Although aging caregivers have the best intentions, and a lifetime of love, the physical condition of an elderly caregiver may play a role in cancer care for a patient

Although aging caregivers have the best intentions, and a lifetime of love, the physical condition of an elderly caregiver may play a role in cancer care for a patient. “The caregiver may affect the quality of care,” says Lodovico Balducci, MD, Chief of Geriatric Oncology at H. Lee Moffitt Cancer Center in Tampa, Florida. “Right now the most common types of caregivers are aging spouses with health problems of their own or a child (more often a daughter) who has to support both his/her own family and the sick parent.” Dr. Balducci says caregivers of older individuals are subjected to decreased survival, increased risk of depression and other diseases, and increased risk of divorce.

Physical and Mental Limitations

If a patient has an elderly caregiver, the health care provider must be very alert to the caregiver limitations because these may impact the patient’s safety, saidBarbara A. Murphy, MD, Professor of Medicine, Director of Pain and Symptom Management, and Program Leader of the Head and Neck Research team at Vanderbilt-Ingram Cancer Center in Nashville, Tennessee.

“For example, an elderly caregiver may have poor eyesight, limiting the ability to administer shots that require the medication to be drawn up and measured in a syringe. Elderly caregivers with arthritis may have trouble with mechanical devices, such as feeding tubes, tracheostomy tubes, and ostomies,” says Dr. Murphy. “Short-term memory declines with age; an aging caregiver may have trouble remembering complex supportive care regimens or tasks. High-functioning caregivers may be able to problem-solve and still provide good supportive care, [but] others may have limited problem-solving capacity and may need additional services and support. The elderly frequently try to hide incapacity. Thus the health care provider must be watchful.”

Depression is also common in the elderly. This may affect the caregiver and the patient. “It may mask itself as a slowing in cognition,” Dr, Murphy says. “Furthermore, it may limit motivation to follow medical recommendations. Treatment with pharmacologic agents remains the standard of care. That being said, one must be careful to monitor for side effects.” Counseling is advocated and has been shown to be effective.

Another distinct issue to consider is frailty, a geriatric syndrome characterized by slow gait, low physical activity, weight loss, fatigue and weakness, says Beatriz Korc-Grodzicki, MD, PhD, Chief of the Geriatrics Service in the Department of Medicine at Memorial Sloan-Kettering Cancer Center in New York. Affecting the patient and their caregiver, it is a form of pre-disability, very prevalent in older adults, and often not recognized. “It increases the vulnerability to worsening balance, falls, and an array of complications that may end in loss of independence, worse quality of life, and institutionalization of the patient,” says Dr. Korc-Grodzicki.

Battling their own health issues 

Now that people are living longer, it’s not uncommon to see the elderly and frail function as caregivers. “Often the older adult/elderly caregiver is simultaneously a patient themselves coping with their own cancer diagnosis or other illness while caring for their partner/spouse/loved one who also has cancer,” says AnnammaAbraham Kaba, LCSW-R, Senior Social Worker at Memorial Sloan-Kettering Cancer Center. “Being a caregiver—and an elderly caregiver—takes a toll on the body; therefore, [these individuals] may be prone to injuries, fatigue, and weakness than their counterparts.”

Another variable may be the impact on a patient’s care if the caregiver is hospitalized. “Often, caregivers who are told they need another level of care become noncompliant or reluctant to accept the medical team’s recommendations (ie, rehab or nursing home) despite it being unsafe medically to return home if they are hospitalized,” Kaba says.

Support

Caregiving, even for healthy and able-bodied adults, takes a toll on health and well-being. When the caregiver is elderly and has physical and/or mental health implications, the situation can become unsafe. Many cancer centers have social workers who can provide resources or support to assist. Support groups can also provide a forum of other individuals with experience or who are in a similar situation to act as a sounding board. A support system of family and friends who may be able to provide respite care may also be of benefit. Senior service organizations, retirement communities, the local Office on Aging, and other community outreach centers may have caregiver services in the community. Furthermore, community transportation services are often available for rides to medical appointments, treatment appointments, adult day care, or other activities. Some are offered free or on a sliding-scale.

Helpful Web sites

• http://www.aoa.gov/AoA_programs/HCLTC/Caregiver/index.aspx
• http://www.cdc.gov/aging/caregiving/