ATrain Education

 

Continuing Education for Health Professionals

Elders and Their Care

Module 8

Caregivers

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).

Caregiver Facts

  • More than 34 million unpaid caregivers provide care to someone age 18 and older who is ill or has a disability.
  • An estimated 21% of households in the United States are impacted by caregiving responsibilities.
  • Unpaid caregivers provide an estimated 90% of the long-term care.
  • The majority (83%) are family caregiversunpaid people such as family members, friends, and neighbors of all ages who are providing care for a relative.
  • The typical caregiver is a 46-year-old woman with some college experience and she provides more than 20 hours of care each week to her mother.
  • The out-of-pocket costs for caregivers caring for someone age 50 or older averaged $5,531 in 2007. About 37% of caregivers for someone age 50 and older reduced their work hours or quit their job in 2007.
  • Caregivers report having difficulty finding time for themselves (35%), managing emotional and physical stress (29%), and balancing work and family responsibilities (29%).
  • About 73% of surveyed caregivers said praying helps them cope with caregiving stress, 61% said that they talk with or seek advice from friends or relatives, and 44% read about caregiving in books or other materials.
  • About 30% said they need help keeping the person they care for safe and 27% would like to find easy activities to do with the person they care for.
  • Half (53%) of caregivers who said their own health had gotten worse due to caregiving also said the decline in their health has affected their ability to provide care.
  • Caregivers said they do not go to the doctor because they put their family’s needs first (67% said that is a major reason), or they put the care recipient’s needs over their own (57%). More than half (51%) said they do not have time to take care of themselves and almost half (49%) said they are too tired to do so.

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:

  • Remembering you are not alone.
  • Seeking out resources that can assist during this emotionally stressful time (books, organizations, web pages, support groups).
  • Consulting an Eldercare Specialist, a trained expert, who can help find the needed services and support.

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:

  • Information about health conditions, resources, and community-based, long-term care services that might best meet a family’s needs
  • Assistance in securing appropriate help
  • Counseling, support groups, and caregiver training to help families make decisions and solve problems
  • Respite care so that families and other informal caregivers can be temporarily relieved from their caregiving responsibilities
  • Supplemental long-term care services on a limited basis. This could include:
    • Home modifications
    • Incontinence supplies
    • Microwave
    • Air conditioner (for a caregiver with asthma or allergies)
    • Nutritional supplements
    • Washing machine
    • Assistive devices (AOA, 2012)

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.

Unsafe Driving

Because of the aging U.S. population, there are an increasing number of older drivers33 million over the age of 65 in 2009who 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:

  • Exercise regularly to increase strength and flexibility.
  • Review medications to reduce side effects and interactions.
  • Check your eyes at least once a year.
  • Drive only during daylight and in good weather.
  • Use safe routes with well-lit streets, intersections with left turn arrows, and easy parking.
  • Plan the route before driving.
  • Maintain a large distance behind other cars.
  • Avoid distractions in the car such as a loud radio, as well as phoning, texting, and eating.
  • Consider alternatives to driving.

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:

  • Be respectful but firm.
  • Give specific examples of unsafe driving.
  • Discuss alternative transportation and acknowledge the difficulties older adults face when they give up driving.

If the older adult refuses to give up driving when it is clearly unsafe, further steps may be necessary:

  • Hide the car keys.
  • Replace the keys with a set that won’t start the car, or file down the ignition key.
  • Disable the car or sell it.
  • Move the car out of sight.
  • Have police confiscate the person’s driver’s license.

The Effects of Medications on Driving

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:

  • Alcohol
  • Anticholinergics
  • Anticonvulsants
  • Antidepressants
    • Bupropion
    • Mirtazapine
    • Monoamine oxidase (MAO) inhibitors
    • Selective serotonin reuptake inhibitors (SSRI)
    • Tricyclic antidepressants (TCA)
  • Anti-emetics
  • Antihistamines
  • Antihypertensives
  • Antiparkinsonians
  • Antipsychotics
  • Benzodiazepenes and other sedatives/anxiolytics
  • Muscle relaxants
  • Narcotic analgesics
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Stimulants (NHTSA, n.d.)

Elder Abuse

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:

  • Physical abuseinflicting physical pain or injury such as slapping, bruising, or restraining by physical or chemical means
  • Sexual abusenon-consensual sexual contact of any kind
  • Neglectthe failure by those responsible to provide food, shelter, healthcare, or protection for a vulnerable older adult
  • Exploitationthe illegal taking, misuse, or concealment of funds, property, or assets of an older adult for someone else’s benefit
  • Emotional abuseinflicting mental pain, anguish, or distress through verbal or nonverbal acts (humiliating, intimidating, or threatening)
  • Abandonmentdesertion of a vulnerable older adult by anyone who has assumed responsibility for care or custody of that person
  • Self-neglectthe failure of a person to perform essential self-care tasks when such failure threatens the older adult’s own health or safety (AOA, 2009)

Warning Signs of Abuse

While one sign does not necessarily indicate abuse, tell-tale signs of physical, emotional, financial, verbal, or sexual abuse, neglect, or mistreatment include:

  • Bruises, pressure marks, broken bones, abrasions, and burns
  • Unexplained withdrawal from normal activities, a sudden change in alertness, and unusual depression
  • Bruises around the breasts or genital area
  • Sudden changes in a person’s financial situation
  • Bedsores, unattended medical needs, poor hygiene, and unusual weight loss
  • Behavior such as belittling, threats and other uses of power and control by spouses
  • Strained or tense relationships, frequent arguments between the caregiver and elder (AOA, 2009)

Reporting Elder Abuse

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 abusedphysically, emotionally, or financiallytalk 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 an older adult is in urgent danger, call 911 or the local police.
  • If the danger is not immediate, report the suspected abuse to the Adult Protective Services agency in the state where the person resides (AOA, 2010d).

If nursing home care abuse is suspected, call the Long Term Care Ombudsman at:

NORC
1001 Connecticut Avenue, NW, Suite 425
Washington, DC 20036
(phone) 202 332 2275
(fax) 202 332 2949
(e-mail) info@theconsumervoice.org

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