Psychiatrists Should Expect to See More Caregivers Seeking Treatment

Although there do not seem to be any statistics on how many clinical psychiatrists see Alzheimer's caregivers, the number is probably substantial, Constantine Lyketsos, M.D., chair of psychiatry at Johns Hopkins Bayview Medical Center and a geriatric psychiatrist, estimates. Certainly psychiatrists who see older patients encounter many Alzheimer's caregivers, he said, but also those who see younger patients probably have contact with a number as well “because about 10 percent of people in the current workforce are caregivers of an older parent, typically someone with dementia,” (see MH Stressors Debilitating in Alzheimer's Caregivers).

Furthermore, there are generally two types of situations in which clinical psychiatrists can help Alzheimer's caregivers. One involves a psychiatrist who is treating a patient and can indirectly offer the patient's caregiver support and guidance. The other involves a caregiver who is in psychiatric treatment because of problems related to caregiving.

In the first situation, for example, “the psychiatrist can play a critical role in identifying caregivers at high risk of adverse outcomes by asking a few questions about caregiver depression, safety (for example, does the patient have access to weapons), and access to informational and support resources,” said Richard Schulz, Ph.D., a professor of psychiatry at the University of Pittsburgh and associate director of the university's Institute on Aging.

Peter Rabins, M.D., a professor of psychiatry at Johns Hopkins Medical Institutions and chair of APA's Committee on Long-Term Care of the Elderly, agreed. “I mention support groups as an available resource to every caregiver I see. I would guess that about a quarter try it. For caregivers who have particular psychosocial or financial needs, I try to refer them to specific agencies that I know of. Some people follow through, others don't.”

In the second situation—in which the caregiver seeks psychiatric treatment for himself or herself—“I would try to see exactly what the caregiver is coming in for,” Nhi-Ha Trinh, M.D., a clinical researcher at Massachusetts General Hospital and a member of APA's Committee on Long-Term Care of the Elderly, said. “Is it that they are having trouble coping with the recent diagnosis of Alzheimer's in their loved one? Is it that they are experiencing depression, stress, or burnout from taking care of their loved one? And what steps have they taken to get more support for their caregiving? If they are lucky enough to be in a family where they can share the responsibility, they might try to enlist more family members. Or I might try to give them resources in the community such as the Alzheimer's Association. And then I might sort of troubleshoot with them—has it gotten to the point where they should consider alternate arrangements for caregiving, such as an in-house aide, or having their loved one move to an assisted living or a nursing home?”

All things considered, the mental and physical health of Alzheimer's caregivers will become an issue of greater importance to clinical psychiatrists in the next few years, Rabins predicted. “And for a couple of reasons,” he said. “The number of people with Alzheimer's is increasing dramatically. And the people involved in the care of those individuals are not only spouses of the same generation, but often their children, who more and more are younger and middle-aged individuals who recognize psychiatric treatment as acceptable if they are having problems.” ▪