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https://www.bandlab.com/feed/trending

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The cloud platform where musicians and fans create music, collaborate and engage with each other across the globe.

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https://freesound.org/people/solidphase/sounds/442830/

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Freesound: collaborative database of creative-commons licensed sound for musicians and sound lovers. Have you freed your sound today?

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https://freesound.org/people/sonically_sound/sounds/612873/

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Made this sound a while ago but I must have generated a “sine” wave and just pasted the same thing at the beginning of 10 consecutive seconds. And then I applied some reverb to the final thing.

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https://www.youtube.com/watch?v=t4NPpl_vE-Y&t=79s

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A Christmas message from Ashford's Dementia Peer Support Group (no subs)

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https://www.alextennapel.nl/about-alzheimer

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Portraits of Alzheimer created by Dutch Portrait Photographer Alex ten Napel. Exhibitions, publications and comment.

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https://www.itsnicethat.com/articles/alex-ten-napel

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Beautiful monochrome portraits of Alzheimer’s patients

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The best portrait photography is truly mesmerising; a compliment which can surely be paid to Alex Ten Napel’s series of Alzheimer’s patients. In a somewhat ironic manner, the Dutch photographer has created enrapturing, memorable images of elderly and enigmatic faces. They’re both heartbreaking and j…

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https://www.itsnicethat.com/articles/tom-gauld-1

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Tom Gauld is one of those illustrators It's Nice That can't really function without; between his hilarious short comics, his book Goliath and his glorious Bookshelf feature I think we can happily resign ourselves to the kind of long-term fandom that only the die-hard will commit to.

With that in mind, obviously we were delighted to see the brilliant work he undertook recently for the Wellcome Trust's new online magazine Mosaic Science. Tom created a series of illustrations to run alongside a long-form piece about the labyrinthine questions that stem from Alzheimer's. Using his trademark humour to make the heartbreaking reality of the disease that little bit easier to swallow, his visual solution revolved around the image of a maze, with it's nooks and crannies and corners and puzzlement all aligning excellently with the strangely inexplicable dead-ends that come with mental illness. Sensitively and wittily done, Tom. We're your biggest fans, forevz.

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Illustration: Tom Gauld brings a dose of humour to the trickiest of topics, Alzheimer's

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Tom Gauld is one of those illustrators It's Nice That can't really function without; between his hilarious short comics, his book Goliath and his glorious Bookshelf feature I think we can happily resign ourselves to the kind of long-term fandom that only the die-hard will commit to.

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https://www.itsnicethat.com/articles/brain-scan-psa

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Sometimes an ad blows us with away through sheer effort and we're wowed as much by the planning, time and expense as by the finished product. But at other times organisations show they appreciate that in the information-saturated shouting match the modern media landscape sometimes resembles, whispering can be the most effective way to get a message across. This short spot by Rethink Communications for the Alzheimer's Society of British Columbia is incredibly communicative and moving, bringing the charity's "Protect your Memories" campaign to life with simplicity and pathos. It reminded me of the first few minutes of Up in its less-is-more approach, which is just about the highest creative yardstick I can use.

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Extraordinary short promo to promote personal nature of Alzheimer's disease

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Sometimes an ad blows us with away through sheer effort and we're wowed as much by the planning, time and expense as by the finished product. But at other times organisations show they appreciate that in the information-saturated shouting match the modern media landscape sometimes resembles, whispering can be the most effective way to get a message across.

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https://www.youtube.com/watch?v=jFHgNuS_5XI&t=25s

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Brain Scan PSA for Alzheimer Society of B.C.

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https://www.nhsfife.org/news-updates/latest-news/2021/03/mri-scanner-arrives-destination-diagnostic-and-imaging-department/

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Skip to Content Skip to navigation

Our Replacement programme

The replacement programme, which has taken approximately three months to complete, includes the removal of the old scanner; replacing the Radio Frequency (RF) cage which shields the MRI room from external interference which can affect the scans; replacing existing electrical and mechanical appliances required to support the safe use of the scanner, and the installation of the new scanner. The new scanner is one of the most modern on the market, replicating the scanner currently on the Victoria Hospital site.

Orthopaedic

Imaging of the musculoskeletal system, which are the bones and joints - knee, hips, shoulder, wrist, hand, ankle, feet etc.

Diagnostic imaging is a critical component of modern and effective healthcare, with more than 14,000 MRI scans carried out in Fife last year alone. With the demand for MRI increasing year-on-year, it is essential that we continue to have the capacity to meet this demand.

Claire Dobson , NHS Fife Director of Acute Services

Other Articles

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MRI scanner arrives: Destination: Queen Margaret Radiography suite | NHS Fife

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Skip to Content Skip to navigation The replacement programme, which has taken approximately three months to complete, includes the removal of the old scanner; replacing the Radio Frequency (RF) cage which shields the MRI room from external interference which can affect the scans; replacing existing electrical and mechanical appliances required to support the safe use of the scanner, and the installation of the new scanner.

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https://www.plymouthhospitals.nhs.uk/mri-referrer-information

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If you do not give us the correct information in the referral the patient may be refused their scan. Anxious Patients
The scanner is a short tunnel which is open at both ends so please advise patients who are particularly claustrophobic to contact us to let us know before they come for their scan. Many patients worry about this aspect of the scan but find that it isn't as bad as they had imagined or been told.

Some patients benefit from taking a sedative prior to the scan which must be prescribed by the referrer.
Surgical Implants
We need to know whether the patient has any implants in situ. We will then decide if they are MRI compatible or not.

Cardiac pacemakers, ICDs, aneurysm clips and certain other surgical implants need to be investigated before the patient's appointment. Please complete the mandatory section of the request form accurately being aware that the presence of a pacemaker or aneurysm clip will possibly be a contraindication for the scan.

Please give details of implants (make, model etc.) on the request form or contact the department on 01752 (4)32511so that we can make necessary enquiries/arrangements.
Contrast Media
Sometimes we need to give an injection of contrast media. This contains Gadolinium which rarely causes any reactions, however it is important that we know if a patient has any renal function impairment prior to administering contrast media. To this end it would be appreciated if you could provide a recent eGFR on the request form, if possible. This is particularly important for patients over the age of 65, those with diabetes, or impaired liver or renal function.
Pregnancy
If patients are pregnant, national safety guidelines recommend that we do not carry out an MRI scan unless it is clinically urgent. Please decide with the radiologist if the scan is necessary or could be delayed until after the pregnancy. You must state the patient's positive pregnancy status on the request form. Many pregnant women have had MRI scans with no reported problems. Please advise patients to contact the department if they have any concerns about this.
What happens during the scan?
Please see ' Information for Patients ' section.
What happens after the scan?
Please see ' Information for Patients ' section.

For more information for clinicians visit our Staffnet page here.

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If you do not give us the correct information in the referral the patient may be refused their scan. Anxious Patients The scanner is a short tunnel which is open at both ends so please advise patients who are particularly claustrophobic to contact us to let us know before they come for their scan.

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https://www.nhs.uk/conditions/alzheimers-disease/treatment/

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There's currently no cure for Alzheimer's disease. But there is medication available that can temporarily reduce the symptoms.
Support is also available to help someone with the condition, and their family, cope with everyday life.

Medicines

A number of medicines may be prescribed for Alzheimer's disease to help temporarily improve some symptoms.

The main medicines are:

Acetylcholinesterase (AChE) inhibitors

These medicines increase levels of acetylcholine, a substance in the brain that helps nerve cells communicate with each other.

They can currently only be prescribed by specialists, such as psychiatrists or neurologists.

They may be prescribed by your GP on the advice of a specialist, or by GPs that have particular expertise in their use.

Donepezil, galantamine and rivastigmine can be prescribed for people with early- to mid-stage Alzheimer's disease.

The latest guidelines recommend that these medicines should be continued in the later, severe, stages of the disease.

There's no difference in how well each of the 3 different AChE inhibitors work, although some people respond better to certain types or have fewer side effects, which can include nausea, vomiting and loss of appetite.

The side effects usually get better after 2 weeks of taking the medication.

Memantine

This medicine is not an AChE inhibitor. It works by blocking the effects of an excessive amount of a chemical in the brain called glutamate.

