Caring for Someone with Alzheimer's

DOCTOR'S VIEW ARCHIVE

Medical Author: Frederick Hecht, M.D.
Medical Editor: Barbara K. Hecht, Ph.D.

Caring for someone withAlzheimer's diseasetakes its toll. According to the first detailed study ever done of caregivers and the end of life, family members looking after a relative withdementiahave higher levels ofdepression, and greater need for support while they are providing end-of-life care than they do after a period ofbereavement.Depressionoften results when a familycaregiver, who endures high levels ofstress, is unable to alleviate the suffering of a loved one," said Dr. Richard Schulz, the University of Pittsburgh, who led the study which was published in the New England Journal of Medicine⁽¹⁾.

Home caregivers usually begin to recuperate from theirdepressionwithin three months after the death of their loved one withdementia, and the improvement they experience tends to continue for a year. Knowing that the patient's death marks the end of his or her suffering may help cushion the blow of losing the loved one. More than 60% of the home caregivers in the study said they thought the patient was inpainoften or most of the time prior to death, 72% of caregivers said they were somewhat or strongly relieved by the relative's death. and more than 90% said they thought that death would be a relief to the patient.

On Duty 24 Hours a Day

The research focused on 217 family caring for relatives withdementiaduring the year before the patient's death and after death. Half the caregivers reported they spent at least 46 hours a week assisting their relative with activities of daily living. More than half the caregivers reported that they felt they were "on duty" 24 hours a day and that they had had to end or reduce employment owing to the demands ofcaregiving.

护理人员有高水平的抑郁symptoms while providing care to relatives with dementia. But the caregivers showed remarkable resilience after the death of their demented relative. Within three months of the death, the caregivers had clinically significant declines in the level of their depressive symptoms, and within a year the levels of symptoms were substantially lower than levels reported while they were caregivers.

Grieving Ahead of Time

"The home caregiver may begin to grieve while the patient is still alive. They may psychologically distance themselves and rehearse what life will be like once he or she is gone," Schulz said. More than two-thirds of the home caregivers said they felt prepared for their loved one's death.

The study concludes that end-of-life care for patients with dementia is extremely demanding of family caregivers. Intervention and support services are most needed by family caregivers before the patient's death. When death is preceded by a protracted and stressful period of caregiving, caregivers feel considerable relief at the death itself.

Perspective

This research clearly suggests that services currently available only to patients who arehospiceeligible would benefit caregivers and patients with dementia. These needed services includebereavementand counseling services before death for the family andpaincontrol for the patient.

Dr. Holly Prigerson from Yale commented that: "Providing for the心理健康care needs of the second victim ofAlzheimer's disease, the family caregiver, may prove a tangible and cost-effective way to ensure that both patients and caregivers have the best quality of life possible." We agree.

QUESTION

One of the first symptoms of Alzheimer's disease is __________________.See Answer