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Health Promotion: Prevention of Disease
CASE STUDY: Family Member with Alzheimer’s Disease: Mark and Jacqueline Mark and Jacqueline have been married for 30 years. They have grown children who live in another state. Jacqueline’s mother has moved in with the couple because she has Alzheimer’s disease. Jacqueline is an only child and always promised her mother that she would care for her in her old age. Her mother is unaware of her surroundings and often calls out for her daughter Jackie when Jacqueline is in the room. Jacqueline reassures her mother that she is there to help, but to no avail. Jacqueline is unable to visit her children on holidays because she must attend to her mother’s daily needs. She is reluctant to visit friends or even go out to a movie because of her mother’s care needs or because she is too tired. Even though she has eliminated most leisure activities with Mark, Jacqueline goes to bed at night with many of her caregiving tasks unfinished. She tries to visit with her mother during the day, but her mother rejects any contact with her daughter. Planning for the upcoming holidays seems impossible to Mark, because of his wife’s inability to focus on anything except her mother’s care. Jacqueline has difficulty sleeping at night and is unable to discuss plans even a few days in advance. She is unable to visit friends and is reluctant to have friends visit because of the unpredictable behavior of her mother and her need to attend to the daily care. Reflective Questions
How do you think this situation reflects Jacqueline’s sense of role performance?
How do you think that Jacqueline may be contributing to her own health?
Provide examples of behavioral changes (functional, potentially dysfunctional, and dysfunctional) within the health patterns of families.
Full Answer Section
Role Conflict: She faces a clear conflict between her caregiver role for her mother and her roles as a wife to Mark, a mother to her grown children, and an individual with personal needs. Her inability to visit children on holidays, reluctance to see friends, and elimination of leisure activities with Mark show that her caregiving role has completely overshadowed and, in some cases, extinguished her other important life roles. This conflict is further evidenced by Mark's frustration with her "inability to focus on anything except her mother's care."
Role Commitment (and potential over-commitment): Jacqueline's unwavering commitment stems from a long-standing promise to her mother. While admirable, this deep commitment, coupled with her being an only child, seems to drive her to take on the entire burden, potentially to the point of self-sacrifice. This commitment, while born of love and loyalty, is now leading to detrimental consequences for herself and her marriage.
Role Confusion/Ambiguity: The mother's inability to recognize Jacqueline ("calls out for her daughter Jackie when Jacqueline is in the room") despite Jacqueline's presence creates a painful form of role ambiguity. Jacqueline is physically present as the caregiver, but emotionally, her mother is seeking someone else – potentially a version of Jacqueline from the past, or an idealized 'daughter' figure. This constant rejection ("her mother rejects any contact with her daughter") despite her efforts could lead to profound emotional distress and a questioning of her effectiveness and identity in the caregiving role.
In essence, Jacqueline is struggling to perform the multifaceted roles demanded of her, with the caregiving role consuming her identity and leading to a significant imbalance in her life.
2. How do you think that Jacqueline may be contributing to her own health?
Jacqueline's actions and responses to her caregiving burden are significantly contributing to a decline in her own health across multiple dimensions:
Physical Health:
Sleep Deprivation: Her "difficulty sleeping at night" is a direct consequence of stress, unfinished tasks, and likely constant vigilance or anxiety about her mother's care. Chronic sleep deprivation severely impacts physical health, leading to fatigue, weakened immune system, increased risk of accidents, and exacerbation of other health conditions.
Sample Answer
Analyzing Jacqueline's Caregiving Situation
This case study vividly illustrates the immense strain that caring for a family member with advanced Alzheimer's disease can place on an individual and a family unit. Jacqueline's situation presents several critical points for reflection regarding her role performance, personal health, and family health patterns.
1. How does this situation reflect Jacqueline’s sense of role performance?
Jacqueline's situation highlights a profound sense of role strain and role conflict, alongside a potentially overwhelming sense of role commitment and role confusion.
Role Strain: Jacqueline is clearly experiencing significant role strain as a caregiver. She's struggling to meet the extensive and unpredictable demands of her mother's daily needs. The "pulsating pain" of caregiving for someone "unaware of her surroundings" who "often calls out for her daughter Jackie when Jacqueline is in the room" suggests constant vigilance and emotional exhaustion. Despite her relentless efforts, she "goes to bed at night with many of her caregiving tasks unfinished," indicating an impossible workload and a feeling of inadequacy in her primary caregiving role. This persistent feeling of not doing enough, despite immense effort, is a hallmark of caregiver strain.