DESK REVIEWS | 08.02.04.01. Health impact
DESK REVIEW | 08.02.04.01. Health impact
Studies have examined the impact of unpaid care on the mental health of caregivers in India. For instance, a case control study conducted in Northern India examined the perceived stress experienced by caregivers of people with Alzheimer’s disease type dementia (Anand et al., 2016). The study reported that when compared to caregivers of individuals with chronic illness, caregivers of individuals with Alzheimer’s disease type dementia had higher amounts of perceived stress. Similarly, Pattanayak and colleagues (2010) also examined the experiences of carers of people with Alzheimer’s type dementia. The authors found that caregivers experienced a moderate level of burden, with female caregivers in particular perceiving higher levels of burden with respect to their physical and mental health. Another study conducted in rural Tamil Nadu reported prevalence of depression among informal caregivers of older adults as 10.6% (Brinda et al., 2014). Behavioural issues (Jathana, Latha and Bhandary, 2010; Prince et al., 2012; Shaji et al., 2009; Shaji et al., 2003), time/duration spent on caregiving (Brinda et al., 2014; Jathana, Latha and Bhandary, 2011; Prince et al., 2012) and functional disability (Brinda et al., 2014; Sinha et al., 2017) were commonly found to be associated with caregiver strain/burden across studies in India.
Anand, K., Dhikav, V., Sachdeva, A., & Mishra, P. (2016). Perceived caregiver stress in Alzheimer′s disease and mild cognitive impairment: A case control study. Annals of Indian Academy of Neurology, 19(1), 58. https://doi.org/10.4103/0972-2327.167695
Brinda, E. M., Rajkumar, A. P., Enemark, U., Attermann, J., & Jacob, K. (2014). Cost and burdenof informal caregiving of dependent older people in a rural Indian community. BMC Health Services Research, 14(1), 207. https://doi.org/10.1186/1472-6963-14-207
Jathanna, R. P., KS, L., & Bhandary, P. V. (2011). Burden and coping in informal caregivers of persons with dementia: a cross sectional study. Online Journal of Health and Allied Sciences, 9(4).
Pattanayak, R. D., Jena, R., Tripathi, M., & Khandelwal, S. K. (2010). Assessment of burden in caregivers of Alzheimer’s disease from India. Asian Journal of Psychiatry, 3(3), 112–116. https://doi.org/10.1016/j.ajp.2010.06.002
Prince, M., Brodaty, H., Uwakwe, R., Acosta, D., Ferri, C. P., Guerra, M., … & Liu, Z. (2012). Strain and its correlates among carers of people with dementia in low-income and middle-income countries. A 10/66 Dementia Research Group population-based survey. International Journal of Geriatric Psychiatry, 27(7), 670–682. https://doi.org/10.1002/gps.2727
Shaji, K.S., George, R.K., Prince, M.J., Jacob, K.S., (2009). Behavioral symptoms and caregiver burden in dementia. Indian J. Psychiatry 51, 45–9. https://doi.org/10.4103/0019-5545.44905
Shaji, K. S., Smitha, K., Lal, K. P., Prince, M. J. (2003). Caregivers of people with Alzheimer’s disease: a qualitative study from the Indian 10/66 Dementia Research Network. International Journal of Geriatric Psychiatry, 18(1), 1–6.
Sinha, P., Desai, N. G., Prakash, O., Kushwaha, S., & Tripathi, C. B. (2017). Caregiver burden in Alzheimer-type dementia and psychosis: A comparative study from India. Asian journal of psychiatry, 26, 86-91.
Tatisina and Sari (2017) report that where family members cannot adapt to the caregiver role, they experience stress, which can be expressed through fatigue that does not go away despite resting, alcohol or drug use, social isolation, lack of attention of carers’ own needs, inability and unwillingness to accept help from other people, feeling unappreciated, anger, depression, anxiety, and feeling guilty because he/she did not live up to their own expectations of the carer role (Yuniati, 2017). The complaints which were expressed by families included feeling tired, experience back pain, pain in the limbs, sleep disruption, headache, muscle strain, and dizzyness. The families also reported feelings of anger, impatience, stress, sadness, worry, and guilt because sometimes they mistreated the older person with dementia.
Tatisina, C. M., & Sari, M. (2017). The Correlation Between Family Burden And Giving Care for Dementia Elderly at Leihitu Sub-District , Central Maluku , Indonesia. 2(3), 41–46.
Yuniati, F. (2017). Pengalaman Caregiver dalam Merawat Lanjut Usia dengan Penurunan Daya Ingat. Jurnal Bahana Kesehatan Masarakat, 1(1), 27–42.
Although not documented in Kenya, caregivers to people with dementia are often called “invisible second patients” due to the high rates of psychological morbidity and physical ill-health (Brodaty & Donkin, 2009). Caring for a person with dementia is particularly associated with reduced self-efficacy, quality of life, mental health (including depression and anxiety), physiological changes such as irregular immune and metabolic function, cardiovascular reactivity, and increased stress hormones e.g., cortisol which may contribute to impaired cognitive function, risk of developing obesity, hyperinsulinemia, and inflammation. In addition, some carers report physical exertions due to little time for exercise and preparation of healthy meals (Cuijpers, 2005; Richardson et al., 2013; Sörensen et al., 2006).
Brodaty, H., & Donkin, M. (2009). Family caregivers of people with dementia. Dialogues in Clinical Neuroscience, 11(2), 217-228. https://doi.org/10.31887/DCNS.2009.11.2/hbrodaty
Cuijpers, P. (2005). Depressive disorders in caregivers of dementia patients: a systematic review. Aging & Mental Health, 9(4), 325–330. https://doi.org/10.1080/13607860500090078
Richardson, T. J., Lee, S. J., Berg-Weger, M., & Grossberg, G. T. (2013). Caregiver health: health of caregivers of Alzheimer’s and other dementia patients. Current Psychiatry Reports, 15(7), 367. https://doi.org/10.1007/s11920-013-0367-2
Sörensen, S., Duberstein, P., Gill, D., & Pinquart, M. (2006). Dementia care: mental health effects, intervention strategies, and clinical implications. The Lancet Neurology, 5(11), 961–973. https://doi.org/10.1016/S1474-4422(06)70599-3
Caring for a person living with dementia has been linked to increased stress (e.g., emotional, financial) (Gurayah, 2015), high levels of care burden (Pretorius et al., 2009), and that an increase in social-/relational conflict and stressors may result in the declining physical health of the caregiver (Gurayah, 2015).
Gurayah, T. (2015). Caregiving for people with dementia in a rural context in South Africa. South African Family Practice, 57(3), 194–197. https://doi.org/10.1080/20786190.2014.976946
Pretorius, C., Walker, S., & Heyns, P. M. (2009). Sense of coherence amongst male caregivers in dementia: A South African perspective. Dementia, 8(1), 79–94. https://doi.org/10.1177/1471301208099046