February 15, 1999 Physical and psychological wellbeing is higher for physically disabled patients looked after by caregivers who are effective problem-solvers, say a team of rehabilitation psychologists in Alabama. Their findings may affect support services available for partners of men who are coping with advanced prostate cancer.
     Who prepares the caregiver? Many patients with advanced stages of this disease (which kills 39,000 men a year in the USA) are disabled. Elderly women in the role of unassisted caregiver may find the task isolating, tiring, frustrating, and even frightening.
     In another recent study, Swedish scientists found that for women, social isolation and suppressed anger can lead to illness by reducing the variability in how the heart rate responds to daily stress.
     Disabled patients are best cared for, the Alabama psychologists say, by caregivers who demonstrate social problem-solving abilities, such as handling stress and the demands of home-base care. Again, this may sound obvious, but it will have social impact if insurers hear that well-adjusted caregivers save insurers money by decreasing the health care expense associated with secondary complications.
     Psychologists Timothy R. Elliott, Ph.D., Richard M. Shewchuk, Ph.D., and J. Scott Richards, Ph.D., of the University of Alabama at Birmingham assessed the problem-solving abilities of 66 family member caregivers for patients with spinal cord injuries. A correlation was documented between caregiver characteristics and patient's emotional and physical outcomes. For example, caregivers who tended to solve problems impulsively and carelessly were associated with patients that had difficulty accepting their disability and who were diagnosed with pressure sores when returning for follow-up evaluation.
     According to Dr. Elliott, lead author of the study, "Our research indicates the need to consider psychological intervention for the family members of disabled patients immediately after the onset of the condition. The role of caregiving for persons with permanent and severely disabling conditions comes suddenly and imposes immediate and extreme changes in the caregiver's personal and professional life. As our health care delivery system changes, there is more necessity for family members to take on the caregiving function. If the family members are unable to meet the demands of their new role, the risk of overall health care expense increases."
     The psychologists note that this study "is the first to establish a meaningful link between caregiver problem-solving styles and patient psychological and health outcomes. The implications of these findings for clinical practice and policy formation are considerable."
    The Swedish study looked at 300 women between the ages of 30 and 65 with no previous signs of heart problems. The authors, Myriam Horsten and Kristina Orth-Gomér, found that women who "tested high for social isolation and inability to discuss their anger" had an less flexible heart rate which put them at higher risk for heart disease and "all cause" mortality.

Sources
Caregiver Social Problem-Solving Abilities and Family Member
Adjustment to Recent-Onset Physical Disability, Timothy R. Elliott, Ph. D., Richard M. Schewchuk, Ph.D., and J. Scott Richards, Ph.D., University of Alabama at Birmingham, Rehabilitation Psychology, Vol. 44, No. 1.

Myriam Horsten, Kristina Orth-Gomér, PhD, MD, and colleagues at the Karolinska Institute in Stockholm report in the January-February issue of the Journal of Psychosomatic Medicine.

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