Memantine is used for moderate or severe Alzheimer's disease. It's suitable for those who cannot take or are unable to tolerate AChE inhibitors.

It's also suitable for people with severe Alzheimer's disease who are already taking an AChE inhibitor. Side effects can include headaches, dizziness and constipation but these are usually only temporary.

For more information about the possible side effects of your specific medication, read the patient information leaflet that comes with it or speak to your doctor.

Medicines to treat challenging behaviour

In the later stages of dementia, a significant number of people will develop what's known as behavioural and psychological symptoms of dementia (BPSD).

The symptoms of BPSD can include:

increased agitation

anxiety

wandering

aggression

delusions and hallucinations

These changes in behaviour can be very distressing for both the person with Alzheimer's disease and their carer.

If coping strategies do not work, a consultant psychiatrist can prescribe risperidone or haloperidol, antipsychotic medicines, for those showing persistent aggression or extreme distress.

These are the only medicines licensed for people with moderate to severe Alzheimer's disease where there's a risk of harm to themselves or others.

Risperidone should be used at the lowest dose and for the shortest time possible as it has serious side effects. Haloperidol should only be used if other treatments have not helped.

Antidepressants may sometimes be given if depression is suspected as an underlying cause of anxiety.

Sometimes other medications may be recommended to treat specific symptoms in BPSD, but these will be prescribed "off-label" (not specifically licensed for BPSD).

It's acceptable for a doctor to do this, but they must provide a reason for using these medications in these circumstances.

Treatments that involve therapies and activities

Medicines for Alzheimer's disease symptoms are only one part of the care for the person with dementia.

Other treatments, activities and support - for the carer, too - are just as important in helping people live well with dementia.

Cognitive stimulation therapy

Cognitive stimulation therapy (CST) involves taking part in group activities and exercises designed to improve memory and problem-solving skills.

Cognitive rehabilitation

This technique involves working with a trained professional, such as an occupational therapist, and a relative or friend to achieve a personal goal, such as learning to use a mobile phone or other everyday tasks.

Cognitive rehabilitation works by getting you to use the parts of your brain that are working to help the parts that are not.

Reminiscence and life story work

Reminiscence work involves talking about things and events from your past. It usually involves using props such as photos, favourite possessions or music.

Life story work involves a compilation of photos, notes and keepsakes from your childhood to the present day. It can be either a physical book or a digital version.

These approaches are sometimes combined. Evidence shows they can improve mood and wellbeing.

Read more about how dementia is treated.

Find out how to live well with dementia and more useful information in the NHS Dementia Guide.

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There's currently no cure for Alzheimer's disease. But there is medication available that can temporarily reduce the symptoms. Support is also available to help someone with the condition, and their family, cope with everyday life.

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https://www.healthline.com/health/alzheimers-facts#life-expectancy

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Alzheimer's disease is a primary cause of dementia. Alzheimer's disease damages nerve cells in the brain. In the early stages, there may not be many, if any, symptoms. Short-term memory loss is often the first sign.

Over time, as more neurons are damaged, Alzheimer's disease results in problems with judgment, language, and thought processes. Eventually, it affects a person's ability to function and care for themselves.

A diagnosis of Alzheimer's disease can be very upsetting for the person who receives the diagnosis and for their loved ones.

There's ongoing research into ways to prevent and manage Alzheimer's disease. As we learn more about how Alzheimer's disease develops, we may be able to prevent or slow the progression.

There are a few medical treatments available. The newest medication, called Aduhelm (aducanumab), was just approved in . This medication reduces the buildup of beta-amyloid protein plaques in the brain. In Alzheimer's disease, these plaques start to block and disrupt normal nerve cell function.

There's ongoing research for other therapies for Alzheimer's disease. There's also hope that someday a cure can be found.

Here are some key stats and figures about Alzheimer's disease.

Alzheimer's disease is the most common form of dementia. The term dementia is used to define brain diseases related to memory loss and diminished cognitive skills. Alzheimer's disease is probably the most recognized type, but there are other types of dementia.

They include:

vascular dementia

dementia with Lewy bodies

mixed dementia

dementia caused by Parkinson's disease

dementia caused by Huntington's disease

Stats from 2022 estimate that there are more than 6.5 million people with Alzheimer's disease in the United States.

Rates of Alzheimer's disease are significantly higher in women, according to a report from the Alzheimer's Association. The report, which grouped participants into men and women, estimated that the lifetime risk of developing Alzheimer's disease is 1 in 5 for women. For men, the rate is half of that, at 1 in 10.

In the United States, there are 4 million women and 2.5 million men living with Alzheimer's disease.

One of the reasons for higher rates in women is that women tend to live longer. Age is considered the biggest risk for developing Alzheimer's disease. Another theory is that women born before 1950 didn't typically have as much formal education as men. Lower levels of education are associated with higher rates of Alzheimer's disease.

Alzheimer's disease seems to progress more quickly in women than it does in men. Research suggests that women often receive a diagnosis at later stages. Typically, women have an advantage over men when it comes to memory and recall. It's possible that changes in memory are not caught as early because they could still be within a "normal" range on standard tests.

There may be some associations between hormonal changes over the life cycle and Alzheimer's disease. Several have shown a link between earlier menopause and greater odds of developing Alzheimer's disease.

It's possible that starting hormone replacement therapy in menopause may be helpful to protect the brain. This research isn't yet conclusive. It's also worth noting that going through menopause often causes some memory loss. This often resolves in the postmenopausal period.

People who experienced hypertensive disorders in pregnancy had greater brain shrinkage, even many years later. Hypertensive disorders include eclampsia, preeclampsia, and HELLP syndrome. Research is needed to figure out whether hypertensive disorders should be considered a risk for Alzheimer's disease.

It's also possible that there's something else at play that puts people at risk of both hypertensive disorders during pregnancy and Alzheimer's disease in later life.

There's interesting research on how inflammation in one part of the body can lead to inflammation in other parts. In Alzheimer's disease, there's a buildup of inflammatory proteins in the brain. Many chronic conditions including diabetes and heart disease are also shown to involve inflammation.

There are links between heart disease, metabolic syndrome, diabetes, and the development of Alzheimer's disease. All of these are recognized to involve inflammation in different parts of the body.

According to a 2019 report in Circulation Research, a failing heart might "activate or aggravate" a disease in the brain like Alzheimer's disease.

There are things you can do to help prevent or manage heart disease, metabolic syndrome, and diabetes. These things may play a role in preventing or managing Alzheimer's disease.

Recommendations include:

eating an anti-inflammatory diet, such as the Mediterranean way of eating

regular monitoring of blood pressure and treatment with dietary changes, activity, and medications, as needed

quitting or cutting down on smoking if you smoke

practicing physical activity

managing cholesterol levels with dietary changes and medications, as needed

monitoring blood sugar levels and managing prediabetes or diabetes with dietary changes, physical activity, and medications, as needed

Heart disease may also be a cause of vascular dementia, which results from narrowed blood vessels in the brain. This leads to a decrease in oxygen to brain tissues.

There's an association between higher education levels and a lower risk of Alzheimer's disease. More formal education may shape the brain differently starting from a young age. Learning new things creates more connections between neurons and may make the brain more resistant to damage.

It's also possible that the higher income that often comes with more education may lower the risk of Alzheimer's disease.

It's never too late to learn something new and expand your social networks. Doing group activities or having more social contacts may also lower your risk.

Consider the following things that are especially good for your brain:

taking classes

learning languages

playing instruments

joining community groups to increase social contact

The Alzheimer's Association states that Alzheimer's disease is the sixth leading cause of death in the United States. About 1 in 3 people over 65 years die with Alzheimer's disease or another form of dementia.

The Centers for Disease Control and Prevention (CDC) reported that 121,499 people died from Alzheimer's disease in the United States in 2019. This number may not be very accurate, as it's based on the official cause of reported death. Other health conditions are often made worse in a person with Alzheimer's disease. This can reduce life expectancy.

Only heart disease, cancer, some respiratory diseases, stroke, and accidents caused more deaths than Alzheimer's disease.

Rates of Alzheimer's disease increase with age. In the United States, 5 percent of people ages 65 to 74 have Alzheimer's disease. These rates increase to 13.1 percent in people between the ages of 75 and 84. Among people ages 85 and up, 33.2 percent have Alzheimer's disease.

