Joey Wahler (Host): It can go overlooked when taking care of someone else. So, we're discussing caregiver health. Our guest is Dr. Pavitri Dwivedi. She's a geriatrician and primary care provider at UM Baltimore Washington Medical Group, Adult and Senior Care. This is the Live Greater podcast series, information for a healthier you from the University of Maryland Medical System. Thanks so much for joining us. I'm Joey Wahler. Hi there, Doctor. Welcome

Pavitri Dwivedi, DO: Thank you so much for having me.

Host: Absolutely. We appreciate the time. So first, what are some of the basic physical and even emotional signs that indicate caregiving is starting to affect one's health?

Pavitri Dwivedi, DO: Absolutely. There's so many both physical and emotional signs when it comes to caregiver burnout. Unfortunately, a lot of caregivers don't present with these signs, so you have to make that extra effort to start noticing them and identifying them when they do present to these patient appointments.

One of the major sign of physical burnout that I see is chronic fatigue and exhaustion. A lot of these caregivers are not getting the rest and sleep that you need to, you know, function on a daily basis. So it makes it really hard for them to not just take care of themselves, but also the person that they're taking care of.

Emotional exhaustion is a huge component when it comes to caregiver burnout. A lot of times, you know, there's so much attention on sadness, but burnout can present as irritation, anger, anxiety. And this can all make it really hard, for them to keep taking care of the person that they are there for. So, I think all of us can do such a better job by not just paying attention to our patients, but also the person who's sitting next to them, so we don't miss these signs.

Host: So, one of the things you mentioned there, Doctor, is lack of sleep. So, what are some other examples of the main things that caregivers tend to ignore or maybe put out of their mind because they are so busy focusing on someone else?

Pavitri Dwivedi, DO: It makes it really hard for them to make time for their medical appointments or even taking their medications on time. So, one thing that I hear a lot from the caregivers is, "Well, you know, on Monday, I have this scheduled, and on Tuesday I have this scheduled for the patient, so I'm just going to skip my mammogram," or, "I'm going to not get my colonoscopy done for another year." So, there is this need to keep putting their needs aside and not taking care of, you know, things that can actually keep them healthy.

Because unfortunately, over time, I don't know if you know, but 18% to 40% of caregivers who are taking care of patients with Alzheimer's pass away before the person that they're taking care of, and that's a scary number. And this was actually told to me by one of the caregivers, because they started noticing that, "Hey, I have not made time for my health." so, I think there's just this huge lack of time, lack of space where they even have the opportunity to take care of their own needs when it comes to their own health.

Host: Yeah, you make a great point about the fact that oftentimes these caregivers have health issues of their own that need to be kept an eye on at the very least, and oftentimes that does in fact go by the wayside. So, I want to ask you a little bit more about getting enough sleep, which I mentioned a moment ago, because it seems like that's a big part of this, and it seems like it's tied to a lot of other potential problems, right? Like, concentration as well as the physical effects of obviously not getting enough rest, right?

Pavitri Dwivedi, DO: Absolutely. And, you know, chronic stress is a silent killer. Not sleeping, not taking care of your basic needs does tend to add up. And it's not that you can always keep catching up on sleep or catching up on rest. Like human beings, one of our basic needs is making sure that we're getting that adequate seven to eight hours of quality sleep, and that's clearly not happening when it comes to our caregivers.

Host: And when you talk about stress, Doctor, what are some of the things that that can affect in terms of not just taking care of someone else, but taking care of yourself? Because it can make a number of things go haywire, right?

Pavitri Dwivedi, DO: Absolutely. I mean, just the overall medical health is one thing, but I always try to focus on preventative care, making sure that, you know, they are doing their scheduled mammograms or colonoscopies, making sure their bone scan is getting done. Because when you start putting these things aside over time, it is going to add up. And then there's no caregiver who's going to take care of the actual caregiver. So, that makes it really hard. And just day-to-day, you know, basic hygiene, making sure you're eating on time, making sure you're getting adequate nutrition, because all of these things matter for your health as well.

Host: And speaking of which, what symptoms here would you say, Doctor, a caregiver should not simply write off as stress or exhaustion, which we've discussed? Where's that line where they know that, "Hmm, maybe I'm neglecting myself here"?

