
• 11:18So what do we need to do now?
• 11:21So we need caregiver and assessment
• 11:24and support in healthcare.
• 11:26We need to find out who the caregivers
• 11:28are and really give them support
• 11:31early in the healthcare system.
• 11:33We also need caregiver education and support
• 11:36interventions in the community widely.
• 11:39So not just in healthcare,
• 11:41but all around in the community,
• 11:45and we need to measure the mechanisms of
• 11:48interventions to design simple solutions.
• 11:50So finding out what the active
• 11:53ingredients are of interventions
• 11:55to really make the most of them.
• 11:57We need to embrace technology.
• 11:59So things like smartphones and
• 12:02virtual education programs are going
• 12:04to be even more important and really
• 12:07have been over the past two years.
• 12:10And then we need to educate and prepare
• 12:12all adults for caregiving because people
• 12:14are going to either be a caregiver
• 12:17themselves at some point in their life
• 12:19or they're going to be cared for.
• 12:24Thank you.