geriatrics
Family Caregiving for Older Adults
Effects of caregiving
Although caregiving can be very rewarding, it can also have negative effects. Family caregivers may experience considerable stress (called caregiver burden) and subsequent health problems, isolation, fatigue, and frustration, sometimes leading to a sense of helplessness and exhaustion (caregiver burnout) or Elder Abuse . The impact on the caregiver is likely to be greater when an older person has a greater burden of disease and disability and greater intensity of care is required. Caregiving may also become a financial burden. Couples in which one partner cares for the other tend to be disproportionately poor. Adult children or their spouses may need to reduce work hours or take prolonged leaves of absence from work. Although policies such as the Family Medical Leave Act assure mechanisms to challenge discriminatory termination or treatment associated with such absenteeism (including among same-sex couples), lost wages are a serious reality for many caregivers. Recent policies such as the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act of 2018 aim to identify steps that government, communities, health care professionals, employers, and others can take to help relatives and partners who provide care to loved ones. During the COVID-19 pandemic (because it required isolation and disrupted formal care), family caregivers reported significant increases in stress, anxiety, depression, sleep disturbance, fatigue, food insecurity, and financial worries and a decrease in social participation and in their sense of financial well-being ( References ). All caregivers of older adults should be connected to social workers to assess their needs for support, referral to services, and counseling and to assess their eligibility for the training, respite, financial support, and other services made available to caregivers throughMedicaid-waiver programsfor nursing home eligible older adults who elect to remain at home. Effective interventions for caregivers include interdisciplinary care coordination; benefits optimization; education about conditions and treatments; immediate and ongoing emotional support; individual, family and group counseling; respite care services; and pragmatic assistance with care tasks. Importantly, caregivers can often obtain reassurance and learn helpful information or strategies for caregiving from physicians, nurses, social workers, and case managers. Caregivers can also take the following measures to prepare themselves for caregiving and to avoid caregiver burnout: Attending to their own physical, emotional, recreational, spiritual, and financial needs When appropriate, asking for help with caregiving or support from other family members and friends Investigating outside groups that can offer psychologic support (eg, support groups) or help with caregiving (eg, counseling, home health care, adult day care, meals programs, respite care) If their family member is hostile or difficult, learning strategies for not taking it personally and coping with emotional strain 