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Chronic Stress and Caregivers

Chronic Stress and its Role in Caregiver Stress Syndrome

by Don Drake, Connelly Law Offices, Ltd.

Attorney RJ Connelly III

"At Connelly Law, it's not uncommon for us to see families who have reached a point of frustration and burnout when caring for an elderly family member who may be living at home or in their residence," said professional fiduciary and certified elder law Attorney RJ Connelly III. "We often speak about the psychological effects of caregiver stress syndrome, but there are also significant physiological effects. And some of these can be life-altering and even lead to incapacitation or death."

"Caregivers are usually the last ones to complain about what they feel when caring for a loved one," Attorney RJ Connelly continued. "In most cases, this is because they don't want to burden others or feel guilty about the feelings they are experiencing. This leads to chronic stress, and much like a dripping faucet, each drop at first appears inconsequential, but eventually, the sink will fill and spill over, affecting everything around the sink. Such is chronic stress; those feelings eventually spill over, affecting family, social relationships, finances, and health."

Studies have shown that chronic stress can impact a caregiver's health much more than most realize. These include the following:

  • Eleven percent of caregivers stated that their role has caused their physical health to decline.

  • Forty-five percent of caregivers reported chronic conditions, including heart attacks, heart disease, cancer, diabetes, and arthritis.

  • Caregivers have a twenty-three percent higher level of stress hormones and a fifteen percent lower level of antibody responses than non-caregivers.

  • Ten percent of primary caregivers report that they are under physical stress from the demands of assisting their loved one physically.

  • Women who spend nine or more hours a week caring for a spouse increased their risk of heart disease by one hundred percent.

  • Seventy-two percent of caregivers report not going to the doctor as often as they should have.

  • Fifty-eight percent of caregivers stated that their eating habits are worse than before they assumed this role.

  • Caregivers between the ages of 66 and 96 have a 63% higher mortality rate than non-caregivers of the same age.

Dr. Jeffery Shapiro's Thoughts

On Saturday, April 22, 2023, Dr. Jeffrey Shapiro, Assistant Professor of Internal Medicine and Cardiology at the New York-Presbyterian Hospital/Columbia University and the New York University Langone Medical Center,, appeared with WAEB Radio host Bobby Gunther Walsh and discussed the physiological effects of chronic stress on the body. He pointed out that chronic stress causes high blood pressure, diabetes, coronary artery disease, chronic inflammation of the body, which could lead to arteriosclerosis and cancers, and belly fat because of the cortisol hormone being released into the body.

Chronic stress leads to inflammation

Dr. Shapiro stated that when a person is emotionally or psychologically stressed, the body goes into the fight or flight response, releasing a stress hormone called cortisol. Cortisol suppresses the nonessential functions of the body when an emergency is present, sending glucose to large muscles, like the legs, to boost energy. As this happens, insulin production is inhibited, causing the arteries to narrow, forcing the heart to work harder to push blood through the body.

As this occurs, another hormone called adrenaline is released, increasing the heart rate and respiratory system to get more oxygen into the muscles. The body then produces glycogen, which stores glucose (sugar) to power the muscles should they be needed. Stress also decreases lymphocytes, or white blood cells, needed to fight viruses and other diseases.

As Dr. Shapiro stated, with chronic stress, the body is always ready to "fight or flight", which is a maladaptive response leading to numerous health problems. With excessive amounts of sugar circulating in the body, cortisol begins storing fat for survival; the immune system is not running at optimal levels opening the body to illnesses, and constricted arteries force the heart to work harder, leading to high blood pressure.

If the body were a machine, it would function optimally as this occurs. But even the most well-constructed machines cannot run like this indefinitely without breaking down. Think of an automobile; if one of the engine's parts breaks down and is not fixed, other parts are affected until the motor no longer runs. The same with our bodies.

