"Planning for Eldercare" Articles

Strategies to Reduce Caregiver Stress

January 10, 2008


Last month, we discussed how chronic stress can be dangerous to the life and health of caregivers. But it isn't just just caregivers who experience chronic stress. The following information and advice can apply to anyone who experiences constant stress over many years.

Over the years, scientists have devised a simple blood test to measure stress. They measure the level of IL-6 (Interleuken 6), one of the immune system proteins produced by the stress response. If a person is experiencing stress, his IL-6 levels are high. This doesn't mean, however, that high levels of IL-6 can't occur in the absence of stress. A heavy workout can cause muscles to produce IL-6, but eventually levels return to normal after exercise ceases. It is thought the IL-6 directs the immune system to repair damaged, overtaxed muscle fibers. Fat cells also produce IL-6, so obese people sustain high levels in their blood. And chronic depression results in long-standing high levels of IL-6.

Sustained high levels of IL-6 can be dangerous, especially in adults age 50 and older, who seem to lack the ability to clear the stress response chemicals as quickly as younger people. For older adults, a constant initiation of the stress response --so-called chronic stress-- impairs the immune system and results in early aging, development of debilitating disease and early death. In this altered state, the body maintains high, potentially harmful levels of IL-6.

Prolonged high levels of IL-6 and the accompanying hormones and immune proteins have been linked to: cardiovascular disease, type II diabetes, frequent viral infections, intestinal, stomach and colon disorders, osteoporosis, periodontal disease, various cancers and auto immune disorders such as lupus, rheumatoid arthritis and multiple sclerosis. Alzheimer's, dementia, nerve damage and mental problems are also linked to high IL-6. Wounds heal slower, vaccinations are less likely to take and recovery from infectious disease is impaired. People who have depression also have high levels of IL-6. Depression in caregivers is about 8 times higher than the non-cargiving population.


Exercise is a powerful and effective way to fight stress. It is recommended you do about 30 minutes of moderate exercise at least 3 days a week. Here are a few reasons why exercise works.

  • Distraction--Exercise provides time away from the stresses of the day.
  • Endorphins--Endorphins are opiate-like chemicals that the body produces naturally during periods of stress or physical exertion to relieve pain. Some evidence suggests that they may be involved in the regulation of mood.
  • Neurotransmitters--During exercise, the body releases higher levels of dopamine. These hormones improve the thought process by facilitating transfer of information between neurons.
  • Self-esteem--Exercise can be a gratifying and fulfilling activity for people. The act of doing something good for self can promote self-esteem.
  • Reduces IL-6--Although muscles temporarily produce IL-6 during heavy workouts, exercise tends to lower levels between workouts.

Do a better job of managing time
In our modern world, one of the most prevalent threats to our well-being is the improper use of time. Not meeting deadlines may cost us a promotion or our career. Failure to make appointments or to meet obligations threatens our self-image or social standing. These and many more time-related threats cause stress. Finding help with managing your time would probably go a long way to relieving your stress.

Develop a support group and maintain social contacts
Participating in a support group can help manage stress. Sharing coping strategies in a group setting lets you help others while helping yourself. It may also help you to realize that some problems have no solutions and that accepting the situation is reality. Social support has a huge impact on reducing stress. Many studies show that social support decreases the stress response hormones in our bodies. In his book, Love and Survival (Harper Perennial, 1998) Dr. Dean Ornish notes that people who have close relationships and a strong sense of connection and community enjoy better health and live longer than those who live in isolation or alienation. People who suffer alone, suffer a lot.

Get adequate sleep
The catch-22 with sleep is that if you are over-stressed, you are likely to experience a disturbed sleeping pattern, and if you are experiencing a disturbed sleeping pattern, you are likely to become over-stressed! Research also shows that abnormal sleep increases levels of IL-6 while normal sleep decreases IL-6.

