Family Stress at the Time of a Geropsychiatric Hospitalization

Abstract

The intensity and sources of stress experienced by family members of elderly psychiatric patients were examined. Family members were distressed at a rate similar to reports of other points of caregiving, except males who reported particularly high levels of caregiving burden. Family members' distress was more strongly related to general life event stress than to patient-related burden although many of their life stressors were likely secondary to the caregiving role. Distress was also affected by characteristics of the family structure such as clarity in decision-making roles and family support. Key Words: aging family, caregiving, geriatric hospitalization, stress. Stephen J. Owens and Sara Honn Qualls** The admission of an older adult into an inpatient psychiatric unit marks a crisis point for the patient, the individuals who were previously providing care to that patient, and potentially for the entire family. Given that psychiatric hospitalizations are both unusual and often dramatic events, family members, particularly those involved in making caregiving decisions, are likely to be stressed at the time an older family member is admitted to a geropsychiatric unit. It is well established that families are extensively involved in the lives of older adults, especially during times of illness (Horowitz, 1985; Shanas, 1979). Approximately 80% of ill and frail older adults receive care from members of their family (Brody, 1985). An acute illness episode or a disruption in functioning affects family members who provide care or assist with decisions. Whether family members are providing daily care, or less formal assistance to the older adult, a geropsychiatric hospitalization will at least cause a change in routine, and may result in family members significantly restructuring roles and responsibilities. Hospitalizations are usually precipitated by severe behavioral problems or deterioration in daily functioning, either of which is likely to be disturbing to family members, regardless of the family member's role. In addition, either of these events would likely pull the family into the role of either decision-maker or caregiver, both of which are potentially stressful. If this reasoning is correct, family members should report being highly distressed at the time their elderly relative is admitted. The purpose of this paper was to describe the psychiatric symptoms, burden, and life stress that is reported by family members of geropsychiatric inpatients. In addition, answers to the following questions were investigated. Is there a relationship between either burden or life stress and psychiatric symptoms? If such relationships exist, does burden or life stress have more negative psychological consequences for family members? Which family characteristics are significantly correlated with burden and life stress? Caregiver Distress Family members who are responsible for caring for an ill or frail older adult often experience distress. A commonly reported negative consequence for caregivers has been termed burden, the negative emotional and physical costs of providing health care to a family member (Zarit, Reever, & Bach-Peterson, 1980). The source of burden in the caregiving role may result from reduced personal time, role strain, disrupted household routines, the deteriorating physical and mental health of the care provider (Noelker & Wallace, 1985), decreased social activities (Thompson, Futterman, Gallagher-Thompson, Rose, & Lovett, 1993), and behavioral problems exhibited by the care-receiver (Kosberg, Cairl, & Keller, 1990; Pearson, Verma, & Nellett, 1988). Family members who provide care and assistance to older adults are exposed to burden and associated distress throughout the time they function as care providers. However, it is likely that this burden and distress will be elevated during the crisis surrounding the admission to a psychiatric unit because admission is often precipitated by behavior problems. …