Research on Alzheimer's, like so many other research, lacks diversity. Participants in studies don't accurately reflect the diverse population in the United States. This is an issue for all health conditions, but especially for a condition like Alzheimer's disease, which may disproportionately affect People of Color.

Data shows that 18.6 percent of Blacks and 14 percen t of Hispanics over the age of 65 have Alzheimer's disease. This is much higher than the 10 percent of White people over the age of 65 with Alzheimer's disease.

Higher rates of Alzheimer's disease in People of Color isn't likely due to genetic differences. It's more likely related to structural racism that creates major barriers to accessing healthcare and increases rates of poverty. Structural racism affects education, income, stress, housing, and exposure to violence.

With more than 6.5 million people in the United States living with Alzheimer's disease, the cost of treating the condition continues to rise. In 2016 the annual cost was about $236 billion. In 2022, this number was projected to rise to $321 billion.

The number of people with the disease is expected to increase in the years ahead. It's estimated that Alzheimer's disease may cost the United States just under $1 trillion by 2050.

A German doctor named Alois Alzheimer first observed Alzheimer's disease in 1906. He described a patient known as Auguste D. who had memory loss and other problems with thinking.

After the patient's death, Dr. Alzheimer noted that parts of the patient's brain were shrunken. A psychiatrist who worked with Dr. Alzheimer named the condition in 1910.

A person with Alzheimer's disease may lose their sense of smell. suggests that changes in the sense of smell may be an early sign of progression from mild cognitive impairment to Alzheimer's disease.

It's important to note that changes in your ability to smell may also be due to other causes, such as:

Parkinson's disease

brain injury

sinus infection

It's hard to predict how long someone with Alzheimer's disease will live. There are so many factors that determine life expectancy after this diagnosis.

The stage of the disease in which a person receives a diagnosis will affect life expectancy. The progression of Alzheimer's disease will also vary from person to person.

It's estimated that people will live an average of 4 to 8 years after diagnosis. There are people who live up to 20 years after a diagnosis of Alzheimer's disease.

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Alzheimer's disease is a primary cause of dementia. Alzheimer's disease damages nerve cells in the brain. In the early stages, there may not be many, if any, symptoms. Short-term memory loss is often the first sign. Over time, as more neurons are damaged, Alzheimer's disease results in problems with judgment, language, and thought processes.

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https://www.alzheimers.org.uk/sites/default/files/pdf/factsheet_the_progression_of_alzheimers_disease_and_other_dementias.pdf

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https://www.iriss.org.uk/resources/esss-outlines/carers-mental-and-physical-health

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Introduction

This summary provides an overview of evidence relating to:
Carers mental and physical health, with additional focus on finances and employment.
About the evidence presented below

We searched for academic research and grey literature using a wide range of search terms including: carer, mental health, physical health, resilience, social care, carer identification, benefits, employment.

Carer health is an understudied area with a lack of robust evaluation of interventions and support services.

Accessing resources

Where possible we identify where evidence is published open access, which means the author has chosen to publish their work in a way that makes it freely available to the public. Some are identified as author repository copies, manuscripts, or other copies, which means the author has made a version of the otherwise paywalled publication available to the public. Other referenced sources are pdfs and websites that are available publicly.

Background

While funding and cuts to budgets and services continues to be an issue in social care the number of people in need of long-term care is increasing. An ageing population combined with economic austerity means an increasing reliance on family carers to support people with long term health conditions ( Al-Janabi, 2016).

Most of the care in the UK is provided by family and friends. Recent polling suggests there could be around 8.8 million adult carers in the UK, up from 6.3 million in 2011 ( Carers UK, 2019a), which social services and the NHS rely on to function.

The figures from England ( NHS Digital, 2016) comparable across the UK show:

13% of carers care for 19 hours or less a week

15% care for between 20 and 49 hours a week

almost 15% care for between 50 and 100 hours a week

36% of carers are caring for over 100 hours a week

The numbers caring for 50 or more hours or more each week are rising faster than the general carer population ( Carers UK, 2019b).

The contribution of carers support to the economy is estimated at £132 billion a year ( Carers UK, 2019a; Cottagiri, 2019) but the health and wellbeing of carers are often not prioritised.

If a carer is working, looking after children, or having to travel long distances, then even providing a few hours of care a week can have a serious impact on their life ( Carers UK, 2019b). Providing care can be hugely stressful, affecting both mental and physical health, and resulting in social isolation and financial hardship ( Al-Janabi, 2016).

A Carers UK report ( 2019a) found two thirds of carers focussed on the care needs of the person they care for, rather than their own needs.

Cuts in services

More than a third of carers asked by Carers UK ( 2019a) had experienced a change in the amount of services that they received in the previous year because:

care or support arranged by social services was reduced, or closed with no replacement

the cost increased

their personal budget no longer covers it

It's crucial to a system reliant on informal carers that both practical and financial support are available.

Characteristics of caring

Caring is not a one size fits all concept, and the experience and effects of caring aren't the same for each group of carers. The amount and type of care that carers provide varies considerably - from providing a few hours a week shopping, collecting medication, taking someone to medical appointments, to round the clock care. Figures from NHS Digital ( 2010) show:

82% provide practical help such as preparing meals, doing laundry or shopping

76% keep an eye on the person they care for

68% keep them company

62% take the person they care for out

49% help the person they care for with financial matters

47% help the person they care for deal with care services and benefits

38% help with aspects of personal care

38% provide physical help

Most care for one person, but 17% are caring for two or more people:

40% care for their parents or parents-in-law

26% care for their spouse or partner

8% care for disabled children under 18

5% care for adult children

4% care for their grandparents

7% care for another relative.

9% care for a friend or neighbour

58% of carers look after someone with a physical disability

20% look after someone with a sensory impairment

13% care for someone with a mental health problem

10% care for someone with dementia.

A higher number of hours (over 20 per week) generally means care is more likely to be personal care - for example providing physical help and giving medicines. The same pattern is found for those caring for someone in their household, rather than at a distance ( Carers UK, 2019b). Around half of carers are caring for someone in the same household and half care for someone living elsewhere.

Sandwich caring - people who care for an older or disabled loved one at the same time as they have young children - is growing. Data suggests that 3% of the UK general population, around 1.3 million people, have these responsibilities and are more likely to report symptoms of mental ill-health, feel less satisfied with life, and struggling financially compared with the general population ( Carers UK, 2019b).

Age

Most carers are below state pension age, and the peak age for caring is 50-64. The number of carers over the age of 65 is increasing more rapidly than the general carer population. The 2011 Census indicated that almost 178,000 under 18s have caring responsibilities, but these figures are almost certainly higher ( Carers UK, 2019b).

Gender

Women are more likely to undertake responsibility for caring, often happening at the peak of their careers, and while raising children ( Carers UK, 2019a). There numbers of female carers are higher for young carers ( Barnardo's, 2017) and for those providing round the clock care. Carers over 85 are more likely to be male.

Female carers were found to experience more negative health impacts than male carers. Male carers are more likely to experience less carer burden, and more work interference ( Brenna, 2016).

Carers UK found that Black, Asian and Minority Ethnic carers were less likely to receive financial and practical support, often through difficulty accessing culturally appropriate information, and a lack of engagement with these communities. The Children's Society found that young carers are 1.5 times more likely to be from BAME communities and hidden from services ( Barnardo's 2017).

Disability

A 2019 survey ( Carers UK, 2019b) found carers are more likely to report having a long term condition, disability or illness than non-carers. More than half of those who considered themselves to have a disability said their financial circumstances were affecting their health. Carers with disabilities are:

The effects of caring

Providing care, often putting someone else's needs before your own, can be challenging. Many carers experience significant physical, mental, employment and financial effects as a result of their caring role. When asked about their own wellbeing the impact of stress and anxiety on their health was the most common response from carers ( Carers Week, 2018).

A Carers UK report ( 2019a) found carers who said they were struggling financially were more likely to say they expect their physical health to get worse, and most likely to expect their mental health to get worse, in the next two years.

Carers are less likely to look after their own health and more likely to take part in harmful behaviours such as smoking and drinking ( Cottagiri, 2019).

