Caregiver Stress Awareness in Hospice CareBy: Joelle
Jean, FNPCaring for a loved one who is
terminally ill and on hospice is emotionally and physically taxing. In 2015, an
estimated 39.8 million caregivers provided unpaid care to an adult with a
disability or illness. The estimated value of the service supplied by caregivers
is up to $470 billion since
2013.Caregivers may deny help from
others, perhaps out of guilt or obligation. However, 1 out of 6 caregivers report not
being asked what they need to care for themselves. Caregivers can work up to
8.3 hours per day or 66 hours per week during
their loved ones last days of life. Often, this is in addition to working a
full-time job and caring for their own immediate family.Caregivers are at risk for
depression, severe fatigue, or burnout, or even health issues such as
hypertension, stroke, obesity, or weight loss due to stress.What is a caregiver?A caregiver, also known as an
informal caregiver, is an unpaid individual or group of individuals who provide
care to a loved one. Caregivers can be a spouse, family members, partner,
friend, neighbor, or combination of these individuals.A caregiver assists their
loved ones with activities of daily living which include:BathingDressingEatingToiletingShoppingHousekeepingTransportationMedical tasks such as giving medications, changing wound
dressings, and managing painA caregiver can also play a
significant role in coordinating care for their loved ones. Many are appointed
power of attorney or the primary decision maker for their loved ones, managing
finances, property, and most suitable medical care for the individual. What causes caregiver stress or burnout?There is no clear definition
of caregiver stress. The Merriam-Webster dictionary defines stress as a
physical, chemical, or emotional factor that causes bodily or mental tension
and may be a factor in disease causation. Burnout can be a response to stress,
defined as extreme emotional exhaustion. According to stress.org,
stages of burnout are:EnthusiasmStagnationFrustrationApathy or loss of interestA caregiver with stress or
burnout exhibits signs of feeling overloaded, overwhelmed, emotionally drained,
tiredness, detachment from the person they are caring for, and a reduced sense
of accomplishment.Who is most affected by caregiver stress?Caregiver stress affects the
person or people directly caring for their loved one. Stress can also affect
caregivers in different ways. For example, one caregiver may find specific
tasks stressful or overwhelming while another caregiver may find the task
relaxing and rewarding.What are the signs and symptoms of caregiver stress?Often, caregivers are not
aware of their stress or feeling of burnout. Signs and symptoms of caregiver
stress can be subtle or obvious. It is important to identify caregiver stress
so it can be eased.AnxietyAnxiety is a stress response,
activating the fight or flight response
that happens chemically in the brain. Physically, anxiety can be described as:Increased heart rateFeelings of doom or hopelessnessStomach pain and or spasmsHeadacheSweatingHeavy breathingFeeling weak or tiredWorryFatigueCaregivers suffering from
stress may not realize they are fatigued. Fatigue is the bodys response to
burnout and can be physical, emotional, or psychological.Weight changesStress can cause weight
changes and affect eating patterns. Weight change can occur when dealing with
caregiver stress. Rapid weight gain or unexplained weight loss is a warning
sign of caregiver stress and should be addressed appropriately.IrritabilityCaregivers may become easily
annoyed or short-tempered with loved ones, family members, or friends. Feeling
irritable may be a warning sign of caregiver stress.Feelings of being overwhelmedFeeling overwhelmed or
anxious is normal. Caregivers may become overwhelmed with the amount of care
needed to provide to their loved ones. Trouble concentrating, changes in sleep
patterns, and changes in eating habits may occur.DepressionLosing interest in activities
can be a sign of depression due to the demanding responsibilities of
caregiving. Signs of depression include:Little interest or pleasure in doing thingsFeeling down or hopelessChange in sleep patternsFatigue and tirednessThoughts of death or suicidePotential health risks as a result of caregiver stressChronic stress (or stress
lasting for more than six weeks) can have lasting health problems. Caregivers
exhibiting signs and symptoms of stress and burnout have a higher chance of
developing health risks.High blood pressureCaregivers can suffer from
high blood pressure due to the stress of caring for a loved one in hospice. If
caregivers have already been diagnosed with high blood pressure, stress can
make the disease worse. Uncontrolled high blood pressure puts caregivers at
higher risk for:StrokeAtherosclerosis or disease of the arteriesHeart attackOrgan damageWeakened immune systemThe immune system is in place
to protect the body from illness and disease. Stress can cause a weakened
immune system. With a weakened immune system, caregivers can become sick or
develop chronic illnesses such as:Inflammation throughout the bodyIncrease in fat in the blood and bodyChronic painFrequent colds and infections Short term memory lossStudies have shown that a
symptom of chronic stress is the shrinking of the brain. Shrinking
of the brain causes short-term memory loss. Short term memory loss affects
learning, judgement, and memory process. Headaches and body painsStress can cause headaches
and body pains. On a hormonal level, the increase of cortisol causes headaches
even at rest. The physical nature of caring for a loved one on hospice-
lifting, standing, walking, and rotating- can cause severe body pain or injury. How to relieve or prevent caregiver stress and burnoutSelf-care is imperative for caregivers caring
for their loved ones in hospice. Self-care means caring for yourself, so you
can improve your health to care for others.Exercise regularlyFinding the time and the
energy to exercise might sound difficult. However, even carving out 30 minutes
a day has positive effects on your health. Exercising whether it is running,
walking, swimming, or doing yoga will lower blood pressure, increase energy,
and improve mood.Asking and accepting help from othersAccepting help can be
difficult for some caregivers. It is important to ask and accept help so that
you are available for your loved one mentally and physically.Under most insurances and
Medicare, respite care is available to relieve the burden of caregiver stress.
Respite care will give short term caregiver relief to those who are in need.Eat and sleep wellEating and sleeping well are
fundamental in protecting your physical and mental health. A well-balanced meal
of fruits, vegetables, and plant-based foods is important for physical and
mental well-being. Adding vitamins such as a multivitamin, vitamin D, or
vitamin B-12 can also help improve your mood and energy.Having a good nights sleep
has many health benefits. Feeling well-rested and energized will only benefit
you, as the caregiver, and your loved one. Improved memory, mood, and overall
well-being are all benefits of quality sleep.Seek out support groupsSupport groups add immense
value to caregivers who are caring for loved ones in hospice. Joining support
groups reassures caregivers that they arent alone. Support groups:Allow you to talk about your feelingsHelp you realize others are going through the same situationReduces stress and depressionTeaches coping skills and ways to divert stressMaintain personal relationshipsMaintaining personal
relationships is as important as joining support groups. Meeting up with
friends or family members allows you to relax. It also allows you to take time
for yourself and time away from your loved one. Awareness of caregivers
stress and burnout must be addressed and acknowledged for caregivers to feel
supported and recognized for their challenging work. The hospice team and its
services are a fundamental part of bringing this awareness to the forefront.