BY CINDY BORGMEYER
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"It's a family affair," Sly and the Family Stone sang in the group's 1971 hit. For more than 22.4 million Americans, providing day-to-day care for an older loved one is often just that -- a family affair.
According to Administration on Aging statistics, it's spouses, adult children, other relatives and friends who provide the yeoman's share of informal, unpaid but keenly needed care for older patients in the community -- care worth about $257 billion each year.
Those are some of the numbers. To find the faces, family physicians may have to do some digging, says FP Susan Parks, M.D., of Philadelphia.
In her experience with patients, she explains, "You have to discover that they're caregivers; they're not going to necessarily offer that information to you. Exploring the social history and finding out that they're in that role are important things for you to do as a family doc."
Parks is clinical assistant professor of family medicine and director of the geriatrics fellowship program at Thomas Jefferson University in Philadelphia. She's also medical director for Chandler Hall, an assisted-living and skilled nursing facility in Newton, Pa., and sees elderly outpatients in her practice at the Philadelphia Senior Center.
Specific roles, challenges
Once you know a patient is a caregiver, Parks says, "You have to find out what type of caregiving role it is. Is the person's loved one suffering from advanced dementia, or from congestive heart failure? There's a specific set of challenges that go with different types of caregiving."
Dealing with a loved one with Alzheimer's disease, for example, can be especially trying. "People who are caring for someone with dementia go through an ongoing grief process as the dementia advances," she says, particularly as that loved one becomes unable to recognize the caregiver.
It's essential for family physicians to identify that grief and to empathize with what caregivers and their families are going through, Parks says.
Realize, too, that what goes up one day can easily come crashing down the next, advises Gregg Warshaw, M.D., professor of family medicine-geriatrics at the University of Cincinnati and director of the school's Office of Geriatric Medicine.
"These caregivers need help," says Warshaw. "You need to routinely ask them -- on a scale of one to 10, with one being everything's great, and 10 being they're ready to shoot themselves -- how they're handling things at home. When they say, 'I'm an eight,' you have to start looking at what to do."
Know available resources
"You don't have to be a social worker," says Warshaw, "but you have to know social workers. You have to have a phone number on your desk you can give people, and you need to know what resources in your community to steer them to."
At a national town hall meeting held last December to focus attention on the issue, HHS Secretary Tommy Thompson acknowledged the burden of caregiving, saying, "Too often, caregivers put their own health on the back burner." He highlighted federal efforts to ease the strain on caregivers and their families, especially the National Family Caregiver Support Program.
Under the 2-year-old program operated by the Administration on Aging, states partner with local area agencies on aging and faith- and community-based service providers to offer caregivers information and hands-on support, including counseling and respite care.
Families typically come to their family doctors for information on available support resources, Warshaw notes. "Medicare services are mostly related to management of illness, but most communities have some sort of community support systems.
"The role of family doctors is to help make those connections."
To reach writer Cindy Borgmeyer, e-mail cborgmey@aafp.org.
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Copyright © 2004 by
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