ATHENS, Ga. -- There are two vastly different ways of looking at old age. One is praise for the medical advances that have pushed the average life span of an American far up into the 70s. The other is a deep concern that we must develop a class of caregivers to deal with family members who may live to great age with serious diseases.
Over the past two decades, a considerable body of psychological research has grown around caregivers for patients with Alzheimer's disease. But what are the factors that affect the well-being of caregivers for the whole host of diseases that afflict old age? Intriguing new research by a psychologist at the University of Georgia is pointing the way toward a deeper understanding of the problems these caregivers face.
In general, according to Gail Williamson, a new model can help predict how caregivers who had a good relationship in earlier years with the spouse for whom they must now care will suffer from depression. The model will also help predict when those who had poor relationships in past years will suffer from resentment. Understanding how these dynamics work could make an enormous difference in helping caregivers cope.
"It is critical that we learn what is going on with family members taking care of sick old people," said Williamson. "Caregiving can really have serious effects on the caregiver, even affecting the immune system."
Williamson presented her research as an invited symposium on Aug. 16 at the annual meeting of the American Psychological Association in Chicago. It has also been accepted for publication in the journal Health Psychology. The work is being done with her colleagues Dr. David Shaffer at UGA and Dr. Richard Schulz of the University of Pittsburgh. The research is supported by grants from the National Cancer Institute and the National Institute of Mental Health.
Research on caregivers is only about 20 years old, but a vast amount of work is being done by psychologists now. Still, even in-depth examination of the factors surrounding caregiving has not given researchers a good way to predict how certain people will react to becoming primary caregivers for ill older relatives. Williamson and her colleagues, however, have developed a 10-question multiple-choice test that focuses on the past relationship between the sick elderly person and the caregiver.
The researchers studied 75 cancer patients and their spouses who acted as caregivers. Of the group, 51 were women and 24 men. Williamson said the model was able to determine the levels of depression in those who had good relationships in the past with a spouse, while it was able to predict anger and resentment in those with poorer relationships -- both toward their roles as caregivers and toward the sick spouse as well.
"We did find that people with good relationships were the least distressed by caregiving," said Williamson. "On the other hand, when you're dealing with the serious illness of someone you love, you have a right to be upset."
One reason why the information could have practical application may be in research on the actual abuse of sick old people. While considerable study has been done on child abuse, far less is known about the abuse of the frail elderly -- except that it is pervasive and very serious. At times the abuse can include simple over-medication but it can be far worse, ranging from criminal neglect to physical abuse.
Williamson said that researchers on the problems of caregivers and those studying abuse of the elderly have seldom shared their information or collaborated. The greatest help that could come from Williamson's research, however, is for family caregivers who do the best they can do and still fail. Most crucial could be a way to see how caregiving affects certain people over time.
"Our 10-item scale tells us a lot about who's likely to be upset, why they are upset and in what ways," said Williamson.
Unfortunately, only a small percentage of caregivers ever seek help in dealing with the heavy responsibilities of caring for a sick older relative. Most just get by the best they can. Alzheimer's disease is especially hard to deal with, since diagnosis is largely achieved by eliminating other diseases.
The 10-item scale is still in the study stage, and it is being refined by continuing research. When it is available, it could be administered by a doctor, a nurse-practitioner or a social worker and may make a great difference in helping potential caregivers understand their strengths and weaknesses in dealing with a sick relative.
Problems remain. So far, Williamson said that while it is easy to predict depression in those who had good past relationships with those they now care for, it is very hard to predict resentment in those individuals. At the same time, it's easy to predict resentment in those who had poor past relationships with those they now care for, but hard to predict depression in them. Thus, more study must be done to find ways to understand just how the stress of caregiving affects both patient and caregiver.
"We just don't yet have any foolproof successful intervention techniques," said Williamson. "It appears that different things help different people. But there is no other research like this going on, and we believe we are getting closer and closer to having a clearer idea about helping caregivers involved in these difficult situations."