February 15, 1999 Physical and psychological wellbeing
is higher for physically disabled patients looked after by caregivers
who are effective problem-solvers, say a team of rehabilitation psychologists
in Alabama. Their findings may affect support services available for
partners of men who are coping with advanced prostate cancer.
Who prepares the caregiver? Many patients
with advanced stages of this disease (which kills 39,000 men a year
in the USA) are disabled. Elderly women in the role of unassisted
caregiver may find the task isolating, tiring, frustrating, and even
In another recent study, Swedish scientists
found that for women, social isolation and suppressed anger can lead
to illness by reducing the variability in how the heart rate responds
to daily stress.
Disabled patients are best cared for,
the Alabama psychologists say, by caregivers who demonstrate social
problem-solving abilities, such as handling stress and the demands
of home-base care. Again, this may sound obvious, but it will have
social impact if insurers hear that well-adjusted caregivers save
insurers money by decreasing the health care expense associated with
Psychologists Timothy R. Elliott, Ph.D.,
Richard M. Shewchuk, Ph.D., and J. Scott Richards, Ph.D., of the University
of Alabama at Birmingham assessed the problem-solving abilities of
66 family member caregivers for patients with spinal cord injuries.
A correlation was documented between caregiver characteristics and
patient's emotional and physical outcomes. For example, caregivers
who tended to solve problems impulsively and carelessly were associated
with patients that had difficulty accepting their disability and who
were diagnosed with pressure sores when returning for follow-up evaluation.
According to Dr. Elliott, lead author
of the study, "Our research indicates the need to consider psychological
intervention for the family members of disabled patients immediately
after the onset of the condition. The role of caregiving for persons
with permanent and severely disabling conditions comes suddenly and
imposes immediate and extreme changes in the caregiver's personal
and professional life. As our health care delivery system changes,
there is more necessity for family members to take on the caregiving
function. If the family members are unable to meet the demands of
their new role, the risk of overall health care expense increases."
The psychologists note that this study
"is the first to establish a meaningful link between caregiver
problem-solving styles and patient psychological and health outcomes.
The implications of these findings for clinical practice and policy
formation are considerable."
The Swedish study looked at 300 women between
the ages of 30 and 65 with no previous signs of heart problems. The
authors, Myriam Horsten and Kristina Orth-Gomér, found that women
who "tested high for social isolation and inability to discuss
their anger" had an less flexible heart rate which put them at
higher risk for heart disease and "all cause" mortality.
Problem-Solving Abilities and Family Member
Adjustment to Recent-Onset Physical Disability, Timothy R.
Elliott, Ph. D., Richard M. Schewchuk, Ph.D., and J. Scott Richards,
Ph.D., University of Alabama at Birmingham, Rehabilitation Psychology,
Vol. 44, No. 1.
Myriam Horsten, Kristina Orth-Gomér, PhD, MD, and colleagues at the
Karolinska Institute in Stockholm report in the January-February issue
of the Journal
of Psychosomatic Medicine.
February 15, 1999
prostate cancer survivor news