A study shows that caregivers of dementia patients who place their loved ones into long-term or assisted care facilities get no relief from depression and anxiety. In fact, they suffer additional emotional trauma following their difficult decision, particularly when their loved one experiences cognitive and functional declines.
Even though these declines are common in patients who go into long-term care as a natural course, caregivers often blame themselves and question their decision to place their loved one in a long-term facility.
High Anxiety, Depression
Participants of the study were recruited from six U.S. sites and included 1,222 caregiver-patient pairs. For the 180 caregivers who had to turn over care of their loved one to an institution, symptoms of depression and anxiety stayed as high as when they were in-home caregivers.
Results of a four-year study appearing in the August 25, 2004 issue of the Journal of the American Medical Association, determined that one of the best things caregivers could do for themselves is to seek counseling or other forms of intervention - both before placement and during the placement process.
"Caregivers who place their loved ones in an institution do not get the sense of relief or experience the closure observed among caregivers whose loved ones pass away," says Richard Schulz, PhD, director of the Center for Social and Urban Research at the University of Pittsburgh School of Medicine. "They continue to feel distressed because of the suffering and decline of their loved one as well as having to face new challenges such as frequent trips to the long-term facility, reduced control over the care provided their relative, and taking on responsibilities such as coordinating and monitoring care."
"We need to help caregivers who place their relatives," adds Dr. Schulz. "We need to treat their emotional distress, educate them about the nature of long-term care facilities and their impact on patient functioning, engage them in end-of-life planning, and prepare them for the eventual death of their loved one."
The study recommends that spouses, caregivers who remain actively involved with the care recipient, caregivers who have high levels of depression, and those who lack adequate support from others should receive interventions.
Most at Risk
Caregivers who were married to the patient and those who visited most frequently had the most difficult transition. Spouses reported higher levels of depression both before and after placement and more anxiety after placement than their non-spouse counterparts. Almost half of the caregivers in the study visited the patient daily and continued to provide some form of physical care during their visits.
The study recommends that spouses, caregivers who remain actively involved with the care recipient, caregivers who have high levels of depression, and those who lack adequate support from others should receive interventions.
"The findings of Dr. Schulz and his associates are particularly relevant as Americans live longer and the number of families faced with placing their loved ones into institutional care grows," says Patricia A. Grady, PhD, RN, FAAN. "Knowing that these caregivers are vulnerable to ongoing depression and anxiety following such a placement, health professionals can make a difference in these people's wellbeing by helping them with their emotional distress, and by helping them prepare for and deal with these often difficult transitions." |
