Caring for the Caregiver
Lifestyle intervention shows improved wellbeing
In the March/April 2017 issue of Desert Health®, Dr. Lu introduced a pilot program being conducted by a team of doctors at Eisenhower Medical Center. The results of that intervention program follow.
It is estimated that 5.5 million Americans are living with Alzheimer’s dementia in 2017. Most people with Alzheimer’s dementia have a long duration of illness before death. On average, they will spend at least 40% of this time in a state of disability and dependence. It is challenging to care for a person with progressive memory loss, functional impairment, psychiatric/behavioral disturbance, and health complications. This is especially true for family caregivers who normally have no training in related areas.
Compared to caregivers of people with other conditions, dementia caregivers tend to provide more extensive, intensive and longer assistance and experience financial, emotional and physical difficulties. They are often so concerned with caring for their loved one’s needs that they lose sight of their own wellbeing.
A team of doctors from Eisenhower Medical Center and the Eisenhower Memory Care Center designed a pilot comprehensive lifestyle intervention focusing on helping caregivers arouse their awareness of self-care and teaching them the basic knowledge and skills of self-care. We believe that taking good care of oneself is essential for everyone, especially for caregivers, who need to be mentally and physically healthy to take care of their loved ones.
Seventeen family caregivers participated in this 12-week intervention program at Eisenhower Memory Care Center, an adult day care center for people with memory issues. By attending the center on a regular basis, patients with dementia have an opportunity to get outside of the home into a social environment that keeps them engaged and stimulated. Besides offering respite for caregivers, the center also has a weekly caregiver support group meeting to provide social support for family caregivers.
All participants were required to attend the weekly one-hour support group meetings. Participants became a support group with shared discussions, followed by a one-hour lecture on different topics including nutrition, exercise, sleep, and stress management. Weekly 90-minute therapeutic yoga classes were also offered at Desert Yoga Therapy where caregivers were instructed in the techniques of breathing exercise, deep relaxation and meditation. All participants were asked to follow a low-carbohydrate, anti-inflammatory diet, to exercise on a regular basis, and practice relaxation skills at home.
Among the 17 participants, 15 were women. The average age was 71 years (range: 54-83). Prior to this program, most of the caregivers (70%) had sleep problems, felt little motivation to exercise (77%), ate too much under stress (53%), and did not use any relaxation technique (82%). Thirteen participants felt an excessive amount of stress (77%). Eight participants sought counseling in the past; only one was under therapy during the intervention.
By the end of this intervention, all participants stated that they found this lifestyle intervention useful in their daily life, reporting improved physical health, mental health, sleep quality and stress coping skills. Regarding how much they had changed their lifestyle, none of the them chose “no change” or “little change”; three of them chose “some change”; all the rest chose “fairly much” or “very much.” Most participants applied deep breathing on a regular basis, but only 7 participants practiced meditation more than 10 minutes each day. Overall, diet change is the most challenging compared to exercise, breathing/meditation, yoga or sleep.
After 12 weeks, the participants lost an average of 6.1 lbs. There were significant decreases of body mass index, body fat mass, waist circumference, waist/hip ratio. The average systolic blood pressure and diastolic blood pressure dropped an average of 10 and 5 mmHg respectively. Participants’ subjective report of medical symptoms questionnaire showed the average score decreased from 30 to 18 (higher score means more complaints). The average depression score decreased from 15 to 9. The average perceived stress scale decreased from 18.2 to 12.5.
The results from this intervention strongly suggest an improvement of overall wellness of all participants even though most of them were not able to be completely compliant of all lifestyle changes. These results are encouraging as their daily stress is far more than most people. More than half of the participants reported major stressful events during these twelve weeks, such as the loss of a close relative, heart surgery of a grandchild, hospice care for a spouse, and cancer diagnosis of an adult child. Nevertheless, our data suggest that these people were able to lead a relatively normal life through this intervention. For example, the national data of perceived stress scale showed that the average scale is 12 for Americans 65 years and older, which is similar to our participants scale after intervention (12.5).
In conclusion, the lifestyle changes, including diet, exercise, sleep and stress management, are an effective approach to improve the overall wellness of caregivers. We believe this will also benefit their loved one with dementia, other family members and friends.
Team members for this community intervention program include Dr. Yani Lu, FM resident at EMC, Denise Latini, Manager of Memory Care Center, Dr. Joseph Scherger, Dr. Kenneth Thrasher and Dr. Kulwinder Fayssoux. With appreciation of the Family Medicine Resident Program at EMC, Eisenhower Wellness Center, Eisenhower IRB committee, Dr. Farhad Limonadi, Dr. Alfred Shen, Dr. Seymour Young, Dr. Barry Hackshaw, Dr. Kiran Dintyala, and Dr. Michael Del Rosario. For more information contact the Eisenhower Memory Care Center at (760) 836.0232.