Burden of Depression & Anxiety

from COVID-19 For Families and Caregivers

Sofia Sundberg, BSW | June 16, 2020

A Look at Caregiver Stress

Caregiver Stress: Who is Impacted?• Vast majority (87%) of unpaid caregivers are family members • Among all caregivers, the population is split almost evenly with

slightly more women (53%) than men (47%)

• Key findings:• 36% provide 100 or more hours of care per month• 32% of primary caregivers have been providing care for 5+ years• 53% of primary caregivers are also employed full-or-part time• 21% say their health has declined since becoming a caregiver• 22% say their financial situation has worsened

(Transamerica Institute, 2017)

Caregiver Burden• Dementia caregivers spend average of 69-100 hours per week

providing care• Caregivers of patients who have dementia report

• 46% more physician visits• Over 70% more prescribed drugs• More likely to be hospitalized

(Transamerica Institute, 2017)

Types of Caregiver Stress• Time deficits• Financial burdens• Emotional strain• Health problems• Mental health problems

Caregiver Stressors• Dangerous behavior• Embarrassing behavior• Agitation, restlessness• Anger, suspiciousness• Loss of sleep

This Photo by Unknown Author is licensed under CC BY

Common Stressors

• Resistant care recipient• Family disagreement(s)• Physical care needs• Change• Uncertainty• Poor/Ineffective medical

care

• Resistance to medical care• Need for move to higher

level of care• Safety concerns• Long-distance caregiving• Finances & legal matters

Caregiver Burden• Watching loved one decline – “losing self”• Reduced shared activities• Changing roles• Changing relationships within family• Loss of emotional support• Diminished quality of verbal communication

Impact of COVID-19

Impact of COVID-19 on Daily Life• Change in routine• Job loss or reduced hours/pay• Increased isolation• Loss of hobbies and leisure activities• Daily activities more difficult• Lower supply of needed items and prescriptions• Changes in support access• Increased risk of mental health issues

Impact of COVID-19 on Caregivers

Impact of COVID-19 on Caregiver Anxiety• Anxiety about providing financially• Repeatedly explaining to confused individual• Trying to minimize the individuals’ worry• Separation anxiety• Patient stress may change dementia behaviors

Impact of COVID-19 on Caregiver Depression• Loss of routine/structure• Decreased access to resources and services• Decreased hobbies and activities• More isolation, yet less time alone• Sense of hopelessness• Guilt about reduced visiting

Impact of Depression & Anxiety

Symptoms of Anxiety• Feeling nervous, restless or tense• Sense of impending danger or doom• Increased heart rate and/or rapid breathing• Feeling weak or tired• Trouble concentrating on things other than worry• Sleep trouble• Gastrointestinal (GI) problems• Urge to avoid things that trigger anxiety

(Mayo Clinic, 2018)

Physiological Responses to Stress• Proper functioning requires synced brain and body, including key hormones• Neuroendocrine system vital to integration of body function and behavior• Role of serotonin and norepinephrine in balancing mood• Key factor is the hypothalamic-pituitary-adrenal axis• The fight-or-flight response: under stress amygdala sends signals that

increase blood pressure, adrenaline, and the hormone cortisol • Substances that are good for mood may be deficient• Stress substances may be in excess• These imbalances in brain & body over time can cause depression and

anxiety

Symptoms of Depression• Persistent sadness• Feeling slowed down • Excessive worry• Frequent tearfulness • Feeling worthless or helpless • Weight changes • Pacing and fidgeting • Difficulty sleeping • Difficulty concentrating • Physical symptoms such as pain or GI problems

Strategies for Depression and Anxiety Management

Interventions• Psychoeducational—teach caregivers information and

skills in managing dementia• Cognitive behavior therapy—focus on caregiver

emotional reactions, teach ways to manage caregiver reactions

• Support— Direct care providers, loved ones, local agencies and support groups

• Respite – Utilize local home health care agencies and adult day care centers

Strategies for Depression & Anxiety• Prioritize self-care• Limit information to official sources• Maintain routine, when possible• Know yourself• Know how to get in touch with medical/mental health providers

Take Care of You!1. Eat well & hydrate2. Get enough sleep3. Move your body4. Take rest breaks5. Get organized6. Engage your creative side7. Connect with loved ones8. Journal9. Practice mindfulness10. Make time to laugh!

