Because the immune system’s defense mechanisms become impaired as we grow older, our ability to resist infection progressively declines. So does our ability to respond effectively to other causes of inflammation that have been implicated in age related atherosclerosis, osteoporosis, arthritis, Type 2 diabetes, cancers and dementia. Chronic stress is widely believed to accelerate biologic aging and support comes from studies confirming its adverse effects on immune system function, as well as how we respond to hidden inflammation. Stress significantly reduces the immune response to influenza and pneumococcal vaccine in the elderly, and to hepatitis B vaccine in younger individuals. The stress of care giving for a spouse or loved one with dementia has also been shown to delay wound healing and shorten life that may be related to effects on inflammation. Interleukin-6 (IL-6) is an important indicator of sublinical inflammation thought to contribute to degenerative diseases. When such caregivers were followed for six years, it was found that their average IL-6 levels increased four times more than controls matched for age, sex, health and socioeconomic status. Furthermore, this increased difference in IL-6 persisted for years after care giving activities ceased, which could speed up the aging process and explain higher death rates. In one study, senior citizens who felt stressed out from taking care of their disabled spouses were 63 percent more likely to die within 4 years than caregivers without this complaint. In another study that focused on telomere research, spouses and children who provided such constant care shortened their lives by as much as four to eight years! Telomeres are areas of genetic material on the ends of a cell’s chromosomes that provide protection. As a cell divides, telomeres shorten and some of these genetic instructions are lost. An enzyme called telomerase normally prevents this, but as we grow older, our ability to make telomerase decreases, and the protective telomeres become shorter. Thus, telomere length is a basic indicator of cellular aging and telomerase activity is a measure of cellular capacity for ongoing replication. Both of these were shown to be significantly reduced in these Alzheimer caregivers compared to controls. Caregivers also had double the rate of severe depression and prior research has shown that this can increase risk of death by as much as four times when compared with non-depressed controls.
Coping with Caregiver stress and Alzheimer’s
There is little doubt that the stress of chronic care giving to a spouse or family member has significant adverse effects on health and longevity. Studies suggest that many of these problems are due to disruption of immune system function, as well as increased inflammation and depression. Such individuals have weaker immune responses to vaccines, increased susceptibility to infection and delayed wound healing. Inflammation is a normal response to injury and stress that is triggered by the production of chemicals like interleukin-6. However, too much inflammation has been implicated in several age related diseases, including Alzheimer’s and Parkinson’s disease, arthritis, Type 2 diabetes and coronary heart disease. One study of men and women serving as caregivers to spouses with Alzheimer’s disease found that they had a fourfold annual increase interleukin-6 levels compared to age-matched controls without such responsibilities. What is particularly disturbing is that even when care giving ceased due to the death of a spouse, increased interleukin-6 levels persisted for years, and this could accelerate the aging process.
In one study, senior citizens who felt stressed out from taking care of their disabled spouses were 63 percent more likely to die within 4 years than caregivers without this complaint. In another that focused on telomere research, spouses and children who provided such constant care shortened their lives by as much as four to eight years. Caregivers also had double the rate of severe depression and prior research has shown that this can increase risk of death by as much as four times when compared with non-depressed controls.
Some of the early warning signs of caregiver stress are:
- feeling overwhelmed, lonely, guilty, sad or constantly worried
- feeling fatigued most of the time
- becoming easily irritated or angered
- lack of interest in activities you previously enjoyed
- significant change in weight or sleep habits
- frequent headaches, neck or low back pain
- abuse of alcohol or drugs
- Some tips on how to reduce caregiver stress include:
- Identify what you can and cannot change. You may not be able to alter the way somebody else behaves but you can change the way that you react to it.
- Make a list of your top priorities and establish a daily routine.
- Set realistic goals by breaking large tasks into smaller ones that you can do individually when you have time.
- Don’t hesitate to ask for and to accept assistance and make a list of things that others could help with. Let them choose what is best for them, such as assisting with meals, shopping for groceries, relieving you for a few hours, or taking the patient for a walk once or twice a week.
