Millions of older adults with chronic diseases depend on the assistance of unpaid family caregivers to maintain their independence and quality of life. The Centers for Disease Control and Prevention (CDC) considers the welfare of caregivers an evolving public health concern and estimates the cost of care provided by these unpaid individuals to be over $470 billion annually (CDC, 2021).
Caregivers are usually family or friends who provide community-based care on a long-term basis to older adults or individuals with disabilities. Caregivers provide a variety of services including bathing, dressing, managing medications, shopping, cleaning, paying bills, and driving to medical appointments. Caregivers also act as companions and provide emotional support as well as social engagement to the recipients of their care.
Fifty-eight percent of caregivers are female, and 79% care for adults older than 50 years of age. Seventy-six percent of the recipients of care are 65 years of age or older (CDC, 2021). Approximately one-third of caregivers provide 20 or more hours of care each week, and typically most caregivers are not formally trained in the care they provide. Caregivers frequently suffer financial burdens and work-related concerns (e.g., leaving work early or needing to take time off to care for a loved one). Two in 10 employed caregivers report having to stop working, and 4 in 10 report having to reduce their paid working hours. Eighty percent of caregivers report paying out-of-pocket expenses for their care recipients (CDC, 2021). The overall financial strain becomes cumulative with each year of caregiving and can result in a significant burden for the caregiver.
The complex role of acting as a caregiver also creates physical, emotional, and psychological stress. Nearly two out of five caregivers have at least two chronic diseases, whereas one in five report only fair to poor health (CDC, 2021). Caregivers often neglect their own health needs, increasing their risk for poor health and chronic disease. Emotional and psychological demands on caregivers increase significantly when they care for neurocognitively impaired individuals, resulting in increased depression, anxiety, and feelings of isolation. The dramatic need for caregivers is increasing yearly as the population ages. It is anticipated that by 2030, 73 million individuals in the United States will be 65 years of age or older. At some point, most of these individuals will require daily assistance of some kind from a family or other unpaid caregiver to maintain independence and a reasonable quality of life (CDC, 2021).
Caregivers are critical to the health and well-being of the individual, but also require the attention and support of home care clinicians. They are an integral part of the care team but often do not receive the support they need in terms of self-care. Caregiver support groups are an excellent intervention to provide support, education, and resources to manage health and well-being. Support groups can be found in many community-based organizations, such as community centers, hospitals, places of worship, local Area on Aging, and disease-specific organizations such as the Alzheimer's Association or the American Diabetes Association. Home care social workers often have access to lists of local support groups. Support groups may meet in person or via an online format.
The therapeutic/curative factors for all types of groups are based on Irvin Yalom's eleven Therapeutic Factors. Dr Yalom, a renowned Stanford University School of Medicine psychiatrist and group therapist identified the benefits of group interactions to support and treat individuals with a wide variety of struggles. A brief description of six of the most prominent therapeutic factors found in support groups will assist home care clinicians to educate their caregivers on the benefits of participating in a support group (Yalom, 1983).
Installation of Hope: Many individuals come to the group feeling defeated and overwhelmed by the multiple tasks of caregiving. Are they doing the best they can, are they doing it correctly? When caregivers with these struggles join a group of people struggling with similar problems, they have the remarkable opportunity of witnessing change in others while at the same time having their own small victories acknowledged and celebrated by group members. Through this process, hope begins to emerge, and positive feelings regarding the future begin to form.
Universality: Caregiving can be isolating. In a support group, caregivers encounter other individuals who have faced similar problems. They become aware they are not alone and can feel tremendous satisfaction in this connection. The sense that their struggles are not unique and others with similar problems are willing to support them can be profoundly healing. This helps caregivers move beyond their isolation, and it gives further energy to hope.
Imparting Information: The exchange of information in a support group helps members get from one day to the next. This mutually shared success gives positive energy to the group members and encourages positive change. They feel comfortable utilizing the techniques gleaned from other group members to provide care or engage in self-care.
Altruism: Fundamental to the human condition is the desire to help others. For the most part, all group members of a support group have a strong desire to help others. The group offers the members opportunities to aid one another. As caregivers recognize they have something of value to give their fellow caregivers, their self-esteem rises as positive change and self-efficacy are supported.
Existential Factors: Loss and death are frequent issues that caregivers cope with. As they become more aware of the frustrations of reality and the limits they face, caregivers can receive support from the group in accepting "life on life's terms" in a healthy fashion by helping them accept the inevitable. Often the group will have members that have undergone a recent loss. Their insight and movement toward healing provide remarkable reassurance to those facing the uncertainty of a future loss.
Group Cohesiveness: Group cohesion is a sense of belonging that defines the individual not only in relation to him/herself but also to the group. It is a powerful feeling that one has meaning in relationships and that one is valued. The experience of belonging is both nurturing and empowering, providing members with a sense of being something bigger than their struggles.
(Yalom, 1983)
Home care clinicians should be able to identify and assess the needs of unpaid/family caregivers and provide resources for self-care. Support group involvement is just one of many resources that caregivers can engage in to manage the day-to-day stress of caregiving. Support groups provide an important sense of belonging and decrease the feelings of isolation often felt by dedicated caregivers.
Low-dose aspirin may increase risk of anemia in older adults
NIH: Daily low-dose aspirin increases the risk of anemia in people aged 65 years and older by approximately 20%. Scientists from the Aspirin in Reducing Events in the Elderly (ASPREE) study examined the effect of long-term low-dose aspirin use on incident anemia and the effect of aspirin on changes in hemoglobin concentration, as well as ferritin levels, as an indicator of iron deficiency. The researchers found low-dose aspirin led to increased anemia in otherwise healthy older adults at enrollment, independent of major bleeding. Given these findings, older adults on low-dose aspirin and their care providers may want to consider periodic monitoring of red blood cells or hemoglobin. Anemia in older adults is associated with functional decline, increased fatigue, disabilities, depressive symptoms, and cognition problems. Previous ASPREE data analyses suggested daily low-dose aspirin does not decrease risk for dementia and cognitive decline; and that daily low-dose aspirin had no effect on healthy lifespan in older people.
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