Inflammation - The Elephant in the Room

According to Dr. Shapiro, inflammation is the body's response to threats, such as bacteria, cancer, a virus, and even those with transplanted organs. When the body is stressed, the immune system sends out chemicals called pro-inflammatory cytokines to attack the invaders.

Research shows that the "pro-inflammatory" cytokines do their job and retreat in a healthy body. But in a body under chronic stress, the inflammatory response becomes habituated, activating multiple mechanisms responsible for disease. The Mayo Clinic reports that long-term activation of the stress response system can lead to an increased risk of many health problems, including:

  • Anxiety

  • Depression

  • Digestive problems

  • Headaches

  • Muscle tension and pain

  • Heart disease, heart attack, high blood pressure, and stroke

  • Sleep problems

  • Weight gain

  • Memory and concentration impairment

Cancer is also affected by chronic inflammation in the body. The Southern Medical Association website reports that Lisa M. Coussens, Ph.D. of the Cancer Research Institute, University of California, San Francisco, describes it this way: "The functional relationship between inflammation and cancer is not new. Although it is now clear that the proliferation of cells alone does not cause cancer, sustained cell proliferation in an environment rich in inflammatory cells, growth factors, activated stroma, and DNA-damage-promoting agents certainly potentiate and/or promote neoplastic risk.

"During tissue injury associated with wounding, cell proliferation is enhanced while the tissue regenerates; proliferation and inflammation subside after the assaulting agent is removed or the repair completed. In contrast, proliferating cells that sustain DNA damage and/or mutagenic assault continue to proliferate in microenvironments rich in inflammatory cells and growth/survival factors that support their growth. In a sense, tumors act as wounds that fail to heal."

"The key concept," she adds, "is that normal inflammation is usually self-limiting; however, dysregulation of any of the converging factors can lead to abnormalities and, ultimately, pathogenesis - this seems to be the case during cancer progression."

Stress Management

"With this information, it's quite clear why caregivers suffer from illnesses at a higher rate than others their age," stated Attorney RJ Connelly. "The key to avoiding this appears to be early recognition of chronic stress, the ability to share what you are feeling with others, and not trying to be everything to everybody."

The Mayo Clinic also recommends these stress management strategies:

  • Eating a healthy diet, exercising regularly, and getting plenty of sleep.

  • Practicing relaxation techniques such as yoga, deep breathing, massage, or meditation.

  • Keep a journal and write about your thoughts or what you're grateful for.

  • Take time for hobbies like reading, listening to music, or watching your favorite show or movie.

  • Fostering healthy friendships and talking with friends and family.

  • Having a sense of humor and finding ways to include humor and laughter in your life, such as watching funny movies or looking at joke websites.

  • Volunteering in your community.

  • Organizing and prioritizing what you need to accomplish at home and work and removing tasks that aren't necessary.

  • Seeking professional counseling can help you develop specific coping strategies to manage stress.

"Avoid unhealthy ways of managing stress, such as using alcohol, tobacco, drugs, or excess food," said Attorney RJ Connelly. "If you're concerned that your use of these products has increased or changed due to stress, talk to your doctor. There is no shame in seeking help when you need it."

Finally, Dr. Shapiro stated that the body needs to increase the consumption of Omega 3 fatty acids, which act as natural anti-inflammatories. He pointed out that since the body does not produce this, it must be gained from outside sources, which include:

  • Fish and other seafood (especially cold-water fatty fish, such as salmon, mackerel, tuna, herring, and sardines).

  • Nuts and seeds (such as flaxseed, chia seeds, and walnuts).

  • Plant oils (such as flaxseed oil, soybean oil, and canola oil).

  • Fortified foods (such as certain brands of eggs, yogurt, juices, milk, soy beverages, and infant formulas).

  • Supplements.

"We are not giving out any medical advice in this blog and suggest that taking any type of supplementation needs to be a decision between you and your doctor," stressed Attorney RJ Connelly. "But one thing is certain, caregiver stress syndrome is real and must be addressed for those exhibiting symptoms given the long-term negative outcomes of chronic stress."

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