Monday, June 27, 2016

International seminar review: "Healthy Ageing: Focus on Caregiver Stress"

As the global population ages, an increasing number of people are caring for family members who no longer care for themselves. Research is needed to better understand potential risks for caregiver health, and the best means for intervention where needed. Four leading researchers in this area, both Irish and international, gathered at the Brookfield Health Sciences Complex, University College Cork, to present their work.

At the first session, chaired by Professor Timothy Dinan, Professor Ian Robertson, Trinity College Dublin, highlighted the resilience of caregivers, outlining findings that most caregivers report good (or better than good) mental health. He drew on the classic Yerkes-Dodson law to outline how a medium level arousal is generally optimal for performance-so perhaps the stress that caregivers experience may not be detrimental unless it is quite high, or if it is coming on top of existing stressors.

Professor Janice Kiecolt-Glaser, Ohio State University, drew on her substantial catalogue of research in this area to highlight the often detrimental impact on immune system of dementia caregiving. Carer burden may heighten inflammation that is often already elevated by the ageing process in older spousal caregivers (a bit like a physiological version of the Yerkes-Dodson law highlighted by Ian Robertson). It can also be associated with heightened activity of the HPA axis, with increased release of the stress hormone cortisol being evident in caregivers.

At the second session, chaired by Professor D. William Molloy, Dr Rónán O'Caoimh, NUI Galway, highlighted the excellent work he has done with Professor D William Molloy and others to develop a tool for assessing risk of negative outcomes for dementia patients in the community. This work places an emphasis on the caregiver network- a primary caregiver typically has support from others around them (e.g. a spousal caregiver with adult children who pitch in at evenings/weekends). He raised the interesting point that although an increased network may intuitively seem positive, it may actually be a warning that an extended family is trying to rally around an increasingly impaired patient, or primary caregivers who are becoming less capable of coping with their role. 

Professor Constança Paúl, University of Porto, highlighted the complexity of factors moderating the caregiver experience and whether it leads to stress. Factors such as the relationship between the caregiver and the care recipient and length of care were highlighted. Age is generally considered and controlled for in studies, although Professor Paúl made the important point that stage of life is important too (e.g. two people caring for their mother could be the same age, but one has children of their own aged 21-25 whereas the other has children aged 8-12). She also highlighted some broader trends that could have large implications for care requirements in the near future-for example, within the EU, almost half of woman aged 85 or more are living alone.

There was a great dialogue at the end of the session. Although the seminar had been primarily advertised as a researcher/clinician event, a number of carers were in attendance who brought their own perspective. An interesting point was the highlighting of issues around guilt in seeking help outside the home among some caregivers, and how this may lead to a reluctance to explore the option of long-term care, or even to seek respite, regardless of the quality of care available.

The session would not have been possible without generous funding from the Health Research Board, as well as the substantial organisational work of Poonam Gururajan (check out her wedding blog here) and the experienced guidance of our PI Dr Gerard Clarke.

Related posts:
He ain't heavy, he's my carer
Performance under pressure

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