CLEVELAND -- Having positive cultural beliefs about caring for elders and strong religious beliefs can ward off depression and other mental health difficulties for female caregivers of spouses and parents with dementia, but sustained elevated levels of the stress hormone, cortisol, puts these women at risk for physical health problems, according to a study published in the American Journal of Geriatric Psychology.
"Caregiving for someone with dementia is stressful for almost everyone and can negatively influence mental and physical health," said T. J. McCallum, assistant professor of psychology at Case Western Reserve University.
Since stress is common in caregiving, McCallum, along with Kristen H. Sorocco from the University of Oklahoma's Health Sciences Center, and Thomas Fritsch, formerly of Case's University Memory and Aging Center (who is now at the University of Wisconsin at Milwaukee), set out to study how different cultural and religious beliefs in different ethnic groups impact the overall health of the caregivers.
In a pilot study, the researchers studied 54 caregivers (30 African Americans and 24 European Americans) and compared their mental health and cortisol levels with 64 non caregivers (48 African Americans and 15 European Americans). The participants were closely matched for their income levels, college education and length of time caring for their family members (less than five years). Each caregiving group spent a similar amount of time bathing, dressing, preparing food and other activities to care for their loved ones.
African American women in the study had an average age of 58 and more often cared for parents. European American women (average age of 67) primarily provided help to their husbands.
To assess mental health outcomes, the study participants took a number of written tests that gathered information about their religious beliefs, general stress levels and cultural beliefs.
The researchers were looking for factors associated with "stress-related growth," the concept that some people are more adept at finding meaning and experiencing psychological and emotional growth resulting from a stressful situation. For example, when a family member or close friend dies, individuals who are higher in stress-related growth may be better able to find meaning in death and view the circumstances in a more positive light.
The physiological reaction to caregiver stress was measured over a two-day period (five times each day) through saliva samples that were analyzed for cortisol levels. Cortisol levels are normally higher in the morning and taper off by evening.
Yet, when the cortisol levels from the caregivers' saliva were examined, it was found that older European American women and African American women of all ages had little change in their cortisol levels over the day, which may be an indication of elevated stress levels, said McCallum.
This can have risks for the physical health, added McCallum.
While it was known that within the African American community there is a cultural norm to care for ailing family members and that strong religious beliefs support this care, the study affirmed that finding. The African American caregivers reported higher levels of stress-related growth and competency in the caregiving role, as well as stronger positive cultural beliefs about caring for elders and stronger religious beliefs as compared to the European Americans.
This study is the first of several studies that McCallum hopes to undertake looking at how cultural and religious beliefs help caregivers cope with caring for family members with dementia. His next research project is to study Native Americans in Oklahoma and then compare those findings with information gathered in this study.
The research findings were reported recently in the article, "Mental Health and Diurnal Salivary Cortisol Patterns Among African American and European American Female Dementia Family Caregivers."
Funding support for the project came from the National Institute on Aging through its Alzheimer's Disease Research Centers to University Memory and Aging Center, a partnership of University Hospitals Case Medical Center.
Case Western Reserve University is among the nation's leading research institutions. Founded in 1826 and shaped by the unique merger of the Case Institute of Technology and Western Reserve University, Case is distinguished by its strengths in education, research, service, and experiential learning. Located in Cleveland, Case offers nationally recognized programs in the Arts and Sciences, Dental Medicine, Engineering, Law, Management, Medicine, Nursing, and Social Work. http://www.case.edu.
Journal
American Journal of Geriatric Psychiatry