Sleep isn't a luxury; it's a necessity. Sleep restores the body and mind and helps us maintain our mental and physical health. Studies have shown that people who get seven to eight hours of sleep each night enjoy better health and live longer than people who get less sleep. According to the National Institutes of Health, each year approximately 60 million Americans experience frequent insomnia, the inability to get adequate sleep.

To ensure that you get enough sleep, try some of the following suggestions:

  • Develop a sleep schedule and stick to it. Try to go to bed at the same time each night. Wake up at the same time, too. Avoid sleeping in on weekends; sleeping in will reset your body clock, making it harder to wake up on time on Monday.
  • Get 30 or more minutes of physical activity each day. Avoid working out during the three hours before bedtime. Working out close to bedtime will energize you and may interfere with your sleep.
  • Avoid caffeine, nicotine, and alcohol. These substances rob you of quality sleep. Switch to decaf or herbal tea. Quit smoking. An alcoholic beverage (a "night cap") before bed may make you drowsy but it actually deprives you of deep, restorative sleep.
  • Engage in relaxing activities before bed. Think of it as "wind down" time. Read a book. Soak in a hot tub. Avoid doing physically or mentally stimulating activities such as vigorous housecleaning or intense office work close to bedtime.
  • Leave your troubles outside the bedroom door. Make your bedroom a worry-free zone. If you start to ruminate about problems when you are in bed, try relaxation techniques such as deep breathing or visualization (visualize that you are in a warm, breezy, tropical place, with the sun streaming down on you, nothing but sand, surf, and coconut trees for miles...).
  • Create a cozy sleep environment: wear comfortable pajamas, make the temperature of the room comfortable for you, darken the room, use soft, comfortable bedding that enhances your sleep experience. If your bed is too hard or lumpy or soft, invest in a new one. If noise is an issue, try to get at the root of the problem: ask your snoring partner to seek evaluation and treatment, ask your neighbors to be quieter, etc.

Pursue diversions, hobbies and relaxing activities
Another simple way to reduce stress is to distract yourself -- go to a movie, play a sport, immerse yourself in a hobby, listen to some favorite music or take a walk. It cannot be emphasized enough how important it is as a caregiver you spend some quality time alone every week, doing exactly what it is you like to do.

Try taking anti-depressants and anti-anxiety medications
Dr. Kiecolt-Glaser points out that anti-depressants lower IL-6 levels in chronically depressed patients, so they might be useful. She also said there have been suggestions that cholesterol-lowering statins might reduce IL-6, because they seem to reduce inflammation.


Being overweight (eating too much)
Many people react to stress by eating. Eating too much for a long period causes obesity. This causes your heart and lungs to work harder, overloads your organs and reduces stamina. Studies show that fat cells excrete IL-6 and that overweight people have high levels of IL-6 in their blood. This in turn leads to the IL-6-associated illnesses such as heart disease, immune disorders and diabetes.

Not eating properly
Some people react to stress and stress-induced depression by not eating or eating poorly. If you eat a good, well-balanced diet, your body will be receiving all the nutrients it requires to function properly. On the other hand, if you are eating an unbalanced diet or not eating enough you may be stressing your body and contributing to stress-related complications by depriving yourself of essential nutrients.

Coffee, tea, caffeine soft drinks and chocolate
Caffeine is a stimulant. One of the reasons you probably use it is to raise your level of activity. This chemical actually enhances the stress response and thus increases your existing stress. Small quantities probably do little harm but large quantities over a long period produce excessive stress and lead to many of the physical ailments attributed to chronic stress. Too much caffeine can be dangerous. If you are drinking many cups of caffeine products a day, then you may find you can reduce a lot of stress and save your health by switching to caffeine-free products for a portion of your daily intake.

Some people react to stress by imbibing in alcohol. In small amounts, spirits may help you relax. In larger amounts alcohol may increase stress as it disrupts sleep. Over the long-term, alcohol will damage your body. Alcohol is also a depressant. If you're prone to depression, alcohol will only make it worse. Studies show that depressed people have eight times the level of IL-6 as compared to the general population. As we have seen, high, prolonged levels of IL-6 are a marker for debilitating illness and early death.

