Improve Quality-of-life and Stress Responses in Caregivers for Patients with Dementia
By John M. de Castro, Ph.D.
“Mindfulness also happens to be a salvation for caregivers facing the ongoing stress from caring for a loved one with dementia. There is another reason mindfulness practice can be a game changer for dementia caregivers. Mindfulness can also help you provide care for your loved one with greater ease.” – Marguerite Manteau-Rao
Dementia is a progressive loss of mental function produced by degenerative diseases of the brain. Dementia patients require caregiving particularly in the later stages of the disease. Alzheimer’s disease is the most common type of dementia and accounts for 50 to 70 percent of dementia cases. Other types of dementia include vascular dementia, mixed dementia, dementia with Lewy bodies and frontotemporal dementia. For Alzheimer’s disease alone, there are an estimated 10 million caregivers providing 9 billion hours of care at a value of over $100 Billion dollars.
Caregiving for dementia patients is a daunting and all too frequent task. It is an intense experience that can go on for four to eight years with increasing responsibilities as the loved one deteriorates. In the last year, 59% of the caregivers report that they are effectively on duty 24/7. Over time dementia will lead to loss of memory, loss of reasoning and judgment, personality and behavioral changes, physical decline, and death. The memory and personality changes in the patient may take away all those characteristics that make the loved one identifiable, unique, and endearing, producing psychological stress in the caregiver. The feelings of hopelessness can be overwhelming regarding the future of a patient with an irreversible terminal degenerative illness. In addition, caregivers often experience an anticipatory grief associated with a feeling of impending loss of their loved one. If this isn’t bad enough, a little appreciated consequence is that few insurance programs cover dementia care outside of the hospital. So, medical expenses can produce extra financial strain on top of the loss of income for the caregiver. It is sad that 72% of the caregivers reported relief when their loved one passes away.
Obviously, there is a need to both care for the dementia patients and also for the caregivers, for all types of caregiving but particularly for dementia. They play an essential and often irreplaceable role. So, finding ways to ease the burden is extremely important. Mindfulness practice for caregivers has been shown to help them cope with the physical and psychological demands of caregiving. In today’s Research News article “Randomized Controlled Trial of Inner Resources Meditation for Family Dementia Caregivers.” See summary below or view the full text of the study at:
Waelde and colleagues employ a mindfulness meditation with mantra practice to treat caregivers for dementia patients. They recruited female dementia caregivers and randomly assigned them to receive either an 9-week, once a week for 90 minutes, group-based, meditation with mantra practice with encouraged home practice, or a psychoeducation with telephone support condition. They were measured before and after training and one month later for satisfaction with life, depression, self-efficacy, subjective improvement, mental status, and diurnal salivary cortisol slope, a measure of stress.
They found that at the one-month follow up the mindfulness meditation with mantra practice group had significantly greater improvement than the psychoeducation group in life satisfaction and diurnal salivary cortisol slope. This suggests that the intervention reduced stress and improved the caregivers perceived quality of life. There were not significant improvements in depression or self-efficacy, but this may have been due to the amount of home practice. Indeed, the greater the amount of meditation practice occurring at home the greater the decrease in depression and the greater the increase in self-efficacy. This suggests that, in order for the mindfulness meditation with mantra practice to be effective for reducing depression and for improving the caregiver’s ability to cope with stress, it must be practiced regularly at home.
These results are potentially important. They suggest that meditation may be an effective means to improve the physical and psychological conditions of dementia caregivers. It should be mentioned that no one dropped out of the meditation condition, indicating that it is tolerable within the framework of the taxed time availability of the caregivers.
So, improve quality-of-life and stress responses in caregivers for patients with dementia.
“Mindfulness practice is especially relevant to the predicament of dementia caregiving. It can give caregivers the inner resources to sustain themselves emotionally and physically over the long haul and is a tool they can always fall back on moment to moment, regardless of the intensity of the care relationship.” – Marguerite Manteau-Rao
CMCS – Center for Mindfulness and Contemplative Studies
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Waelde, L. C., Meyer, H., Thompson, J. M., Thompson, L. and Gallagher-Thompson, D. (2017), Randomized Controlled Trial of Inner Resources Meditation for Family Dementia Caregivers. J. Clin. Psychol.. doi:10.1002/jclp.22470
This randomized controlled trial examined the comparative effectiveness of 2 interventions for improving diurnal cortisol slope and life satisfaction and reducing stress symptoms among older female dementia family caregivers.
Thirty-one family dementia caregivers were randomized to 8 weeks of Inner Resources for Stress mindfulness meditation and mantra training (IR) or psychoeducation and telephone support (PTS).
Intention-to-treat analyses revealed statistically significant pre-post improvements in diurnal cortisol slope and overall life satisfaction, but not depression or self-efficacy, in the IR relative to the PTS group. Adherence to between-session meditation practice was significantly associated with decreases in depression and self-reported improvements in ability to cope with stress. In addition, IR participants rated the overall benefits of the program more highly than the PTS group.
These results indicate that mindfulness meditation and mantra has promise as a feasible and effective caregiver intervention for quality of life and physiological responding to stress.