Family Caregiving

Family caregivers play a critical role in our health and long term care system by providing a significant proportion of the care for both the chronically ill and aging. Estimates suggest that there are currently over 44 million Americans age 18 and older providing unpaid assistance and support to older people and adults with disabilities who live in the community (NAC & AARP, 2004). Further, the economic value of the services that family caregivers provide is estimated at approximately $350 billion annually (AARP, 2007).

• A typical family caregiver in the U.S. is female, approximately 46 years old, has at least some college experience, and spends an average of 20 hours or more per week providing unpaid care to someone 50 or older. However, the proportion of caregivers who are men is also substantial (NAC & AARP, 2004).

• Rates of caregiving can vary somewhat by ethnicity. Among the U.S. adult population, approximately one-fifth (21%) of both the Caucasian and African-American populations are providing informal care, while a slightly lower percentage of Asian-Americans (18%) and Hispanic-Americans (16%) are family caregivers (NAC & AARP, 2004).

• Duties of caregivers are usually full time and include, but are not limited to: cooking, cleaning, bathing, medical care adherence monitoring, errand running (grocery shopping, transportation to appointments) and other activities of daily living (ADLs).

• Family caregivers who provide care for individuals with Alzheimer's disease often provide more ADL assistance than non-Alzheimer's caregivers due to the impairments of the care recipient (Alzheimer's Association, 2004).

• While caregiving can be rewarding and positive, many family caregivers experience significant physical, psychological, and financial stressors in association with their caregiving role.

• Caregivers report increased physical ailments as compared to non-caregivers (Roth, Haley, Owen, Clay, & Goode, 2001), that include, but are not limited to, chronic pain such as headaches and backaches (Wight, LeBlanc, & Aneshensel, 1998), and weakened immune systems (Shewchuk, Richards, & Elliott, 1998). Over time, caregiving may erode one's subjective experience of health (Wight et al., 1998).

• Caregiving can also have significant consequences on mental health. When compared to their non-caregiving counterparts, family caregivers report higher levels of stress/distress, depression, emotional problems, and cognitive problems (Brehaut et al., 2004; Douglas & Daly, 2003).

• Estimates suggest that between 40 to 70 percent of caregivers have clinically significant symptoms of depression, with approximately one-fourth to one-half of these caregivers meeting the diagnostic criteria for major depression (Zarit, 2006).

• Caregivers who experience strain in care provision have the greatest physical and psychological health effects, including symptoms of depression; higher levels of anxiety; and inadequate time for sleep, self-care, and other health related activities (Schulz, Mittelmark, Burton, Hirsch, & Jackson; Schulz & Beach, 1999). In fact, strained caregivers had a 63 percent greater chance of death within 4 years as compared to non-caregivers (Schulz & Beach, 1999).

• Female caregivers fare worse than their male counterparts, reporting higher levels of depressive and anxiety symptoms and lower levels of subjective well-being, life satisfaction, and physical health than male caregivers (Miller & Cafasso, 1992; Pinquart & Sorensen, 2006; Yee & Schulz, 2000).

• Family caregivers also face financial burdens, as estimated caregiver out-of-pocket expenses are, on average, $2,400 per year to help care recipients (AARP, 2007). Further, family caregivers can experience loss in wages and other work related benefits due to changes in work patterns (AARP, 2007).

While caregiving can be physically, psychologically, and economically stressful, critical supports can help to reduce the burden of family caregiving. The following resources can help to promote the health and well being of family caregivers:

• Family Caregiver Assessment - to evaluate the needs of family caregivers, develop a support plan, and make appropriate referrals

• Caregiver Education and Counseling - to help identify available resources and make appropriate decisions regarding care recipient

• Respite Care - to provide temporary relief from the ongoing responsibility of caring for an individual with special needs, or who may be at risk of abuse or neglect

• Individual and Group Therapy - to aid family caregivers in their management of stress and burden of caregiving and the balance between work and family

• Financial Support - to help alleviate the economic burden of family caregiving

• Additional Support Services - resources such as adult day care, home delivered meals, and home health care to ease the burden of family caregiving

Psychologists have been at the forefront in developing and delivering cost-effective health promotion programs that:

• Help older adults and their families manage disease and prevent excess disability through programs that improve treatment adherence, stress management skills, and access to social support

• Increase family caregivers' knowledge of effective and safe caregiving strategies and improve their emotional coping skills in order to reduce or prevent stress-related problems and enhance their quality of life

• Provide safe and effective alternatives to medication when the use of medication is inappropriate due to side effects, the risk of drug interactions, or a lack of evidence of their effectiveness in treating the problem

• Increase the ability of families to safely care for their loved ones at home and avoid or delay costly institutionalization