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caregiver stress (caregiver burden, caregiver burnout)

Etiology: - inadequate daily help with tasks (primary factor) [4] - no association with - duration of disability - degree of disability, - socioeconomic status [4] - caregiver risk factors [3] - female sex - low educational attainment - residence with the care recipient - higher number of hours spent caregiving - depression - social isolation - financial stress - lack of choice in being a caregiver - white caregivers at greater risk than black caregivers [1] - patient risk factors - agitation - aggression - irritability - hallucinations - movement disorder [7] Epidemiology: - caregivers of patients with dementia - likelihood of elderly to remain at home as disabilities increase depends on capacity & sustainability of caregiving support at home - caregiver stress affects rates of nursing home placement, behavioral & psychologic symptoms of dementia, hospital utilization, & elder abuse Pathology: - impaired immunity - higher incidence of: a) depression (50%) b) acute illness (especially respiratory tract) c) anxiety Laboratory: 1) diminished titers in influenza vaccine 2) increased serum IL-6 Complications: - increased mortality among stressed caregivers [2] - caregiver support will likely have little effect on the course of a patient's illness [1] Management: - assess level of caregiver distress before providing personal care services when assisting disabled elderly to remain in his/her home (GRS11) [1] - respite care - caregiver support group [3,5] - cognitive behavioral therapy [3,6]

Related

caregiver respite care Zarit burden scale

General

psychosocial stress

References

  1. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004 - Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022 - Geriatric Review Syllabus (GRS12) Colburn JL, Westcott AM, Potter JF (eds) American Geriatrics Society. 2025
  2. Kiecolt-Glaser JK et al, PNAS 100:9090, 2003
  3. Adelman RD, Tmanova LL, Delgado D, et al. Caregiver burden: a clinical review. JAMA. 2014;311(10):1052-1060 PMID: 24618967
  4. Garlo K, O'Leary JR, Van Ness PH, Fried TR. Burden in caregivers of older adults with advanced illness. J Am Geriatr Soc 2010 Dec; 58(12):2315-2322. PMID: 21087225
  5. Keiro Senior Health Care Benefits of a Support Group for Caregivers http://www.keiro.org/caregivers-support-group
  6. Livingston G et al Long-term clinical and cost-effectiveness of psychological intervention for family carers of people with dementia: a single-blind, randomised, controlled trial. The Lancet Psychiatry. 19 November 2014 PMID: 26361313 http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366%2814%2900073-X/abstract
  7. Chiari A, Pistoresi B, Galli C et al Determinants of Caregiver Burden in Early-Onset Dementia. Dement Geriatr Cogn Dis Extra. 2021 Aug 13;11(2):189-197. PMID: 34721497 PMCID: PMC8460976 Free PMC article.
  8. Stall NM, Kim SJ, Hardacre KA et al Association of Informal Caregiver Distress with Health Outcomes of Community- Dwelling Dementia Care Recipients: A Systematic Review. J Am Geriatr Soc. 2019 Mar;67(3):609-617. PMID: 30536383 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.15690
  9. Terum TM, Testad I, Rongve A et al The association between aspects of carer distress and time until nursing home admission in persons with Alzheimer's disease and dementia with Lewy bodies. Int Psychogeriatr. 2021 Apr;33(4):337-345. PMID: 32524943 Free article. https://www.intpsychogeriatrics.org/article/S1041-6102(24)03617-2/fulltext