Mel P. Daly

Weight Change An Indicator of Caregiver Stress

This study evaluated weight change and caregiver stress in 200 informal caregivers to elderly patients discharged from a rehabilitation hospital. Previous laboratory and epidemiologic studies have shown that stress predisposes to weight change. Nineteen percent of the caregivers had gained or lost at least 10 pounds since becoming caregivers. Weight change was significantly associated with higher scores on standardized measures of burden and stress (e.g., Burden Interview, Perceived Stress Scale, Geriatric Depression Scale) and with lower education, poorer self-rated health, more psychotropic medication use, and caring for patients with more ADL limitations who had been hospitalized for stroke or a frail elderly condition. Caregivers to patients with a stroke or frail elderly condition reported 2.8 times more weight change than caregivers to patients with a rehabilitation problem. These results suggest that weight change is a valid indicator of stress in caregivers, and they have public health, clinical, and research applications.

Diagnosis and Management of Alzheimer Disease

Background: Alzheimer disease afflicts millions of older Americans, with an estimated cost to society approaching

Burden among White and Black Caregivers to Elderly Adults

100 million annually. Family physicians will care for an increasing number of patients with Alzheimer disease as well as their caregivers and families. Methods: A comprehensive and systematic review of the literature published between 1985 and 1998 about diagnosing and treating Alzheimer disease was conducted, using “dementia,” “Alzheimers disease,” and “treatment” as search strategy key words. Data and information that reported significant conclusions were critically reviewed. Potentially important new data about new agents that might be of benefit when caring for patients with Alzheimer disease are discussed. Results and Conclusions: The primary goals when treating Alzheimer disease patients are enhancing autonomy and functional abilities and maintaining quality of life for patients and caregivers. In addition to diagnostic and pharmacologic treatment, primary care physicians will be called upon to provide non-pharmacologic support to assist with behavioral, social, and living environment problems faced by these patients and their families. The most common pharmacologic treatment is cholinesterase inhibition. Two cholinesterase inhibitors, tacrine and donepezil, are effective in treating cognitive and global function. Newer cholinesterase inhibitors should soon be available that might offer safety advantages as well as efficacy in treating behavioral and psychiatric symptoms related to Alzheimer disease. Other agents, including vitamin E, nonsteroidal anti-inflammatory drugs, estrogen, and Ginkgo biloba, are under investigation. Nonpharmacologic measures are important components in the management of Alzheimer disease. Support groups can help to diminish behavioral problems, maintain the patients independence, and provide relief for caregivers and families.