In the short-term tobacco use seems to relax people but the toxic effects of nicotine raise the heart rate and enhance the stress response. If you smoke, try taking your pulse before and after a cigarette, and notice the difference. After the initial period of giving up smoking, most ex-smokers report feeling much more calm.

Sugar and refined flour
Sugar can be a stimulant for people experiencing stress and stress-induced depression. Sugar-rich foods (the starch in refined flour is also a form of sugar) can raise your energy level in the short-term. The problem is your body copes with high levels of sugar by secreting large amounts of insulin, which in turn, quickly reduces the excess amount of sugar in your blood stream often causing blood sugar levels to swing too low.

These up and down spikes in blood sugar can cause agitation, mood swings, irritability and fatigue, which in turn can contribute to the creation of additional stress. The ups and downs of sugar spikes also contribute to depression. And of course, excess sugar is readily converted to body fat thus causing obesity. Consuming sugar in the form of complex carbohydrates--whole grains, fruits, vegetables and tubers--forces the digestive tract to release blood sugar more slowly and keeps insulin and blood sugar levels more normal. Avoid fruit drinks, sugar drinks, candy, pastas, white bread and pastries.

Nutritional supplements
There are thousands of supplement suppliers and scores of books that claim success with managing stress by using herbs, herbal extracts or synthesized biochemicals. These compounds often come with the claim of enhancing mood or strengthening the immune system. Since there are so many different competing claims, you must decide for yourself which supplements help and which don't.


Music therapy
Listening to music does wonders to alleviate stress. Choosing what will work for any individual is difficult; most people will choose something they 'like' instead of what might be beneficial. In doing extensive research on what any given piece of music produces as a physiological response, many unexpected things were found. Many of the so-called Meditation and Relaxation recordings actually produce adverse EEG patterns in the brain--just as bad as Hard Rock and Heavy Metal. The most profound finding: Any music performed live and even at moderately loud volumes even if it is somewhat discordant has a very a beneficial response.

Laughter therapy
Numerous studies show that laughter has the uncanny ability to wipe out stress. Here are some suggestions for caregivers:

  • Look up jokes on the internet.
  • Try to see the humor in being a caregiver.
  • Write on a card "Have you laughed with your care-receiver today?" and place it in a conspicuous place in the bathroom or kitchen.
  • Read funny books or jokes, listen to funny tapes or watch humorous movies or videos that make you laugh.
  • Share something humorous with your care-receiver, a friend, or relative.
  • Attend social groups where there is a lot of comeraderie, joy and fun.
  • Be aware of how often you smile; it takes fewer muscles to smile than to frown.
  • If you find that you are feeling hopeless, and humor or laughter is not affording you the up-lift you want. contact a counselor. And remember, laughter is the best medicine. Try it, you'll like it!

Laughter clubs
There is no medicine like laughter therapy. After 15 minutes of laughter, in the morning, at a local club, stress is relieved and you will continue to be able to handle new pressure throughout the day. Laughter has benefited many people who were on heavy tranquilizers and sleeping pills. Now they are getting better sleep and their depression is reduced. Under the Laughter Club concept, people laugh in a group without the help of any jokes. To make it more spontaneous and keep the sessions interesting and avoid boredom, laughter techniques need to be stimulating. That's the job of the club Certified Laughter Leader. These clubs are popular in India and England and are quickly catching on in the U.S. Just for laughs, you may want to start a local chapter.

If you have ten free minutes a day, you can reduce stress, improve insomnia, lessen anxiety and depression, and decrease your chances of developing cardiovascular disease. Sound too good to be true? In fact, the meditative technique known as the "relaxation response" was described a quarter century ago by Harvard physician Herbert Benson, M.D. and has been scientifically proven not only to reduce stress and anxiety but also to improve symptoms of cancer, AIDS, and other conditions.

