What Causes Dementia and Caregiver Burnout
From the Show: UHS-The Valley Health System
Summary:
Air Date: 9/19/22
Duration: 10 Minutes
We all know or have heard of someone with a loss of memory severe enough that it interferes with daily life and sometimes, this can be attributed to dementia. Dr. Uzma Zafar and Chris Bateman discuss dementia, what causes it, what you need to know about caregiver burnout, and more.
Transcription:
Cheryl Martin (Host): We all know or have heard of someone with a loss of memory severe enough that interferes with daily life. Dementia is a word used to describe a group of symptoms, affecting memory loss, and Alzheimer's is the most common type. What can accompany dementia is the need for a caregiver coming up next, a discussion on dementia, what causes it and caregiver burnout, what you need to know. Welcome to Health Talk with the Valley Health System presented by the Valley. I'm Cheryl Martin. With me to discuss dementia and caregiver burnout are Chris Bateman, the director of the geriatric psychiatry program at Desert Springs Hospital and Dr. Uzma Zafar a psychiatrist and the medical director of the Desert Springs Hospital, geriatric psychiatry program. Welcome both of you.
Chris Bateman: Thank you.
Dr Uzma Zafar: Thank you.
Cheryl Martin (Host): Dr. Zafar let me begin with you, what causes dementia?
Dr Uzma Zafar: thank you so much, for having us on board. It's a very important question that needs to be answered. And what we need to understand about dementia is that it is caused by damage to a loss of nerve cells or their connections in the brain. And depending on the area of the brain that is damaged, dementia can affect people differently and cause different symptoms. 5% people over the age of 65 will have some form of memory loss. This percentage doubles every five years and around the age of 85, approximately 35% will have some form of memory loss.
Cheryl Martin (Host): Will you go into more detail about the different stages of dementia and also the types of dementia?
Dr Uzma Zafar: There are different types of dementia. some are reversible and others are irreversible. The most common age related dementia is dementia of Alzheimer's type. Which has a gradual and progressive course followed by vascular dementia, which accounts for about 20% of cases of dementia. The other common dementias would be dementia of Lewey body, frontal temporal dementia, normal pressure hydrocephalus, and Parkinson's disease related dementia. There are several stages of dementia, but none of them are reversible.
Cheryl Martin (Host): So what are the primary treatments for someone diagnosed with dementia?
Dr Uzma Zafar: So treatments depend on the cause, if the cause is reversible, It should be addressed first and reversible causes could be from drugs, toxins, infections, endocrine, or metabolic causes. So treating that cause should ameliorate the symptoms, but for non reversible causes, Psychosocial and behavioral interventions are needed early in the treatment, such as educating the patient and the family, ensuring patient safety, informing that driving may become impossible as the disease progresses, addressing legal issues, such as living wills or durable power of attorney, suggesting assistance with financial management.
And when appropriate raising possibility of placement. Pharmacological treatments should target specific symptoms that are usually seen in advanced dementia, such as psychosis, agitation, irritation, aggressive behavior, and these treatments should target the specific symptom.
Cheryl Martin (Host): You did a great job of talking about things, how families can prepare for this. What are some other things that families should expect long term, especially as the dementia progresses, does it typically get worse over time or is it such that it can stay at the same place?
Dr Uzma Zafar: There's currently no care for dementia or other dementias Alzheimer's or the other dementias I just mentioned, nor can their progress be reversed. So the involvement in the person's care is going to increase substantially as the disease advances from early to middle to late stages or advanced dementia. Care may be required 24 hours a day in those cases. And it's important to support the person to the highest quality of care but it's also important to need more support for the caregivers through support drops or respite care options, or adult care up programs. And just making sure that the family members are also taken care of.
Cheryl Martin (Host): I'm glad you brought out the need for caregivers. And Chris Bateman, talk about the importance of the role for caregivers and also the need for them to be careful that they don't burn out?
