The health effects illustrated in Table 29.1 also serve to bring another issue to the forefront. Obviously, health effects experienced by the caregiver and care-recipient do not exist in isolation from each other. The mental and physical health of each member of the caregiving dyad likely affects the mental and physical health of the other individual, a phenomenon often referred to as contagion. Several recent studies have demonstrated that the mental health status (e.g., depressive symptomatology) of a manifiied older adult has a significant impact on the mental health of their spouse, even after taking into account the spouse's physical health status (Bookwala & Schulz, 1996; Coyne et al., 1987; Tower &z Kasl, 1995). This picture emerges over many years, making it difficult to determine the causal ordering of such effects.
Evidence for the negative effects of informal caregiving on both the caregiver and care-recipient suggests that psychosocial interventions that are designed to improve the caregiving situation should target both the caregiver and care-recipient. To date, interventions have primarily been targeted at lessening the burden and subsequent negative health effects of informal caregiving through such approaches as education, support groups, counseling or psychotherapy, in-home respite programs, and free-standing or institutional adult day-care programs. Other literatures examine the efficacy of psychosocial interventions for improving the quality of life of specific chronic illness populations, such as individuals with arthritis, visual impairment, terminal illness, and individuals rcovering from stroke or myocardial infarction. To date, there are only a handful of studies evaluating the efficacy of psychosocial interventions targeted at both members of elder caregiving dyads, in the context of conditions such as visual impairment (e.g., Horowitz, November 1997), osteoarthritis (e.g., Keefe et al., 1996) and psychiatric illness (e.g., Sheill, Frank, Geary, Stack, & Reynolds, 1997; Teri, Logsdon, Uomoto, & McCurry, 1997). Clearly, there is a need for research of this kind.
Psychosocial interventions should target caregivers through efforts to relieve their burden as well as education in regard to providing the best assistance and support to the older adult. Given the importance of autonomy and control issues to many older adults, interventions aimed at getting nursing home staff to be more autonomy-supportive may be usefully applied to informal caregivers (Baltes, Neumann, & Zank, 1994). Care-recipients can be targeted through efforts to help them find the best ways to communicate the need for help, and education in regard to how their illness affects their caregiver. Of course, the most thorough psychosocial intervention would also target the older adult's primary health care provider in an attempt to improve communication between this individual and both the patient and caregiver and subsequently improve the quality of care provided to the patient (Council on Scientific Affairs, American Medical Association, 1993). An added benefit of multitargeted psychosocial interventions in the context of informal caregiving is that findings from this research can inform models of the health effects of caregiving and care receiving by identifying mediating and conditioning factors in these processes.
Preparation of this chapter was in part supported by grants from the National Institute of Mental Health (MH46015, MH52247, and MH19986), the National Institute on Aging (AGI3305 and AGI532), and the National Cancer Institute (CA61303 and CA64711).
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