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NRI 01-006 – HSR&D Study

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NRI 01-006
Stress-Busting Program for Caregivers of Patients with Neurological Diseases
Sharon L. Mantik Lewis PhD MS BS
South Texas Health Care System, San Antonio, TX
San Antonio, TX
Funding Period: July 2002 - June 2006

BACKGROUND/RATIONALE:
Although family caregivers perform an incredibly valuable service for their relatives and the formal health care system, they do so at a considerable cost to themselves both emotionally and physically. Effective stress management techniques can 1) help to decrease the caregivers' feelings of burden and stress; 2) improve the emotional and physical health of caregivers; and 3) empower caregivers to gain control of their lives.

OBJECTIVE(S):
To determine the effectiveness of a Stress-Busting Program (SBP) for caregivers of patients with Alzheimer's disease or a related dementia or Parkinson's disease. Specific research objectives include 1) prospectively determine the effects of a SBP on quality of life and immune response in caregivers, 2) determine subjects' relaxation response as well as their response to acute laboratory stressors using bioinstrumentation (muscle tension, electrodermal response, skin temperature, blood volume pulse, and blood pressure will be measured), and 3) compare the effectiveness of SBP for various populations including males versus females, adult children caregivers versus spousal caregivers, and Hispanics versus whites based on quality of life measurements, immune parameters, and relaxation response.

METHODS:
The multicomponent SBP focused on a variety of approaches based on cognitive behavioral and relaxation response theories. SBP consisted of a 9-week program with 1 -hour sessions per week done in a support group setting. Topics included stress, stress and challenges of caregiving, depression, coping strategies, positive thinking, and taking time for oneself. In addition, subjects were taught simple relaxation strategies that they could practice at home. Subjects were tested at baseline, at completion of 4 and 8 weeks of SBP, and at 2- and 4-month follow - up sessions.

FINDINGS/RESULTS:
1. Hispanic caregivers, as compared to white caregivers, showed higher subjective and objective caregiver burden. Further, social function and physical function were found to be statistically higher for white caregivers compared to the Hispanic caregivers. Hispanic caregivers reported higher somatic symptoms and lower somatic well-being compared to the white caregivers. 2. Male caregivers, as compared to female caregivers, had significantly lower levels of stress, depression, caregiver burden, and anger-hostility, and higher-levels of general and mental health and social functioning at the beginning of the study. Males also had higher natural killer (NK) cell number and function. At the end of the study, both groups had increases in mental health scores and females' scores were approaching those of males. 3. When adult children caregivers are compared with spousal caregivers at study entry, the adult children caregivers had statistically significant higher levels of stress, depression, anxiety, anger-hostility, and caregiver burden, and decreased sense of coherence, social function, mental health scores, coping, and natural killer (NK) cell number as compared to spousal caregivers. In general, adult children experience greater emotional distress than spousal caregivers. Over the course of the study there were many improvements for both spousal and adult children caregivers. However, the children caregivers do not improve to the same level as the spousal caregivers. 4. When white daughter caregivers are compared with Hispanic/Latina daughter caregivers at study entry, Hispanic/Latina daughter caregivers have less perceived stress and anxiety, higher levels of mental health and vitality, and increased use of coping resources. Hispanic/Latina daughter caregivers have a higher quality of life as compared to white daughter caregivers. Hispanic/Latina daughter caregivers may accept the role of caregiver better than the white daughters because of cultural expectations. 5. Over the course of the study caregivers had significant improvements in general health, vitality, social function, and mental health scores and decreases in anxiety, anger/hostility, depression, perceived stress, and caregiver burden (subjective).

IMPACT:
The population served by the VA is rapidly shifting to older adults and there is an increased incidence of chronic neurological diseases in older adults. This will result in the need for more caregivers, especially family caregivers who are usually middle-aged adult children and older spouses. If the health and well-being of caregivers are threatened, patients are in jeopardy. If the needs of family caregivers of these patients can be addressed, the caregivers can more effectively care for the patients and thus, prevent hospitalization and placement of these patients in long-term care facilities. Caregivers must see themselves as valuable, important, and worthy of taking the time necessary to meet their own needs or the patients that they take care of will ultimately suffer.

PUBLICATIONS:

Conference Presentations

  1. Hale J, Lewis S, Novian DA, Blackwell P, Escamilla M. Are Acute Laboratory Stressors Effective in Biofeedback Testing [Citation Award]. Paper presented at: Association for Applied Psychophysiology and Biofeedback Annual Meeting; 2004 Apr 1; Colorado Springs, CO.
  2. Stanley AD, Blackwell PH, Hale JM, Lewis SL. Does relaxation therapy improve natural killer function in caregivers? Paper presented at: Southern Nurses Research Society Annual Conference; 2003 Feb 15; Orlando, FL.


DRA: Aging, Older Veterans' Health and Care, Health Systems
DRE: Prevention
Keywords: Caregivers – not professionals, Home care, Parkinson's disease
MeSH Terms: Adaptation, Psychological, Caregivers