Chris Bateman: So as Dr. Zafar mentioned, the more progressed dementia becomes There's a significant increase in the need for hands on care, observation and intervention. Caregiver burnout is a oftentimes overlook thing for a lot of people looking in from the outside. And it's easy to assume that it's nothing more than they're just a little frustrated. They're tired of the same thing. When actually caregiver burnout is a state of physical, emotional, and mental exhaustion.
So it's characterized by things like lack of energy or overwhelming fatigue, sleep problems, either sleeping too much or too little changes in appetite that can have accompanying weight loss or weight gain, feelings of hopelessness, withdrawing, or losing interest in activities you used to be interested in neglecting your own physical and emotional needs. And some studies have actually indicated that caregiver burnout can cause PTSD. I think the interesting thing in those particular symptoms that is often almost identical to some of the symptoms we would see in diagnosing clinical depression.
Cheryl Martin (Host): What are some of the reasons for this? Is it as a result of maybe one person carrying the bulk of the load or maybe working a full-time job and trying to be a caregiver as well?
Chris Bateman: Sure. I think that's definitely a big part of it. And whether it's cultural or just a family norm or, whatever, the reason, a lot of times we take on this caregiving role out of guilt or a sense of obligation. I'd say there's probably about five, really common reasons for it. First, would be like a role confusion where I lose a little bit of my identity in, where my place is in the family or my role in the family is, either a caregiver or a spouse or a child or a friend. And that all kind of becomes just a gray area.
Another one would be unrealistic expectations. I think that people go into it, certainly with this altruistic ideal. They're doing it just to be helpful. And they care for this other person. But a lot of times with the amount of effort that's put into caregiving, one of the things that can cause burnout is the expectation that we see, the patient either improve their health or their happiness improves. And a lot of times that's an Unrealistic expectation for patients who have a progressive disease like Parkinson's or Alzheimer's.
Another one would be lack of control, just in regard to decreased, money and resources and skills to manage a loved one's care. There's often unreasonable demands. you were taking on too much, because like you said, we're seeing that as my job alone. And I think the final and a big one is a lack of privacy or a lack of personal life, like doctors so far alluded to, some of this can be just a 24 hour a day nonstop thing that, especially with dementia things like that, we can see even the middle of the night can be a pretty demanding time.
Cheryl Martin (Host): So what are some suggestions to help prevent or reduce this?
Chris Bateman: I would say the number one thing is for caregivers to ask for help. And a lot of times I feel like, caregivers don't do that because like I said, out of a sense of guilt or obligation, this is my family member. It's something that I agreed to it's my parent or things like that, but that really is probably the number one thing. I would say, give yourself permission to take breaks. oftentimes we are the last to give ourselves permission to do it because we've taken that role on. Definitely take care of yourself, the appetite sleep exercise are gonna be super important. A lot of people have heard that phrase, if I can't take care of myself or I don't do for myself, I can't do for somebody else that's definitely true in a caregiver's role.
Even if somebody does something as simple as wakes up 15 minutes earlier than usual, just to have that alone time, I can have a cup of coffee. I can read. I can do, something I like, I would say make a list of daily activities or tasks, that helps provide a sense of direction and purpose and accomplishment during the day. Even if you're not seeing these dramatic changes in your loved one's health or happiness or anything like that, if you are working a job, I would definitely say if you're trying to balance those, then check into some of the family lead benefits from your work.
Cheryl Martin (Host): Are there resources available through hospitals or through the federal government where caregivers may be able to get assistance or to get someone, and to lessen the load?
Chris Bateman: Insurance companies will have different resources, if it gets to that level, but the federal government does provide a family leave, benefit for employees to sort of be able to balance that.
Cheryl Martin (Host): Okay. And Dr. Zafar, you talked about so many, symptoms when someone is diagnosed as dementia, that most of the time it's irreversible. So is there anything people can do to reduce, even getting dementia or even slowing the process?
