Brittany Butts understands that for many families, Alzheimer’s comes as a double burden. As a teenager, she watched not only her grandmother’s mental decline from the disease but also her aunt’s struggles as the primary caregiver.
Brittany Butts
New research by Butts and her colleagues shows that the stress of caregiving is more than mental — that it can actually cause the caregiver’s cells to age faster. At a time when one in nine adults ages 65 or older in the U.S. lives with Alzheimer’s or related dementia, the stress on caregivers is emerging as a health problem in itself.
“The most common caregivers are either a spouse or a child, usually a daughter,” Butts says. “If it's a spouse, they might be sharing a bed or a room. There could be a lot of sleep lost, for example. Or a daughter might be caring for both her younger children and her older parent. There are a lot of health impacts from things like stress, lack of sleep, and not having time for self-care, such as diet and exercise.”
In her recent study, published in Alzheimer’s & Dementia, Butts found that caregivers who reported more perceived stress had measurably poorer psychological health as well as shorter telomeres, the structures of repeated DNA sequences and proteins that protect the ends of human chromosomes. Because telomeres are known to shorten with stress and with age, they are considered biomarkers for biological aging as well as cardiovascular disease risk.
“If you stress anything, it's gonna wear out, whether it's a rubber band or your favorite pair of jeans. Our cells do the same thing.”
Butts and her colleagues focused on Black caregivers, a population considered particularly at risk, who often report less satisfaction in their role, compared to white caregivers. While they’re more likely to be part of a social support network, they also have fewer socioeconomic resources. The researchers measured a panel of biomarkers in 142 Black family caregivers from the Atlanta area, including the stress-related hormone cortisol as well as markers of biological risk pathways activated by chronic stress.
Psychological stress was measured through questionnaires. Telomere length was measured to capture cumulative biological aging and cellular wear and tear. They found greater feelings of stress were associated with worse psychological health, anxiety, depression, poorer sleep, shorter telomere length and greater cardiometabolic risk markers.
Butts says the findings are a strong basis for providing focused interventions and support.
“If you have to be constantly taking care of a loved one with dementia, you may not have time to exercise every day. Or you may not have time to visit a support group. So one step in our research is finding those physiological pathways, but another is finding more creative ways to provide support for the caregivers where they would have time to address those stressors, find ways to meditate or whatever they need to do to reduce that stress and disrupt those pathways.”
Beyond that need, Butts says a larger study could probe how the stress effects she found are compounded by health disparities found in the Black subjects of her research.
“The harder it is for someone to get access to health care or resources, the higher the burden of health care can be,” she says. “If you’re doing it alone or not getting the right treatment, it can compound that stress and perhaps long-term cardiovascular risk.”