I am 64 years old and taking care of my 84-year-old mother who suffers from advanced dementia. But the strain is taking its toll on my health. Is my response typical? And is this stress related?

Your Menopause Question: I am 64 years old and taking care of my 84-year-old mother who suffers from advanced dementia. I love my mother and want to do everything I can to help her. But the strain is taking its toll on my health. Is my response typical? And is this stress related?

Our Response: Your question will resonate with many women who find themselves as caregivers to an aging parent, even as they confront their own families’ (and children’s) needs and demands. Fortunately, our understanding of stress has come a long way since the early 70s when I first entered obstetrics and gynecology. At that time in history, the concept of stress as a biological entity was simply ignored, as were the impact of premenstrual dysphoria and the etiology of menopausal symptoms. But like all aspects of medicine, scientific advances have helped to clarify and address stress, an entity that previously was ill defined.

To understand stress, one must differentiate acute from chronic stress. Acute stress triggers the “fight or flight” response that through the generations has been fundamental for survival. As such, it relies on our innate immunity, the “always present” immunity, and our adaptive immunity, defined as that which is called upon when needed in an emergency. The rewards are evidenced by wound healing, vaccinations, and anti-cancer responses (Dhabhar, 2016).

The story, however, starts with our brain, which determines what is novel and possibly threatening and orchestrates all the behavioral and physiological responses to evaluate what may be helpful versus what may be harmful (Goulin, 2008). This all happens under the umbrella of our circadian clock, or internal rhythm, which is centered in specialized cells within our hypothalamus that influence our sleep and wake cycles as well as metabolic enzyme activity and hormone release (Alberts, 2002). Stress, in turn, invokes changes in our hippocampus and amygdala that impact other systems to determine
whether we will achieve stability, called allostasis, or loss of control, called allostatic load.

But, acute stress also is defined by its duration, often described as lasting for a few hours or days. The protective immune response addresses wound healing, cancer risk, and combats invading pathogens. But like all defensive biologic processes, these responses must be controlled by other types of immune cells and anti-inflammatory cytokines that keep these proinflammatory events from overwhelming the body.

If acute stress is immune protective, why does chronic stress not offer the same protection (Dhabhar, 2014)? Chronic stress is known to suppress our innate and adaptive immune responses. These adverse changes often are connected to our early childhood experiences, which can permanently affect later responses to life stresses. Moreover, lower socioeconomic status (SES) can enhance depression and anxiety. But a common theme in chronic stress is aging. Chronic stress appears to dysregulate our circadian cortisol systems that are critical for activating our immune response. Aging also is linked to an increase in the inflammatory cytokine, IL-6. Too much IL-6 leads to tissue fragility.

Where is the evidence that chronic stress affects the aging of caregivers? Chronic stress has been shown to lead to premature aging with a greater risk of hypertension, diabetes, and infections. These are, in part, linked to decreased cellmediated immune responses and poorer control over latent viruses like herpes simplex 1 and 2, shingles, and varicella
zoster. Some of this risk can be traced to the effects of chronic stress on our chromosomes. Telomeres are made up of nucleoproteins that cap our chromosomes to ensure chromosome stability and regulate cellular replication. Lower telomere activity, which is found with chronic stress, can lead to damaged DNA (Blackburn, 2001, and Gouin, 2008).

Clinically, a four-year study of caregivers of aging parents documented a 63% higher mortality versus the community controls (Gouin, 2008). In another study, only 38% of caregivers had a four-fold increase in response to vaccine versus 66% of the controls group; in those individuals over 70 years old, only 26.3% showed the standard response to vaccine versus 68% of controls (Kiecolt-Glaser, 1996). Numerous animal studies have confirmed these findings (Gouin, 2008).

So is this all bad news? Not really (Hawkins, 2018). The question is, can one control chronic stress created by taking care of one’s aging parent? The answer is favorable.

There are numerous studies on managing chronic stress among cancer survivors (Golubic, 2018). And many of the methods to reduce stress overlap with those of caregivers who are responsible for an aging parent. But one composite study focused specifically on caregivers. The findings of this review by Hawkins identified that problem-focused coping was associated with a better caregiver adjustment than emotional-focused coping. In this review of reports dating from 1996 to 2015, 2,084 participants were included with ages ranging from 17 to 74 with a mean age of 55.7 years. Problem-focused coping was associated with less psychological distress and more positive outcomes. Some took steps to reduce the pressure they were experiencing and communicate more with others in similar situations. Others found exercise or religion to be supportive. Emotional-focused coping was associated with more negative outcomes, poor mental health perception, and more depression.

Coping is a complex, dynamic process that varies from individual to individual but includes cognitive strategies, participation in social and supportive discussion groups, and family support. Life presents us with challenges. How we confront them determines how well we live our lives.

James Woods | 1/13/2022

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