Dr Uzma Zafar: So, just in terms of preventing dementia, there isn't much out there. Some preventative strategies have been mentioned, but they're not very conclusive. But I just want to add that people who have dementia can live, a healthy and long life and Prevent themselves from progressing into the later stages of the disease, because brain is just another muscle that needs exercise and stimulation. So yes, certainly there are many things one can do to maintain a healthy lifestyle and slow the progression of the disease.
And I would recommend challenging your brain, working out your brain, exercising your brain through brain challenging games. Such as chess, jigsaw puzzles, crosswords, people who like to play games on computers can find games where they can interact and play with other people. Following a healthy diet is extremely important. Avoiding processed food, sugar, simple carbohydrates, drugs, excessive alcohol, because in the long run, nutritious food helps maintain brain function.
Staying physically active because physical fitness helps maintain brain fitness. And just making sure that, they live safely and independently, that should be the goal. And that should most definitely help in living, a more useful life and delaying the progression into later stages.
Cheryl Martin (Host): And how often should you play the brain games?
Dr Uzma Zafar: As often as you can, there's no set schedule. I think that you should just incorporate them in our daily schedule. It should be once a day, once or twice a day. if that's something that, gives happiness to the patients, they can most certainly do that more often.
Cheryl Martin (Host): Chris, any final thoughts on preventing caregiver burnout?
Chris Bateman: I would just say that It's a matter of recognizing your own limits and it's not a sign of weakness or caring less to need respite from that. And for those who are around caregivers, be particularly, mindful of the challenges that go along with that.
Cheryl Martin (Host): Great. Any final thoughts Dr. Zafar?
Dr Uzma Zafar: just take care of yourself and your loved ones, it's cliche. But if we really follow it to the tea, that's the most important thing.
Cheryl Martin (Host): Thanks so much to both of you for sharing your expertise on these two vital topics. Dr. Uzma Zafar and Chris Bateman. And if you'd like more information, just visit valleyhealthsystemlv.com that's valleyHealthSystemlv.com. Thanks for listening to this episode of Health Talk with the Valley Health System presented by the Valley. If you found this podcast helpful, please tell others and share it on your social channels and be sure to check out the entire podcast library for other topics of interest to you. Physicians are independent practitioners who are not employees or agents of the Valley Health System. The system shall not be liable for actions or treatments provided by physicians.
Cheryl Martin (Host): We all know or have heard of someone with a loss of memory severe enough that interferes with daily life. Dementia is a word used to describe a group of symptoms, affecting memory loss, and Alzheimer's is the most common type. What can accompany dementia is the need for a caregiver coming up next, a discussion on dementia, what causes it and caregiver burnout, what you need to know. Welcome to Health Talk with the Valley Health System presented by the Valley. I'm Cheryl Martin. With me to discuss dementia and caregiver burnout are Chris Bateman, the director of the geriatric psychiatry program at Desert Springs Hospital and Dr. Uzma Zafar a psychiatrist and the medical director of the Desert Springs Hospital, geriatric psychiatry program. Welcome both of you.
Chris Bateman: Thank you.
Dr Uzma Zafar: Thank you.
Cheryl Martin (Host): Dr. Zafar let me begin with you, what causes dementia?
Dr Uzma Zafar: thank you so much, for having us on board. It's a very important question that needs to be answered. And what we need to understand about dementia is that it is caused by damage to a loss of nerve cells or their connections in the brain. And depending on the area of the brain that is damaged, dementia can affect people differently and cause different symptoms. 5% people over the age of 65 will have some form of memory loss. This percentage doubles every five years and around the age of 85, approximately 35% will have some form of memory loss.
Cheryl Martin (Host): Will you go into more detail about the different stages of dementia and also the types of dementia?
Dr Uzma Zafar: There are different types of dementia. some are reversible and others are irreversible. The most common age related dementia is dementia of Alzheimer's type. Which has a gradual and progressive course followed by vascular dementia, which accounts for about 20% of cases of dementia. The other common dementias would be dementia of Lewey body, frontal temporal dementia, normal pressure hydrocephalus, and Parkinson's disease related dementia. There are several stages of dementia, but none of them are reversible.
