DIMENSIONS Summer 2003

Spotlight on Research: Investigator Explores Relationship Between Stress and Health in Caregivers

by Cheryl Dawes

photo of researchers

Countless life changes go along with becoming a caregiver of a spouse with Alzheimer's disease. In the midst of making all these changes and providing care for their spouses, caregivers often neglect their own needs. They may not realize how much the stress of caregiving increases their own risk for health problems.

For more than 15 years, Dr. Peter Vitaliano, professor of psychiatry and behavioral sciences and psychology, has been delving into this increased risk by studying older adult caregivers and the psychological and physiological effects of caregiving. In studies comparing spouses who are caregivers and non-caregivers, similar in age, gender and income, Vitaliano's research has linked the chronic stress of caregiving to greater psychological distress, poorer health habits, and increased physiological risk and health problems.

Recent work points to the critical role stress hormones play in the chain that links health problems with the perceived stress, anger, hassles and lack of positive experiences often associated with caregiving. By identifying subgroups of caregivers at the highest risk, Vitaliano hopes to build a foundation for developing targeted interventions to reduce that risk.

Vitaliano has found that, especially for caregivers who already have health conditions, the chronic stress of caregiving magnifies the chances the condition will worsen. "By far, the most at-risk group is caregivers who already have a co-morbidity," he says. "Trying to manage your own illness while you're taking care of your spouse who has AD is like pouring salt on a wound."

Vitaliano and his colleagues evaluated four subgroups using biological markers relevant to three illnesses-hypertension, coronary heart disease, and cancer. They compared caregivers with illness or co-morbidity, caregivers without illness, and non-caregivers with and without illness. "In every case, we found that having a co-morbidity and being a caregiver was like mixing oil and fire. Persons who were caregivers and who had the co-morbidity were worse off physiologically than non-caregivers with that illness."

Caregivers with a history of cancer had the lowest natural killer cell activity, which provides immunological protection against tumors. Natural killer cell activity in non-caregivers with a history of cancer was not different from caregivers and non-caregivers without cancer histories.

Caregivers with hypertension had much greater blood pressure reactivity than non-caregivers with hypertension and caregivers and non-caregivers without hypertension. Blood pressure reactivity is related to the development of hypertension and complications from this illness.

Relative to non-caregivers with coronary disease, caregivers with coronary disease were high on the metabolic syndrome, a combination of insulin, glucose, lipids, blood pressure, and obesity. This syndrome predicts and exacerbates coronary disease.

Some caregivers are more vulnerable to the chronic stress of caregiving than others. "I think of vulnerability as hard-wired, hard-to-change factors in individuals that typically exist prior to becoming a caregiver-mainly genes, gender, and personality," says Vitaliano. These factors interact with caregiving and help explain which subgroups are most vulnerable.

Vitaliano found that the caregivers at highest risk for new cases of coronary disease were men, particularly obese men. Another subgroup at risk is men and women who have high levels of anger relative to other caregivers.

Clinicians might use this type of information to help caregivers understand the importance of developing good diet and exercise, dealing with anger, and having positive experiences, explains Vitaliano.

"Our findings point to the renewed and belated interest in positive experiences among behavioral scientists," says Vitaliano. "We showed that caregivers, especially those with heart disease, have very low levels of uplifts--that is, positive experiences in daily life. Low levels of uplifts helped to explain the strong relationship we observed between caregiving and the metabolic syndrome in persons with heart disease, as opposed to the weak relationship of caregiving with this syndrome in persons free of heart disease."

"As I've talked to hundreds of caregivers over the years one thing I've learned is that many caregivers give up things that used to give them pleasure," notes Vitaliano. "Many caregivers don't use resources that would allow them to continue to pursue pleasures and possibly leave the house a few days each week to do things they enjoy like playing golf or going to a movie. Yet, the maintenance of positive experiences is critical because we've shown that they are related to better physiological functioning in caregivers with heart disease and cancer histories."

Vitaliano suggests doing things that are pleasurable and maintaining physical activities that are protective against illness. The only way many caregivers can do that, depending on the level of their spouses' impairment, is to be willing to rely upon and accept help.

"If caregivers don't care for themselves and they become ill, who will care for them and their loved one? This is the bottom line," says Vitaliano. "They have to take care of themselves."

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