Caregivers of patients with dementia are a vulnerable population themselves. They go through various phases of roles, based on the stage of the illness. There is a phase of acquiring the caregiving role, defining the quantum of involvement, and also finally dealing with eventual loss and the re-defining the role once the loss is final. This put the caregivers through a lot of stress, and makes them vulnerable to a host of psychological concerns themselves
Through a series of cases, this article attempts To understand caregiver issues, and find a way to help, as well as shown how a lot of hand-holding at each stage aids the caregiver from reaching burn out and at times depression.
United Nations, Department of Economic and Social Affairs, Population Division. World Population Ageing. New York: United Nations; 2013. pp. 1-2.
Prince, MJ.; Wimo, A.; Guerchet, M., et al. World Alzheimer Report. 2015: the global economic impact of dementia. London: Alzheimer's Disease International; 2015. pp. 10-12.
Ferri CP, Prince M, Brayne C, Brodaty H, Fratiglioni L, Ganguli M, Hall K, Hasegawa K, Hendrie H, Huang Y, et al. Global prevalence of dementia: a Delphi consensus study lancet. 2006 Dec;366(9503):2112-2117.
Archbold PG. Impact of parent-caring on women. Fam Relat 1983 Jan;32(1):39-45.
Aneshensel CS.; Pearlin LI.; Mullan JT., et al. Caregiving. career and stress processes. In: Profiles in caregiving: the unexpected career. 1st ed Waltham.(MA): Academic Press;. 1995. p. 24.
Prince M, The 10/66 Dementia Research Group. Care arrangements for people with dementia in developing countries. Int J Geriatr Psychiatry. 2004 Feb;19(2):170-177.
Brodaty H, Donkin M. Family caregivers. of people. with dementia. Dialogues Clin Neurosci. 2009 Jun;11(2):217-218.
Brodaty H Module. 4—Role of family caregivers. In: Draper B, Brodaty H, Finkel SI, editor The IPA. complete guides. to behavioural. and psychological. symptoms of. dementia— specialists guide. Northfield.(IL): International Psychogeriatric Association; 2015. pp. 4.2-4.12.
Schoenmakers B, Buntinx F, De Lepeleire J. Factors determining the impact of care-giving on caregivers of elderly patients with dementia. A systematic literature review. Maturitas 2010 Jun;66(2):191-200.
Campbell P, Wright J, Oyebode J, Job D, Crome P, Bentham P, Jones L, Lendon C. Determinants of. burden in. those who. care for someone with dementia. Int J Geriatr Psychiatry 2008 Oct;23(10):1078-1085.
Poulshock SW, Deimling GT. Families caring for elders in residence: issues in the measurement of burden. J Gerontol 1984 Mar;39(2):230-239.
Pearlin LI, Mullan JT, Semple SJ, Skaff MM Caregiving. and. the stress process: an overview of concepts and their measures. Gerontologist 1990 Oct;30(5):583-594.
Goode KT, Haley WE, Roth DL, Ford GR. Predicting longitudinal changes in caregiver physical and mental health: a stress process model. Health Psychol. 1998 Mar;17(2):190-198.
Gottlieb BH, Rooney JA. Coping effectiveness: determinants and relevance to the mental health and affect of family caregivers of persons with dementia. Aging Ment. Health. 2004 Jul;8:364-373.
Schoenmakers B, Buntinx F, De Lepeleire. J The. relation. between care giving and the mental health of caregivers of demented relatives: a cross-sectional study. Eur J Gen Pract. 2009;15(2)99-106.
Vedhara K, Cox NK, Wilcock GK, Perks P, Hunt M, Anderson S, Lightman SL, Shanks NM. Chronic stress in elderly carers of. dementia patients and antibody response to influenza vaccination. Lancet. 1999 Feb;353(9153):627-631.
Vitaliano PP, Zhang J, Scanlan JM. Is caregiving hazardous to one's physical health? A meta-analysis. Psychol Bull 2003 Nov;129(6):946-972.
Schulz R, Martire LM. Family caregiving. of persons. with. dementia: prevalence, health effects, and support strategies. Am J Geriatr Psychiatry. 2004 May-Jun;12(3):240-249.
Alzheimer's Association. Alzheimer's disease facts and figures Chicago.(IL): Alzheimer's Association;.2007.
Brodaty H, Hadzi-Pavlovic D. Psychosocial effects on carers. of living with persons with dementia. Aust N Z J Psychiatry 1990 Sep;24(3):351-361.
