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Tuesday, July 9, 2013

Caregivers: The True Karma Yogis

by Ram
Last Leaves by Melina Meza
You could be a sister, brother, parent, relative, friend, or neighbor who provides care and assistance to a recipient without receiving any payment for such services. You are a true karma yogi. Karma Yoga, as we know, is a path of yoga that allows for an individual to carry out his/her duties selflessly as a service without looking to reap any benefits from such service. Such individuals have the opportunity to directly experience the inner joy and wellbeing that selfless service brings. These individuals are also known as caregivers since they provide a wide variety of selfless services to a recipient, including assisting with daily tasks like personal care, providing meals, helping the recipient with their daily physical activities, administering medications, meeting with healthcare providers, daily supervision and activity, coordinating treatment regimens, management of the recipient’s medical care and health insurance, etc.

The following subset of statistics mentioned below and drawn from the National Alliance for Caregiving speaks volumes of the caregivers’ true act of karma yoga:
  1. More than 65 million people (representing about 1/5 of the U.S. population) are caregivers providing care for a chronically ill, disabled or aged family member or friend during any given year and spending an average of 20 hours per week providing care for the recipient. Approximately 66% of caregivers are women. More than 37% have children or grandchildren under 18 years living with them.
  2. The value of the free services caregivers provide for older adults is estimated to be $375 billion a year.
  3. Twenty hours per week is the average number of hours family caregivers spend caring for their loved ones while 13% of family caregivers are providing 40 hours of care a week or more.
  4. Thirty-six percent of family caregivers care for a parent and 7 out of 10 caregivers are caring for loved ones over 50 years old.
On the disturbing side are the statistics drawn from the same National Alliance regarding the impact of care-giving on a caregiver’s health that is a serious cause for concern:
  1. Women caregivers are 2.5 times more likely than non-caregivers to live in poverty and five times more likely to receive Supplemental Security Income (SSI).
  2. Forty-seven percent of working caregivers indicate that an increase in care-giving expenses has caused them to use up all or most of their savings.
  3. Nearly 25% of caregivers caring for 5 years or more report their health is fair or poor. 20% of employed female caregivers over 50 years old report symptoms of depression compared to 8% of their non-caregiving peers. 40-70% of family caregivers have clinically significant symptoms of depression. 1 in 10 caregivers report that care-giving has caused their physical health to deteriorate.
  4. Sixty-three percent of caregivers report having poorer eating habits than non-caregivers.
  5. Family caregivers experiencing extreme stress have been shown to age prematurely. The level of stress can take as much as 10 years off a family caregiver's life.
Thus, while care-giving may be rewarding mentally, spiritually and emotionally, for a majority of caregivers it is undoubtedly stressful. Caregivers were found to have a 15% lower level of immune response and a 23% higher level of stress hormones compared to non-caregivers, suggesting that the stress encountered by primary caregivers greatly impacts their health and ability to recover from any illness. The stress associated with caring for persons with chronic degenerative diseases has been shown to drastically reduce caregivers' immune system thus increasing their chances of developing a chronic illness themselves.

There are several strategies that caregivers can use to reduce the effects of this added stress. One such strategy that is receiving a lot of attention is yoga and meditation. While yoga has been shown to help people with a multitude of health problems, several recent studies indicate that yoga could help the caregivers as well. Research studies involving caregivers (see here and here) have shown that yoga and meditation can help lower depression, reduce fear, worry and anxiety, improve cognitive functioning, decrease overall stress and slow down cellular aging associated with stress among caregivers. A majority of caregivers find the yoga and meditation strategy useful and report improvements in physical and emotional status.

As a researcher working to understand the mechanisms of Alzheimer’s disease, I am saddened to hear that a majority of the Alzheimer's caregivers experience high levels of stress. Caring for a person with Alzheimer’s disease is an extremely difficult task and can become overwhelming, especially when the disease is at its late stage where the patient has completely lost memory and other cognitive functions. Performing basic activities of daily living becomes difficult to manage for the Alzheimer's patient and the caregiver. Each day brings new challenges for the caregivers as they try to manage care with the patient’s new patterns of behavior. This puts the caregivers at a greater risk for developing depression and other chronic illness unless they seek remedial measures.

A recent study on caregivers of Alzheimer’s disease confirms the therapeutic benefits of yoga and meditation. For the study, researchers recruited a total of 46 caregivers of Alzheimer’s disease to participate in a stress-reduction program for a 2-month period and randomly placed them in one of two groups. 25 volunteer caregivers were assigned to receive a yoga and meditation program and the other group of 21 served as a control group and did not receive any specific treatment.

The program lasted two months, with the yoga and meditation sessions lasting 1 hour and 15 minutes (25 minutes yoga, 25 minutes pranayama and 25 minutes mindfulness meditation), three times per week. The participants had to attend one live training session per week, whereas the other two weekly sessions were performed at home with the aid of a DVD. The levels of stress, anxiety, depression, and morning salivary cortisol of the participants were measured before and after the intervention. At the end of the two-month program, the group that received the yoga, meditation and pranayama training had significantly lower levels of depressive symptoms and greater improvement in mental health and cognitive functioning, compared to the control group. The intervention group also exhibited a statistically significant reduction in the stress and anxiety scores, thus indicating that yoga and meditation type of intervention is very useful in reducing stress in caregivers directly involved with patient care tasks.

It is believed that the beneficial effects of yoga and mediation are due to a reduction in sympathetic activity with a concomitant increase in parasympathetic activity. These changes result in increases in GABA, serotonin and melatonin concentrations and a reduction in the levels of adrenalin and noradrenalin, all of which result in improvements of mood, reduction in body temperature, reduction in stress and anxiety, and greater improvement in mental health. The study also draws attention to the close relation between mental and physical health by documenting the mechanistic links at the cellular level. While there are many psychosocial interventions that enhance mental health for caregivers, the yoga and meditation intervention seems attractive as a simple therapeutic practice that could be distributed and applied for use in clinical practice not only for patients but for caregivers as well.
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