I Dont Think We Are In Oz

• 1.I dont think were in OZ anymore Peggy Naugle, CIRS-A, BCII Area Agency on Aging of Central Texas (AAACT) a partner of theCentral Texas Aging and Disability Resource Center (ADRC)

2. Overview

• Caregiver Stress

• • Identify the ten most common warning signs of caregiver stress

• • Identify the physical, emotional and psychological manifestations of stress related to caregiving

• • ZBI(Zarik Burden Interview)

• • So what if I dont make my bed!

3. Welcome to their world Introducing the Caregiver Wave 4. Symptom Cycle ANGER DENIAL SLEEPDEPRIVATION HEALTH PROBLEMS IRRITABILITY ISOLATION LOSS OF CONCENTRATION EXHAUSTION ANXIETY DEPRESSION CDSMP Stanford University 5. Loss of Concentration "the ability to direct one's thinking in whatever direction one would intend STOP ATTENDING WORRY TIME ACTIVE LEARNING 6. ANGER Modern psychologists view anger as a primary, natural, and mature emotion experienced by all humans at times, and as something that has functional value forsurvival. High Blood Pressure Increased Heart Rate Increased Adrenaline Relaxation Cognitive Restructuring Problem Solving Better Communication Humor Counseling 7. Denial

• Mom was always forgetful

• Grandpa does those things for attention

• Well, yes, mother still drives, she takes the side roads

• I think grandma is faking her pain

• Dad can walk he just wants me to wait on him

• She doesnt need all those pills

Denialis a defense mechanism postulated by Sigmund Freud, in which a person is faced with a fact that is too uncomfortable to accept and rejects it instead, insisting that it is not true despite what may be overwhelming evidence. 8. Difficulty Sleeping

• Almost 74% of all Americans do not get enough sleep each night

• Most will feel sleepy or groggy during the week

• 51% of adults say they have problems sleeping at least a few nights each week

• Almost 1/3rd have trouble sleeping every night

• Half of all Americans can not get up without an alarm clock

• Alarm clocks interrupt sleep cycle causing, lack of energy, feeling unrefreshed in the morning

• Those with sleep problems are twice as likely to feel stressed and tired

• Lack of sleep leads to

National Sleep Foundation 2002 survey 9. Health Problems

• Fatigue

• Obesity

• High Blood Pressure

• Heart disease

• Shortened lifespan

• Suppressed immune systems

• Depression

• Recent studies implicate sleep deprivation in diabetes

• Sleep problems are reaching epidemic proportions, estimated to be the #1 health related problem in America - CNN, May 1997.

• We sleep on average 6.9 hours/day, almost an hour less than a few decades ago.

National Sleep Foundation 2002 survey 10. Irritability Why do you always fall asleep on the table? You havent taken your pills yet! Please, not today, cant you hurry up! Thats your second donut!! *Warning Sign #1 An excessive response to stimuli (something external that influences an activity) 11. Social Withdrawal

• Not returning calls

• Stop going to church

• Dont want to burden anyone with my problems

• No longer interested in their favorite hobby/pastime

• My kids all work, I cant call them

• I dont need anything

12. Constant Exhaustion

• A feeling of extreme fatigue (even when you do get the chance to sleep, it isn't a restful sleep); Becoming more emotional, for example, you get angry more quickly and are less patient which increases the risk of abuse and you feel a deep sadness which may lead to depression;

• arguing more with your spouse, your children, your siblings, even with your parent;

• a change in your eating habits (eating all the time or not eating enough);

• a haggard appearance;

• showing poor judgment;

• having trouble remembering things;

• constantly feeling overloaded and stressed;

• feeling in danger of "crashing," having a fear of breaking down and then not being able to care for your parent, or yourself.

youragingparent.com 13. Anxiety

• Characteristics of anxiety include:

• • Feelings of fear, worry or apprehension, Additional symptoms, such as tension, restlessness, jitteriness, insomnia, fatigue, distractibility, shortness of breath, numbness or muscle tension, Long duration (generalized anxiety) or short, intense bouts (panic attacks)

• Causes of anxiety can include:

• • Difficulty adjusting to the illness, Common fears about death, including isolation and separation, Poorly-controlled pain, Side effects of medication, Withdrawal from benzodiazepines or opioids, if these are decreased abruptly, Medical conditions, such as dehydration, electrolyte imbalance, or withdrawal from drugs such as nicotine or alcohol.

netofcare.org 14. Depression

• depression

• 1.the act of depressing.

• 2.the state of being depressed.

• 3.a depressed or sunken place or part; an area lower than the surrounding surface.

• 4.sadness; gloom; dejection.

• 5.Psychiatry .a condition of general emotional dejection and withdrawal; sadness greater and more prolonged than that warranted by any objective reason.

• dictionary.com

• What causes depression?

• Depressionseems to be related to achemicalimbalance in the brain that makes it hard for the cells to communicate with one another.Depressionalso seems to be hereditary (to run in families).

• Depressioncan be linked to stressful events in your life, such as the death of someone you love, a divorce or loss of you a job. Taking certain medicines, abusing drugs or alcohol or having other illnesses can also lead todepression .Depressionisn't caused by personal weakness, laziness or lack of willpower.

• righthealth.com

15. Dangers of Caregiving

• personal illness/stress

• potential for abuse of person being cared for

• burnout

• suffering from grief/loss

• depletion of income

• feelings of isolation, loneliness

• legal/ethical issues -- power of attorney, substitute decision making

16. Mortality

• Caregiving as a

• Risk Factor for Mortality

• The Caregiver Health Effects Study

• Richard Schulz, PhD; Scott R. Beach, PhD

17. Facts

• 4 year research (1993-1998)

• First known research regarding caregiver and mortality

• A total of 392 caregivers and 427 noncaregivers aged 66 to 96 years who were living with their spouses.

• 63% mortality rate for spousal caregivers

18. Summarize

• Primary care physicians who care for community-residing older adults may be in the best position to identify caregivers at risk. Older married couples should be evaluated as a unit, both in terms of their health status as well as the caregiving demands that exist in the home environment. To the extent that caregiving demands are high, opportunities for restorative behaviors are limited, and the caregiver is physically compromised, an intervention that reduces caregiving demands such as the provision of respite services may be needed.

• Under extreme circumstances, it may be appropriate to relieve a vulnerable older person from caregiving responsibilities permanently by finding an alternative caregiver or institutionalizing the care recipient. In general, it is essential that we develop treatment approaches for older marital dyads that focus on the needs of both individuals simultaneously.

• For more information on this study, google:

• The Caregiver Health Effects Study

19. ZARIK BURDEN INTERVIEW (ZBI)

• Professor Steven Zarit

• One of the most widely used tests of caregiving burden

• It is simple to use and score

• If you receive a high score on the test, you may be at risk for the physical complications of caregiver stress

• Original 22 questions

20. What Glenda the Good Witch Recommends

• Listen to the caregiver, really listen

• Acknowledge their feelings

• Share experiences but never force your ideas on how caregivers should be dealing with caregiver issues

• As individuals, it is very important for each of us especially caregivers to make our own decisions

• PERSON CENTERED THINKING

• Leave educational information about caregiving, support groups, mental counseling, respite, etc with the caregiver

• Everyone of us gets busy, but making one follow-up phone call can help start the process for the caregiver to understand the importance of reaching out

21. 9 Ways to get to the Emerald City

• 1.Raise your activity levelto pump up your energy. If you'r