Eat Your Way to Less Stress• Vitamin C:

• Can reduce stress and boost the immune system• Can help lower cortisol levels and blood pressure during high-anxiety situations

• Complex Carbohydrates: • Prompts the brain to increase serotonin production, stabilizing blood pressure to reduce stress

• Magnesium:• Adequate level is key to avoiding headaches and fatigue • Found to improve sleep quality in older adults• Healthy sources of magnesium include spinach or other leafy greens, salmon, and soybeans

• Omega-3 Fatty Acids: • Fatty fish (salmon and tuna) and nuts and seeds • Shown to reduce surges of stress hormones• Protection against heart disease & depression

• Dark Chocolate: • May help relieve stress at the molecular level.

• Oatmeal: • Can reduce stress hormones and result in serotonin boost, stimulating feeling of calm

Prioritize Quality Sleep• According to National Sleep Foundation survey, 43% of people

aged 13–64 report lying awake due to stress in the past month• Improve mood, energy, concentration, functioning• CDC reports that at least 7 hours of sleep may decrease risk of:

• obesity• heart disease• diabetes• stroke• depression• arthritis• kidney disease

Practice Mindfulness• A mental state achieved by focusing awareness on the moment• Pay attention to your breathing • Use the power of visualization• Focus on what you love• Accept the things you cannot change• Celebrate small achievements • Keep a daily gratitude journal

Mindfulness – The “STOP” Method• Stand up and breathe. Feel your connection to the world

around you.• Tune in to your body. Lower your gaze. Scan your body and

notice physical sensations or emotions. Notice any pleasant ones and let them fill you up on the in breath. Release unpleasant sensations, emotions or feelings on the “out” breath.

• Observe. Lift your eyes and take in your surroundings. Observe something in your environment that is pleasant and be grateful for it and its beauty.

• Possibility. Ask yourself what is possible as the next forward step.

Caregiver’s Bill of Rights - I have the right…• To take care of myself. This is not an act of selfishness. It will give me the capacity to take better care of my relative.

• To seek help from others even though my relative may object. I recognize the limits of my own endurance and strength.

• To maintain facets of my life that do not include the person I care for, just as I would if they were healthy. I know I do everything that I reasonably can for this person, and I have the right to do some things for myself.

• To get angry, be depressed, and express other difficult feelings occasionally.

• To reject any attempt by my relative (either conscious or unconscious) to manipulate me through guilt, anger, or depression.

• To receive consideration, affection, forgiveness, and acceptance for what I do for my loved one for as long as I offer these qualities in return.

• To take pride in what I am accomplishing and to applaud the courage it has sometimes taken to meet the needs of my relative.

• To protect my individuality and right to make a life for myself that will sustain me when my relative no longer needs my full-time help.

• To expect and demand that as new strides are made in finding resources to aid physically and mentally impaired older persons in our country, similar strides will be made toward aiding and supporting caregivers.

— Jo Horne, author of Caregiving: Helping an Aging Loved One

Helpful ResourcesCOVID-19, Diagnosis/coping information, Caregiver support groups, Virtual activities & more• Alzheimer’s Association: https://alz.org/• Alzheimer’s Foundation of America: https://alzfdn.orgCOVID-19 Updates & Resources• CDC: https://www.cdc.gov/coronavirus/2019-ncov/index.htmlCaregiver Education Videos & More• Positive Approach to Care,Teepa Snow: https://teepasnow.com/Mindfulness Exercises• https://mindfulnessexercises.com/

Helpful Resources – If You Are in a Crisis• Disaster Distress Helpline: 1-800-985-5990, or text TalkWithUs to

66746• National Suicide Prevention Lifeline: 1-800-273-TALK (8255) • National Domestic Violence Hotline: 1-800-799-7233 or text LOVEIS

to 22522• The Eldercare Locator: 1-800-677-1116 • Veteran’s Crisis Line: 1-800-273-TALK (8255)

Find a health care provider or treatment for mental health:• SAMHSA’s National Helpline: 1-800-662-HELP (4357) • Treatment Services Locator

Questions & Answers

Sofia Sundberg, BSW

Memory Disorder Clinic CoordinatorUniversity of South Florida

Phone: (813) 974-6460Email: ssundberg@usf.edu