Weight change: an indicator of caregiver stress

What's eating you? Risk factors for poor health behaviors among family caregivers

OBJECTIVES

Overeating and obesity are major public health issues in the United States. Caregivers are at greater risk of engaging in poor health behaviors, such as emotional eating, to cope with the demands of caregiving. Using Heatherton and Baumeister (1991) Escape Theory, this study examines the associations between caregiver characteristics (i.e. age, gender, and BMI) and emotional eating, including the extent to which family strain mediates these associations.

METHOD

Data are from the MIDUS 3 dataset (N = 326) and include family caregivers of older adults and children with special health care needs (Mage = 62.88 years, SD = 10.28; 69.6% female).

RESULTS

Female caregivers were more likely than male caregivers to engage in emotional eating. Age was significantly associated with emotional eating, where increased age was associated with less emotional eating. ANCOVA results indicated that obese caregivers were the most likely to engage in emotional eating. Results also indicated that family strain significantly mediated the association between caregiver age and emotional eating. Linear regression analyses indicated that female gender predicted emotional eating, although family strain did not mediate the association between gender and emotional eating. Similarly, after controlling for family strain as a mediator, higher BMI was still significantly associated with emotional eating, suggesting that BMI is a strong predictor of emotional eating among family caregivers regardless of present family strain.

CONCLUSION

Interventions targeted at managing family strain, particularly for younger, female caregivers, could improve coping and decrease poor health behaviors.

Self-efficacy for controlling upsetting thoughts and emotional eating in family caregivers

OBJECTIVES

Self-efficacy for controlling upsetting thoughts was examined as a predictor of emotional eating by family caregivers of physically and cognitively impaired older adults.

METHODS

Adult women (N = 158) providing healthcare assistance for an older family member completed an online survey about caregiving stressors, depressive symptoms, self-efficacy, and emotional eating. A stress process framework was used as a conceptual model to guide selection of variables predicting emotional eating scores.

RESULTS

A hierarchical multiple regression was conducted and the overall model was significant (R² = .21, F(4,153) = 10.02, p < .01); self-efficacy for controlling upsetting thoughts was a significant predictor of caregivers' emotional eating scores after accounting for IADL, role overload, and depression scores.

CONCLUSION

These findings replicate previous research demonstrating the relationship between managing cognitions about caregiving and behavioral responses to stressors, and point to the importance of addressing cognitive processes in efforts to improve caregiver health behaviors.

Chronic stress increases vulnerability to diet-related abdominal fat, oxidative stress, and metabolic risk

BACKGROUND

In preclinical studies, the combination of chronic stress and a high sugar/fat diet is a more potent driver of visceral adiposity than diet alone, a process mediated by peripheral neuropeptide Y (NPY).

METHODS

In a human model of chronic stress, we investigated whether the synergistic combination of highly palatable foods (HPF; high sugar/fat) and stress was associated with elevated metabolic risk. Using a case-control design, we compared 33 post-menopausal caregivers (the chronic stress group) to 28 age-matched low-stress control women on reported HPF consumption (modified Block Food Frequency Questionnaire), waistline circumference, truncal fat ultrasound, and insulin sensitivity using a 3-h oral glucose tolerance test. A fasting blood draw was assayed for plasma NPY and oxidative stress markers (8-hydroxyguanosine and F2-Isoprostanes).

RESULTS

Among chronically stressed women only, greater HPF consumption was associated with greater abdominal adiposity, oxidative stress, and insulin resistance at baseline (all p's≤.01). Furthermore, plasma NPY was significantly elevated in chronically stressed women (p<.01), and the association of HPF with abdominal adiposity was stronger among women with high versus low NPY. There were no significant predictions of change over 1-year, likely due to high stability (little change) in the primary outcomes over this period.

DISCUSSION

Chronic stress is associated with enhanced vulnerability to diet-related metabolic risk (abdominal adiposity, insulin resistance, and oxidative stress). Stress-induced peripheral NPY may play a mechanistic role.

Is Canadian surgical residency training stressful?

BACKGROUND

Surgical residency has the reputation of being arduous and stressful. We sought to determine the stress levels of surgical residents, the major causes of stress and the coping mechanisms used.