Leong J, Madjar I, Fiveash B. Needs of family carers of elderly. people with dementia living in the community. Australas J Ageing. 2001 Sep;20(3):133-138.
Access Economics. The dementia epidemic: economic impact. and positive solutions for Australia. Canberra: Alzheimer's Australia; 2003.
Brodaty, H.; Green, A.; Low, LF. Family carers for people with dementia. In: Burns A, O'Brien J, Ames D, editors Dementia. 3rd ed. London: Hodder Arnold; 2005. pp. 117-135.
Boerner K, Schulz R, Horowitz A. Positive aspects. of. caregiving and adaptation to bereavement. Psychol Aging 2004 Dec;19(4):668-675.
Farran CJ. Theoretical perspectives concerning positive aspects of caring for elderly persons with dementia: stress/adaptation and existentialism Gerontologist. 1997 Apr;37(2):250-256.
Brodaty H, Green A, Koschera A. Meta-analysis of psychosocial interventions for caregivers of people with dementia. J Am Geriatr Soc. 2003 May;51(5):657-664.
Pinquart M, Sörensen S. Helping caregivers of persons with. dementia: which interventions work and how large are their effects? Int Psychogeriatr. 2006 Dec;18(4):577-595.
Acton GJ, Kang J. Interventions to reduce the burden of caregiving for an adult with dementia: a meta-analysis. Res Nurs Health. 2001 Oct;24(5):349-360.
Pinquart M, Sörensen S. Helping caregivers of persons with. dementia: which interventions work and how large are their effects? Int Psychogeriatr. 2006 Dec;18(4):577-595.
Robinson JL, Jou H, Spady DW. Accuracy of parents in measuring body temperature with a tympanic thermometer. BMC Fam Pract 2005 Jan;6(1):3.
Gensheimer KF. A public health perspective on child care. Pediatrics 1994 Dec;94(6 Pt 2):1116-1118.
Louhiala PJ, Jaakkola N, Ruotsalainen R, Jaakkola JJ. Form of day care and respiratory infections among Finnish children. Am J Public Health 1995 Aug;85(8 Pt 1):1109-1112.
Wagner JR. A clinical and histological case study using resorbable hydroxylapatite for the repair of osseous defects prior to endosseous implant surgery. J Oral Implantol 1989;15: 186-92.
LeGeros RZ. Calcium phosphates in oral biology and medicine. In: Myers HM (Ed). New York: Karger Press 1991;15.
Fang Y, Agrawal DK, Roy DM. Thermal stability of synthetic hydroxylapatite. In: Brown PW, Constantz B (Eds). Hydroxylapatite and Related Materials. CRC Press: Boca Raton, Fla: 1994:269-82.
Brown WE, Eidelman N, Tomazic B. Octacalcium phosphate as a precursor in biomineral formation. Adv Dent Res 1987;1:306-13.
Urist MR, Dowell TA. The newly deposited mineral in cartilage and bone matrix. Clin Orthopaed Rel Res 1967;50:291-308.
Bonar LC, Roufosse AH, Sabine WK, Grynpas MD, Glimcher MJ. X-ray diffraction studies of the crystallinity of bone mineral in newly synthesized and density fractionated bone. Calcif Tissue Int. 1983;35:202-09.
Roberts JE, Bonar LC, Griffin RG, Glimcher MJ. Characterization of very young mineral phases of bone by solid state phosphorus magic angle sample spinning nuclear magnetic resonance and X-ray diffraction. Calcif Tissue Int 1992;50: 42-48.
Lee DD, Landis WJ, Glimcher MJ. The solid, calcium-phosphate mineral phases in embryonic chick bone characterized by highvoltage electron diffraction. J Bone Min Res 1986;1:425-32.
Roberts WE, Turley PK, Brezniak N, Fielder PJ. Bone physiology and metabolism. Calif Dent Assoc J 1987;15:54-61.
Roberts WE. Bone tissue interface. J Dent Educ 1988;52: 804-09.
Brunski JB. Biomechanical factors affecting the bone-dental implant interface. Clin Mat 1992;10:153-201.
Spivak JM, Ricci JL, Blumenthal NC, Alexander H. A new canine model to evaluate the biological response of intramedullary bone to implant materials and surfaces. J Biomed Mat Res 1990;24:1121-49.
Karande V, Levrant S, Hoxsey R, Rinehart J, Gleicher N. Lysis of intrauterine adhesions using gynecoradiologic techniques. Fertil Steril 1997;68:658-62.
