Dementia & Spousal Caregiver Health

elderly-couple

by Heather Jeng

Earlier this month, I had a long conversation with a client’s wife. She was struggling with guilt and sadness about having moved her husband into long-term care after his needs became too great for her to manage at home. At the same time, though, she admitted that she felt “healthier than I have in years.” It makes intuitive sense that caregiver burden, especially for elderly caregivers, affects one’s own health. But I wondered about the specifics of how this plays out. So for Research Tuesday this month, I did some digging about the health impact of being a spousal caregiver to a person with dementia.

Cruel Irony

Spouses of people with dementia, compared to spouses of people who don’t have dementia tend to:

  • experience more depression
  • report poorer sleep quality
  • experience more social isolation and loneliness
  • take in more calories but have less time to exercise
  • have higher levels of stress hormones
  • have higher fasting insulin levels
  • experience greater decline in cognition (vocabulary, processing speed) over time

All of which are themselves risk factors for – you guessed it – dementia. The mind-blowing reality is that spouses who care for a partner with dementia have an up to 600% greater risk of developing dementia themselves. (Again, compared to people whose spouses do not have dementia.) Even on the low end, the risk is at least 48%. It goes up with the length of time the spouse has been caring for their partner with dementia. These figures accounted for other risk factors for dementia, namely age, gender, education, socioeconomic status, and presence of at least one Apolipoprotein E ε4 allele.

Furthermore, the risk was more elevated for males caring for female partners with dementia than for females caring for male partners with dementia. The authors discuss that this follows trends for males in general: they have higher rates of chronic disease than women, and they have lower life expectancy than women. But the authors also point out that men have “greater physiological reactivity” to stressors than women do, at least in lab situations. This, they suggest, likely exacerbates the negative health effects of caregiving stress.

How Can SLPs Help?

I firmly believe that SLP services have a greater public health impact beyond the patient in front of us. When we train caregivers in strategies that help their loved one be more calm and exhibit fewer “problem” behaviors, the caregivers probably reap health benefits as well: lower blood pressure, lower cortisol levels, less inflammation, etc. Are we doing enough in our treatments to educate caregivers about the health risks of caregiving?  Likewise, are we educating them that taking care of their own health will ultimately help them be better caregivers? General topics that we could bring up include:

  • importance of activity and good diet
  • the option of seeking talk therapy to manage depression
  • offering to invite friends to sessions for training in dementia communication techniques, to increase the patient’s AND the spouse’s social participation
  • the need to learn and use stress reduction techniques (therapy? yoga? Tai Chi? respite care in order to go out with friends? whatever forms stress reduction may take for a particular caregiver!)

Role for SLPs in Preventative Health Care?

Looking at the bigger picture, does the current system of third-party reimbursement allow us to be maximally effective in improving the health of not only the patient, but also their spouse? Could outcome data help healthcare practitioners build a case that, at least for dementia and likely for other diseases, treating the patient necessarily includes treating those close to the patient? In the future, could our notion of “patient” change to include a network of people rather than just the person with the disease? It would seem to fit the data, and it makes sense to address caregivers’ health proactively rather than waiting until they’ve developed their own chronic condition to work with them.

Citations:

Norton, M. C., Smith, K. R., Østbye, T., Tschanz, J. T., Corcoran, C., Schwartz, S., … Welsh-Bohmer, K. A. (2010). Increased Risk of Dementia When Spouse Has Dementia? The Cache County Study. Journal of the American Geriatrics Society, 58(5), 895–900. http://doi.org.offcampus.lib.washington.edu/10.1111/j.1532-5415.2010.02806.x

Vitaliano, P. P. (2010). An Ironic Tragedy: Are Spouses of Persons with Dementia at Higher Risk for Dementia than Spouses of Persons without Dementia?. Journal of the American Geriatrics Society, 58, 5, 976-978.

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