Saturday, September 13, 2008

Caregiving in Canada

Caregiving has been related to both physical and mental health issues and an increase in depression in several studies (Gallagher–Thompson and Coon, 2007; O’Rourke, Cappeliez, and Neufeld, 2007). Depression rates in caregivers of terminally ill cancer patients ranges from 18% to 55% (Tang, Li, and Liao, 2007), with other studies reporting high rates for various morbidities between 20% and 30% (Grov et al., 2005; Kim et al., 2005). To promote the well being of caregivers, interventions should address improving social supports for caregivers. Lack of social supports, such as counselling and respite care, have been associated with increased levels of depression among caregivers (Redinbaugh, MacCallum, and Kiecott–Glaser, 1995).

The stress involved in caregiving relationships is exacerbated by the age and health of the caregiver, the degree of illness or disability in the care recipient, and the supports and outside resources available to the caregiver; the effects can be: arthritis, hypertension, insomnia, pain, stiffness, headaches, and hearing problems (Emick and Hayslip, 1999). There are limits to the ability of a caregiver to look after both herself and her loved one.

Pagel and Becker (1978) studied the impacts of social supports and self-esteem on depressive thinking in caregivers, finding that caregivers with high levels of depressive cognition had high levels of depression only if social supports were low. They found a need for interventions with caregivers to alleviate stress by addressing social supports and controllable life stressors (see also Redinbaugh, MacCallum, and Kiecott–Glaser, 1995).

Caregivers tend to have work responsibilities (two-thirds work outside the home, according to the Women’s Healthcare Network (1998). They tend to have problems with being absent from work, which impact their rates of pay, career advancement, physical and spiritual health, pensions, and long-term financial security.

Caring for ailing or disabled kin is an international situation. Schreiner and Morimoto (2003), in a Japanese study, found that persons with a higher sense of mastery, the degree to which caregivers believe they are not governed by forces outside their control, and their sense of efficacy, agency, and autonomy affect their sense of control, and they have less stress and strain and depressive symptoms in contrast to Western caregivers (Morimoto, Schreiner, and Asano, 2001; Magai and Cohen, 1998).

With neighbours enabling my parents’ transition from independent, self-directed individuals to totally dependent patients, my parents began to call upon friends, family, and neighbours to meet their IADL and ADL. The health care system failed us as my parents managed, in denial, to continue to live in a small town where they could not get their mail, mow their lawn, shovel snow, shop for groceries, or meet many other needs. When my mother was dying at home, no one gave me suggestions or support in finding respite care, hospice care, or any other resources that would help me help my mother. I ended up “retiring” early, with a huge cut in my anticipated pension, so I could look after these needs. I am not the only daughter or daughter-in-law who has had to change her life for this reason.

I would like to see the statistics that support an argument in favour of this approach. It is a faulty one. My parents did not want help from me; my mother stopped me from attending doctors’ appointments, including those with the oncologist and the surgeon. She did not hear well, misunderstood what she was hearing, and avoided allowing me to help her and share the burden of her health care.

[Excerpt from my book: Living and Dying With Dignity]

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