ManagedCareSupplement3

GENERATIONS – Journal of the American Society on Aging

2011). Consequently, Gary, a man in his 70s, can expect to spend about a year and four months of his remaining life providing care (Schulz et al., 2016). And while breakthroughs in medical knowl- edge, interventions, and technologies have served to extend life and improve its quality for individuals with an illness or disability, these changes also have meant that caregivers are now managing more complex types of care—often for someone having multiple conditions. Wound care and medication management are just some of the tasks family members take on. Many care- givers express discomfort with performing these tasks, and receive little training (Reinhard, Levine, and Samis, 2012). The demographics of the caregiver popula- tion also are changing. Today, one in four care- givers are Millennials (Flinn, 2018). While women remain disproportionately represented among caregivers—approximately 60 percent of caregivers are women (National Alliance for Caregiving [NAC] and AARP Public Policy Insti- tute [AARP], 2015)—this difference is less pro- nounced among Millennial caregivers. Also, younger cohorts of caregivers are more racially, ethnically, and culturally diverse than previous cohorts. And we are seeing more families bal- ancing care for children with care for an older relative, and many family members are living far away from older adults who need care. Health- care providers need to be aware of family mem- bers’ limitations when being asked to provide care and support services. Even when care is given from a place of love or compassion, caregiving takes a toll. Caregivers are at heightened risk of musculoskeletal injury compared to non-caregivers, due to perform- ing tasks such as lifting the care recipient (Dar- ragh et al., 2015). Spousal caregivers are prone to declines in cardiovascular outcomes (Monin et al., 2010). In particular, caregivers are at risk of psychological morbidities, including depression (Pinquart and Sörensen, 2003 ). Poor health among caregivers is attributed to both damaging health

behaviors (e.g., poor nutrition) and the impacts of caregiver burden and stress (Adelman et al., 2014; Hoffman, Lee, and Mendez-Luck, 2012). Given the growing number of older adults who will need care, and the restrictions on fam- ilies’ ability to provide care, it is projected that there will be fewer family caregivers to sup- port the growing aging population (Schulz et al., 2016). Thus it is all the more critical to support families as they provide care and to reduce risks to their health and well-being. The negative consequences associated with care- giving are not inevitable, and there are programs whereby healthcare providers can refer caregiv- ers to supports. Several interventions have been shown to reduce depression and other mental health morbidities that are common among care- givers (Schulz et al., 2016). Although effect sizes for these interventions are small to moderate, they are comparable to Food and Drug Admin- istration–approved prescription medications for depression (Gitlin et al., 2015). Particularly promising are interventions administered at the time of diagnosis or during a care transition, when caregivers are adjusting to new demands. The National Family Caregiver Support Program (NFCSP) also funds community-based organiza- tions to provide information and referrals, assess client needs, provide education and training, distribute respite care, and provide counseling services to caregivers. For Gary, NFCSP-funded programming could identify respite care options so he could take a break from caregiving and see his friends. Community-based programs also can serve as “eyes and ears” for healthcare providers. Family caregivers make it possible for people with an illness or disability to remain members of their communities. Community-Based Supports for Family Caregivers

44 | Spring 2019

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