Six Clinical Questions to Ask Older Caregivers of Alzheimer`s Patients

Mr. Q is a hands-on caregiver. He comes to his wife’s appointments wearing blue jeans and with his sleeves rolled up, ready to help with whatever she needs. He walks her into the office and leads the discussion, parrying questions and jibes from his wife and accompanying daughter. For most appointments, he has had to take time off from work, where he oversees 50 employees at a printing company.

I am amazed at both his energy and his involvement caring for his wife who has suffered from Alzheimer’s disease for the past five years. But I am even more amazed at the fact that Mr. Q is 93 years old! 

Mr. Q is not the only 90-plus caregiver who comes to my office. With the lifespan growing longer, we are seeing more relatively robust individuals in their eighties and nineties with dementia, and their equally robust spouses who assume significant caregiving responsibilities. 

These “old-old” caregivers often wrestle with their own physical and mental health issues, as well as marital problems and challenging family dynamics that go back decades. This is no sandwich generation – they are the plate holding the entire meal in place! 

These individuals are admirable, but we cannot be lulled into thinking that they can do it all. If anything, they underscore the importance of assessing each and every caregiver for excess burden. In addition to asking about the symptoms of the impaired person, then, it is critical to devote time to the caregiver. Here are several important questions to assess actual and perceived burden, based in part on the work of Stephen Zarit and colleagues (1986):

1.   Are you feeling stressed out as a caregiver?

2.      Do you need more daily assistance?

3.       Are you feeling depressed? Anxious?

4.       Are you frequently exhausted during the day? Missing sleep?

5.       Do you feel hopeless?

6.       Have you ever thought about ending your life and/or that of your loved one?

The more “yes” answers to these questions, the more you are dealing with an overburdened and potentially depressed caregiver. 

Remember that caregivers, regardless of age, suffer from excess depression, medical illness, and even mortality compared with non-caregivers (Taylor et al., 2008; Depp et al., 2011). The oldest caregivers, such as Mr. Q, are especially vulnerable to burden since they tend to have more complex medical issues and greater frailty, and they themselves may be suffering from some degree of cognitive impairment. 

Some of these caregivers are so involved not by choice but because they lack children or other social supports to help. For example, one “old-old” caregiver in our memory center had no children and relied upon her impaired husband to drive to the appointments, even though he had marked cognitive impairment. There are numerous community resources that can help, however, including the Alzheimer’s Association, home health agencies, care managers, and eldercare attorneys. 

In your own practice, do you routinely spend time assessing caregiver burden? 

References

Depp CA, Romero R, Thompson LW, Gallagher-Thompson D. (2011). The geriatric caregiver. In: M.E. Agronin and G.J. Maletta (Eds.). Principles and Practice of Geriatric Psychiatry, 2nd Edition (pp. 43 – 58). Philadelphia: Wolters Kluwer Lippincott Williams and Wilkins.

Taylor DH, Ezell M, Kuchibhatla M, et al. (2008). Identifying the trajectories of depressive symptoms for women caring for their husbands with dementia. J Am Ger Soc , 56(2):322- 327.

Zarit SH, Todd PA, Zarit JM. (1986). Subjective burden of husbands and wives caregivers: a longitudinal study. Gerontologist , 26(3): 260-266

Marc E. Agronin, MD is Medical Director for Mental Health and Clinical Research,Miami Jewish Health Systems, Miami,   FL. He also is Affiliate Associate Professor of Psychiatry and Neurology, University of Miami Miller School of Medicine, Miami, FL.

The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors.