Caregivers provide assistance to someone who is, in some degree, incapacitated and needs help. The recipients of care live in both residential and institutional settings, and range from children to older adults. Typically, the recipients have a chronic illness or disabling condition and need ongoing assistance with everyday tasks to function on a daily basis (CDC, 2010b).
Caregiver demand is partly driven by the steady increase in our older adult population. As the number of older Americans rises, so does the number of needed caregivers. In 2030, when all baby boomers will be at least 65 years old, the population of adults in this age group is projected to be 71 million. The number of people 65 years old and older is expected to rise by 101% between 2000 and 2030, at a rate of 2.3% each year. However, over that same 30-year period, the number of family members who are available to provide care for these older adults is expected to increase by only 25%, at a rate of 0.8% per year (CDC, 2010b).
Caregiving exacts a tremendous toll on caregivers’ health and well-being, and accounts for significant costs to families and society as well. Family caregiving has been associated with increased levels of depression and anxiety as well as higher use of psychoactive medications, poorer self-reported physical health, compromised immune function, and increased mortality. Over half (53%) of caregivers indicate that their decline in health compromises their ability to provide care (NINDS, 2011).
The emotional and physical burden of caring for someone with dementia can be overwhelming. Support groups can often help caregivers deal with these demands and they can also offer helpful information about the disease and its treatment. It is important that caregivers occasionally have time off from round-the-clock nursing demands. Some communities provide respite facilities or adult daycare centers that will care for dementia patients for a period of time, giving the primary caregivers a break. Eventually, many patients with dementia require the services of a full-time nursing home (NINDS, 2011).
Source: CDC, 2011e.
It is important that caregivers take care of themselves and their health. Caregivers should get yearly flu shots and other vaccinations as recommended. They need to have regular health checkups, eat healthy foods, and not skip meals. Caregivers need to find resources if the burden becomes too great with time, asking for help and support from other family members, friends, and neighbors.
Research suggests that the physical and emotional demands on caregivers put them at greater risk for health problems like infectious diseases or chronic diseases such as heart problems, diabetes, and cancer. Depression is twice as common among caregivers as non-caregivers.
Learning coping strategies may help caregivers avoid reaching the point of exhaustion and burnout. Caregiver may be experiencing burnout if they become numb to a loved one’s needs and feelings. Coping strategies include:
The National Family Caregiver Support Program (NFCSP) started in 2000 as part of the reauthorization of the Older Americans Act (AOA) to help older adults and their families. Managed by the Administration on Aging, funds are given to aging service provider networks in all states and territories to help family caregivers with:
To gain access to services under the National Family Caregiver Support Program, contact the nearest Area Agency on Aging. The Eldercare Locator can help to find the nearest one. Call 1-800-677-1116 or visitwww.eldercare.gov.
Because of the aging U.S. population, there are an increasing number of older drivers—33 million over the age of 65 in 2009—who represent a 23% increase from 1999. Normal age-related declines in vision and cognitive functioning, as well as physical changes, may affect some older adults’ driving abilities.
The risk of being injured or killed in a motor vehicle crash increases as we age; an average of 500 older adults are injured every day in crashes. In 2008 more than 5,500 older adults were killed and more than 183,000 were injured in motor vehicle crashes. This amounts to 15 older adults killed and 500 injured in crashes every day.
Driving depends on three areas of wellness: physical fitness, clear thinking, and good vision. Dementia affects a driver’s ability to process information quickly and deal with unexpected circumstances. Regular screening for changes in cognition might help to reduce the number of driving accidents among elderly people, and some states now require that doctors report people with AD to their state motor vehicle department. However, in many cases it is up to the person’s family and friends to ensure that the person does not drive.
Older adults can take several steps to stay safe on the road:
Older adults do not always recognize or will not admit when they should no longer drive. If it is suspected that an older driver should no longer be driving, it is important to have a conversation with that person. During this conversation:
If the older adult refuses to give up driving when it is clearly unsafe, further steps may be necessary:
Both prescription and non-prescription medications impair driving ability, either by themselves or in combination with other drugs. In general, any drug with a prominent central nervous system effect can impair an individual’s ability to safely operate a motor vehicle. The level of impairment varies from patient to patient, between different medications within the same therapeutic class, and in combination with other medications or alcohol.
Medication side effects that can affect driving performance include drowsiness, dizziness, blurred vision, unsteadiness, fainting, slowed reaction time, and extrapyramidal side effects. In many cases, these side effects are dose-dependent and attenuate with time (NHTSA, n.d.).
When considering a new medication, review all prescription and non-prescription medications a patient is taking, including those taken seasonally. Combinations of drugs may affect drug metabolism and excretion to produce additive or synergistic interactions. Use of multiple psychoactive medications is a common cause of hospitalization for delirium among older adults.
Because individuals react differently to drug combinations, the degree of impairment caused by polypharmacy may vary from patient to patient. With polypharmacy’s strong but unpredictable potential to produce impairment, new medications should be added at the lowest dosage possible, while encouraging the patient to be alert to any impairing side effects, and adjusting the dosages of individual medications as needed to achieve therapeutic effects with a minimum of impairment (NHTSA, n.d.).
Medications that can impair driving include:
Each year hundreds of thousands of older people are abused, neglected, and exploited. Many victims are people who are frail and vulnerable and cannot help themselves. They often depend on others to meet their most basic needs. Abusers of older adults are both women and men and may be family members, friends, or “trusted others” (AOA, 2009).
Elder abuse is known to be widespread throughout the United States and the world but because it is largely hidden it is under-reported. Although estimates vary widely, experts believe that nearly 85% of elder abuse cases go unreported and 40% of all elder abuse involves some form of financial exploitation by caretakers, guardians/conservators, or attorneys (Abramson, 2003).
There are many reasons why victims do not report the abuse, including lack of confidence, a history of abuse, fear of retaliation by the abuser, cultural beliefs, embarrassment, and shame. For example, people who have never been self-confident are not likely to ask for help when they become dependent. Those who have been abused or neglected their entire lives expect maltreatment to continue, do not think someone would want to help, and often reject help when it is offered.
In general, elder abuse is a term referring to any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult. Legislatures in all fifty states have passed some form of elder abuse prevention laws. Laws and definitions of terms vary considerably from one state to another, but broadly defined, abuse may be:
While one sign does not necessarily indicate abuse, tell-tale signs of physical, emotional, financial, verbal, or sexual abuse, neglect, or mistreatment include:
Many older adults are ashamed to report abuse or are afraid a report will get back to the caregiver and the abuse will get worse. If you think someone is being abused—physically, emotionally, or financially—talk to the person alone and offer to get help from adult protective services (AOA, 2010d).
The Administration on Aging has a National Center on Elder Abuse with listings of government agencies and state laws that deal with abuse and neglect. Go to www.ncea.aoa.gov for more information or call the Eldercare Locator weekdays at 800 677 1116 (AOA, 2010d).
Many local, state, and national social service agencies can help with emotional, legal, and financial problems. Most states require doctors, nurses, and other healthcare professionals to report mistreatment of older adults; this is known as mandatory reporting. You do not have to verify that abuse is occurring, only alert others of your suspicions. Family and friends can also report suspected abuse:
If nursing home care abuse is suspected, call the Long Term Care Ombudsman at:
1001 Connecticut Avenue, NW, Suite 425
Washington, DC 20036
(phone) 202 332 2275
(fax) 202 332 2949