Emerging research suggests that being a caregiver to an individual with cardiovascular disease can increase the caregiver’s risk of cardiovascular disease. In response, a new Canadian study investigated a proof-of-concept couples-based intervention that holds promise for reducing caregiver stress.
Nearly half of Canadians have been in caregiving roles to family and friends, with similar figures in the United States and Europe. A caregiver is broadly defined as someone who provides informal or unpaid work to a family member or friend with a chronic condition or disability.
Caregivers provide crucial support to sick family members or friends and are rarely recognized or paid for their efforts. About 40 per cent of caregivers, of whom more than half are women, report high psychological, emotional, physical, social, and financial stresses imposed by the caregiving role.
These factors can contribute to a higher risk of CVD among caregivers themselves. However, despite an appreciation of these issues, few approaches have been effective in reducing caregiver stress.
This need is expected to increase because pressures on “cardiac” caregivers are projected to rise in the next decade as the population ages, length of hospital stays decline, and CVD and associated risk factors continue to increase.
In the new proof-of-concept studies, investigators discovered caregiver stress can be reduced. Findings are reported in the Canadian Journal of Cardiology, with future studies planned to evaluate the impact of couples-based intervention on both caregivers’ and patients’ cardiovascular health.
“It is abundantly clear that caregivers need to be better supported!” said lead investigator Heather Tulloch, Ph.D., University of Ottawa Heart Institute (UOHI). First author, Karen Bouchard, Ph.D., postdoctoral fellow in behavioral medicine at UOHI added, “Caregivers are critical for patients’ cardiovascular health management and are an invaluable healthcare resource, contributing enormously to the Canadian healthcare system. Individuals who care for their partners may experience additional cardiovascular risk, a risk that should be recognized and to which we should respond.”
In this narrative review, investigators look at evidence from the fields of health psychology and relationship science and highlight the direct (e.g., physiological) and indirect (e.g., behavioral, emotional) factors that link caregiver distress with caregivers’ own cardiovascular risk.
Researchers discovered caregivers are more likely to continue a host of unhealthy health behaviors such as smoking, and consume a diet high in saturated fat intake leading to greater body mass indexes. Caregivers are less likely to be physically active than individuals who provide no or low levels of care and they spend less time engaging in self-care activities and report poor preventive health behaviors. Less or disordered sleep is often reported and they demonstrate poor adherence to medication.
Spousal caregivers have higher levels of depressive symptoms, physical and financial burden, relationship strain, and lower levels of positive psychological wellbeing compared to adult children caregivers, for example.
The researchers report that the risk of hypertension and metabolic syndrome may be directly related to high-intensity caregiving, defined as providing more than 14 hours of caregiving per week over two consecutive years. They also report findings that estimate the economic contribution of caregivers’ unpaid labor to be $26 billion annually in Canada, which is projected to increase to $128 billion by 2035 (likely translating to over a trillion dollars each in the USA and Europe).
The investigators contend that the cardiovascular health of both patient and caregiver could be improved by enhancing the quality of the patient-caregiver relationship. They describe a proof of concept testing of Healing Hearts Together, a relationship-enhancement and educational program for patients and partners.
Based on attachment theory, which states that close emotional bonds are essential when faced with a threat such as a cardiac event, the program guides couples through conversations in which they review information on heart health and attachment.
Couples are asked to share their unique experiences with heart disease with partners and peers, and learn to clearly communicate their need for connection and reassurance.
This connection enhances couple satisfaction and problem solving. Participants reported improvements in relationship quality, mental health, and select quality of life measures. A controlled evaluation of the impact of the program on cardiovascular risk factors is underway.
“The aim of Healing Hearts Together is to increase emotional accessibility and responsiveness in couples facing CVD,” explained Tulloch.
“Taken together, couples-based interventions in a cardiac rehabilitation setting may be a timely and appropriate approach to reduce caregiver distress and enhance caregivers’ comprehensive health outcomes. There is an emerging opportunity to care for those who care for their partners and enhance the health of both. It is important that healthcare professionals recognize the burden of caregiving and act sensitively and strategically to address these challenges.”