This randomized clinical trial compared PT, a biofield/touch therapy, with an ERC for the reduction of stress in AI dementia caregivers. The primary outcome variable, perceived stress, along with depression and pain showed a statistically significant reduction in the PT group compared with the ERC group, and general health and vitality increased significantly in PT participants compared with ERC participants. Thus, PT is an effective intervention for highly stressed AI caregivers.
In addition to the significant treatment findings, this investigation provides information about AI caregivers living in the Pacific Northwest. At baseline, almost half of the participants had PSSs greater than or equal to 20, which places them at the top of the range of perceived stress reported in other caregiving studies (de Vugt et al., 2005
; Kiecolt-Glaser, Dura, Speicher, Trask, & Glaser, 1991
). Almost 70% of participants scored above 16 on the CES-D, indicating significant levels of depressive symptoms. Baseline SF-36 scores were worse than those for the general population and were similar to the norms for individuals diagnosed with depressive disorder (Ware, 2000
). Sleep was also significantly disrupted; the mean scores at baseline were nearly twice the cutoff score for “normal” sleep (Buysse et al., 1989
). Finally, this sample reported high levels of chronic illness. At the baseline assessment, 57% of participants reported chronic headaches, 57% had arthritis, 47% had chronic heartburn, 40% had heart palpitations (those with heart disease were excluded from the study), 29% smoked cigarettes, 29% had hypertension, 21% had asthma, and 12% had early stage diabetes mellitus.
As noted earlier, stress, depression, fatigue, sleep problems, and poor health are the frequently cited problems of dementia caregivers. For AI caregivers, they appear even more common. Furthermore, these problems may filter down to the care recipient, leading to decreased capacity for continued caregiving and consequent institutionalization. Culturally acceptable caregiver interventions, such as PT, that reduce stress, depression, and pain and improve health and vitality are urgently needed.
There is a growing body of literature on the relationships between social stress (Pearlin, Schieman, Fazio, & Meersman, 2005
), including discrimination based on ethnicity, socioeconomic status, and poor health outcomes (Seeman et al., 2004
). Scharlach and colleagues (2006)
found that AI caregivers felt that their caregiving experience was affected by experiences such as discrimination, poverty, and isolation. These experiences negatively influenced their willingness to access caregiver services. For urban and rural AIs, caregiver stress co-occurs within a social and cultural backdrop of historical trauma and intergenerational grief arising from the colonization experience. Memory and awareness of historical trauma are evident in the daily consciousness of many AIs (Jervis, 2006
). Exposure to interpersonal violence and accidental trauma, which in this sample was high, is widely believed to be the sequelae of historical trauma and intergenerational grief (Evans-Campbell, 2008
). Interaction between the stress of caregiving and the ongoing social stress among many AIs is an important area for future study.
Recruitment and retention are challenging in AI populations (Buchwald et al., 2006
), older minorities (Levkoff & Sanchez, 2003
), and minority dementia caregivers (Gallagher-Thompson, Solano, Coon, & Arean, 2003
). AI populations are often small and separated by great geographical distances. Research is widely distrusted among AIs (Oberly & Macedo, 2004
). In this study, we observed obstacles to recruitment and retention including significant time constraints due to multiple role responsibilities, lack of systematic diagnosis of dementia, and a small subject pool made smaller by exclusion criteria that included two major diseases common in this population: diabetic neuropathy and heart disease.
Results of this study illuminate health vulnerabilities among AI dementia caregivers and point the way to providing appropriate supports. Tribal medicine services are increasingly recognizing the role of CAM and traditional medicine services in the health care of AI communities—this study suggests that PT is an effective CAM for reducing stress (and thereby potentially improving health and well-being) of AI family caregivers. In the United States, there are more than 90,000 board-certified massage therapists, many of whom practice or can be trained in biofield touch therapy methods such as PT; thus, there already exists a cadre of potential care providers. In addition, the specific PT protocol used in this study is straightforward and easily taught to laypersons; thus, it may provide a low-cost, culturally acceptable, effective strategy for stress reduction in AI caregivers.
In the current study, we attempted to equalize social contact between the PT and ERC conditions. PT is not a social treatment per se. It is a form of bodywork or manual therapy with a focus on the human energy field. Yet, it is possible that the weekly contact with the same therapist and the feeling of empathy and care that typically accompany therapeutic touch could result in a more positive response compared with the less intense contact provided in the respite condition. Future studies are needed to compare PT to other, more intensive caregiver interventions to determine whether therapeutic touch is more beneficial than one-on-one counseling or caregiver education and support. One of the limitations of this study is that only two assessment points were collected. Future studies might address the duration of effects at different assessment points.
AIs and Alaskan Natives are a very diverse population, and healing traditions vary from place to place. Thus, the use of therapeutic touch may not be acceptable to all individuals, and additional types of caregiver support for AI caregivers should be explored. What remains certain, however, is that there is a great need for culturally appropriate, low-cost, accessible support services for AI caregivers of individuals with dementia and that this need will continue to grow in the future.