Pavitri Dwivedi, DO: Absolutely. So, I always say there's not one symptom that is generalized for everyone. I always say, "Hey, let's say you are getting the rest, you're getting the sleep, you're making sure you get three meals a day," which is rare, but let's say despite all of this, you're still not feeling okay, it's time that you get seen and you get a routine checkup. Because these are things that do tend to add up, and it's not something that you can always go back and fix. So, it's very important that anything that just feels different from your baseline, it's important that it does get addressed in a timely manner.

Host: Of course, as you well know, oftentimes caregivers are doing it all alone, right? They have no one else to rely upon. The person they're taking care of has no one else to do what they're doing. So, how do you protect your health when taking a break doesn't seem possible or realistic?

Pavitri Dwivedi, DO: Yeah. I mean, people think that, "Hey, you know, if I just keep going, my summer vacation is going to help me feel better." But a lot of them don't get to that point. So, I always say, even just the five minutes that you get by taking a shower or going for a walk, if that person that you're taking care of, if they're, you know, sleeping or resting, use that time to do something for you."

So if that means that you want to read a book or you want to watch TV or absolutely do nothing, that's okay. So, really finding those pockets of joy throughout the day, that can give you some sort of peace. It's very important than keep relying on those bigger vacations or those bigger time-offs that may not actually happen.

Host: So, it's almost like you're suggesting it seems an adult version of the old saying, when you have a baby, sleep when they sleep. Sometimes easier said than done, but if you can schedule it that way, it can work out for everybody, right?

Pavitri Dwivedi, DO: When I had my newborn, that was one thing people always told me, and I never understood that because you have so many tasks that you have to complete when the baby is sleeping. So, that's why I never say sleep when the patient is sleeping because it's really important for you to use that time in any way that you want to use that's not about doing something else for someone else. So, use that time to define what matters to you, and just do it, and do it without any guilt.

Host: Naturally, the last thing a caregiver needs is a health issue of their own that hurts their ability to take care of that other person, right? So is that important? How important is that to keep in mind for them so when they're plowing ahead trying to do whatever needs to be done, they realize that there's a danger if they take it too far, right?

Pavitri Dwivedi, DO: One thing I always do is I ask the caregivers, "Hey, do you have a primary care doctor?" And some of them do, others don't. So, what I always say is, "Why don't you also schedule an appointment with me or one of my colleagues in the office?" Which really helps a lot because now not only you're taking care of the patient, but also making sure that the caregiver is also getting their healthcare needs met.

And this makes it easier for them to kind of make that appointment one-stop for both of their healthcare checkups. This way, we're, you know, simultaneously part of the whole picture. So when I do become one of the doctors for the caregivers, I'm also starting to identify their specific needs and making sure that I'm doing a better job of catering to that.

Host: A couple of other questions for you. First, if someone realizes they have in fact been neglecting their own health while caring for someone else, when that thought finally shakes them, wakes them up, if you will, what should they do first? Is that where that primary care provider comes into play?

Pavitri Dwivedi, DO: Find a doctor who's going to actually offer you the resources that you need. And I always say that use that time to tell them, "Hey, I'm not okay, and this is really hard for me. And what can I do to get more help?" A lot of times people don't know that there's so many local resources, case managers, social workers that can be part of your team. A lot of them don't have additional support from family or friends. So, that is our job as their primary caregiver, is to make sure that we offer them the care that they deserve.

Host: And in summary here, Doctor, you've done such a great job of breaking down some details for us here. What's your best overall advice for those joining us right now regarding caregiver health? Let's say someone's thinking to themselves, "Okay, this sounds like great advice. Where do I start?" What would you say is job one?

Pavitri Dwivedi, DO: I think job one is identifying that you are burnt out, and that's okay. But what can we do to help you get out of that, or at least help you simplify your day-to-day? And one of the best ways to do that is finding a doctor who's not only going to help you with your medical care, but also making sure that your social and personal needs are being met.

And that's where I think a geriatrician is a great resource, because they can help you identify resources that may be very beneficial, not just to you, but also the patient that you're taking care of.

Host: That being said, we trust you're now more familiar with caregiver health. Again, the message here mainly seems to be take care of whomever you need to, but do take care of yourself as well. Doctor, as always, a pleasure. Thanks so much again.

Pavitri Dwivedi, DO: Thank you so much.

Host: And for more information, please visit umms.org. If you found this podcast helpful, please do share it on your social media. Thanks again for listening to Live Greater, a health and wellness podcast from the University of Maryland Medical System. We look forward to you joining us again.