These effects differ across the groups of people being cared for and the type of carer, with women, those married, and providers of intensive care especially affected ( Bom, 2019).

The Scottish Government ( 2015) found more than a third of carers reported caring having a negative impact on their health, and with the more care provided, the less likely the carer is to report good health.

Research by Carers Scotland found that almost half of carers with health problems reported that their conditions began after they started caring. Of those whose condition pre-dated their caring role, a quarter said their condition had worsened since becoming a carer ( Carers UK, 2019b).

A UK survey of 1007 family carers found that around a third rated their health as fair or poor. Almost half had a longstanding physical complaint. A fifth reported restricting their activities because of a health problem. Worry, depression and tiredness was recorded most, with indications that smoking, alcohol and drug intake had increased as a result of caring responsibilities ( Bailey, 2019). Studies from around the world show similar effects.

Intense carers (those who provide at least 20-49 hours of care a week) were more likely to be physically inactive, smoke cigarettes, gain weight, and eat unhealthily. They were more likely to self-report or have a diagnosis of depression or anxiety. Carers who had given up work to care were more likely to be smokers and have common mental disorders ( Future Care Capital, 2019; Tseliou, 2019).

Studies of COPD carers ( Cruz, 2017) found carer burden was associated with carer-patient relationship quality, caregiving hours per week, carers' mental and emotional health and patients' physical health. Carer emotional distress was associated with disease‐specific factors (such as symptoms, severity and duration) but also with carers' background characteristics, such as gender, age and educational levels.

Positives

This is dependent on the amount of care being provided and the ability to balance it with other aspects of life, and in part, on the availability of appropriate support. Analysis found that those who provide up to 4 hours per week have higher mental wellbeing scores than non-carers ( Scottish Government, 2015).

This suggests that support and interventions should both reduce the negative aspects and enhance the positive aspects of caring.

Physical health

The physical impact of caring has been studied less than mental impact, but what is often highlighted is the impact of long-term stress and anxiety, poor health behaviours and the difficulties in maintaining a healthy lifestyle, and musculoskeletal problems ( Cottagiri, 2019).

Carers are more likely to have a long-standing health condition, with higher levels of arthritis, high blood pressure, and long-term back problems more common amongst carers who provide hands-on care.

Caring can be physically demanding, particularly if it means lifting the person needing care, helping them dress, wash and move around the house. Not having the necessary practical support and equipment such as hoists or stairlifts to ease the physical strain of moving and handling can lead to or worsen injury. Half of carers ( Carers UK, 2016) taking part in research said that missing out on support had an impact on their physical health.

Without the support to look after themselves, to sleep, eat and exercise properly, and to attend health appointments carers physical health problems can escalate resulting in long term injury, jeopardising their ability to provide care.

From the Scottish Government's ( 2015) report:

More recent papers show 40% of carers reporting their physical health being affected by caring, with tiredness (35%), trouble sleeping (28%), reduced fitness (20%) and back pain (18%) the most common impacts. Carers also highlighted being unable to find time to care for themselves if they become ill. These figures increase as duration and hours of caring increase, and are generally higher for those who live in the same house as the person they care for. Women and older people were also more likely to mention an impact upon their physical health ( Alzheimers Research UK, 2019; Carers UK, 2019b; Cruz, 2017; Future Care Capital, 2019).

Mental Health

Caring is seen to influence emotional and mental health and is a predictor of poor mental wellbeing.

Half of all carers reported that their mental health has been affected by providing care for another person ( Future Care Capital, 2019). Carers Week ( 2018) highlighted not getting enough sleep, providing hands on care for the person they care for, and managing financially were the three things that carers said contributed most to their stress and anxiety. Without support they can suffer from depression, stress and anxiety, strained relationships with friends and family, loneliness and isolation ( Carers UK, 2019a; Cottagiri, 2019; Future Care Capital, 2019). The Family Carers Ireland survey ( 2019) saw almost half of the respondents reporting being diagnosed with depression and / or anxiety, with two thirds of these saying it was caused or made worse by their caring role.

Carers identified social isolation and loss of recreational activities as one of the greatest impacts of caring ( Alzheimers Research UK, 2019; Carers UK, 2019b; Cottagiri, 2019; Cruz, 2017). Carers are seven times more likely to say they are always or often lonely compared with the general population, and overall 80% of all carers reported having felt lonely or isolated as a result of their caring role ( Carers UK, 2019a). Carers frequently lack support and often have no time or resources for social activities, with one survey showing 40% having not had a full day off from caring in over a year, and 25% in the last five years ( Carers UK, 2019b).

Carers UK State of Caring ( 2019a) report recorded 27% of carers rating their mental health as bad or very bad, and their happiness level at 4.7 out of 10, compared to a population average of 7.5 out of 10. There are many factors at play when it comes to the effects of caring on the carer.

The amount and duration of care increases the likelihood of experiencing mental health issues ( Brenna, 2016; Cottagiri, 2019; Future Care Capital, 2019). Carers who provide more than 35 hours per week, particularly for those with a long-term illness such as dementia, are much more likely to have lower mental wellbeing scores and exhibit signs of possible psychiatric disorders ( Scottish Government, 2015).

The type of care required also impacts, with effects on mental health most common among close family carers - parent, spouse, or child ( Future Care Capital, 2019). Carers looking after disabled children under the age of 18 reported significantly poorer mental health. 36% described their mental health as bad or very bad ( Carers UK, 2019a).

Carers of people with predominantly non-physical health conditions were most likely to experience mental health issues themselves, particularly if the person they are providing care for suffers from autism, addiction, or mental health conditions ( Future Care Capital, 2019). Carers who care for those with mental illness often have to cope with challenging, irrational, aggressive and violent behaviour ( Alzheimers Research UK, 2019; British Psychological Society, 2019; Cottagiri, 2019).

Young carers also come with their own challenges, particularly when providing full time care in addition to schoolwork. Previous studies show young carers are more likely than their peers to be bullied, miss school and have mental health issues. Over 50% of young carer respondents in a Barnardo's survey ( 2017) reported caring had impacted on their emotional and mental health.

At least half of carers expect their mental and physical health, and quality of life to get worse ( Carers UK, 2019a; Carers Week, 2018).

Risk behaviours and self-care

Chronic stress may promote unhealthy behaviours such as drug and alcohol abuse, smoking, poor nutrition, and sedentary lifestyle, that are often associated with physical and mental health problems. An Australian study of women aged 50 years or more, found carers reporting higher symptoms of depression, anxiety and stress, and lower participation in health promoting and physical activities ( Mohanty, 2019).

An exploratory study ( Bailey, 2019) conducted with carers of people with various mental illnesses, looked at health risk behaviours in carers. It found most carers consuming inadequate fruit and vegetables, more than half engaging in inadequate amounts of physical activity, and almost a third at risk for harmful alcohol consumption. Around two-thirds were at risk for multiple behaviours.

Findings suggest carers may require risk reduction programs particularly tailored to their caring roles / context.

Carers health might be affected by:

prioritising the health and wellbeing of the people they care for

time, transport and financial constraints on seeking support around risky behaviours

health professionals focussing on the health and wellbeing of the person they care for

There is inconsistency in carers being made aware of support available to look after their own physical, mental and emotional health and wellbeing including eating properly, exercising and sleep, access to health checks, flu jabs, supporting with medication and flexible appointment times.

The importance of carers talking about their experiences, taking a break where possible, the Carers Assessment, support groups, and information and signposting are frequently mentioned across the literature.

A scoping review from the United States on health-promoting self-care interventions in family carers of people with dementia found interventions helped reduce carer depression and burden, and increased quality of life, and physical activity ( Oliveira, 2019).

The carers in the Future Care Capital report ( 2019) frequently mention limited opportunity for formal or informal respite, making self-care difficult, resulting in their own needs coming second.

Carer identification

Providing care can take a toll on carers' health and wellbeing, finances, ability to work and relationships with family and friends. Too often carers are only identified when they are struggling to manage or are in crisis ( Carers UK, 2016). Despite policy and legislation many carers are still not routinely identified and thus supported by health and social care professionals. For example, more than a third of people who care for someone with cancer have not been recognised as a carer by any health or social care professional or organisation ( Macmillan Cancer Support, 2016).

