Caregiving

In my previous post, Public Health and the Elderly, I highlighted a few issues that family therapists could inquire about during clinical sessions.  A very important issue facing the elderly is caregivers.  The CDC has made caregiving a public health priority.  The CDC has recognized the discrepancy between those who will need caregiving and those who are caregivers.  The Administration on Aging has published a profile on older Americans since 1999 simply called, Profile of Older Americans. The current profile (2009) has projected future growth, through the year 2030, in the USA will have approximately 71 million adults over the age of 65 which is a growth of 2.3% per year.  Yet, Mack and Thompson (2001) of the Center on an Aging Society reported that family members available to be caregivers will only grow at a rate of 0.8%.  This means that there will be less familial caregivers leading to an increased population in nursing home and/or increased stress for familial caregivers.

This is especially so for ethnic minority populations for two reasons.  First, caregiving as a cultural responsibility is more prominent for African Americans, Latinos, and Native Americans.  This results in an informal network of support (e.g., friends, neighbors, family) rather than formal network (e.g., nurses, nursing homes).  For example, California Health Advocates highlighted a study in which White elders were morel likely to utilize the Medicare hospice benefit. Second, exposure to health disparities over a lifetime, ethnic minority elders tend to have higher issues of morbidity in the final months of their lives.

Another concern is the gender inequity in caregiving.  California did a survey in 2003 called, A Profile of Family Caregivers (this link will open the report) and found that 75% of family caregivers were women with an average age of 51 AND 31% had a child under the age of 18 living at home (nationally this number is higher, 41%).  A recent New York Times article She Works. They’re Happy suggested that the rise of women in the workplace has had an effect of heterosexual marital stability.  One has to wonder how this stability will be maintained if she has to care for her or his parents.  This should not read as women needing to leave the workforce but instead men need increase their engagement around familial caregiving.

The data all point to one fact, there are not going to be enough caregivers leading to significantly more stress for families (especially for ethnic minority women).  There is already evidence that caregivers of today have more mental and physical health problems when compared to non-caregivers.  Family therapists have an opportunity to begin the conversation with their clients about caregiving.  If possible, this conversation should occur prior to the need.  Have families had conversations about caregiving?  Who is going to be the primary caregiver?  With whom will the person needing caregiving live?  How will siblings contribute to caregiving?  How will couples share the responsibility?  How will caregivers recognize they are “over their heads” and need help from more formal networks?  This conversation can take place during an initial assessment, while constructing a genogram, or be part of therapeutic thread.  Below is a list of resources for family therapists as well as a number of resources to share with clients.  If you have any suggestions, comments, or stories you would like share, please leave a comment.  Take care.

John

CAREGIVING RESOURCES

Administration of Aging Programs (A number of Federal Programs funded under the Older Americans Act)

American Association for Marital and Family Therapy Consumer Update-Caregiving for the Elderly

California Healthcare Advocates (Focuses on Medicare Issues in California but has some interesting research)

Center for Disease Control and Prevention-Caregiving

Center for Disease Control and Prevention-Caregiving Resources

Family Caregiver Alliance (This is a very rich resource for therapists and clients)

Many States have an Office of Aging.  Google “Office of Aging” to find you local office.

Public Health and the Elderly

A test of a people is how it behaves toward the old. It is easy to love children. Even tyrants and dictators make a point of being fond of children. But the affection and care for the old, the incurable, the helpless are the true gold mines of a culture.~Abraham J. Heschel

The field of family therapy has not fully explored the area of mental health issues with elderly or their caregivers.  There are some wonderful family therapists that work with aging adults yet there is not a lot of literature to help guide therapists.  This post is not a critique of the family therapy field.  Nor will it highlight all the key public health areas that affect healthy aging.  Instead, I will use the next few posts to highlight just a few public health issues that therapists could address with families.

The Center for Disease Control and Prevention published a report in 2007 called The State of Aging and Health in America.  This report examined 15 key health indicators across four areas; Health Status, Health Behaviors, Preventive Care and Screening, and Injuries.  In 2008, the CDC updated this report with the State of Mental Health and Aging in America.  This report examined 6 key indicators that included Social and Emotional Support, Life Satisfaction, Frequent Mental Distress, Current Depression, Lifetime Diagnosis of Depression, and Lifetime Diagnosis of Anxiety Disorder.  If you are a researcher in the field of gerentology, these reports are vital to your research but there are some very interesting facts here for clinicians.   Here are some interesting points:

  • Adequate social and emotional support is associated with reduced risk of mental illness, physical illness, and mortality.
  • Life satisfaction is the self-evaluation of one’s life as a whole, and is influenced by socioeconomic, health, and environmental factors.
  • Life dissatisfaction is associated with obesity and risky health behaviors such as smoking, physical inactivity, and heavy drinking.
  • Older adults with frequent mental distress were more likely to engage in behaviors that can contribute to poor health, such as smoking, not getting recommend amounts of exercise, or eating a diet with few fruits and vegetables
  • Anxiety, like depression, is among the most prevalent mental health problems among older adults. The two conditions often go hand in hand, with almost half of older adults who are diagnosed with a major depression also meeting the criteria for anxiety.

There are three points that should be stressed.  First, the vast majority of the elderly are doing well.  Many aging adults report feeling supported, being satisfied with life, and do not struggle with depression or anxiety.  Next, it is important to stress that this is a population based survey.  This means that clinical and non-clinical aging adults were surveyed.  Since we work with clinical populations, we should expect to see more reports of depression, anxiety, and lack of social support.  Lastly, we know that racial & ethnic health disparities occur across the life span & they can have a cumulative effect.  One way to improve health for aging minority adults is to improve health for minority groups. The State of Aging and Health in America reported, “The care of older adults who are chronically ill, poor, and members of an ethnic community is an increasingly urgent health priority” (p.3).

When family therapists are doing an initial interview, collecting information for an assessment, or doing a genogram we need to make sure that we are asking how aging adults in the family are doing (regardless of who the “client” is).  While the vast majority of the elderly have a positive outlook and social support, we need to make sure that those who do not get the help they need.  Below are a list of public health resources for additional information.  My next post will focus on caregivers and public health.  Please leave a comment, share a story, or offer some new resources.  Take care.

John

AGING ADULT  RESOURCES

Administration on Aging

Center on an Aging Society

Center for Disease Control and Prevention

Center for Medicare & Medicaid Services

National Institute of Aging

US Department Health and Human Services