Chen FP, Soong YK, Hui YL. Successful treatment of severe uterine synechiae with transcervical resectoscopy combined with laminaria tent. Hum Reprod 1997;12:943-47.
Protopapas A, Shushan A, Magos A. Myometrial scoring: A new technique for the management of severe Asherman's syndrome. Fertil Steril 1998;69:860-64.
Coccia ME, Becattini C, Bracco GL, Pampaloni F, Bargelli G, Scarselli G. Pressure lavage under ultrasound guidance: A new approach for outpatient treatment of intrauterine adhesions. Fertil Steril 2001;75:601-06.
Coccia ME, Becattini C, Bracco GL, Bargelli G, Scarselli G. Intraoperative ultrasound guidance for operative hysteroscopy: A prospective study. J Reprod Med 2000;45:413-18.
Polishuk WZ, Weinstein D. The Soichet intrauterine device in the treatment of intrauterine adhesions. Acta Eur Fertil 1976;7:215-18.
March CM. Intrauterine adhesions. Obstet Gynecol Clin North Am 1995;22:491-505.
Amer MI, El Nadim A, Hassanein K. The role of intrauterine balloon after operative hysteroscopy in the prevention of intrauterine adhesion: A prospective controlled study. MEFS J 2005;10:125-29.
Amer MI, Abd-El-Maeboud KH. Amnion graft following hysteroscopic lysis of intrauterine adhesions. J Obstet Gynaecol Res 2006;32:559-66.
Burns JW, Skinner K, Colt J, Sheidlin A, Bronson R, Yaacobi Y, Goldberg EP. Prevention of tissue injury and postsurgical adhesions by precoating tissues with hyaluronic acid solutions. J Surg Res 1995;59:644-52.
De Iaco PA, Stefanetti M, Pressato D, Piana S, Dona M, Pavesio A, Bovicelli L. A novel hyaluronan-based gel in laparoscopic adhesion prevention: Preclinical evaluation in an animal model. Fertil Steril 1998;69:318-23.
Tsapanos VS, Stathopoulou LP, Papathanassopoulou VS, Tzingounis VA. The role of Seprafilm bioresorbable membrane in the prevention and therapy of endometrial synechiae. J Biomed Mater Res 2002;63:10-14.
Pace S, Stentella P, Catania R, Palazzetti PL, Frega A. Endoscopic treatment of intrauterine adhesions. Clin Exp Obstet Gynecol 2003;30:26-28.
Katz Z, Ben-Arie A, Lurie S, Manor M, Insler V. Reproductive outcome following hysteroscopic adhesiolysis in Asherman's syndrome. Int J Fertil Menopausal Stud 1996;41:462-65.
Everett C. Incidence and outcome of bleeding before the 20th week of pregnancy: Prospective study fromgeneral practice. BMJ 1997;315:32-34.
Kumari AS, Haq A, Jayasundaram R, Abdel-Wareth LO, Al Haija SA, Alvarez M. Metformin monotherapy in lean women with polycystic ovary syndrome. R & Pro D. Biomed Online 2005;10:100-04.
Crave JC, Fimbel S, Lejeune H, Cugnardey N, Dechaud H, Pugeat M. Effects of diet and metformin administration on sex hormone binding globulin, androgens, and insulin in hirsute and obese women. J Clin Endocrinol Metab 1995;80:2057-62.
Pasquali R, Gambineri A, Biscotti D, Vicennati V, Gagliardi L, Colitta D, Fiorini S, Cognigni GE, Filicori M, Morselli-Labate AM. Effect of long-term treatment with metformin added to hypocaloric diet on body composition, fat distribution, and androgen and insulin levels in abdominally obese women with and without the polycystic ovary syndrome. J Clin Endocrinol Metab 2000;85:2767-74.
Ehrmann DA, Cavaghan MK, Imperial J, Sturis J, Rosenfield RL, Polonsky KS. Effects of metformin on insulin secretion, insulin action, and ovarian steroidogenesis in women with polycystic ovary syndrome. J Clin Endocrinol Metab 1997;82:524-30.
De Leo V, la Marca A, Ditto A, Morgante G, Cianci A. Effects of metformin on gonadotropin-induced ovulation in women with polycystic ovary syndrome. Fertil Steril 1999;72:282-85.
Yarali H, Yildiz B, Demirol A, Zeyneloglu HB, Yigit N, Bukulmez O, Koray Z. Co-administration of metformin during rFSH treatment in patients with clomiphene citrate-resistant polycystic ovarian syndrome: A prospective randomized trial. Hum Reprod 2002;17:289-94.