METHODS

We developed and distributed a survey among surgical residents across Canada.

RESULTS

A total of 169 participants responded: 97 (57%) male and 72 (43%) female graduates of Canadian (83%) or foreign (17%) medical schools. In all, 87% reported most of the past year of residency as somewhat stressful to extremely stressful, with time pressure (90%) being the most important stressor, followed by number of working hours (83%), residency program (73%), working conditions (70%), caring for patients (63%) and financial situation (55%). Insufficient sleep and frequent call was the component of residency programs that was most commonly rated as highly stressful (31%). Common coping mechanisms included staying optimistic (86%), engaging in enjoyable activities (83%), consulting others (75%) and exercising (69%). Mental or emotional problems during residency were reported more often by women (p = 0.006), who were also more likely than men to seek help (p = 0.026), but men reported greater financial stress (p = 0.036). Foreign graduates reported greater stress related to working conditions (p < 0.001), residency program (p = 0.002), caring for family members (p = 0.006), discrimination (p < 0.001) and personal and family safety (p < 0.001) than Canadian graduates.

CONCLUSION

Time pressure and working hours were the most common stressors overall, and lack of sleep and call frequency were the most stressful components of the residency program. Female sex and graduating from a non-Canadian medical school increased the likelihood of reporting stress in certain areas of residency.

Association between insomnia symptoms and weight change in older women: caregiver--study of osteoporotic fractures study

OBJECTIVES

To determine whether self-reported insomnia symptoms were associated with weight change in older women and whether caregiving, comorbidities, sleep medication, or stress modified this association.

DESIGN

One-year prospective study conducted in four communities from 1999 to 2003 nested within a larger cohort study.

SETTING

Home-based interviews.

PARTICIPANTS

Nine hundred eighty-eight participants (354 caregivers and 634 noncaregivers) from the Caregiver--Study of Osteoporotic Fractures.

MEASUREMENTS

Self-reported insomnia symptoms in the previous month: trouble falling asleep, trouble staying asleep, and waking early and having trouble getting back to sleep. Weight was measured at baseline and 12 months.

RESULTS

The average weight change was -1.9 ± 7.8 pounds. Trouble staying asleep was significantly associated with an average weight loss of 1.3 pounds (P = .03) in multivariable analyses. Neither of the other insomnia symptoms was associated with weight change. Use of sleep medications modified the association between trouble falling asleep (interaction term P = .03) and weight change. Insomnia symptoms were associated with weight loss only in women not taking sleep medications. Neither caregiving status, presence of multiple comorbidities, nor stress modified the association.

CONCLUSION

Trouble staying asleep was associated with weight loss over 12 months in older women. Practitioners should inquire about sleep habits of patients presenting with weight loss, because this may identify a marker of declining health and may be a factor that can be modified.

Review: a conceptual model of perceived burden of informal caregivers for older persons with a severe functional psychiatric syndrome and concomitant problematic behaviour

AIMS AND OBJECTIVES

This literature review aims to delineate the determinants of perceived burden by informal caregivers and provide insight into the interrelatedness between these determinants.

BACKGROUND

Despite the attention given to the various determinants of perceived burden, their interrelatedness has not been unravelled. Insight into this interrelatedness is mandatory for the development of successful, complex, multivariate interventions to reduce perceived burden of informal caregivers. DESIGN; Systematic review.

METHOD

Four electronic databases, CINAHL, Embase psychiatry, Medline, Psychinfo and reference lists of selected articles, were searched. Publications between January 1985-2008 were included if they concerned mental illness, burden and care giving. Articles were selected according to predefined inclusion and exclusion criteria.

RESULTS

The results of mostly descriptive, cross-sectional and univariate research and the more process-oriented results coming from qualitative burden research are organised in a process orientated conceptual scheme or model adapted from the stress-theoretical framework by Lazarus and Folkman. The model indicates that perceived burden must be understood through the individual appraisal of stressors and the availability and use of internal and external resources. Perceived burden is the outcome of multiple, clinically overlapping psychiatric problems, problematic behaviour and functional disabilities.

