Caregiving in Geriatric Psychiatry

Abstract

Received February 20, 2004; revised February 26, 2004; accepted March 2, 2004. From the University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, PA. Send correspondence to Richard Schultz, Ph.D., Professor of Psychiatry, Director, University Center for Social and Urban Research, University of Pittsburgh, 121 University Place, 6th Floor, Pittsburgh, PA 15260. e-mail: schulz @pitt.edu 2004 American Association for Geriatric Psychiatry Research on family caregiving has moved from relative obscurity to prominence in less than a decade. Studies on caregiving are regularly featured in the major medical journals in the United States; the majority of professional medical societies have official position statements on caregiving; and policy debates on caregiving are commonplace at all levels of government. A search of the phrase “family caregiving” on the worldwide web yields more than 150,000 entries, perhaps the most telling piece of evidence that caregiving, as a topic, has arrived. The reasons for the almost-explosive growth of caregiving research are multiple. First and foremost, caregiving has emerged as a critically important public health issue. According to a recent report to Congress, caregiving is relevant to more than 22 million persons, caring for 14 million elderly Americans, and, by the year 2050, these numbers will increase to 40 million caregivers, caring for 28 million older persons. As noted by Schulz and Martire in their overview of the caregiving literature, caregivers perform an important service for their relatives and the broader society, but they do so at considerable cost to their own well-being. There is strong consensus that caring for an elderly individual with a disability is burdensome and stressful to many family members and contributes to psychiatric morbidity in the form of increased depression and anxiety. Researchers have also suggested that the combination of loss, prolonged distress, physical demands of caregiving, and biological vulnerabilities of older caregivers may compromise their own physiological functioning and increase their risk for physical health problems. Inasmuch as depression and anxiety have become the bellwether markers for the burdens of caregiving, it is particularly appropriate that this topic be addressed within the pages of The American Journal of Geriatric Psychiatry. The second reason for the strong interest in caregiving research is the breadth of research questions inherent in the caregiving context. In addition to addressing basic questions about the prevalence and health effects of caregiving, researchers have used caregiving as a setting for testing theories of chronic stress exposure, including the search for biological mediators of stress exposure—exploring the role of a wide range of mediators and moderators of response to stress, and for the development of intervention strategies to alleviate burden and reduce the depression associated with caregiving. In short, caregiving provides a rich platform for conducting basic and applied social and behavioral science research across many disciplines. As a result, the scientific literature on caregiving now includes nearly 2,000 published studies, carried out by researchers from all of the social science and many of the health-science disciplines. Despite the rich array of findings currently available, many important questions remain unanswered, as noted by Schulz andMartire in their overview of the caregiving literature.