Now that I've finished up this round of classes, I have time to catch up on everything else. I finally got to look at the most recent "Geri-Notes." It's the journal of the Geriatric Section of the APTA. In it was an article by William Staples, PT, DPT, GCS, looking at the stresses of care giving. I've often found myself wondering how some elderly people were able to manage to care for their loved ones at home. These caregivers weren't that healthy themselves, yet they had taken on the care of someone else. Those care recipients were also elderly with multiple medical problems and impaired mobility.
Staples cited research that identified the four most frequent stresses these individuals encounter. They are disorganization of household tasks, sleep disturbances, lack of social interaction and inability to get away at the holidays. I think lack of respite care and limited resources could easily be added to that list. I now understand why some caregivers view a hospital stay as an excuse to stay home. They need a break. A hospital is one place they know their loved one will receive adequate care. It might also be why I've seen some caregivers drag out the discharge process.
According to Staples, putting someone in a nursing home isn't always the answer. That is associated with its own unique stresses. I've often wondered why some people refuse to put someone in a nursing home when it's obvious the level of care needed is too much for one person. It seems like it would easier to let the nursing home take over the responsibility. Staples points out that admitting someone to a nursing home may create a feeling of failure because the caregiver could no longer keep the person at home. This also explains why some family members are never happy with nursing home care. They're judging the care against what they provided at home. In that comparison the nursing home will always come up short. I've also met caregivers who consider it a source of pride to describe all the things they've given up to care for a loved one.
I've read many articles documenting the problems experienced by caregivers. These include depression, isolation, failure to care for themselves and premature mortality. It's also been established that the majority of these caregivers are women. Women aren't known for taking the best care of themselves. My women friends, with myself included, aren't the best at taking care of ourselves. Sure we're busy but we could make the time if we had to. Compare us to an older women taking care of her husband. Making the time isn't her problem. To go to the doctor she either takes her husband with her if she can or must find someone to watch him while she is gone. I wonder if there is a relationship between the stress of care giving and the increasingly complex illness we're seeing in older women.
As PTs there's not a lot we can do. Increasing the functional status and mobility of the patient will relieve some of the burden for awhile. We can educate the caregivers on time saving techniques. We can provide information about available resources. I think the biggest thing we can do is listen. PTs are among the few outsiders who have some idea of what they're going through. We can also answer questions and offer support. These caregivers probably don't have many outlets for their feelings. Giving them a chance to let it out may be the best thing we can do.
Staples, W. (2009) How stress affects caregivers of people with chronic illness and dementia. Geri-Notes. 16, 9-11.