Cheryl Martin (Host): So what are the primary treatments for someone diagnosed with dementia?
Dr Uzma Zafar: So treatments depend on the cause, if the cause is reversible, It should be addressed first and reversible causes could be from drugs, toxins, infections, endocrine, or metabolic causes. So treating that cause should ameliorate the symptoms, but for non reversible causes, Psychosocial and behavioral interventions are needed early in the treatment, such as educating the patient and the family, ensuring patient safety, informing that driving may become impossible as the disease progresses, addressing legal issues, such as living wills or durable power of attorney, suggesting assistance with financial management.
And when appropriate raising possibility of placement. Pharmacological treatments should target specific symptoms that are usually seen in advanced dementia, such as psychosis, agitation, irritation, aggressive behavior, and these treatments should target the specific symptom.
Cheryl Martin (Host): You did a great job of talking about things, how families can prepare for this. What are some other things that families should expect long term, especially as the dementia progresses, does it typically get worse over time or is it such that it can stay at the same place?
Dr Uzma Zafar: There's currently no care for dementia or other dementias Alzheimer's or the other dementias I just mentioned, nor can their progress be reversed. So the involvement in the person's care is going to increase substantially as the disease advances from early to middle to late stages or advanced dementia. Care may be required 24 hours a day in those cases. And it's important to support the person to the highest quality of care but it's also important to need more support for the caregivers through support drops or respite care options, or adult care up programs. And just making sure that the family members are also taken care of.
Cheryl Martin (Host): I'm glad you brought out the need for caregivers. And Chris Bateman, talk about the importance of the role for caregivers and also the need for them to be careful that they don't burn out?
Chris Bateman: So as Dr. Zafar mentioned, the more progressed dementia becomes There's a significant increase in the need for hands on care, observation and intervention. Caregiver burnout is a oftentimes overlook thing for a lot of people looking in from the outside. And it's easy to assume that it's nothing more than they're just a little frustrated. They're tired of the same thing. When actually caregiver burnout is a state of physical, emotional, and mental exhaustion.
So it's characterized by things like lack of energy or overwhelming fatigue, sleep problems, either sleeping too much or too little changes in appetite that can have accompanying weight loss or weight gain, feelings of hopelessness, withdrawing, or losing interest in activities you used to be interested in neglecting your own physical and emotional needs. And some studies have actually indicated that caregiver burnout can cause PTSD. I think the interesting thing in those particular symptoms that is often almost identical to some of the symptoms we would see in diagnosing clinical depression.
Cheryl Martin (Host): What are some of the reasons for this? Is it as a result of maybe one person carrying the bulk of the load or maybe working a full-time job and trying to be a caregiver as well?
Chris Bateman: Sure. I think that's definitely a big part of it. And whether it's cultural or just a family norm or, whatever, the reason, a lot of times we take on this caregiving role out of guilt or a sense of obligation. I'd say there's probably about five, really common reasons for it. First, would be like a role confusion where I lose a little bit of my identity in, where my place is in the family or my role in the family is, either a caregiver or a spouse or a child or a friend. And that all kind of becomes just a gray area.
Another one would be unrealistic expectations. I think that people go into it, certainly with this altruistic ideal. They're doing it just to be helpful. And they care for this other person. But a lot of times with the amount of effort that's put into caregiving, one of the things that can cause burnout is the expectation that we see, the patient either improve their health or their happiness improves. And a lot of times that's an Unrealistic expectation for patients who have a progressive disease like Parkinson's or Alzheimer's.
Another one would be lack of control, just in regard to decreased, money and resources and skills to manage a loved one's care. There's often unreasonable demands. you were taking on too much, because like you said, we're seeing that as my job alone. And I think the final and a big one is a lack of privacy or a lack of personal life, like doctors so far alluded to, some of this can be just a 24 hour a day nonstop thing that, especially with dementia things like that, we can see even the middle of the night can be a pretty demanding time.