Palomba S, Falbo A, Orio F (Jr), Manguso F, Russo T, Tolino A, Colao A, Dale B, Zullo F. A randomized controlled trial evaluating metformin pretreatment and coadministration in nonobese insulin-resistant women with polycystic ovary syndrome treated with controlled ovarian hyperstimulation plus timed intercourse or intrauterine insemination. Hum Reprod 2005 Jun 15 (Epub ahead of print).
Stadtmauer LA, Toma SK, Riehl RM, Talbert LM. Metformin treatment of patients with polycystic ovary syndrome undergoing in vitro fertilization improves outcomes and is associated with modulation of the insulin-like growth factors. Fertil Steril 2001;75:505-09.
Stadtmauer LA, Toma SK, Riehl RM, Talbert LM. Impact of metformin therapy on ovarian stimulation and outcome in ‘coasted’ patients with polycystic ovary syndrome undergoing in vitro fertilization. Reprod Biomed Online 2002;5:112-16.
Glueck CJ, Phillips H, Cameron D, Sieve-Smith L, Wang P. Continuing metformin throughout pregnancy in women with polycystic ovary syndrome appears to safely reduce firsttrimester spontaneous abortion: A pilot study. Fertil Steril 2001;75:46-52.
Kocak M, Caliskan E, Simsir C, Haberal A. Metformin therapy improves ovulatory rates, cervical scores, and pregnancy rates in clomiphene citrate-resistant women with polycystic ovary syndrome. Fertil Steril 2002;77:101-06.
Cole PA, Robinson CH. Mechanism and inhibition of cytochrome P-450 aromatase. J Med Chem 1990;33:2933-42.
Akhtar M, Njar VC, Wright JN. Mechanistic studies on aromatase and related C-C bond cleaving P-450 enzymes. J Steroid Biochem Mol Biol 1993;44:375-87.
Palter SF, Tavares AB, Hourvitz A, Veldhuis JD, Adashi EY. Are estrogens of import to primate/human ovarian folliculogenesis? Endocr Rev 2001;22:389-424.
Weil S, Vendola K, Zhou J, Bondy CA. Androgen and follicle stimulating hormone interactions in primate ovarian follicle development. J Clin Endocrinol Metab 1999;84:2951-56.
Vendola KA, Zhou J, Adesanya OO, Weil SJ, Bondy CA. Androgens stimulate early stages of follicular growth in the primate ovary. J Clin Invest 1998;101:2622-29.
Mitwally MF, Casper RF. Aromatase inhibitors for the treatment of infertility. Expert Opin Investig Drugs 2003;12:353-71.
Mitwally MF, Biljan MM, Casper RF. Pregnancy outcome after the use of an aromatase inhibitor for ovarian stimulation. Am J Obstet Gynecol 2005;192:381-86.
Mitwally MFM, Casper RF. The use of aromatase inhibitor for induction of ovulation in cases of clomiphene citrate failure. Curr Opin Obstet Gynecol 2002;14:255-63.
Mitwally MF, Casper RF. Use of an aromatase inhibitor for induction of ovulation in patients with an inadequate response to clomiphene citrate. Fertil Steril 2001;75:305-09.
Sammour A, Bijan MM, Tan SL, Tulandi T. Prospective randomised trial comparing the effects of letrazole (LE) and clomiphene citrate (CC) on follicular development, endometrial thickness and pregnancy rate in patients undergoing superovulation prior to intrauterine insemination (IUI). Fertil Steril 2001;76(Suppl 1):S110.
Mitwally MF, Casper RF. Single-dose administration of an aromatase inhibitor for ovarian stimulation. Fertil Steril 2005;83:229-31.
Fisher SA, Reid RL, Van Vugt DA, Casper RF. A randomized double-blind comparison of the effects of clomiphene citrate and the aromatase inhibitor letrozole on ovulatory function in normal women. Fertil Steril 2002;78:280-85.
Fatemi HM, Kalibianakis E, Tournaye H, Camus M, Van Steirteghem AC, Devroey P. Clomiphene citrate vs letrozole for ovarian stimulation: A pilot study. Reprod Biomed Online 2003;7:543-46.
Hu Y, Cortvrindt R, Smitz J. Effects of aromatase inhibition on in vitro follicle and oocyte development analyzed by early preantral mouse follicle culture. Mol Reprod Dev 2002;61: 549-59.
Shetty G, Krishnamurthy H, Krishnamurthy HN, Bhatnagar S, Moudgal NR. Effect of estrogen deprivation on the reproductive physiology of male and female primates. J Steroid Biochem Mol Biol 1997;61:157-66.
