Wednesday, March 20, 2013

Older Adults as Caregivers to Spouses with Dementia

I have chosen the population of older adults who function as caregivers for spouses diagnosed with dementia. Typical negative health behaviors for this population include a decrease in exercise, inadequate sleep, unhealthy diets, excessive smoking, and alcohol consumption (Gallant & Connell, 1998). For the purposes of this discussion, I have chosen lack of exercise because evidence suggests caregivers are less active after a spouse's diagnosis of dementia (Gallant & Connell, 1998).

Caregiving to family members with dementia is emotionally and physically challenging, even in the best conditions (Rabinowitz, Mausbach, Atkinson & Gallagher-Thompson, 2009). Because of the tremendous personal burden of caregiving, it is not uncommon for caregivers to experience a decline in psychological and physiological health, usually because of a decrease in self-care. Lazarus and Folkman's coping paradigm determined that when individuals perceive their subjective burden as exceedingly challenging and beyond their control, they are prone to experiencing excessive stress, which affects psychological health (Gräßel & Adabbo, 2011). A decrease in psychological health and well-being provokes inadequate self-care, and this inadequacy has been associated with an increase in disabilities and mortality in older adults (Breslow & Breslow, 1993; Gallant & Connell, 1998).

Older adults are considered a vulnerable population because they have chronic conditions that demand a higher level of self-care, they are less mobile, have access to fewer resources, and suffer higher rates of depression (Remley & Herlihy, 2010). Maintaining a healthy exercise program while caregiving can be difficult for an older adult whose mobility may have already been compromised. Furthermore, the psychological burden of caregiving may decrease the ability to maintain normal routines (Gallant & Connell, 1998) and increase negative perceptions of the role of caregiving (Rabinowitz et al., 2008). Additionally, it can increase a sense of personal vulnerability and isolation, and decrease self-efficacy (Schwarzer & Luszczynska, 2008). All of these factors may increase the caregiver's subjective burden, which can contribute to a sense of self-inadequacy, which promotes inadequate self-care, in this case, failure to engage in physical exercise.

Lowering Subjective Burden

Changing negative health behaviors has significant implications for the continued care of the patient as well as for the caregiver (Rabinowitz et al., 2009). Failure to maintain caregivers' health undermines their ability to care for the ill family member and contributes to increased institutionalization (Rabinowitz et al., 2009). Health psychology can help this population by determining how to increase self-efficacy to lower the caregiver's subjective burden. Lowering the perception of subjective burden of caregiving may have a meaningful affect on caregivers by increasing psychological health and the impetus for self-care. For example, if caregivers receive adequate support, it may increase their coping skills and their ability to deal with their role as a caregiver, lowering their subjective burden, and changing their perspective that they can manage and perform their caregiver role effectively (Gallant & Connell, 1998; Rabinowitz et al., 2009; Schwarzer & Luszczynska, 2008). Support may be in the form of a support group, psychotherapy, or other assistance. As self-efficacy is increased, they will gain psychological well-being, which will, consequently incite their desire to care for themselves, in this case, develop and utilize an exercise routine.


It has been shown that the use self-control strategies and increasing self-efficacy helps individuals contend with emotions, behavior and negative thought patterns typical in extremely challenging circumstances (Gallant & Connell, 1998; Schwarzer & Luszczynska, 2008). In sum, cognitive interventions that increase self-efficacy and self-control may help caregivers perceive their role differently. However, this may not be as simple as it sounds. Glanz, Rimer, and Viswanath (2008) claim changing and maintaining health behavior does not take place in a social vacuum. Older adult caregivers, like any other population may only instigate and maintain long-term change with adequate social support, an encouraging environment, and the continual reinforcement of effective strategies (Glanz, Rimer, & Viswanath, 2008).


Breslow, L. & Breslow, N., (1993). Health practices and disability: Some evidence from Alameda County. Preventive Medicine, 22, 86-95

Gallant, M. P., & Connell, C. M. (1998). The stress process among dementia spouse caregivers: are caregivers at risk for negative health behavior change? Research on Aging, 20(3), 267-297. doi: 10.1177/0164027598203001

Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2008). Health behavior and health education: Theory, research, and practice (4th ed.). San Francisco, CA: Jossey-Bass.

Gräßel, E., & Adabbo, R. (2011). Perceived burden of informal caregivers of a chronically ill older family member: Burden in the context of the transactional stress model of Lazarus and Folkman. Geropsych: The Journal Of Gerontopsychology And Geriatric Psychiatry, 24(3), 143-154. doi:10.1024/1662-9647/a000042

Rabinowitz, Y. G., Mausbach, B. T., Atkinson, P. J., & Gallagher-Thompson, D. (2009). The relationship between religiosity and health behaviors in female caregivers of older adults with dementia. Aging & Mental Health, 13(6), 788-798. doi:10.1080/13607860903046446

Remley, T. P., Jr., & Herlihy, B. (2010). Ethical, legal, and professional issues in counseling (3rd ed.). Upper Saddle River, NJ: Merrill/Pearson Education.

Schwarzer, R., & Luszczynska, A. (2008). How to overcome health-compromising behaviors: The health action process approach. European Psychologist, 13(2), 141-151. doi:10.1027/1016-9040.13.2.141

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