Fear of Neighborhood Crime Can Worsen Glucose Levels of Caregivers
People who care for elderly family members and who believe their neighborhood is unsafe due to burglaries, muggings or the presence of drugs, may be at increased risk for poor blood glucose control and ultimately to related health issues, according to researchers from Duke University Medical Center.
Simply being a caregiver or fearing crime in their neighborhoods did not appear to influence glucose problems; but the combination does, said the researchers, whose findings appear in the September/October 2005 issue of Psychosomatic Medicine. The study was supported by grants from the National Institute on Aging, the National Institute of Environmental Health Sciences and the National Institute of Mental Health.
"I think it's important that health care providers take into account not just single risk factors but the joint impact of multiple factors on health," said Redford Williams, M.D., professor of psychiatry at Duke and an author on the study. "We typically focus on issues such as depression or anxiety among caregivers, not on the combination of factors. But that's not the way the real world works," he said.
Previous studies from Duke and elsewhere have shown that caregivers of relatives with dementia and adverse physical and social environments, such as living conditions in neighborhoods, all independently correlate with poor health. However, said Williams, the Duke study is the first to examine the combined effect of neighborhood environments on the stress already associated with being the caregiver of a relative with dementia.
The team conducted a survey of caregivers who provide care to an older adult relative with varying severities of dementia, as well as of non-caregivers. The survey covered three areas: perception of crime, perception of neighbors and perception of decline in the neighborhood in which they live. At multiple points during the study the researchers measured the participants' blood glucose levels, signs of depression, quality of sleep and anxiety levels.
"We know that caregivers are under a significant burden of stress," said Beverly Brummett, Ph.D., an assistant research professor in medical psychiatry at Duke and lead author on the study. "When we learned that the combination of stressors impacted glucose levels the most, we searched for plausible explanations. We didn't find any direct evidence that it was a caregiver's perception of stress that mattered, or things like social support. Although we couldn't verify this, we think that people who fear crime in their neighborhood may be less likely to leave the house for health care, pick up prescriptions or even to get some exercise."
The study participants consisted of 147 adults who reported significant caregiver responsibilities for a relative - 96 percent of whom were parents - or a spouse with dementia and an equal number of non-caregivers. The survey covered perception of crime in the neighborhood (muggings, fear of being a crime victim, presence of drugs or drug users); perception of neighbors (helpfulness, trustworthiness, tidiness of streets or buildings); and perception of the state of neighborhood (state of improvement or decline). Standard clinical tests such as the HbA1c were used to measure fasting blood glucose levels for the primary study measures. Standard psychological measures were used to explore depression scores, anxiety levels and sleep quality as secondary parts of the study.
The majority of people enrolled were older, middle-aged white females and, the authors acknowledge, may not be the optimal demographic representation of Americans. However, a typical caregiver is 46 years old, married, has some college education and provides care to a woman over the age of fifty, according to a recent report issued by the National Alliance for Caregiving and the AARP. Although race did not appear to influence the study findings, the authors caution that black Americans are generally at increased risk for problems with blood glucose regulation and should pay close attention to their health particularly if they are caregivers and fear crime in their neighborhoods.
The authors further noted that income and education levels among caregivers did not correlate to their findings.
"In other words, the relation between neighborhood perception, caregiving and glucose was true no matter how educated or relatively wealthy or poor the study participant happened to be," Brummett added.
Current estimates by the AARP suggest that by the year 2007, nearly 39 million Americans will be the primary caregiver of an older adult, and many of them will be caring for someone with Alzheimer's disease.
The researchers believe that as the population continues to live longer with chronic illnesses it will become increasingly important to pay attention to the health and well-being of caregivers.
"We have to find ways to ensure that caregivers who live in neighborhoods they perceive as dangerous have adequate health care access and follow-up," said Brummett. "There may also be strategies for helping them cope better with their concerns about crime. Any change that helps people deal better with health issues would be beneficial."