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Caregiving and StressDepression, loneliness, feeling isolated, and negative affect in spousal caregivers often persist for a significant period after their obligation ends. In one study, levels of negative emotions remained similar to those of current caregivers for up to 3 years after caregiving ceased (). The most important stress predictors were social support and intrusive-avoidant thinking. Both acute stress and chronic stress such as spousal caregiving can be associated with a shift in immune response (). Percentage of lymphocytes (one of the major immune system cells) that produced compounds that inhibited protective immune functions was higher in caregivers than in controls. There was an age dependent significant interaction between stress and aging for these cells. The difference between caregivers and controls was substantially greater in younger than in older subjects. Chronically depressed caregivers can have adversely altered growth hormone gene expression in their mononuclear cells (). Growth hormone enhances immune responses. Alterations in wound healing, vaccine responses, chronic endocrine and immune dysregulations have been seen in caregivers of parents or spouses who have long-term dementia such as Alzheimer’s disease (, , , , , , ). Chronic stress in caregivers changes natural killer cell (NK cells) cytotoxicity (). NK cells are important cells for warding off some kinds of infections and may be important in fighting tumors. Current and former spousal caregivers of Alzheimer’s patients were compared to controls. Both of the caregiver groups showed significant decreases in NK cell responses. Higher NK cell response seemed to be correlated with increased levels of positive and tangible social support, independent of levels of depression. Interestingly, even though an average of 2 years had passed since the former caregivers had given care, their values were equally as depressed as the current caregivers. So, it seems that consequences of chronic stressors may persist well past the cessation of the stressors (). If chronic stress is high enough, people without an apparent genetic predisposition to syndromal depressive disorders can experience clinically significant aberrations in neuroendocrine and immune functions, as was shown in a study of caregivers for a demented spouse (, ). Caregiving spouses of demented patients may also have inhibited virus specific lymphocyte responses to influenza virus vaccines and inhibited antibody responses to pneumococcal bacteria vaccines (). This may be significant as older folks suffer considerable morbidity and mortality from influenza and pneumococcal infections. A two-year study examined the roles of positive and negative affect on the health of gay caregivers for AIDS afflicted patients (). For HIV-positive caregivers, self-injurious forms of avoidance coping predicted higher levels of physical symptoms. For HIV-negative caregivers, higher levels of social coping predicted increases in positive affect, which resulted in lower levels of physical symptoms. On the other hand, higher levels of cognitive avoidance predicted increases in negative affect, which resulted in higher levels of physical symptoms. A number of fine studies have been conducted to try to develop support systems for caregivers both in the USA and in Europe. The ACTON (Assisting Carers using Telematics Interventions to meet Older person’s Needs) project is being carried out in Ireland (). They found that the majority of caregivers are constantly searching for support and information, and this can be a frustrating task. Inconsistent support and lack of information were major concerns and resulted in significant frustration and anxiety. The caregivers have resorted to a number of positive and negative coping strategies to deal with their stress. Another good source of information is the 4-part series on family caregivers in Sweden. The reader is referred to (, , , ). An index for assessing coping strategies by family caregivers (CAMI) is presented in the British Journal of Nursing also (). It presents a basis for assessment and support. Cognitive based stress management and psychoeducational programs seem to be efficacious in reducing stress and depression in caregivers of folks with at least some diseases (, , , , , , ). The most critical needs of family caregivers may be help, hope, and happiness (). |
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