Just what is the relaxation response? Simply put, it is the opposite of the "adrenaline rush" we associate with stress and anxiety. Physiologically, our bodies respond to perceived threatening situations with an increased release of the hormones epinephrine and norepinephrine, leading to increased heart rate, increased blood pressure, accelerated breathing rate and increased blood flow to the muscles. Because these reactions prepare our bodies to flee the situation or to fight, this reaction has been termed the "fight-or-flight" response. The relaxation response described by Dr. Benson and his colleagues is a state in which our bodies undergo an opposite reaction - leading to decreased breathing rate, heart rate, blood pressure, and metabolism.

Almost anyone can learn to elicit the relaxation response, and no special equipment is necessary. The relaxation response technique consists of the repetition of a word, sound, phrase, etc. while sitting quietly with eyes closed. Intruding thoughts are dismissed by passively returning to the repetition. This should be practiced for 10-20 minutes a day in a quiet environment, free of distractions. A seated position is recommended to avoid falling asleep, and you may open your eyes to check the time but do not set an alarm. Don't feel discouraged in the beginning if it is difficult to banish intruding thoughts or worries; this technique requires practice. With consistency and time the relaxation response will occur effortlessly and smoothly.

For maximum benefits you should schedule time to practice the relaxation response into your daily routine. Many people find it helpful to practice this technique at approximately the same time each day; for example, upon returning home after a busy work day it may ease your transition to a relaxed and enjoyable evening.

Another technique is practicing what the Buddhists call 'mindfulness'. At various times of the day try to focus on your breathing. Notice how the air feels cool when you inhale, and then feels warm when you exhale.

You can do this while you are doing the washing up, making the beds, waiting at a red light, or even standing in a post office queue, etc. The instant benefit from this is that it brings you immediately to the present moment. It is also very effective if done during or before an important meeting, an exam, or even while sitting in the dentist's chair. As you breathe out, you will start to feel your body relax, and your mind will become more focused. So each time you feel yourself getting stressed or find that you have unexpected time on your hands, you can do a quick 60 second meditation.

Tai Chi
Tai Chi Ch'aun is a centuries old Chinese system of physical exercise based on the principles of effortless breathing. It can be practiced by an individual, alone, and in a limited space. It requires no equipment, except a loose-fitting garment that permits continuous rhythmic body movements. It can be learned by anyone regardless of age, sex, or athletic ability. Tai Chi emphasizes relaxation, receptivity and inner calm rather than strength. The flowing stretching movements make the body limber, tone up muscles, and help release muscle tension. This is accomplished by practicing movements slowly and evenly in circular patterns. Many people also report it is an excellent and effortless way to lose weight. Videotapes or DVDs are available for practicing this technique.

Yoga is a wonderful way to release stress. Meditation, breathing exercises and sustained poses help you focus on relaxing your mind and body. Once having learned the techniques in a class, it can be done at home. Yoga also helps you develop greater control over your thoughts and worries.

Acupuncture can treat a wide spectrum of ailments since it approaches injury and disease by looking at the underlying cause as well as the symptoms. Since acupuncture treats the root of the problem, it is favored over traditional therapy because with acupuncture symptoms rarely return. Although acupuncture is renowned for its effectiveness in the treatment of pain, such as back pain, frozen shoulders and migraines it is also effective for many other problems such as stress and anxiety

Massage therapy
Massage therapy works to improve an individual's health and well-being through the hands-on manipulation of muscles and other soft tissues of the body. Massage therapy is designed to stretch and loosen muscles, improve blood flow and the movement of lymph throughout the body. It facilitates the removal of metabolic wastes resulting from exercise or inactivity, and increases the flow of oxygen and nutrients to cells and tissue. In addition, massage stimulates the release of endorphins -- the body's natural feel-good chemicals-- into the brain and nervous system. It provides a relaxed state of alertness, reduces mental stress and enhances capacity for calm thinking and creativity. Massage also satisfies the need for caring and nurturing touch, creates a feeling of well-being and reduces anxiety levels.