Cheryl Martin (Host): So what are some suggestions to help prevent or reduce this?
Chris Bateman: I would say the number one thing is for caregivers to ask for help. And a lot of times I feel like, caregivers don't do that because like I said, out of a sense of guilt or obligation, this is my family member. It's something that I agreed to it's my parent or things like that, but that really is probably the number one thing. I would say, give yourself permission to take breaks. oftentimes we are the last to give ourselves permission to do it because we've taken that role on. Definitely take care of yourself, the appetite sleep exercise are gonna be super important. A lot of people have heard that phrase, if I can't take care of myself or I don't do for myself, I can't do for somebody else that's definitely true in a caregiver's role.
Even if somebody does something as simple as wakes up 15 minutes earlier than usual, just to have that alone time, I can have a cup of coffee. I can read. I can do, something I like, I would say make a list of daily activities or tasks, that helps provide a sense of direction and purpose and accomplishment during the day. Even if you're not seeing these dramatic changes in your loved one's health or happiness or anything like that, if you are working a job, I would definitely say if you're trying to balance those, then check into some of the family lead benefits from your work.
Cheryl Martin (Host): Are there resources available through hospitals or through the federal government where caregivers may be able to get assistance or to get someone, and to lessen the load?
Chris Bateman: Insurance companies will have different resources, if it gets to that level, but the federal government does provide a family leave, benefit for employees to sort of be able to balance that.
Cheryl Martin (Host): Okay. And Dr. Zafar, you talked about so many, symptoms when someone is diagnosed as dementia, that most of the time it's irreversible. So is there anything people can do to reduce, even getting dementia or even slowing the process?
Dr Uzma Zafar: So, just in terms of preventing dementia, there isn't much out there. Some preventative strategies have been mentioned, but they're not very conclusive. But I just want to add that people who have dementia can live, a healthy and long life and Prevent themselves from progressing into the later stages of the disease, because brain is just another muscle that needs exercise and stimulation. So yes, certainly there are many things one can do to maintain a healthy lifestyle and slow the progression of the disease.
And I would recommend challenging your brain, working out your brain, exercising your brain through brain challenging games. Such as chess, jigsaw puzzles, crosswords, people who like to play games on computers can find games where they can interact and play with other people. Following a healthy diet is extremely important. Avoiding processed food, sugar, simple carbohydrates, drugs, excessive alcohol, because in the long run, nutritious food helps maintain brain function.
Staying physically active because physical fitness helps maintain brain fitness. And just making sure that, they live safely and independently, that should be the goal. And that should most definitely help in living, a more useful life and delaying the progression into later stages.
Cheryl Martin (Host): And how often should you play the brain games?
Dr Uzma Zafar: As often as you can, there's no set schedule. I think that you should just incorporate them in our daily schedule. It should be once a day, once or twice a day. if that's something that, gives happiness to the patients, they can most certainly do that more often.
Cheryl Martin (Host): Chris, any final thoughts on preventing caregiver burnout?
Chris Bateman: I would just say that It's a matter of recognizing your own limits and it's not a sign of weakness or caring less to need respite from that. And for those who are around caregivers, be particularly, mindful of the challenges that go along with that.
Cheryl Martin (Host): Great. Any final thoughts Dr. Zafar?
Dr Uzma Zafar: just take care of yourself and your loved ones, it's cliche. But if we really follow it to the tea, that's the most important thing.
Cheryl Martin (Host): Thanks so much to both of you for sharing your expertise on these two vital topics. Dr. Uzma Zafar and Chris Bateman. And if you'd like more information, just visit valleyhealthsystemlv.com that's valleyHealthSystemlv.com. Thanks for listening to this episode of Health Talk with the Valley Health System presented by the Valley. If you found this podcast helpful, please tell others and share it on your social channels and be sure to check out the entire podcast library for other topics of interest to you. Physicians are independent practitioners who are not employees or agents of the Valley Health System. The system shall not be liable for actions or treatments provided by physicians.