Leaving Behind the Victim of Dementia

Unfortunately, I come across many anecdotal stories of caregivers dying.  And as a result, leaving behind the person who depended upon them. Increasingly, those left behind are suffering from dementia.

This observation raises two questions. The obvious one, which is an emotional question; who will look after the care recipient now? But a second question has a more radical focus; why are these caregivers dying earlier?

What has been described as a ‘living bereavement’, caring for a loved one with dementia becomes increasingly difficult the further the disease progresses. Unlike most other caregiving, where the care, in most cases, becomes less stressful because the person improves (eg some stroke patients) or they grow up (eg children) or they die quickly (eg some cancer patients) , with dementia the diseases progressively incapacitates the victim. With further incapacity comes a greater burden on the caregiver. Caregivers of loved ones with dementia carry an extra burden that is reflected in more sever and negative effects.

Although David Roth and his colleagues, in their study of 3,503 family caregivers, reported that caregiving was not associated with increased risk of death, they failed to identify the specific type—and intensity—of care being provided. Not all caregiving is the same. And you learn that when you look after a victim of dementia.

As early as 1990, Janice Kiecolt-Glaser from Ohio State University and her colleagues measured the different impact caring for a patient with dementia had on their caregivers. They reported that caregivers of people with dementia had significantly more depression, reported less support and fewer important personal relationships, and experienced more days of illnesses from infections, when compared with caregivers of non-demented loved ones. What was convincing in their argument is that these caregivers had physical immunological deficiencies. They were sicker.

Richard Schulz and his colleagues from the University of Pittsburgh in 1999 showed how even after adjusting for a variety of factors, caregivers who are experiencing strain had mortality risks that were 63% higher than non-caregiving controls. The beneficial spiritual and physical effects of caregiving do not override the negative effects of caring for someone with dementia.

One indicator of sickness, which also reduces your lifespan—is the size of your telomeres. These DNA blocks at the end of each of our 46 chromosomes have been likened to an aglet—the plastic at the end of shoelaces. The size of these telomeres determine how many times each cell can replicate—the longer the telomeres, the more your cell can replicate, the longer they live, the longer you live. There are numerous studies being published showing how stress and trauma reduces telomeres. With varying intensities of care there are reduction in these telomeres. Dementia caregivers not only have vastly shortened telomeres, but this change is permanent even after their loved one dies. Despite most caregivers of dementing illness being older and frailer than other caregivers, most choose to look after their loved ones. The decision, of whether providing this care accelerates your mortality faster than the mortality of your care recipient, is not an easy one to make.

© USA Copyrighted 2014 Mario D. Garrett

Older Adults' Fascination with Obituaries

The fascination of reading the obituaries forms a purely older adult phenomenon. And it is not a morbid fascination with death, but a testament that the reader is still alive. Longevity is related to being happy with your lot. Even if you could change events, you wouldn’t--that kind of happiness. Because the only anti-aging that nature knows is death, nature rewards those who accept aging and the losses we experience on the way.

How older adults deal with loss points to effective strategies that they have learned to use in maintaining an optimistic perspective. These are patterns of coping that start early in life. These coping strategies result in less damage to the body and result in greater longevity. One theory popular in the 1980s is now known as the Baltes’s Selective Optimization with Compensation—SOC—theory. Here Baltes describes strategies of how we address physical and mental losses as we age in order to minimize their effect.

Let's take for example that you are becoming deaf. The theory predicts three main strategies that older adults follow. First you become selective. You will increasingly choose quieter social settings without conflicting noises. You stop going to loud parties. Then you will optimize those situations that you choose to participate in.  You will choose to be with people that you can hear better, sitting closer, giving them your best ear, you optimize what hearing you do have. This optimizes your remaining ability to listen. Lastly, you will start to compensate. You might start going to the cinema or theatre more where you do not have to converse with anyone. You might do more activities where you do not have to talk (running, swimming, hiking.) You might also compensate by learning to use hearing aides. These three SOC strategies allow you to participate without drastically changing your lifestyle. SOC is a strategy for accepting your losses. To focus on what you can do rather than what you cannot do. This strategy, learned earlier on, gets more useful with increasing age as we experience more deficits.

One of the uniquely frequent experiences in older age is the death of a close friend. Although death never becomes easier to accept--it is so final--there is a greater appreciation of acceptance. In 2001 Christopher Davis from St. Francis Xavier University and Susan Nolen-Hoeksema from the University of Michigan reported that older adults who have lost a loved one often try to extract some meaning of their loss. Even if meaning cannot be found the authors report that older adults search for some benefit in the loss. This is different from grief of younger adults or children. The belief that there is meaning or some benefit even in anguish of loss suggest a positive strategy. Again, the strategy of SOC is to accept the reality and to try and compensate the loss by finding some hidden meaning or benefit.

The philosophy is “it could be worse.” Which brings us back to the fascination older adults have with the obituaries. You are always better than those who are dead.

© USA Copyrighted 2014 Mario D. Garrett