CONCLUSIONS

So far, intervention programs to reduce perceived burden of informal caregivers have not devoted much attention to the interrelatedness of the origins of burden. The conceptual model provides an overview of the various determinants of perceived burden and a clear picture of the possible interrelatedness appears. This overview of the most important sources of burden helps to develop a complex, multivariate intervention that is comprehensive, long-term, individually tailored and has the flexibility to meet the dynamics of burden over time.

RELEVANCE TO CLINICAL PRACTICE

Use of the conceptual model is crucial to professional nursing and the quality of support of informal caregivers.

An open-ended question: Alzheimer's disease and involuntary weight loss: which comes first?

BACKGROUND AND AIMS

After the onset of Alzheimer's disease (AD), a substantial percentage of patients experience involuntary weight loss (IWL), but there is some debate as to whether IWL is a cause or a consequence of AD. It may play a causal role, because nutritional deficiencies have been found to be associated with worsened cognitive performance, even in subjects without dementia. Conversely, it may be an effect of the disease, considering the hypothesis that the neurodegenerative process associated with AD may itself lead to IWL. The aim of the present review was to help to shed some light on the relationship between IWL and AD.

METHODS

We focus on the problem of the relationship between AD and IWL, and on which comes first.

RESULTS

Even when external factors are well controlled, the association between IWL and the progression of AD seems, for the time being, to be unavoidable.

CONCLUSION

In the light of the literature on the topic, we conclude that IWL is more a consequence than a cause of AD, although chronic diseases and disabilities are factors that may facilitate cognitive decline and accelerate the onset of AD if they are not adequately treated from the nutritional standpoint.

Predictors of life satisfaction in stroke survivors and spousal caregivers after inpatient rehabilitation

A global measure of life satisfaction has become increasingly important as an adjunctive outcome of healthcare interventions for people with disabilities, including those caused by stroke. Life satisfaction of stroke survivors mayaffectcaregivingspouses, as well. The purpose of this study was to identify, among many physical and psychosocial variables, specific variables that were associated with life satisfaction at 12 months after discharge from inpatient rehabilitation, and variables that were predictive of life satisfaction 1 year later (at 24 months). Between 12 and 24 months, life satisfaction decreased for stroke survivors, while it increased for caregiving spouses. The relationship between the couple (mutuality) was the only variable that was a significant predictor of life satisfaction for both stroke survivors and their spouses.

Correlates of physical health of informal caregivers: a meta-analysis

Effects of caregiving on physical health have received less theoretical and empirical attention than effects on psychological health. This meta-analysis integrates results from 176 studies on correlates of caregiver physical health. Caregiver depressive symptoms had stronger associations with physical health than did objective stressors. Higher levels of care recipient behavior problems were more consistently related to poor caregiver health than were care receiver impairment and intensity of caregiving. Higher age, lower socioeconomic status, and lower levels of informal support were related to poorer health. Predictors of physical health are not identical to predictors of psychological health. Associations of caregiving stressors with health were stronger among older samples, dementia caregivers, and men. In sum, negative effects of caregiving on physical health are most likely to be found in psychologically distressed caregivers facing dementia-related stressors.

Are all caregivers created equal? Stress in caregivers to adults with and without dementia

OBJECTIVE

Caregiving for older adults is stressful; however, by treating caregivers as a homogenous group, it is possible that stress-related factors are misrepresented for some. This study of 349 elderly caregivers explored mediators of the caregiving / stress relationship for caregivers to adults with (n = 106), and without (n = 243) dementia.

METHODS

The sample was from the Caregiver Study of Osteoporotic Fractures (CG-SOF), ancillary to SOF, a four-site cohort of 9,704 women.

RESULTS

Stress was higher (p < .001) in dementia than nondementia caregivers (m = 19.85; 16.45). For caregivers overall, intensity and recipient problems were associated with stress but mediated through role captivity. However, relationships differed when stratified by recipient dementia status. Only recipient problems among nondementia caregivers was mediated through captivity.

DISCUSSION

Results confirm previous findings of lower stress among nondementia caregivers and suggest that different factors influence caregivers' appraisal of the situation, including their perception of stress, based on recipients' dementia status.

