Family Caregivers: Psychosocial Impacts and Clinical Needs

The authors describe how 3 groups of family caregivers (spouses, daughters, and sons) are affected by the caregiving role. In addition, clinical considerations and interventions for mental health professionals working with these different groups of family caregivers are discussed. A clinical case example is also presented. ********** The aging process for most individuals is accompanied by some loss of cognitive and behavioral functions. For some, significant cognitive impairments develop in response to various etiologies. According to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) dementia disorders "are characterized by the development of multiple cognitive deficits (including memory impairment) that are due to direct physiological effects of a general medical condition, to the persisting effects of a substance, or to multiple etiologies" (p. 147). The decline in functioning stemming from dementia symptoms leads to an increased need for physical and emotional assistance, which is usually provided by a family caregiver. The purpose of this article is to describe three subgroups of family caregivers (i.e., spouses, daughters, and sons) of individuals experiencing dementia and discuss clinical considerations and interventions to use with these individuals. Identifying the positive and negative aspects of caregiving for the different caregiver groups provides greater opportunities for caregivers and mental health providers to better understand all aspects of this valuable role. Providing care to a family member experiencing dementia can be very demanding for spouses and adult children, who often provide the majority of care within the family context (Robertson, Zarit, Duncan, Rovine, & Femia, 2007). Family caregivers provide much needed emotional and physical support that plays a significant role in the health and adjustment of persons with dementia (S. Cohen & Wills, 1985). Additionally, family members provide the majority of care for older adults with functional impairments (Robertson et al., 2007). However, this role comes with the additional challenge of managing one's own personal care needs and affairs while managing the personal needs and affairs of a loved one. This challenge presents the caregiver with a significant amount of psychological strain and burden. Whether the person with dementia resides independently or in an assisted-living facility, the caregiver is at risk of psychological distress and depression (Levesque, Ducharme, & Lachance, 1999; Schulz & Martire, 2004). Meuser, Marwit, and Sanders (2004) suggested that grief is a primary reaction to providing care for a person with dementia. With expectations that the number of Americans age 65 and older experiencing dementia will grow to nearly 3 million by the year 2015 (U.S. General Accounting Office, 1998), mental health counselors will likely experience an increase in the number of clients who must address issues related to family caregiving. FAMILY CAREGIVERS Family members meet the caregiving needs of an overwhelming majority of dementia patients (Alzheimer's Association and National Alliance for Caregiving, 2004; Clark & Standard, 1996). Despite popular myths (e.g., patients with dementia cannot be cared for at home or most dementia patients are relegated to nursing homes), the majority of patients with dementia have a spouse or child as their primary caregiver (Zarit, Stephens, Townsend, & Greene, 1998). According to the Alzheimer's Association and National Alliance for Caregiving, 22% of the approximately 44 million American caregivers provide substantial and unpaid care to a family member. Compared to family caregivers for patients with other diseases, individuals who care for a person with dementia are twice as likely to be providing the highest level of home care (more than 40 hours of direct care each week) and are also more likely to be living with the person (Alzheimer's Association and National Alliance for Caregiving, 2004). …