Caregivers – Suffering and Underappreciated
The Dual Role of Caregivers with Chronic Condition
An interesting report from Express Scripts about the role of Caregivers.
Behind the scenes of the traditional healthcare system exists a role that is largely underappreciated: the role of caregiver. An estimated 42 million Americans spend an average of 20 hours a week caring for friends or loved ones.1 They provide a spectrum of care that ranges from making phone calls to doctors and pharmacists to a daily routine that can include hands-on services such as cooking, cleaning, bathing and administering medications. But although many of these caregivers consider this noble act fulfilling and satisfying, a large segment of this dedicated population experiences reduced happiness, diminished engagement in daily activities, exacerbated health issues and a nonexistent work-life balance. In this article, we explore the cost of caregiving and the complications of the caregiver role.
Caregiving: A Closer Look
In providing unpaid care for an acquaintance, friend or family member, caregivers often sacrifice considerable time and money. This personal sacrifice can create a great deal of stress2 for many caregivers, sometimes leading them to neglect their own health and wellness. Yet caregivers are often at risk for both mental and physical health problems as they cope with the problems of others.3
As the population in need of health-related care grows, the demand for caregivers will increase as well. According to the U.S. Department of Health and Human Services’ Administration on Aging, the number of Americans age 65 and older is expected to top 70 million in 2030.4 Because older adults are the demographic group that is most likely to require caregiver services,5 this growing population makes it imperative to consider the dual role that caregivers play in the healthcare system. Caregivers don’t just provide care and support for other patients; often, they are patients themselves, with their own healthcare needs.
To better understand the prevalence of caregiving among our members, and to recognize the special role-related challenges that they may face, Express Scripts conducted a telephone survey of members age 18 to 65 who were taking at least one prescription drug regularly for a long-term or chronic health condition. The 12,005 members who participated in the survey were questioned about their general health, well-being and medication-taking behavior. They were also asked: “In the past month, have you provided unpaid care to an adult relative or friend to help them take care of themselves?” The survey revealed that 34.6% of respondents had provided such care during the previous month. The amount of time spent providing care was not taken into consideration.
On average, caregivers were 52 years old, and almost two-thirds reported providing care for a parent, sibling, other relative or friend ― rather than to a spouse or an adult child ― in the month prior to the survey. Further, caregivers were more likely to be female than male (62.9% vs. 37.1%), and about one-third were providing care for more than one person. Providing care for more than one person at a time can intensify stress and increase the amount of resources devoted to caregiving.
The demands of caregiving appeared to change frequently, with caregivers reporting that they provided shifting levels of care at different times. When asked how their caregiving had changed in the past month, 35.6% of Express Scripts caregivers said they had increased the amount of care they were providing; by contrast, 14.9% had decreased the amount of care. Caregiving appeared, in general, to be an ongoing endeavor, with only 8.5% of caregivers saying they were new to the role and an even smaller 3.8% saying they had stopped providing care altogether in the past month.
Providing care over a distance was also something surveyed caregivers had to contend with, as only one in five Express Scripts caregivers resided in the same households as the patients in their care. Among the other 80% of caregivers, more than half (52.0%) lived within 15 miles of the primary recipient of their care, but 27.3% lived more than 15 miles away. Traveling to provide care affects the type of care and degree of supervision that can be provided. If the necessary care is time-sensitive (e.g., providing transportation to physician appointments) or if hands-on interaction is required (e.g., bathing or ensuring that medications are taken as prescribed), long distances involved in caregiving can become problematic. Moreover, already demanding requirements for time and energy are amplified when caregivers themselves have physicians to visit and medications to manage.
Caregiver, Patient or Both?
We also reviewed pharmacy claims to determine which prescription medications caregivers were taking― including those to treat chronic illnesses that are associated with stress, such as high blood pressure/heart disease, high cholesterol, depression and anxiety. Medications for high blood pressure/heart disease topped the list of prescription medications that caregivers were taking, followed by medications for high cholesterol and depression. (See table below.) Although the prevalence of use of drugs to treat the top 10 conditions was somewhat similar among caregivers and noncaregivers (survey respondents who had not provided care in the previous month), utilization of medications in the therapy classes shown in the table below (with the exception of drugs to treat high cholesterol and to treat asthma) was consistently higher among caregivers than noncaregivers. This finding isn’t surprising given the reduced amount of time available to manage one’s own health as a result of this added role.
As further evidence of the stresses associated with the dual caregiver-patient role, the survey found that even after controlling for factors such as age, gender and income, Express Scripts caregivers were more likely to rate themselves as being in poorer health — fair, poor or very poor health as compared to good, very good, or excellent health — than were noncaregivers (14.6.% vs. 12.4%). Not surprisingly, a higher proportion of caregivers also reported being “not very happy” or “not at all happy” than did noncaregivers (5.3% vs. 3.5%).
Being a caregiver also was associated with at least one negative health behavior. The review of pharmacy claims showed that only 63.9% of caregivers were adherent to all of their medications compared to 67.8% of noncaregivers. Particularly important is the finding that 73.2% of noncaregivers took their antidepressant medications as prescribed at least 80% of the time, whereas only 66.6% of caregivers achieved this same rate of compliance. Through noncompliance with their own antidepressant medications, caregivers may affect their own health as well as their ability to provide quality, reliable care to those for whom they are caring.
The Future: A Simpler Life for Caregivers
Those receiving the care think of caregivers as heroes. Others consider them to be the safety net of our healthcare system as estimates project the economic value of their unpaid contributions to be approximately $450 billion,1 a figure that far exceeds national spending for home healthcare and nursing home care.6 In either case, caregivers are vital to providing healthcare in the U.S., and their obligations will increase as the population in need of care grows. Because caregivers’ actions enable individuals to live in community settings rather than institutions, they will become increasingly important as time goes on. After all, if we don’t take care of our caregivers, they will soon be the ones needing care.
As the healthcare industry works toward solutions to simplify the lives of caregivers, we wonder what would happen if we began to look at this role differently. Perhaps technology, actionable data and advanced screening can help us better understand and meet the special needs of this group as they have in other areas of our industry. Express Scripts is committed to making this critical role easier.
Source: Express Scripts Drug Trend Report www.drugtrendreport.com<http://www.drugtrendreport.com
Category: Articles, Senior Health
