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Caregivers face challenges with "silver tsunami"
By KEVIN FRYLING
Reporter Staff Writer
With the United States poised to experience an unprecedented surge in the number of older Americans, a UB faculty member with 20 years experience as a social worker discussed the impact of this "silver tsunami" on families and friends called to serve as caregivers during last week's UBThisSummer lecture.
The explosion predicted in "older old"—individuals 85 and older—is due to the nation's increased life expectancy, decrease in birth rates and aging "Baby Boomer" generation, Deborah Waldrop, associate professor in the School of Social Work, told those attending the lecture, "From Caring to Caregiving: How Families Cope with Chronic Illness," on Aug. 10.
"When you put all that together, you get a great increase," she said.
The U.S. Census projects that the number of Americans age 65 and older will more than double in the next 40 years, to nearly 90 million. An even more rapid increase is predicted in the number of people age 85 and older—more than 20 million in 2050.
The situation is unprecedented, since advances in medicine and public health are prompting the population increase, said Waldrop. Life expectancy is at an all-time high—77.3 years in the U.S.—because chronic illnesses, not infectious diseases, now are the leading cause of death.
Two-thirds of Medicaid dollars currently are spent on people with five or more chronic conditions, she said.
Moreover, she pointed out current statistics reveal most people who require care receive it from "informal caregivers," such as their children, grandchildren, a spouse or neighbor. Only 8 percent of care takes place in nursing homes.
"Nowadays, caregiving lasts almost as long as parenting," she said.
She added there has been an upward trend in "caregiving systems" in which professional or "formal" and informal caregivers work together to provide assistance to seniors.
"Caregiving systems are really a new concept that has emerged in the field," she said.
Informal care can range from household chores, personal finance management and meal preparation to transportation and medical care. In fact, she said 50 percent of informal caregivers administer medication.
More than half of the time, the role of caregiver falls upon whoever resides closest to the care recipient, said Waldrop.
About 56 percent of caregivers are women, she added. But, she noted, the other 44 percent are men and the gap continues to shrink as attitudes change and more people need care.
"We will all be, at some point, caregivers," she said.
In her research, Waldrop focuses on the challenges that nonprofessionals face as informal caregivers. A few major obstacles include not having enough time or money, geographic separation and emotional strain.
Caregiver situations are a natural development in many relationships, but she said individuals fall into the role for other reasons, such as when formal care is beyond financial reach. About 40 percent of caregivers point to finances as contributing to at least part of the equation, said Waldrop.
"Caregiver families tend to have lower incomes," she added, noting that household incomes of $30,000 or less are more common among caregiver families—43 percent—compared to all U.S. families—35 percent.
She said that is because people often reduce their working hours, or quit their jobs altogether, to meet caregiving responsibilities. Some push their jobs into nights and weekends, while continuing to work full time. "It's like going home to a second job," she said of caregiving.
The availability of child care for working parents skyrocketed during the past decade, said Waldrop, and she predicted a similar increase in the current trend toward senior day programs.
She added that 7 million Americans provide long-distance caregiving, noting the average distance between these caregivers and their care recipients is four hours.
Caregivers also frequently neglect their own needs to provide for others, she said, citing research in which caregivers self-reported their health—48 percent claimed "excellent" or "good" health, but 32 percent acknowledged "serious problems."
Interviews with people involved in the health care and social work systems are an important method Waldrop employs to pinpoint issues that cause frustration, thus requiring reform.
She said far more information should pass between informal and formal caregivers than does within current structure.
"Families want straightforward and honest discussion," said Waldrop.
"People need time to make those major choices and decisions in their lives," she added. Informal caregivers asked to provide answers about issues of care for loved ones often fail to receive enough resources for an informed decision, she said, noting it is common for people to turn to friends, libraries and the Internet for more information.
Of 60 informal caregivers Waldrop interviewed, only eight met with a social worker for more than a brief session after a patient's discharge from a medical facility, and only three participated in support groups for caregivers. Those who did not cited time as the main reason for not doing so.
Informal caregivers she interviewed also encouraged one another to be their own advocates—don't wait for someone to return a message, but "call and call again," said Waldrop. In addition, the caregivers noted that communication is important within families. Honest "kitchen-table discussions" are means to coordinate care and plan for situations down the line, she said.
But, she concluded, despite the problems, no one should forget there are significant rewards, as well as burdens, involved with caregiving. She said there is great satisfaction and personal growth that comes with the experience, as well as a powerful bond that can form between parents and children who provide care.