Frontline professionals, such as GPs, social workers and pharmacists play a central role in ensuring carers are identified and then guided to support as early as possible in their caring journey.

Many people - more than half according to Macmillan Cancer Support ( 2016) - do not identify themselves as a carer. For some it's often just seen as something you do. It can take years for carers to recognise themselves in that role. Parent carers, mental health carers and distance carers often take longer than others ( Carers UK, 2016), and almost a quarter take over 5 years to identify as a carer.

Consequences

Not recognising you are carrying out a caring role can be a huge barrier to accessing support. If you do not see yourself as a carer, then you are unlikely to consider asking for a carer's assessment, applying for Carer's Allowance, or seeking advice from others who find themselves in similar circumstances. Early identification means better and earlier support for physical and mental health, access to financial support, support to stay in work, reduced isolation and loneliness, and reduced risk of burn-out ( Carers UK, 2016).

The majority of carers said they missed out on financial or practical support (or both) as a result of not identifying as a carer ( Carers UK, 2016). Those who identified themselves as a carer immediately or within 6 months were less likely to say they missed out on support. Missing out on support can have a significant impact across carers' lives:

Measuring the effects of providing unpaid care is unfortunately an understudied area. There is a lack of tools, and standardisation within them, to measure carer burden.

A lack of consensus about what and how to measure the QoL of carers has not helped practitioners or service funders. Measures need to be appropriate for younger and older carers, type of carer and caring tasks, and be sensitive to cultural and socio-demographic differences ( Manthorpe, 2016). A study on dementia carers concluded that caring often has both negative and positive consequences which need inclusion in measures and can vary by individual and over time.

A short, generic tool, community-based and across health and care, to screen for mental and physical effects on carers would support measurement ( Kudra, 2017). Dow's review ( 2018) looked at ten instruments for measuring the quality of life of carers of people with dementia. The Carer Well-being and Support questionnaire (CWS) has the best quality evidence for the greatest number of measurement of properties and is found to be the most appropriate instrument for the assessment of quality of life in informal carers at present. The Caregiver Well-Being Scale is also worth considering. All instruments included in the review would benefit from further evaluation.

Wellbeing

Despite its prevalence, the concept of wellbeing lacks a clear definition. It's often used interchangeably with quality of life. Carer wellbeing is most used in the context of mental health. But wellbeing is arguably more than just the absence of illness and should encompass both positive and negative dimensions. Cunningham ( 2019) argues the need for standardised and robust measurements that sees wellbeing as a multi-faceted concept to enhance research in this area.

A recent review concluded that there are serious methodological limitations in existing studies looking at negative outcomes due to caregiving, particularly if evidence is examined through a negative‐impact lens only ( Totsika, 2017).

The Social Care Institute for Excellence identified nine key elements of wellbeing:

personal dignity

emotional wellbeing

protection from abuse or neglect

control over everyday life

work, education and training

social

domestic

accommodation

contribution to society

Approaches, support and interventions

Summary Euro Carers ( 2018) highlighted some key factors that increase carers' life satisfaction:

A sizable majority of carers felt that support, and increased support, in some form would be useful. Emotional support is a frequent theme. Around half of carers said that they had received some form of information or support to assist with their role as a carer. Most commonly, this was access to equipment such as stair lifts or adaptations or information on the support available to carers ( Future Care Capital , 2019).

There two main approaches seen across the literature:

formal care services for the cared-for person to reduce the level and burden of informal care

direct support to carers, such as respite care, training, counselling and psychological support

Carers have different needs and trajectories, dependent on the person being cared for, the condition they have, and the stage they are at. What might be useful and effective for one sort of carer might not be useful or effective for another. With no 'one size fits all' approach what's likely to be effective in supporting carers mental and physical health are multicomponent interventions, with an emphasis on the psychosocial and psychoeducational, education and training ( Thomas, 2017; Brimblecombe, 2018).

For dementia carers what's seen to help is shared learning, and computer-delivered psychosocial support. For cancer and stroke carers it can be counselling. For young carers the most important types of service would focus on having someone to talk to, emergency / crisis planning, and mental health support ( Barnardo's, 2017).

Organising accessible long-term care, providing respite care, and enabling family carers to balance work and care should be driven by social policy ( Euro Carers, 2018).

Finances

Many argue finances are the main dictator of the quality and choice of support and care received, and additional financial support would improve quality of life ( Farina, 2017).

Family Carers Ireland ( 2019) found pervasive worries at the heart of carer anxiety, with three quarters worried about money, their own health and wellbeing, the lack of appropriate supports and services as well as fearful for what will happen when they die or cannot care any longer.

Benefits

There are two main policy approaches to cash benefits. Carer's allowance, which is provided directly to the carer after successful application. And a care allowance to a person with care needs who can buy in the services of carers or use it to pay a relative to provide care ( Brimblecombe, 2018).

Carers Allowance remains one of the lowest welfare benefits, though higher in Scotland than in the rest of the UK. The eligibility criteria can act as a disincentive to those who want to take up employment or work additional hours to stay within the earnings limit. Carers Allowance in England also discounts other benefits and pension, and is taxed ( Brimblecombe, 2018) but does protect state pension and national insurance rights.

Carers UK ( 2019a) suggest that financial support for carers must be increased significantly. Carer's Allowance should be raised and increased in line with the National Living Wage, pegged at least to the equivalent of 16 hours a week so carers don't have to choose between Carer's Allowance and staying in work. Carers should also be auto enrolled in a second Carer's Pension that recognises the value of unpaid work and ensures that they do not suffer financial hardship later in life.

Carer-proofing

One problem with carer support is that interventions often come too late, with stress treated as an inevitable side effect of caring. To support carers better, carer outcomes should be considered in healthcare decisions for long term conditions from the outset ( Al-Janabi, 2016).

Health systems could reduce strain on family carers by routinely considering carers' needs alongside patients' needs in everyday healthcare decisions. New treatments and different care can equally affect carers, both positively and negatively, for example reducing physical demands or stress and anxiety, or changing lifestyles. For example, a recent study of stroke follow-up care showed that the intervention reduced carer depression but did not affect patient outcomes ( Al-Janabi, 2016).

The IMPACT mechanisms ( Al-Janabi, 2019) show how health and care services can affect family carers' wellbeing, through:

information (degree to which service delivery informs and trains family carers)

management of care (shifts of responsibility for care between formal and family sectors)

patient outcomes (services changing patient outcomes)

alienation (feelings of alienation or inclusion created by service delivery)

compliance (barriers to patients complying and engaging with services)

timing or location (changes in the timing or location of services).

The IMPACT mechanisms may be useful in designing and evaluating services to optimise the wellbeing of carers as well as patients.

Enhanced carer proofing could complement existing interventions to support carers, such as respite care, carer support groups, and individual education and training.

Carer Assessment / Adult Carer Support Plan

A Carers Assessment (or Adult Carer Support Plan in Scotland) gives carers the right to an assessment from their local authority, looking at the impact of the caring role on them and what support they might need as a result.

For various reasons, including lack of identification as being a carer, only around a third of carers have an assessment, or a review of their assessment. Carers who are providing palliative care and those looking after someone with a mental health condition were slightly more likely to have had an assessment. Parent carers are less likely.

The majority of carers in England who had been assessed / reassessed in the previous year felt that their needs were not given sufficient consideration ( Carers UK, 2019a). Even with a positive experience of the assessment there is often no local services available to support them with anything raised. Cottagiri ( 2019) found this to be a key barrier to carers using the carers assessment. Visible positive outcomes would encourage more carers to take part in carers assessments.

Inflexibility around individual carer needs (and changing needs), lack of communication and coordination before and after the assessment was also seen to be a barrier in effectively carrying out the process.

Practical support

Reducing the amount of care to be provided by informal caregivers could be achieved through interventions like respite, professional home care and assistive technology that could relieve caregivers from some of their tasks ( Cruz, 2017; Bom, 2019).

There has been little investigation into the accessibility and use of occupational therapy services, equipment provided for care-recipients, and manual handling training for carers.