Aromatherapy is the art and science of using essential oils, extracted from plants, for therapeutic benefit including stress management. It's efficacy is backed up by solid scientific research. Because aromatherapy can be done as a self-help technique, its use can be very beneficial as a stress reducer while you work. Most of the workplace applications are available in hand lotions for easy use in the office. Bergamot and lavender work well for stress and anxiety reduction. Pendants are also an excellent way to utilize aromatherapy oils in public. Nebulizers and misters are used at home. There are hundreds of unique oils and scents and each has its own medicinal or theurapeutic value. Here are some common oils: Anise, Sweet Basil, Bergamot, Cedarwood, Atlas, Blue Chamomile, Cinnamon, Clary Sage, Clove, Cypress, Eucalyptus, Sweet Fennel, Geranium, Grapefruit, Juniperberry, Lavender, Lemon, Sweet Marjoram, Nutmeg, Sweet Orange, Palmerosa, Patchouli, Black Pepper, Peppermint, Pine Needle, Rosemary, Sandalwood, Tea Tree, Vetiver, Yarrow, Helichrysum, Neroli, Grapeseed oil and Ylang Ylang.

Pet therapy
There is a saying that "dog is man's best friend." This is certainly true when it comes to dealing with your body's stress response. Many people feel more relaxed when companion animals are present. Several studies have shown that pets are good for us in numerous ways. For example, petting an animal is known to lower your heart rate, lower your blood pressure and brighten your mood. Another study found that simply watching fish in an aquarium made patients waiting to undergo medical procedures less anxious. In fact,"pet therapy" is frequently used in hospitals and nursing homes to increase socialization and to reduce depression, loneliness, anger, and stress

Secondly, having tender physical contact with your pet is also good for you. Having an animal to hold, cuddle and caress has positive effects on people. Especially those who might have limited means to give or receive physical expressions of affection. Most of us have felt a warm fuzzy feeling inside just by getting your face licked by a puppy. After a hard day at work, this kind of attention can really help you to calm down and relax.

Next, simply talking to your pet can be very therapeutic. People often talk to their pets to share their thoughts, feelings, troubles and worries. Although your pet won't give you any solutions for your problems, the very act of talking about your concerns with a good listener may help you find your own solutions. And you must admit pets are great listeners.

Finally, if you have a dog for a pet, you get to go for a walk at least 3 or four times a day. This affords you the perfect excuse to take time to yourself away from your stressors. These walks give you time to breathe fresh air, join with nature, collect your thoughts, make plans for the day, or just daydream. Also, watching your pet frolic and play can't help but bring a smile to your face and help to dry up your sea of troubles. Furthermore, the light exercise you get from walking your pet helps you to deal with the physical stress reactions you have acquired in the course of your day. Specifically, walking with your dog helps you to burn up the pent up energy your stressors have caused.

Relaxing personal retreats
Take a relaxing, scented bath with candles. Every woman knows this is a sure-fire way to relax, but how many of you take time to do it? For the guys, stay thirty minutes in a hot shower, soak in a hot tub or go to the local sauna. Take a weekend break to a spa, even the guys. Get a facial; it's great guys. Take a weekend trip with your partner or with friends. There are tons of activities you can do to remove yourself from the daily grind, have fun and just relax.

Gardening has an important impact on the health of individuals through direct interaction with plants and the natural environment. Horticulture promotes individual health through exercise, stress reduction, social interaction and mental stimulation. Gardening is recommended by such groups as the American Heart Association as a technique to improve general physical health and thus prevent many diseases. In addition, urban agriculture can plan a role in improved health through access to high quality fresh produce either locally produced or self-produced.

The National Care Planning Council is a nationwide alliance of eldercare experts, advisers and providers who promote and support long term care planning. For more information go to our website at LongTermCarelink.net. Or call (800) 989-8137