Background: Caregivers of persons with dementia are at risk for chronic perceived stress, social isolation, and perceived loneliness. Chronic perceived stress disrupts neuroendocrine and neuroimmunological pathways (endogenous mechanisms). Social isolation is a common exogenous factor for this population that may lead to perceived loneliness and exacerbate chronic perceived stress and its sequelae.
Purpose: Review the experience of dementia caregivers through the lens of the interaction of pertinent endogenous mechanisms (influence of chronic stress on neuroendocrine and neuroimmunological functioning) and exogenous factors (social isolation and perceived loneliness).
Methods: Ninety-seven articles were reviewed using PubMed, CINAHL, EMBASE, and PsycINFO databases and reference lists.
Results: Chronic perceived stress disrupts neuroendocrine and neuroimmunological regulation and leads to chronic low-grade inflammation, which is implicated in the development of multiple chronic conditions, including cardiovascular disease, atherosclerosis, arthritis, osteoporosis, cancer, periodontal disease, diabetes, depression, frailty, and functional decline. Social isolation among caregivers may be a result of significant changes that caregiving imposes on caregivers' multiple spheres of life, including employment and family. Social isolation may evoke perceived loneliness; both conditions may contribute to a caregiver’s restructuring his or her life in a way that exacerbates depressive symptoms, chronic perceived stress, and promotes neuroendocrine and neuroimmunological disruption.
Conclusions: Among dementia caregivers, social isolation may play a role in increasing caregivers' chronic perceived stress. Chronic perceived stress and social isolation may form a symptom cluster. Perceived loneliness may be a marker of this symptom cluster. Components of the proposed cluster may reinforce one another and together play a role in the development of chronic diseases to which dementia caregivers are vulnerable.
Implications for nursing practice and research: It is imperative to recognize dementia patients' family caregivers as “patients" too. Early recognition of caregivers at risk for perceived loneliness - a potential marker of a symptom cluster of social isolation and chronic perceived stress - may allow nurses to implement interventions that would improve caregivers’ well-being, increase their health-related quality of life, decrease their caregiver burden, and prevent the risk of the development of chronic illnesses. As a result, early recognition of caregivers at risk for the proposed symptom cluster may ultimately promote higher quality of care for dementia patients and delay their institutionalization. Healthcare professionals may remain the single reliable source of support for dementia caregivers and thus may allow them to mitigate the adversity associated with chronic perceived stress, social isolation, and perceived loneliness.
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