Socioeconomic status and weight change in adults: a review

In developed countries, obesity is inversely associated with socioeconomic status (SES) among women, and less consistently among men; whereas, in developing countries, the association is direct. However, the relationship of SES to weight change over time is unknown. This relationship was the focus of the present literature review. It was hypothesized that, compared with persons of higher SES, persons of low SES would show greater weight gain or risk of weight gain over time. A search of electronic databases identified 34 relevant articles from developed countries reporting on studies that assessed the relationship of various measures of SES with weight change over time in adults (there were too few papers from developing countries (n = 1) to include). Results of the methodologically strongest studies (those which obtained objectively measured adiposity data and used a follow-up period of 4 years or more) showed that, among non-black samples, there were relatively consistent inverse associations between occupation and weight gain for men and women. When SES was assessed using education, evidence was slightly less consistent, but still provided some support for the hypothesized relationship. However, when income was used as the indicator of SES, findings were inconsistent, although there were fewer studies available. There was little support for a relationship between SES and weight gain for black samples. In the context of the worldwide epidemic of obesity, these findings suggest that in developed countries, weight gain prevention efforts might best be focused on those who are most socioeconomically disadvantaged, particularly those in lower status occupations.

Stress and weight gain in parents of cancer patients

OBJECTIVE

To investigate the effects of chronic stress on weight changes and related behavioral changes in parents with a child who had just been diagnosed with cancer compared to parents with healthy children.

DESIGN

Longitudinal case-control study with assessments occurring over a three-month period following the child's diagnosis of cancer.

SUBJECTS

In total, 49 parents of healthy children and 49 parents of cancer patients aged 19-58.

MEASUREMENTS

Body weight, diet, physical activity, self-reported mood and stress.

RESULTS

Parents of cancer patients were more likely to gain weight, and experienced significantly greater weight gain over the 3 months than parents of healthy children. The magnitude of weight gain was related to the degree of psychological distress that the parents experienced. Parents of cancer patients reported lower levels of physical activity and lower caloric intake than parents of healthy children, with the most marked differences between groups occurring in the area of physical activity.

CONCLUSION

Findings suggest that a major stressor, such as a child's diagnosis of cancer, is associated with weight gain. Further research is needed to determine how long these weight gains persist and whether other types of stress also produce weight gains. Such studies should focus not only on the effect of stress on eating behavior but also on physical activity.

Associations of stressors and uplifts of caregiving with caregiver burden and depressive mood: a meta-analysis

In the present meta-analysis, we integrated findings from 228 studies on the association of six caregiving-related stressors and caregiving uplifts with burden and depressed mood. Care recipients' behavior problems showed stronger associations with caregiver outcomes than other stressors did. The size of the relationships varied by sample characteristics: Amount of care provided and care receivers' physical impairments were less strongly related to burden and depression for dementia caregivers than for caregivers of nondemented older adults. For spouse caregivers, physical impairments and care recipients' behavior problems had a stronger relationship to burden than for adult children. Furthermore, we found evidence that the association of caregiver burden with the number of caregiving tasks, perceived uplifts of caregiving, and the level of physical impairment of the care receiver were stronger in probability samples than in convenience samples.

"My mind's made up": assumptions and decision-making in accounts of caregiving women

In this qualitative study, rural women caregivers for elderly relatives or friends were interviewed about their decision-making. Women deliberating decisions differed from women implementing decisions in how they perceived their caregiving tasks and in their experience of stress. The difference in deliberative and implemental accounts suggests that mindset is a mediating factor for the women in the present study. Women in the process of implementing decisions regarding caregiving described their experiences in a more positive light and reported less stress. Deliberating decisions regarding caregiving, however, was likely to color the experience of caregiving, leaving the caregiver feeling vulnerable, doubtful about herself, and more stressed.

