06: Caregiver Stress: Detecting Stress, Burden & Depression

This program will help you:

• Understand the sources of stress associated with caregiving for someone with Alzheimer’s disease
• Learn the common symptoms and effects of stress
• Learn the common symptoms of depression

• There are no easy answer when its comes to the care of another
• Our hope is to offer you useful information and guidelines for caring for someone with dementia
• These guidelines will need to be adjusted to suit our yown individual needs

1. Changing Functionality and Behavior
2. Changing Relationships
3. Changing Lifestyle and Social Activities
4. Challenging Behaviors
5. Long-Term Care and Finances

• Worsen overall with disease progression
• Can fluctuate from time to time
• Caregivers need to remain flexible with approaches and expectations

• Relationships with family and social network will change
• No longer be able to participate in family and social relationships
• Need more and more assistance with everyday activities
• Often feelings of loss, fear, and sadness

Caregivers should talk with others about the feelings of loss, fear, and sadness often caused by the changing relationships that occur as the disease progresses

• As disease progresses, more time is spent caregiving
• Less time for a personal life
• Leads to changes in lifestyle and social activity

• Aggression
• Agitation
• Paranoia
• Refusals to participate
• Wandering
• Packing or rummaging
• Arguing
• Yelling or crying
• Spitting

• Caregivers may have to work fewer hours or quit their jobs
• Person with disease cannot work
• Health insurance issues
• Issues about long-term care in facilities vs. at home
• Contact the Alzheimer’s Association and other Alzheimer’s organization
• Call a family meeting to discuss concerns and possible options

What are some ways in which Mary can help Robert in this mealtime situation? Mary can:

• A. Prompt Robert to use the proper utensils
• B. Remove the fork to reduce confusion
• C. Be observant of Robert at each meal, and adjust the level of assistance accordingly
• D. All of the above

Choice A: Prompt Robert to use the proper utensils, is a good answer. Using short, simple verbal prompts can help people with dementia complete activities successfully and as independently as possible

Choice B: Remove the fork to reduce confusion, is also a good choice. Simplifying the environment can help in many caregiving situations

Choice C: Be observant of Robert at each meal and adjust the level of assistance accordingly, is also a good choice. Caregivers should adjust their level of assistance to match the person’s varying needs Because choices A through C are all good answers,Choice D, all of the above, is the best answer

Key strategies:

• Give him time to respond
• Place the most important words of her sentences last
• Gently assist him
• Cue his first bite
• Remove unnecessary utensils

Flexible caregiving approaches and expectations can improve daily care and reduce caregiver stress and frustration

Combination of the stressful event and the perception of that event Perception is determined by:

• Life experiences
• Living situation
• Emotions
• Mental state
• Genetics
• Personality disposition

• Stress causes physical reactions
• Normal stress is tolerable and temporary
• Chronic stress is prolonged and unhealthy

Triggers short-term physical changes in the body Acute Stress Response

• Heart rate and blood pressure increase
• Breathing rate increases
• Skin feels sweaty, cool, and clammy
• Stomach may feel upset; diarrhea may develop
• Mouth feels dry from decreased saliva production
• Blood sugar increases

Chronic or unresolved stress impacts the mind and body Chronic Stress Increases the Risk for:

• Heart disease
• Strokes
• Diabetes
• Obesity
• Digestive problems
• Physical illnesses
• Sleep problems
• Low sex drive
• Depression and anxiety
• Memory loss
• Earlier death

• Be aware that caregivers are at risk for high stress
• Be familiar with the symptoms of stress
• Stress can affect your body, mind, and behavior

• Headaches
• Muscle aches
• Back pain
• Chest pain
• Fast heart rate
• High blood pressure
• Shortness of breath
• Fatigue or low energy
• Sleep problems
• Jaw pain, jaw clenching
• Tooth grinding
• Stomach problems
• Diarrhea or constipation
• Weight change
• Excessive sweating
• Worsening skin conditions
• Sex problems
• Worsening asthma and autoimmune diseases

• Sad
• Depressed
• Burdened
• Guilty
• Hopeless
• Worthless
• Overwhelmed
• Insecure
• Anxious
• Exhausted
• Angry
• Frustrated
• Dissatisfied
• Irritated
• Moody
• Resentful
• Confused
• Forgetful
• Unable to focus or concentrate

• Arguing or fighting
• Angry outbursts
• Crying
• Isolation and avoiding people
• Less participation in enjoyable activities
• Eating more or less than usual
• Increase in stress-relieving habits
• Increased smoking
• Abuse of alcohol or drugs
• Poor job performance

Chronic stress can increase one’s risk for depression Common Symptoms of Depression

• Feeling sad or gloomy
• Feeling helpless, discouraged, or hopeless
• Feeling worthless, guilty, or overwhelmed
• Feeling nervous, restless, irritable, or anxious
• Concentration or memory problems
• Loss of interest or pleasure
• Inability to see the positive aspects of life
• Thoughts of death or suicide
• Appetite or weight changes
• Aches and pains
• Diarrhea or constipation
• Lack of energy, fatigue, or sluggishness
• Reduced sex drive or sexual dysfunction
• Sleep disturbances

Listen to your body

• Speak with a healthcare professional if you have symptoms of stress or depression
• As you feel better, you will be a better caregiver
• Take time to take care of yourself and your mental and physical health

• Relaxation techniques
• Exercise
• Healthy nutritional choices
• Social support
• Professional therapy

Stressors include:

• –Changing functionality and behavior
• –Changing relationships
• –Changing lifestyle and social activities
• –Challenging behaviors
• –Long-term care and finances
  • Recognize normal, tolerable stress and chronic, unhealthy stress
  • Chronic stress can increase the risk of health problems
  • Stress affects the mind, body, and behavior
  • Monitor levels of stress
  • If you think you have symptoms of chronic stress or depression, talk to a healthcare professional and people you trust

Written by:
Catherine M. Harris, PhD, RNCS.
Mindy J. Kim-Miller, MD, PhD

Edited by:
Sasha Asdourian

www.LightBridgeHealthcare.com

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