Support equipment like grab rails, wheelchairs, stair lifts, and hoists can reduce the physical exertion required by carers and increase the patient's independence, and potentially reduce carer burden and improve physical health ( Cottagiri, 2019).
Carers UK ( 2019a) found a fifth of carers don't buy or receive support with caring, suggesting a fairly large area of unmet need.

Respite

Respite care is often seen as an important form of support for carers, providing them with time to themselves away from caring activities, to look after their own physical and mental health, and to continue providing care safely for longer. The most common forms of respite care include day-care services, in-home respite and institutional respite. A form of longer break can be vacation breaks for carers ( Cottagiri, 2019).

Despite the perception of its usefulness there has been little in the way of robust evaluation on the benefits of respite care and breaks. What there is provides useful insight into the lived experiences of carers, but the findings cannot be easily generalised.

Further research is required to explore the specific respite needs of individuals who provide care.

Carers UK ( 2019d) found almost 70% of carers said that the break had a positive impact with their health and well-being improving as a result. For the 30% of carers whose break worsened / didn't have any impact on their health and well-being, this was most often because of poor quality replacement care, the break being too short or their unhappiness at returning to the caring role following the break.

A report from Alzheimers Research UK ( 2019) shows all carers interviewed were aware of respite care. But often a sense of duty or responsibility, not finding it appropriate or practical to leave their loved one with a friend or full-time carer, meant not using this kind of support.

Many carers have voiced their concerns over the quality of respite services. Lack of trust over the care provided or being unsatisfied with previous respite services has caused unwillingness among carers to use respite services ( Cottagiri, 2019).

Carers who hadn't been able to take a break were asked for further details ( Carers UK, 2019d). 40% said that the person they care for is unwilling to accept replacement care. This echoes other research from Carers UK about worries carers have about the quality and suitability of replacement care. Cost was another issue, with 38% of carers saying that they cannot afford replacement care, and 34% even with free time they cannot afford to do any activities.

While policies ensuring ease of access to respite, such as flexibility, financial assistance, and local support ( Euro Carers, 2018) are important, the services provided must be suited to the individual needs, and are well managed and professionally staffed.

Training and advice

Despite the risk of physical injury, carers rarely receive training for their role. Manual handling training was the most common training need identified when Irish carers were asked what training they would like to receive ( Family Carers Ireland, 2019).

Future Care Capital findings ( 2019) show only 13% of carers had received some form of advice or training in relation to their role as a carer - most commonly this was training in medical tasks, advice on their own mental / emotional health, and training in giving emotional support to the person cared for. Over a quarter of carers, particularly younger and middle-aged carers and those caring for long periods, indicated that some form of advice or training would be useful to them. There was also a need for advice on mental and emotional health, particularly around the stress, isolation and despondency being a carer can lead to.

Recent surveys show that carers would welcome additional support from health professionals. For instance, carers are not always knowledgeable about the disease of the person they care for or have difficulties dealing with disabilities ( Euro Carers, 2018). An example from COPD found carers not receiving full explanations about the disease trajectory and management strategies from health professionals led to frustration and anxiety, and feeling unprepared to care ( Cruz, 2017).

Almost two thirds of people caring for someone with cancer ( Macmillan Cancer Support, 2016) say they would benefit from more support. The most common types mentioned were:

someone to talk to / emotional support

information and advice on the support available to those who care

advice or information on financial issues or benefits

information about cancer and its treatment

Parent carers of children with ASD reported that receiving factual and accurate information on the disorder helped decrease their feelings of stress and anxiety around their child's behaviours ( Catalano, 2018).

Information needed can depend on the type and severity of illness cared for. Caring for someone with a newly diagnosed illness would require support accessing information regarding the side-effects and advantages of treatments, the physical needs of the recipient, financial support and welfare benefits they might be entitled to, how it could affect their working life, and what support services can be accessed. But someone caring for terminally ill patients might need more information about what to expect in future, the severity of the illness, how to manage symptoms and who to contact in emergency situations ( Cottagiri, 2019).

Joined-up services

Carers may not be fully aware of services available to them and may find it difficult to get help from fragmented services ( Euro Carers, 2018).

Daily planning of tasks and duties may be difficult for carers and cause burnout. Dealing with doctors' or social workers' appointments and organising respite care appointments can be stressful, especially when combined with personal or familial duties and employment ( Euro Carers, 2018).

Integrated health and social care services, linking the voluntary and community sector with public authorities can help reduce fragmentation and improve the coordination of services, reducing carer stress and burnout. A one-stop-shop for carers and their families to get medical information and find out about what support (financial, physical, emotional and social) is available could prove beneficial to carers' wellbeing ( Al-Janabi, 2016; Euro Carers, 2018).

Case managers

One suggested measure here is the support of a case or care manager to alleviate some of the administrative burden facing carers following an assessment of their needs and those of the person they care for. Managers can bridge the gaps between health and social care providers, and carers. Identifying carers through adequate professionals trained to support them is a key component of this ( Euro Carers, 2018).

GP's

Carers UK ( 2019b) found that most carers caring for at least 50 hours a week had a GP who knew about their responsibilities but didn't do anything differently to accommodate them. Very few had a GP who gave regular carers health checks or did home or telephone appointments. Over half had not been informed about how to access practical support by their GP. Where GPs didn't support carers through signposting or health checks, over half of carers reported that they let a health problem go untreated and that their mental health got worse ( Carers UK, 2019b).

Workshops, groups and counselling

Studies have shown stress management programs and cognitive behavioural therapy can reduce mental stress among carers ( Cottagiri, 2019). A pilot study investigating an 8-week web-based mindfulness intervention showed improvements in levels of mindfulness, perceived stress, caregiver burden, and self-compassion ( Stjernswärd, 2017). Mindfulness and acceptance and commitment therapy can change long‐standing response behaviours and build personal resilience and improve mental health ( Appleton, 2019; Cook, 2019). Combined with training in problem-solving strategies, these have the potential to improve carers' wellbeing and increase confidence in effectively managing daily challenges ( Catalano, 2018).

Cognitive Behaviour Therapy (CBT) models have been used to treat anxiety and depression, helping people develop coping strategies by working through their thoughts, feelings, and approaches to particular situations. A modern CBT approach, Acceptance and Commitment Therapy (ACT), seemed to be particularly beneficial for carers experiencing high levels of anxiety ( Kishita, 2018).

Recent surveys show that carers would welcome additional psychological counselling. Counselling has proved effective to relieve carers' stress ( Euro Carers, 2018).

Individual counselling and group meetings aimed at providing emotional, educational, and practical support for carers ( Brimblecombe, 2018; Caton, 2019) seem to offer health benefits. There is evidence on the effectiveness of mental health support groups for carers, such as Carer Peer Support Workers ( Visa, 2019) and professionally facilitated, family-led support groups, psychoeducation carers support groups, and professionally facilitated, program-based support groups for people living with mental illness ( Worrall, 2018).

Telehealth and online support services can also offer easier access and convenience to carers but there has been little evaluation of their efficacy ( Sin, 2018)

The higher quality studies of interventions are generally in the field of dementia care. Two examples highlighted by The British Psychological Society ( 2019):

SHARE (Support, Health, Activities, Resources & Education) is an intervention to help couples plan for the future. It is focused on enabling the person with dementia and a key carer to work together to plan for their future with dementia. The sessions involve a range of structured discussions that enable couples to develop their understanding of dementia, think about their care values and their preferences for future care, and plan how to draw on resources as the dementia gets worse.

START (STrAtegies for RelaTives) is a carers' psycho-educational and skills-training intervention focused on enabling carers to cope with caring. The sessions of the programme cover material which carers then put into practice at home, with support from a manual. Topics include psycho-education about dementia; carer stress and sources of emotional support; understanding and managing behaviour of the person with dementia; changing unhelpful thoughts; promoting acceptance; assertive communication; relaxation; planning for the future; increasing pleasant activities; and maintaining the skills learnt.

Income and employment

Finances

1.2 million carers (around a fifth) live in poverty in the UK, highest in the working age carer population and increasing with the number of hours of care provided ( Carers UK, 2019b).

