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Improving the Mental and Physical Health of the Family Caregiver

Introduction

• Family caregivers are at risk for mental and physical problems of their own
• Caregiver fatigue, stress, physical limitations, and time constraints can contribute to increased vulnerability to illness

Assessment

• Look at past coping patterns. What are the strengths that the caregiver has drawn on in the past? What strengths can you help the caregiver to identify in the current situation? Has the caregiver used dysfunctional behaviors to cope with stressors in the past?
• Review past and current medical history of caregivers. Be alert to changes or omissions in the caregiver's present routine that have arisen as a result of their caregiving duties
• Assess other current stressors (job, family, finances etc.). Make referrals to social service, to outside agencies, and to other health care professionals.

Strategies

• Stress management techniques
• Respite
• Delegating responsibilities
• Reframing
• Progressive muscle relaxation
• Distraction (music, humor, prayer)
• Prioritization
• Psychotherapy
• Exercise

• Help caregivers to be deliberate and conscious about how they will take care of themselves. Ask them "How will you do it... and when?". Suggestions include giving them permission to give themselves permission to take time out for themselves... to take a walk, to read the paper, or to leave the home for a short while.

• Problem solving strategies: (Note: for some people, this can be a very effective way to approach problems. However, for people who tend to be very concrete, it may arouse more anxiety than it alleviates)

Steps In Problem-Solving

Step 1:   Clearly define the uppermost problem.

Step 2:   Recognize how you feel about the problem.

Step 3:   Relax and try not to think about solutions for awhile.

Step 4:   Consider all possible solutions, even "bad" ones.

Step 5:   Try to imagine how other people might solve the problem.

Step 6:   Evaluate the pros and cons of each solution.

Step 7:   Arrange the various solutions into a list starting with the least desirable or least practical one. Talk about it with family and friends.

Step 8:   Make a choice. Remember all choices are not final. Remain flexible.

Step 9:   Briefly consider some favorable or positive aspect of the original problem. Can you think about it differently?

• Time management strategies: Managing the Impact on your schedule
  • Self Assessment of Current Status
  • Identify the tasks
  • Prioritize
  • Get and accept additional help
  • Make a list of chores and when others ask "What can I do?" refer to this list. Many times people really do want to help, they just don't know how.
  
  
• Dealing with uncertainty
  • seek out reliable information
  • discuss fears of the unknown
  • make contingency plans
  • explore spiritual and existential concerns.
  
  
• Dealing with social isolation
  • accept offers of help, allow others to stay with the patient while you go out
  • develop telephone buddies
  • get out of the house
  • allow time (give permission) for self each day with enjoyable activities (reading, gardening, TV)
  • seek help from family, neighbors, church members
  • support groups

Keeping Healthy as a Family Caregiver: Cancer Prevention and Early Detection

Rationale

Family caregivers become immersed in their role as caregivers and frequently shift their attention away from their own health care needs. It is important to emphasize prevention and early detection strategies among this group.

Prevention

Although there is no guaranteed method to prevent all cancers there are certain decisions that healthy people can make to lower their chances of developing certain cancers.

1. Tobacco control
   1. Contact your local ACS or your physician for help with smoking cessation. It is now illegal to sell cigarettes to minors in Pennsylvania.
2. Diet
   1. High fiber
   2. Low fat
   3. Five servings of fruits and vegetables each day
   4. Maintain a healthy weight
3. Avoid excess sun exposure

ACS/NCI guidelines are only general guidelines. Individuals with a family history or other predisposing factors should consult their health care practitioners regarding early detection.

Cancers that are found early may be easier to cure.

1. Breast Cancer
   1. mammography
   2. breast self exam
   3. professional breast exam
2. Prostate Cancer
   1. digital rectal exam: all men over 50
   2. prostate specific antigen
   3. Transrectal ultrasound
3. Colon Cancer
   1. colonoscopy
   2. guaiac testing
   3. sigmoidoscopy
4. Cervical Cancer
   1. pelvic exam
   2. pap test
5. Skin Cancer
   1. skin exams

Public education resources that may be helpful

General cancer prevention and early detection

Get a New Attitude About Cancer: A Guide for Black Americans NCINIH publication No.93-3412, December 1992.

Cancer Tests You Should Know About: A Guide for People 65 and Over NCI NIH Publication No. 93-3256, rev. 1992.

Breast and cervical cancer

Literature

• Questions and Answers About Choosing a Mammography Facility NCI NIH Publication No. 93-3228, reprinted May, 1993.
• Do the Right Thing: Get A Mammogram NCI NIH Publication no. 92-3210, rev. September 1992.
• The Pap Test: It Can Save Your Life! NCI, NIH Publication No. 91-3213, October, 1991.
• A Health Guide for All Women NCI NIH Publication No. 93-3536, printed April 1993.
• Helping People Cope: A Guide for Families Facing Cancer
• A Special Touch: A Personal Plan of Action for Breast Health. American Cancer Society
• Breast Cancer Detection Awareness- Questions and Answers American Cancer Society
• Breast Cancer Questions and Answers American Cancer Society
• Breast Self Examination Monthly Reminder Card American Cancer Society
• Three Ways to Take Special Care of Your Breasts American Cancer Society
• Shower Card Breast Self Exam

Posters (from the American Cancer Society)

• Fight Breast Cancer With Your Own Two Hands
• Keep in Touch With Yourself
• Mammography: Your Most Powerful Weapon
• Use This Powerful Weapon Against Breast Cancer
• Are you Watching Your Figure, But Ignoring Your Body? (pap test)

Videotapes

• Breast Self-Exam: A Special Touch 8:15 minutes. 1/2 inch videotape. American Cancer Society
• How to Examine Your Breasts 9:18 minutes. 1/2 inch videotape. American Cancer Society
• Nowhere To Hide (highlights mammography exams) 9:28 minutes. 1/2 inch videotape. American Cancer Society
• Take the Time (importance of pap tests) 15:00 minutes. 1/2 inch videotape. American Cancer Society

Nutrition Resources

• The Food Guide Pyramid, United States Department of Agriculture, Home and Garden Bulletin Number 252
• Dietary Guidelines for Americans, United States Department of Agriculture, Home and Garden Bulletin Number 232
• Diet, Nutrition, and Cancer Prevention: the Good News, American Cancer Society
• Down Home Healthy, National Cancer Institute
• New Food Label Guide

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