Mitwally MF, Casper RF. Aromatase inhibition reduces gonadotrophin dose required for controlled ovarian stimulation in women with unexplained infertility. Hum Reprod 2003;18:1588-97.
Mitwally MF, Casper RF. Aromatase inhibition improves ovarian response to follicle-stimulating hormone in poor responders. Fertil Steril 2002;77:776-80.
Goswami SK, Das T, Chattopadhyay R, Sawhney V, Kumar J, Chaudhury K, Chakravarty BN, Kabir SN. A randomized single blind controlled trial of letrozole as a low-cost IVF protocol in women with poor ovarian response: A preliminary report. Hum Reprod 2004;19:2031-35.
Newkirk KM, Chandler HL, Parent AE, et al. Ultraviolet radiation-induced corneal degeneration in 129 mice. Toxicol Pathol 2007;35:819-26.
Pettenati MJ, Sweatt AJ, Lantz P, et al. The human cornea has a high incidence of acquired chromosome abnormalities. Hum Genet 1997;101:26-29.
Snibson GR. Collagen cross-linking: A new treatment paradigm in corneal disease—a review. Clin Experiment Ophthalmol 2010;38:141-53.
Spoerl E, Raiskup-Wolf F, Kuhlisch E, Pillunat LE. Cigarette smoking is negatively associated with keratoconus. J Refract Surg 2008;24:S737-40.
Rabinowitz YS, Nesburn AB, McDonnell PJ. Videokeratography of the fellow eye in unilateral keratoconus. Ophthalmology 1993;100:181-86.
Goodrich DW, Lee WH. The molecular genetics of retinoblastoma. Cancer Surv 1990;9:529-54.
Moodaley LC, Woodward EG, Liu CS, Buckley RJ. Life expectancy in keratoconus. Br J Ophthalmol 1992;76:590-91.
Honein MA, Dawson AL, Petersen EE, Jones AM, Lee EH, Yazdy MM, Ahmad N, Macdonald J, Evert N, Bingham A, et al. Birth defects among fetuses and infants of US women with evidence of possible Zika virus infection during pregnancy. JAMA 2017 Jan 3;317(1):59-68.
Chervenak FA, Jeanty P, Cantraine F, Chitkara U, Venus I, Berkowitz RL, Hobbins JC. The diagnosis of fetal microcephaly. Am J Obstet Gynecol 1984 Jul 1;149(5):512-517.
Papageorghiou AT, Thilaganathan B, Bilardo CM, Ngu A, Malinger G, Herrera M, Salomon LJ, Riley LE, Copel JA. ISUOG Interim Guidance on ultrasound for Zika virus infection in pregnancy: information for healthcare professionals. Ultrasound Obstet Gynecol 2016 Apr;47(4):530-532.
Chibueze EC, Parsons AJ, Lopes KD, Yo T, Swa T, Nagata C, Horita N, Morisaki N, Balogun OO, Dagvadorj A, et al. Diagnostic accuracy of ultrasound scanning for prenatal microcephaly in the context of Zika virus infection: a systematic review and meta-analysis. Sci Rep 2017 May 23;7(1):2310.
Cordeiro MT. Zika virus: laboratory diagnosis. In: Zika in focus. Springer International Publishing; 2017. pp. 59-62.
Mlakar J, Korva M, Tul N, Popović M, Poljšak-Prijatelj M, Mraz J, Kolenc M, Resman Rus K, Vesnaver Vipotnik T, Fabjan Vodušek V, et al. Zika virus associated with microcephaly. N Engl J Med 2016 Mar 10;374(10):951-958.
Zare Mehrjardi M, Keshavarz E, Poretti A, Hazin AN. Neuroimaging findings of Zika virus infection: a review article. Jpn J Radiol 2016 Dec;34(12):765-770.
Oliveira Melo AS, Malinger G, Ximenes R, Szejnfeld PO, Alves Sampaio S, Bispo de Filippis AM. Zika virus intrauterine infection causes fetal brain abnormality and microcephaly: tip of the iceberg? Ultrasound Obstet Gynecol 2016 Jan;47(1):6-7.
Brasil P, Pereira JP Jr, Moreira ME, Ribeiro Nogueira RM, Damasceno L, Wakimoto M, Rabello RS, Valderramos SG, Halai UA, Salles TS, et al. Zika virus infection in pregnant women in Rio de Janeiro. N Engl J Med 2016 Dec 15;375(24):2321-2334.