When asked how they would describe their financial situation, almost 40% of carers say that they find it difficult to make ends meet. Carers UK ( 2019a) found:

21% are or have been in debt as a result of caring

44% are relying on their savings

36% are using credit cards

33% are using their bank account overdraft

15% are falling into arrears with utility bills

9% are falling into arrears with their housing costs

The combination of higher costs and lower incomes can push families into financial crisis and lasting debt - 21% of UK carers are in or have been in debt as a result of caring and only 46% of UK carers can afford their bills without struggling financially ( Carers UK, 2019b).

Carers looking after children were particularly likely to report that caring has affected their financial situation. Many parents will have to care for their child for several years and are likely to be offering full time care (60% care for 30 hours or more a week), with the resulting continuous spending for caring. They are also more likely to say they have less money due to not working ( Future Care Capital, 2019).

43% of carers said their financial circumstances were affecting their health ( Carers UK, 2019b).

Support

The financial impact of caring is often exacerbated by delays in accessing benefits and other financial support ( Carers UK, 2019b), and even when in receipt of benefits over half of carers receiving Carer's Allowance are also struggling to make ends meet. Carer's Allowance aims to help with the costs of caring, but for many the low payment level and other entitlement conditions, including an earnings limit, leaves the benefit ineffective in preventing financial hardship. Neither the Allowance nor the earnings threshold align with the national living wage, meaning that a carer can only work for a maximum of 15 hours per week without losing the Allowance ( Carers UK, 2019a).

Many carers are frustrated with the state financial support available. Those who receive carers allowance said that the amount received is minimal, particularly if they then have deductions made to other benefits as a result. Others are turned down for the allowance without understanding why given the amount of support they provide, and the impact of this on their own finances. Other issues include young carers unable to claim carer's allowance whilst attending university despite still living at home to support parents ( Future Care Capital, 2019).

Carers also miss out on support due to not identifying as a carer. More than half of carers reported it impacting negatively on their finances, with almost 60% struggling to make ends meet ( Carers UK, 2016).

The Future Care Capital report ( 2019) also notes carers applying for financial support from local authorities for things like adaptations, but only a minority being successful.

Good work-life balance and wellbeing cannot be achieved through financial support on its own. Formal care services, flexible working and poverty alleviation measures are also needed. In many cases a combination of interventions and support would be most effective ( Brimblecombe, 2018).

Employment

The 2011 Census found around half of the UK's carers combine work with unpaid caring responsibilities - over two million full-time and one million part-time. Recent research suggests that both the carer population and proportion of working carers has increased, with 5 million people now combining paid work and caring ( Carers UK, 2019b). Part-time working is much more common amongst carers than non-carers. Carers are also more likely to stop working altogether with difficulties moving to part-time hours ( Brimblecombe, 2018).

The Future Care Capital report ( 2019) showed over 40% of carers working life impacted by caring, with almost 20% having to stop working all together, mostly due to the stress of combining work and care, and the lack of suitable support services. Reduced and flexible working were other common approaches. All of this can be accompanied with decreased performance at work (for example, lateness, tiredness, difficulty concentrating) ( Carers UK, 2019b).

Alongside this there are still a significant number of people working a full week alongside a full caring week ( Carers UK, 2019b). And of those still working there are complications from having to change working patterns, accepting less qualified positions, or being unable to take on promotions ( Carers UK, 2019b).

Generally, carers aged 35-49 are most likely to report an impact on their working life, and to stop working altogether. But again, effects are often dependent on circumstances and those being cared for - for example carers of people with dementia, children, or someone with autism are more likely to have to stop working ( Future Care Capital, 2019).

Future Care Capital ( 2019) highlighted the impact emotional strain can have on resilience in the workplace, with key challenges to maintaining full time employment being appointments and accidents / fluctuations in the health and ability of the person being cared for.

The long-term impact on ability to work can be seen in a loss of skills, knowledge, experience and difficulties in / confidence to return to work when caring ends ( Brimblecombe, 2018; Carers UK, 2019b).

Figures estimate that 70% of carers were over £10,000 worse off as a result of reduced hours and earnings ( Carers UK, 2019b). But costs from carers inability to participate fully in work go beyond the individual. For employers, there are costs associated with recruitment, retention, absenteeism, and reduced productivity. For society, costs result from lower tax revenues and contributions, increased benefits and lost productivity and reduced contributions to GDP. It was recently estimated that the public expenditure costs of carers leaving employment in England are £2.9 billion a year ( Brimblecombe, 2018).

The Department for Work and Pensions Fuller Working Lives report ( 2014) suggests a range of actions are needed to help more carers stay in employment: support services, income protection, flexible working practices, and better use of assistive technology. Carers UK ( 2019b) found what carers saw as important in workplace support: a supportive line manager / understanding employer, the ability to work flexibly, and a right to additional paid time off work to care. Workplace support however remains varied.

There are also differences in what paid support services best support remaining in work ( Brimblecombe, 2018). The type of services that appear to be most effective are day services such as home care, personal assistants, day care and meals-on-wheels.

Carers UK ( 2019a) recommendations:

Care Leave

Working carers often struggle to get time off to coordinate care services or attend medical appointments, and in 2016, 70% of survey respondents had used their annual leave to care.

It is difficult to separate and assess the impact of lack of care leave on caregiving or employment. There is some evidence from Japan that it may have a positive effect on employment in combination with flexible working ( Brimblecombe, 2018). However, the more intense and longer caring responsibilities are the less effective care leave is.

Services

Half of carers ( Carers UK, 2019b) stated problems accessing suitable care services as a reason they gave up work or reduced working hours. Inflexible services unable to accommodate working hours or are unreliable can make work impossible. Carers also describe being unable to find suitable care services to meet the needs of the person needing care, or find they are simply too expensive. Most working carers say they need at least one type of formal service which they are not currently receiving.

Retirement

Only 1 in 6 carers responding to the Carers UK survey ( 2019a) said that their ability to plan or save for retirement had not been affected by caring. This figure decreases further as the years and weekly hours of caring increases.

Long term reduced employment and income has implications for savings, retirement and pensions. Just over 10% of carers said they retired early to care for someone ( Carers UK, 2019b).

Over half of those who have yet to retire are unable to save for their retirement, higher still for those regularly using their own income or savings to pay for care or support services, and higher again for those in receipt of carers allowance ( Carers UK, 2019a). Over 20% don't know how they are going to pay for retirement, particularly those already struggling financially.

There were some notable gender differences with male carers more likely to have a workplace pension, state pension and savings to pay for their retirement.

There is a need for evidence-based research on all aspects of the impact of caring, and evaluation of support services for carers' mental and physical health. The needs of the growing number of former carers remain largely unreported and unresearched ( Watts, 2018).

References

Al-Janabi, H (2016) The need to "carer proof" healthcare decisions BMJ 2016;352:i1651 (paywall)

Al-Janabi, H (2019) Six mechanisms behind carer wellbeing effects: A qualitative study of healthcare delivery Social Science & Medicine Volume 235, August 2019 (open access)

Alzheimers Research UK (2019) Dementia in the Family: The impact on carers (open access)

Alzheimers Society Carers for people with dementia struggling in silence (website)

Aoun, SM (2015) The impact of the carer support needs assessment tool (CSNAT) in community palliative care using a stepped wedge cluster trial PLoS One. 2015;10(4):e0123012 (open access)

Appleton, P (2019) Effects of a mindfulness-based stress reduction group programme on family carers Mental Health Practice (paywall)

Bailey, JM (2019) A survey of the prevalence of modifiable health risk behaviours among carers of people with a mental illness. BMC Public Health (2019) 19:1240 (open access)

Barnardo's (2017) Still Hidden, Still Ignored Who cares for young carers? (open access)

Bom, J (2019) The Impact of Informal Caregiving for Older Adults on the Health of Various Types of Caregivers: A Systematic Review, The Gerontologist, Volume 59, Issue 5, October 2019, Pages e629-e642 (open access)

Brenna, E (2016) Is caring for older parents detrimental to women's mental health? The role of the European North-South gradient Rev Econ Household 14, 745-778 (open access)

Brighton, RM (2016) The Effect of Respite Services on Carers of Individuals With Severe Mental Illness Journal of Psychosocial Nursing and Mental Health Services 2016;54(12): 33-38 (paywall)

Brimblecombe, N (2018) Review of the international evidence on support for unpaid carers Journal of Long-term Care (September). pp. 25-40 (open access)

