Durham, N.C. -- 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."

Other authors on the study include William M. Rohe, Ph.D.,
of the University of North Carolina at Chapel Hill; Peter P.
Vitaliano, Ph.D., of the University of Washington; and Ilene
Siegler, Ph.D., John C. Barefoot, Ph.D., Richard Surwit, Ph.D.,
and Mark N. Feinglos, M.D., all of Duke University Medical
Center.