- Try to lighten your load by learning about local care giving resources such as meal delivery, home health care services (nursing, physical therapy), non medical assistance (housekeeping, cooking, companionship) or home modification changes that make it easier for patients to bathe, use the toilet or move around.
- If you need financial help taking care of a relative, don’t be afraid to ask family members to contribute their fair share.
- Stay in touch with family and friends but say “no” to requests that you no longer can easily handle, such as hosting holiday meals.
- Social support is a powerful stress buster, and in addition to family and friends, there may be a support group for caregivers in your situation. Joining may allow you to make new friends and also pick up useful tips from others who have had similar problems. Check with your local Area Agency on Aging for information.
- Try to find time to be physically active as much as possible, get enough sleep and eat properly.
- Make time each week to do something that you enjoy and can look forward to, such as shopping or seeing a movie.
- If your loved one is not bedridden and does not have dementia, there are emergency response systems (button on a necklace, bracelet or belt that they wear) that can alert medical personnel and you. You can use an intercom system to hear someone in another room, or a Webcam video camera that can see them. Mobility monitors can keep track of dementia patients who wear a transmitter strapped to an ankle or wrist that will alert you when they are out of range.
- Don’t automatically assume that any new symptoms or an increase in previous ones are automatically due to stress and always consult a physician in such instances. People who take an active, problem-solving approach to any care giving issue are much less likely to feel stressed than those who react by worrying or feeling helpless.
The Lethal Effects of Stress, Anxiety and Depression on COPD
Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of disability that affects 11.4 million people in the U. S. It is also very distressful, even when it is not disabling, so it is not surprising that many patients also suffer from anxiety and depression. A recent review of the literature confirmed that COPD patients had a higher prevalence of anxiety and depression than the general population, some of whom had other chronic diseases. It also revealed that such stressed out patients had significantly higher death rates. Possible explanations may be that they are less likely to take medications or follow other medical advice, such as engaging in regular exercise. Depression also encourages smoking and makes it more difficult to stop. COPD patients often do not seek help for their emotional complaints because of the stigma of mental illness and physicians may pay relatively little attention since they also focus on physical complaints. Primary care clinicians and especially pulmonary specialists report that they do not feel comfortable in diagnosing or treating anxiety and depression since this is not part of their training. COPD death rates have doubled over the past 30 years and health care professionals need to be made more aware of the significant contribution of stress to mortality in these patients. The study authors advise that patients should be screened for anxiety and depression with simple, readily available instruments. Those at increased risk should be referred to appropriate specialists or other resources for further assessment and appropriate treatment, which may not necessarily include drugs.
Strong support comes from another study demonstrating that depressive symptoms were associated with higher death rates in 121 patients with stable COPD. All were evaluated for depression and approximately 20 percent were classified as having moderate to severe depression. Over the 8.5 year follow-up period, 76 participants died, and those with clinically significant depression were found to be twice as likely to be at increased risk for death from all causes. This significant association between depression and death could not be explained by age, gender, or the severity of COPD. It was suggested that one reason might be that depression disrupts hypothalamic-pituitary-adrenal activities that regulate responses to stress and immune system resistance to disease. It is well established that depression is associated with impaired immune defenses due to chronic elevated levels of cortisol. These also cause loss of memory, another common complaint in depression, which could be a factor in patients who forget to take their medications or follow medical advice. There is no good evidence that antidepressant drugs lessen these complications of depression, and many have adverse side effects that further diminish the quality of life.
Putman-Casdorph H; McCrone S. Chronic obstructive pulmonary disease, anxiety, and depression: state of the science. Heart Lung. 2009; 38(1):34-47
Piper L. Depressive symptoms contribute to death in chronic obstructive pulmonary disease. Chest. 2009; 135: 619–625
Improve Memory, Concentration, Productivity and Health by Reducing Stress
It has been well established that stress destroys cells in the hippocampus, a brain site responsible for memory storage and retrieval. This happens to most of us as we get older, especially memory for recent events such as forgetting familiar names, what we went shopping for, and where we left our keys or glasses. A recent study that followed over 1200 senior citizens without such problems for 12 years, found that those who began to exhibit mild cognitive impairment due to stress or depression were much more likely to develop Alzheimer’s disease.