British Psychological Society (2019) The psychological needs of families and carers of people with dementia (pdf)

Carers UK (2016) Missing out: the identification challenge (pdf)

Carers UK (2019a) State of Caring: A snapshot of unpaid care in the UK (pdf)

Carers UK (2019b) Facts about carers 2019: policy brief (open access)

Carers UK (2019c) State of Caring (pdf)

Carers UK (2019d) Carers at breaking point: making the case for carers' breaks in England (pdf)

Carers Week (2018) Supporting Carers to be Healthy and Connected (open access)

Catalano, D (2018) Mental Health Interventions for Parent Carers of Children with Autistic Spectrum Disorder: Practice Guidelines from a Critical Interpretive Synthesis (CIS) Systematic Review. Int. J. Environ. Res. Public Health 2018, 15, 341 (open access)

Caton, S (2019) Internet use for family carers of people with intellectual disabilities: A literature review and thematic synthesis. Journal of Intellectual Disabilities, 23(3), 446-468 (paywall)

Cook, T (2019) Mindfulness‐based practices with family carers of adults with learning disability and behaviour that challenges in the UK: Participatory health research Health Expect. 2019; 22: 802- 812 (open access)

Cormac, I (2006) Meeting the mental and physical healthcare needs of carers Advances in Psychiatric Treatment, 12(3), 162-172 (open access)

Cottagiri, SA (2019) Key health impacts and support systems for informal carers in the UK: A thematic review J Health Soc Sci. 2019;4(2):173-198 (open access)

Cruz, J (2017) Impacts of COPD on family carers and supportive interventions: a narrative review Health Soc Care Community, 25: 11-25 (open access)

Cunningham, NA (2019) Understanding and Measuring the Wellbeing of Carers of People With Dementia The Gerontologist, Volume 59, Issue 5, October 2019, Pages e552-e564 (open access)

Department for Work & Pensions (2014) Fuller Working Lives: a framework for action (website)

del-Pino-Casado, R (2019) Sense of coherence, burden and mental health in caregiving: A systematic review and meta-analysis Journal of Affective Disorders Volume 242, 1 January 2019, Pages 14-21 (open access)

Department of Health and Social Care (2018) Carers Action Plan 2018 - 2020: Supporting carers today (website)

Dow, J (2018) How best to assess quality of life in informal carers of people with dementia; A systematic review of existing outcome measures PLoS One. 2018;13(3):e0193398 (open access)

Euro Carers (2018) The impact of caregiving on informal carers' mental and physical health (open access)

Family Carers Ireland (2019) Paying the Price: The Physical, Mental and Psychological Impact of Caring (pdf)

Farina, N (2017) Factors associated with the quality of life of family carers of people with dementia: A systematic review Alzheimer's & Dementia Volume 13, Issue 5, May 2017, Pages 572-581 (open access)

Future Care Capital (2019) A Forgotten Army: Coping as a Carer (website)

Health and Social Care Board (2017) The effectiveness of short breaks in families where there are children with disabilities: A Systematic Review of the Evidence (pdf)

Kishita, N (2018) Which interventions work for dementia family carers?: An updated systematic review of randomized controlled trials of carer interventions International Psychogeriatrics, 30(11), 1679-1696 (open access)

Kudra, A (2017) Measuring carer burden in informal carers of patients with long-term conditions British Journal of Community Nursing 2017 22:5, 230-236 (paywall)

Macmillan Cancer Support (2016) Under Pressure: The Growing Strain on Cancer Carers (pdf)

Manthorpe, J (2016) Quality of life measures for carers for people with dementia: measurement issues, gaps in research and promising paths Research, Policy and Planning (2016) 31(3),163-178 (open access)

McCann, TV (2015) Carers of Parents with Mental Illness Int J Ment Health Nurs, 24: 203-212 (open access)

Mohanty, I (2019) A longitudinal analysis of mental and general health status of informal carers in Australia BMC Public Health 19, 1436 (open access)

NHS Digital (2010) Survey of Carers in Households - England, 2009-10 (open access)

NHS Digital (2016) Personal Social Services Survey of Adult Carers in England (open access)

O'Dwyer, ST (2016) Suicidal ideation in family carers of people with dementia Aging & Mental Health, 20:2, 222-230 (paywall)

Oliveira, D (2019) Improving health-promoting self-care in family carers of people with dementia: a review of interventions Clin Interv Aging. 2019;14:515-523. Published 2019 Mar 1 (open access)

SCIE Impact of caring (website)

Scott, JL (2016) Caring for the carer: a systematic review of pure technology-based cognitive behavioral therapy (TB-CBT) interventions for dementia carers Aging & Mental Health, 20:8, 793-803 (open access)

Scottish Government (2015) Scotland's Carers (website)

Sharma, N (2016) Gender differences in caregiving among family - caregivers of people with mental illnesses World J Psychiatry. 2016;6(1):7-17. Published 2016 Mar 22 (open access)

Sin, J (2018) eHealth interventions for family carers of people with long term illness: A promising approach? Clinical Psychology Review Volume 60, March 2018, Pages 109-125 (open access)

Stjernswärd, S (2017) Outcome of a web-based mindfulness intervention for families living with mental illness - A feasibility study Informatics for Health and Social Care, 42:1, 97-108 (open access)

Thomas, S (2017) Updated meta-review of evidence on support for carers Health Serv Deliv Res2017;5(12) (pdf)

Totsika, V (2017) Informal caregivers of people with an intellectual disability in England: health, quality of life and impact of caring Health Soc Care Community, 25: 951-961 (paywall)

Tseliou, F (2019) Do carers care for themselves? A population-based study. International Journal of Population Data Science (2019) 4:3:054 (paywall)

University College London (2018) The Emotional Wellbeing Of Older Carers (pdf)

Visa, B (2019) Mental health carers' experiences of an Australian Carer Peer Support program: Tailoring supports to carers' needs. Health Soc Care Community. 2019; 27: 729- 739 (open access)

Watts, J (2018) Being a former carer: impacts on health and wellbeing Illness, Crisis and Loss, 26(4) pp. 330-345 (pdf)

Williams, A (2017) Gender and sex differences in carers' health, burden and work outcomes: Canadian carers of community-dwelling older people with multiple chronic conditions. International Journal of Care and Caring. 1. 331-349 (open access)

Williams, F (2019) Interventions for reducing levels of burden amongst informal carers of persons with dementia in the community. A systematic review and meta-analysis of randomised controlled trials Aging & Mental Health, 23:12, 1629-1642 (open access)

Worrall, H (2018) The effectiveness of support groups: a literature review Mental Health and Social Inclusion, Vol. 22 No. 2, pp. 85-93 (paywall)

Suggested reference: Sanders, R (2020) ESSS Outline: Carer mental and physical health. Iriss. https://doi.org/10.31583/esss.20201012

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This summary provides an overview of evidence relating to: Carers mental and physical health, with additional focus on finances and employment. We searched for academic research and grey literature using a wide range of search terms including: carer, mental health, physical health, resilience, social care, carer identification, benefits, employment.

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https://www.appliedradiology.com/communities/MR-Community/mri-shows-brain-iron-accumulation-linked-to-cognitive-deterioration-in-alzheimer-s-patients

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https://www.alz.org/alzheimers-dementia/what-is-alzheimers/brain_tour_part_2

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Under the Microscope

Scientists can also see the terrible effects of Alzheimer's disease when they look at brain tissue under the microscope. Scientists are not absolutely sure what causes cell death and tissue loss in the Alzheimer's brain, but the plaques and tangles in the figures below are prime suspects.

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Under the Microscope Scientists can also see the terrible effects of Alzheimer's disease when they look at brain tissue under the microscope. Scientists are not absolutely sure what causes cell death and tissue loss in the Alzheimer's brain, but the plaques and tangles in the figures below are prime suspects.

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https://www.youtube.com/watch?v=CNdMFXAZK_A&t=28s

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TOP 10 Awesome Acrylic Pouring Techniques | Satisfying Fluid Art | Acrylic Pouring Compilation 2021

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https://www.youtube.com/watch?v=jhhZu4slomg

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Acrylic Flip Cup Technique | Pouring art Technique

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https://www.youtube.com/watch?v=3QQlqWroCp0