Nursing News:
Caregivers at higher risk of heart attack

The stress of taking care of a sick spouse is literally heartbreaking, raising the risk of cardiovascular disease and death, according to two studies published February, 2003.
In the journal Psychosomatic Medicine, Dr. Igor Grant and co-authors report those who take care of spouses with Alzheimer's disease experience potentially damaging biological changes in their circulatory system. Changes to their blood molecules means their blood becomes stickier. That ³hypercoagulable state² puts them at increased risk of stroke and heart attacks. The study by the University of California (San Diego) researchers was done on 54 spouses of Alzheimer's disease patients.
Grant, a neuropsychiatrist who graduated from the University of British Columbia medical school in the 1960s, said the stress of caring for someone with Alzheimer's is huge because the disease is progressive and caregivers are often older people who are particularly vulnerable.
³As a group, caregivers are more likely to develop hypertension, which is one risk factor for cardiovascular disease, but in this study, we were able to show the effect of the stress on blood clotting factors; the association between caregiver stress and biological markers in the blood which contribute to coronary disease,² he said in an interview. On top of the stress associated with being a caregiver, there are usually other stressors in their lives, including financial and housing issues, he said. ³These caregivers don't live in a bubble; they have lots of other problems so primary care doctors, gerontologists, and others must be tuned in to the stress and help in any way they can to lower it.²
In another study by researchers at Boston's Brigham and Women's Hospital and the Harvard School of Public Health, the stress of caregiving was shown to potentially double the risk of heart disease in women who took care of an ill or disabled spouse for nine or more hours a week.
The study, published in the American Journal of Preventive Medicine, was conducted on 54,412 women from the Nurses' Health Study, an ongoing study of a group of nurses in 11 U.S. states. The women were 46 to 71 years old and did not have coronary disease before the study baseline. Information on caregiving responsibilities was collected in 1992 and the women were re-questioned four years later. During the four years of follow-up, there were 321 cases of cardiovascular disease (including 231 nonfatal heart attacks and 90 heart disease deaths).
Those who were caregivers were twice as likely to suffer from heart disease compared to women who were not caregivers. Sunmin Lee, a Brigham and Women's social epidemiologist, said in an interview the caregiving burden creates an enormous amount of ³wear and tear² on the cardiovascular system. The study was done on female caregivers, but Lee said she expects male caregivers would face the same increased risk.
The study also found that caregiving for a disabled or ill parent, or another relative, was not as hazardous as caring for an ill spouse.
³This difference in heart disease risk probably reflects the intensity of commitment involved in caring for a spouse compared to caring for other relatives,² she said. The burden of caring for a parent is often shared amongst siblings or others, whereas spouses are often the main caregivers for each other, added Lee. Like the California researchers, Lee's group found that caregivers tend to be coping with more than just the illness of a loved one; they also have financial worries due to medical expenses and lost income. Faced with such stress, caregivers subjugate their own needs and abandon self care.
³It is likely that caregivers alter their normal patterns of eating, exercising and socializing in response to the stress and time commitment associated with their role,² she said, adding that in other studies, caregiving has also been linked to depression and poorer immune function.
The findings in both studies touched a nerve with Vancouver, Canada resident Marg Morrow whose father, Tom Meglaughlin, had a massive heart attack after caring for his wife, Yvonne, for 11 years at home.
Before his caregiving responsibilities, Meglaughlin had no health problems, but ³the stress of taking care of my mom definitely did my dad in,² says Morrow, a Lion's Gate Hospital emergency department clerk/coordinator. Morrow's mother was diagnosed with Alzheimer's disease at the age of 65. She died at 80, two years after her husband died at the age of 76.
³It killed my dad to watch my mom disintegrate before his eyes; it literally broke his heart. He cared for her at home through all the stages of the disease ­ the agitation, the paranoia, the anxious and argumentative stages.²