Psychiatr News February 1, 2008
Volume 43, Number 3, page 22
© 2008 American Psychiatric Association
Psychiatrists Should Expect to See More Caregivers Seeking Treatment
Joan Arehart-Treichel
Psychiatrists who treat people diagnosed with Alzheimer's disease may
also find themselves caring for the patients' caretakers.
Although there do not seem to be any statistics on how many clinical
psychiatrists see Alzheimer's caregivers, the number is probably substantial,
Constantine Lyketsos, M.D., chair of psychiatry at Johns Hopkins Bayview
Medical Center and a geriatric psychiatrist, estimates. Certainly
psychiatrists who see older patients encounter many Alzheimer's caregivers, he
said, but also those who see younger patients probably have contact with a
number as well "because about 10 percent of people in the current
workforce are caregivers of an older parent, typically someone with
dementia," (see MH Stressors Debilitating in Alzheimer's
Caregivers).
Furthermore, there are generally two types of situations in which clinical
psychiatrists can help Alzheimer's caregivers. One involves a psychiatrist who
is treating a patient and can indirectly offer the patient's caregiver support
and guidance. The other involves a caregiver who is in psychiatric treatment
because of problems related to caregiving.
In the first situation, for example, "the psychiatrist can play a
critical role in identifying caregivers at high risk of adverse outcomes by
asking a few questions about caregiver depression, safety (for example, does
the patient have access to weapons), and access to informational and support
resources," said Richard Schulz, Ph.D., a professor of psychiatry at the
University of Pittsburgh and associate director of the university's Institute
on Aging.
Peter Rabins, M.D., a professor of psychiatry at Johns Hopkins Medical
Institutions and chair of APA's Committee on Long-Term Care of the Elderly,
agreed. "I mention support groups as an available resource to every
caregiver I see. I would guess that about a quarter try it. For caregivers who
have particular psychosocial or financial needs, I try to refer them to
specific agencies that I know of. Some people follow through, others
don't."
In the second situation—in which the caregiver seeks psychiatric
treatment for himself or herself—"I would try to see exactly what
the caregiver is coming in for," Nhi-Ha Trinh, M.D., a clinical
researcher at Massachusetts General Hospital and a member of APA's Committee
on Long-Term Care of the Elderly, said. "Is it that they are having
trouble coping with the recent diagnosis of Alzheimer's in their loved one? Is
it that they are experiencing depression, stress, or burnout from taking care
of their loved one? And what steps have they taken to get more support for
their caregiving? If they are lucky enough to be in a family where they can
share the responsibility, they might try to enlist more family members. Or I
might try to give them resources in the community such as the Alzheimer's
Association. And then I might sort of troubleshoot with them—has it
gotten to the point where they should consider alternate arrangements for
caregiving, such as an in-house aide, or having their loved one move to an
assisted living or a nursing home?"
All things considered, the mental and physical health of Alzheimer's
caregivers will become an issue of greater importance to clinical
psychiatrists in the next few years, Rabins predicted. "And for a couple
of reasons," he said. "The number of people with Alzheimer's is
increasing dramatically. And the people involved in the care of those
individuals are not only spouses of the same generation, but often their
children, who more and more are younger and middle-aged individuals who
recognize psychiatric treatment as acceptable if they are having
problems." 
Related Article:
-
MH Stressors Debilitating in Alzheimer's Caregivers
- Joan Arehart-Treichel
Psychiatr News 2008 43: 22-35.
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