Family caregiver training is needed to improve outcomes for older adults using home care technologies

Family caregivers, although uncompensated, provide daily care for more than 75% of the older adults who are dependent on home care technologies such as home enteral nutrition. The high complication rates and poor outcomes seen in older adults suggest that being an effective caregiver requires specialized training in home care technologies, and dietitians need to be more actively involved in discharge planning and follow-up home care. The level of knowledge and skill mastery required for technology-dependent care, along with the chronic, intensive nature of family caregiving and the disruptions in caregivers' daily lives, lead to negative emotional and physical consequences that may interfere with caregivers' ability to do caregiving well. Recognizing that care recipients and caregivers are underserved populations, dietitians should develop their professional competencies and expand their roles in technology-dependent home care. Dietitians can thereby contribute to better outcomes for both family caregivers and older home care recipients.

The costs of caring: impact of dementia on family caregivers

With the aging of the population, an increasing number of older adults are diagnosed with Alzheimer's disease or a related disorder. Most people with a dementing illness will be cared for at home by a family member, who may experience a variety of physical, emotional, financial, and social burdens associated with the caregiving role. The purpose of this article is to (a) examine the physical and psychological effects of providing care to a family member with a dementing illness, (b) describe the factors that help determine the nature and magnitude of these effects, and (c) discuss several approaches to caregiver intervention designed to reduce the negative impact of this challenging role. Sociodemographic characteristics (e.g., gender, relationship to the patient, culture, race, ethnicity), caregiver resources (e.g., coping, social support, availability of a companion animal), and personal characteristics (e.g., personality, health behaviors) shape the dementia caregiving experience and have implications for interventions designed to prevent or lessen the stress and burden that often accompany the role.

Nutrition education may reduce burden in family caregivers of older adults

The chronic, demanding nature of family caregiving for frail older adults creates a high degree of stress for caregivers, called caregiver burden. Caregiver burden compromises caregivers' emotional and physical health and health-promoting behaviors. Deterioration in caregivers' health and nutritional status may put caregivers at risk for chronic disease, diminish the ability of caregivers to provide care, and impair the quality of life experienced by caregivers and care recipients. Nutrition education may help reduce caregiver stress and maintain caregivers' health and well-being. Mediating caregiver stress may allow family caregivers to meet their societal role, which has intensified because of health care cost containment.

Weight loss in Alzheimer disease

BACKGROUND

Epidemiologic studies have shown that weight loss is commonly associated with Alzheimer disease (AD) and is a manifestation of the disease itself. The etiology of weight loss in AD appears multifactorial. Hypotheses to explain the weight loss have been suggested (eg, atrophy of the mesial temporal cortex, biological disturbances, and higher energy expenditure); however, none have been proven.

OBJECTIVE

In the first part of this article, we describe weight loss in AD (epidemiologic data and hypotheses to explain weight loss and anorexia in AD). In the second part we report the results of a longitudinal study of the changes in nutritional variables in a cohort of patients with a probable diagnosis of AD.

DESIGN

We followed subjects with AD (based on criteria of the National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association) who were recruited from the Alzheimer's Disease Center in Toulouse. All subject underwent a nutritional, neuropsychologic, and functional evaluation. The Zarit scales were used to assess caregiver burden and caregiver reactions to the patients' behavioral and autonomic disorders.

RESULTS

We showed that only results of the Burden Interview and the Memory and Behavior Problems Checklist, which explored caregiver burden, predicted weight loss in AD. It is possible that caregivers who consider themselves overburdened by the disease process are not willing to invest adequate resources to allow AD patients to properly nourish themselves.

CONCLUSION

Nutritional education programs for the caregivers of AD patients seem to be the best way to prevent weight loss and improve the nutritional status of these patients.

Nutrition and Alzheimer's disease

Alzheimer's disease begins with cognitive deficiencies that gradually become worse with the extension of cerebral lesions. Other troubles arise such as loss of independence, orientation impairments, disordered eating behavior, and weight loss. This weight loss increases the risk of infections, skin ulcers, and falls and consequently decreases quality of life in Alzheimer's patients. Various hypotheses (increased energy expenditure, mesial temporal cortex atrophy) were suggested to explain weight loss. We set up a Health Promotion Program that aims to prevent weight loss in patients with Alzheimer's disease. This program uses various tools (nutrition calendar, Mini Nutritional Assessment, nutrition education sessions) described in this article.