Caregivers crisis

30 04 2013

A caregiver is someone whose life is in some way restricted by the need to be responsible for the care of someone who is mentally ill, mentally handicapped, physically disabled or whose health is impaired by sickness or old age.  The UK government defines caregivers or carers as:

• People who – unpaid – look after and support family members, friends or neighbours in need of help because of long-term physical or mental illness or disability or problems related to old age.

• People who provide a substantial amount of care on a regular basis for a disabled person  living at home.

The importance of this issue is highlighted by TEDMED as one of the main global challenges. The reason for this move is driven by the fact that unpaid caregivers (65 million in the US alone) struggle with significant  psychological and health issues and economical  burden.

The issue of caregivers is broad and complex. In order to better understand its scope and main objectives, I strongly recommend to read this comprehensive report by National Alliance for Caregiving in collaboration with the American Association of Retired Persons (AARP). For those of us who don’t have the time/energy to read the full report here is its summary and conclusions.

Caregivers are a diverse group. Their caregiving experiences range from those that are relatively easy to manage, to those that are burdensome. We know that most caregivers today are able to fulfill this role without experiencing overwhelmingly negative physical, emotional, or financial consequences. On the other hand, caregivers with the heaviest responsibilities are vulnerable to risks such as a decline in health, emotional stress, and economic hardship. As the baby boom generation ages over the next 25 years, the numbers of people needing care will swell. The numbers of younger people available to provide care are likely to dwindle. This suggests that in the future, caregivers will be older, on average, than today’s caregivers and may have greater infirmity of their own. In addition, the younger people who step into a caregiving role in the future may perceive they have less choice about becoming a caregiver. A greater share of caregivers may provide care to two or more care recipients. The future may bring some positive changes as well. In particular, we are likely to see an expansion of the use of technologies that are already available to caregivers and recipients, as well as the development of new technologies. It is important to recognize that the nearly 66 million caregivers are a critical extension of our formal health care system. Without their efforts, there would be a shift of recipients into public programs such as Medicaid, and the quality of life and the health status of many who need care would decline. It is important to do all we can to support caregivers so they can continue in their roles. Specifically, it is important to:

1) Identify and help caregivers who are most at risk for deteriorating health, financial security, and quality of life so that they can continue to provide care while maintaining their own well-being
2) Identify and advocate for programs that make a real difference in caregivers’ well being and in their ability to continue providing care
3) Identify and promote the use of technologies that can facilitate caregiving
4) Extend the reach of caregiver programs to all caregivers regardless of the age of  their care recipient
5) Encourage families to plan proactively for aging and potential health/disability issue

 

By all means it is time to promote this burning issue!

 





Clear Lipid-exchanged Anatomically Rigid Imaging/immunostaining-compatible Tissue hYdrogel (CLARITY)

11 04 2013

Nice meeting you, CLARITY! An article by NIMH director. What do you think about this new method?

New Views into the Brain

By Thomas Insel

The physicist and mathematician Freeman Dyson once noted, “New directions in science are launched by new tools much more often than by new concepts.”1 This week marks the publication of a new tool that may alter the way we look at the brain. Karl Deisseroth and his colleagues at Stanford University have developed a method they call CLARITY. Yes, CLARITY is an acronym, for Clear Lipid-exchanged Anatomically Rigid Imaging/immunostaining-compatible Tissue hYdrogel. By replacing the brain’s fat with a clear gel, CLARITY turns the opaque and impenetrable brain into a transparent and permeable structure. Most important, the hydrogel holds the brain’s anatomy intact. And because the hydrogel is permeable, the brain can be stained to localize proteins, neurotransmitters, and genes at a high resolution (see images below). Unlike other recent breakthroughs in neuroanatomy, this one can be used in human brains.

This technique is only for post-mortem tissue. And it measures structure not function. But I predict this new tool will revolutionize neuropathology, opening a new era for studying the neural basis of mental disorders. Indeed, in this initial report Deisseroth and his colleagues describe findings from a brain of someone who had died with autism 6 years earlier. With CLARITY they detected an unusual pattern of bridging connections from a particular class of inhibitory cells in this brain. Of course, this finding from a single brain needs to be replicated. The beauty of CLARITY is that other brains can now be tested, even tissue that has been stored for years.

CLARITY arrives only a week into the new BRAIN Initiative, announced by President Obama on April 2nd. Yes, BRAIN is another acronym—for Brain Research for Advancing Innovative Neurotechnologies. With some 200 neuroscientists in the East Room of the White House, the President declared, “…there is this enormous mystery waiting to be unlocked, and the BRAIN Initiative will change that by giving scientists the tools they need to get a dynamic picture of the brain in action and better understand how we think and how we learn and how we remember. And that knowledge could be—will be—transformative.”

The President proposed $100 million for the first year of what he called “the next great American project.” NIH, the Defense Advanced Research Projects Agency, the National Science Foundation, and several private laboratories and foundations will be working to develop the next generation of tools for decoding the language of the brain. The NIH BRAIN Initiative will begin with a planning process to identify the highest priorities and propose some specific short-term and long-term goals.

Recent investments have already built a foundation for this new initiative. As just one example, the Human Connectome Project has increased the resolution of white matter imaging to provide the first detailed “wiring diagram” of the human brain. In one of the first reports from this project, scientists discovered a surprisingly simple 3-dimensional organization of fiber tracts in the human brain.2 The Human Connectome Project has already posted extensive imaging results and cognitive data on a reference cohort of 68 healthy volunteers, on its way to a database of 1200 subjects including 300 twin pairs. (Note to students and early stage scientists: this goldmine of data is waiting for you!)

The new BRAIN Initiative, building on these recent advances, could not come at a better time. Several recent reports have emphasized the increase in prevalence and the increasing costs of brain disorders, from autism to Alzheimer’s disease. The World Health Organization estimates that neuropsychiatric diseases in the developed world are already the leading source of medical disability.3 A recent report from the World Economic Forum projects that health care for mental disorders will account for the greatest expense among health care costs of all non-communicable diseases in the coming decades, greater than cancer, diabetes, and pulmonary disease put together. Given the contribution of mental disorders to these other medical diseases and recognizing our still limited understanding of the brain, you can see why the President called for “this next great American project.”

If CLARITY is a predictor, the next few years could be a period of rapid new insights into brain structure and function. As Dyson said, “new directions in science are launched by new tools.” One can barely begin to imagine how tools like CLARITY will change our concepts of how the brain works in health and disease.

Video

References

1Dyson F. Imagined Worlds. Cambridge, MA: Harvard University Press, 1997.

 2Wedeen VJ et al. The geometric structure of the brain fiber pathways. Science. 2012 Mar 30;335(6076):1628-34. doi: 10.1126/science.1215280.

 3The Global Burden of Disease: 2004 Update. Geneva, World Health Organization, 2008.

 4Bloom DE et al. The Global Economic Burden of Noncommunicable Diseases. Geneva: World Economic Forum, 2011.