1. Of equal concern is strong evidence that memory loss is starting to surface in individuals in their forties due to increased stress.
2. Fortunately, you can reduce these damaging effects of stress and improve focus, concentration and productivity due to recent advances in neurofeedback. The Peak Achievement Trainer, which provides very understandable real time feedback on brain wave activity in the form of a video display, teaches you how to strengthen the mind to improve alertness and concentration.
3. It has been used by coaches and elite athletes to improve performance and leading golf instructors like David Leadbetter have demonstrated how it can perfect your mental game to lower scores.
4. The Peak Achievement trainer has numerous other applications, needs no messy electrode paste and is easy to use. Other devices that provide immediate heart rate variability feedback can also quickly teach you how to lower stress levels, improve performance and even reduce insomnia.
5. Diminished heart rate variability is seen in a variety of stress related disorders and is a powerful predictor of sudden death. Learning how to increase heart rate variability has numerous cardiovascular and other physical as well as mental health benefits.
1. Wilson, RS, Schneider, JA et al. Chronic distress and incidence of mild cognitive impairment. Neurology 2007; 68:2085-2092.
2. Boehringer Ingleheim Pharmaceuticals, Inc. 1996 Survey Call (203) 798-4700 for a copy.
4. Quencer RM, Winters RK, Leadbetter D. Unlocking the Mental Aspects of the Golf Swing.
5. American Journal of Neuroradiology 2003; 24:1033-1034
Stress, Aging and Telomeres
All the cells in our body contain tiny clocks called telomeres that can determine how long they will live. Telomeres are little caps at the end of chromosomes that prevent loss or injury to genetic information during cell division. Each time a cell divides, part of the telomere is lost and it becomes shorter. When a telomere eventually disappears because of repeated cell divisions, chromosomal damage prevents the cell from accurately reproducing itself. This shortening and eventual erosion of telomeres is prevented or reduced by telomerase, an enzyme in cells that preserves their length. Many believe that telomere destruction and reconstruction is related to the balance between aging and cancer and explains why cancer is more common in the elderly.
In the illustration to the left, chromosomes are stained blue and the protective telomere caps at their ends are stained yellow. Cells with long telomeres live longer. Short telomeres have been linked to a wide range of human diseases, including coronary heart disease, osteoporosis and HIV infection. Shortening of telomeres is prevented or reduced by telomerase, which has been shown to keep immune cells young by preserving their length and ability to continue to divide and reproduce accurate replicas.
UCLA researchers recently confirmed prior reports that people subjected to chronic stress tended to have shorter telomeres. They have now uncovered a mechanism that explains how stress causes telomere shortening, which could lead to breaking the well-known links between stress and heart disease, as well as accelerated aging. Cells with long telomeres live longer. Short telomeres have been linked to a wide range of human diseases, including coronary heart disease, osteoporosis and HIV infection. Shortening of telomeres is prevented or reduced by telomerase, which has been shown to keep immune cells young by preserving their length and ability to continue to divide and reproduce accurate replicas.
Chronic stress results in increased secretion of cortisol that causes a rise in blood sugar and blood pressure and reduces inflammation and immune system resistance to infection. However, this new study shows that cortisol also suppresses telomerase activation in immune system cells so that telomeres are no longer protected during cell division and become progressively shorter. This leads to early cell aging and distorted replicas of the original cell that could lead to cancer and other diseases. As the lead author noted in an interview, “We are testing therapeutic ways of enhancing telomerase levels to help the immune system ward off cortisol’s effect. If we’re successful, one day a pill may exist to strengthen the immune system’s ability to weather chronic emotional stress.”
Choi J. Fauce SR, Effros RB. Reduced telomerase activity in human T lymphocytes exposed to cortisol. Brain Behavior and Immunity May 2008; 22:600-605