Tina Savla

A Fresh Approach to Addressing the Challenges of Aging and Caregiving

The number of older adults in the U.S. will dramatically increase in the coming decades as baby boomers age and medical advances make it possible for people to live longer than ever. According to Tina Savla, professor of human development and research methodologist at the Virginia Tech Center for Gerontology, this unparalleled demographic shift will have significant impacts on American society and family life as more spouses, adult children and other relatives spend a significant portion of their time, emotional energy and financial resources in providing care for their loved ones.

Savla, who cares passionately about older adults and the men and women who support them, has spent her career focusing on the challenges older adults and their caregivers face as well as ways to improve their quality of life and well-being. 

“Over 60 million Americans are caregivers, providing support and assistance with activities of daily living for loved ones each day. I want to understand their challenges and daily experience, especially caregivers of individuals with dementia,” Savla explained. With a predicted 14% increase in the number of persons living with dementia over the next decade alone, the effect on families, especially those caring for their aging relatives, will continue to be substantial.

“Previous research has shown the act of caregiving is associated with negative changes in the health and wellbeing of the caregivers themselves,” Savla said.  “In some of my past research, I have combined a daily diary interview approach with biological indicators of stress to explore how everyday life stress and daily hassles impact emotional and physical health of caregivers.” Savla found that both care and non-care related stressors contributed to increased activity in stress-sensitive biological systems, which in turn can contribute to a variety of health conditions.  

Savla and colleagues Karen Roberto, University Distinguished Professor, and Rosemary Blieszner, Dean of the College of Liberal Arts and Human Sciences, both also fellows at the Center for Gerontology, and Aubrey L. Knight, Professor of Internal Medicine and Family and Community Medicine, and Program Director of the Geriatric Medicine Fellowship at Virginia Tech Carilion School of Medicine and Research Institute, are now conducting a study funded by the National Institutes of Aging called Families in Appalachia Caring for Elders with Alzheimer’s Diseases, or FACES-AD.

“The aims of the study are to understand how families cope with and manage the daily demands of caregiving as well as their current and future formal service use,” Savla said. The personal, social and economic costs of caregiving are compounded for rural, underserved communities, such as Appalachia, where caregivers face even greater challenges due to lack of resources and access to healthcare as well as socioeconomic barriers.

Savla and her team are using several methods to uncover individual and family characteristics, circumstances and cultural beliefs that influence family care roles, responsibilities and formal care usage among Appalachian families who have loved ones with dementia, including Alzheimer’s disease.

“A team of trained undergraduate and graduate students in human development and public health conduct hour-long telephone interviews with caregivers to learn about their family situation, the extent of the family member’s dementia and overall demands on the family,” Savla explained.

This initial interview is followed by a 7-day diary interview that documents the day-to-day experience of the caregivers and their loved ones. Interviewers ask questions about care provided that day, whether the caregiver was able to leave the house to work, run errands or take time for themselves, or if they have a home health worker who provides assistance on a regular basis. They also ask about other topics such as the caregivers’ general health and mood as well as interactions with other family members and relationship stressors.

The project team plans to enroll 120 families into the study. Once this phase of the study is completed, “We will conduct in-depth, face-to-face interviews with a subset of 25 families to further explore the different characteristics and needs of the families,” said Savla.  

The FACES-AD project builds on the results of an analysis of interviews with older adults conducted by Savla and colleagues that was recently published in the Journal of Aging and Healthcare that posits “where you age matters.”  In this earlier study, which also took place in rural Appalachia, they found that individuals living in communities characterized by strong family beliefs and less positive attitudes towards community services preferred informal help over formal care services.

“People who lived in counties where more formal services were available, however, were more likely to use these services, regardless of their beliefs,” Savla said. She and colleagues also found that significant health disparities existed within the counties studied depending on demographic, economic and personal factors.  For example, according to Savla, “women who lived in counties with a higher percentage of older adults below the poverty line were more likely to receive no help than men.”

Savla expects the FACES-AD study will shed additional light on these factors and expand understanding of when and why families do and do not access services, even when available. “Often families wait until there is a crisis before they seek services. Yet, research shows if they access services earlier, they and their loved ones have better outcomes,” said Savla.

If families do not obtain resources and services, either by choice or lack of availability, their loved one may be more likely to go into a nursing home more quickly – often a greater personal, economic and societal cost.

Savla anticipates the results of the FACES-AD study will enable the team to identify ways to destigmatize services in rural communities that often rely on informal support networks and develop more effective and targeted strategies to connect families with services, particularly in regions such as Appalachia and other similarly underserved areas.

She also hopes the study will reveal ways to better address caregiver needs since many caregivers feel overwhelmed with responsibility and constrained in pursuing their own life opportunities. This aspect of the study ties into another area of research that interests Savla – translating research findings into prevention strategies and intervention programs that help to reduce stress, anxiety and depression in caregivers.

“I am running another study with Dr. Mamta Sapra at the Salem Veteran’s Affairs that is testing the effectiveness of mindfulness meditation in reducing negative and intrusive thoughts among caregivers of veterans with dementia and traumatic brain injury,” Savla explained. “If this intervention is successful, the mindfulness components will be added to the U.S. Department of Veteran Affairs’ caregiver support and skill building program used by Veteran families across the nation.”

Savla hopes the findings from the FACES-AD study will likewise result in intervention strategies for older adults and their caregivers that can have a regional reach in Appalachia but also in other underserved areas of the U.S.

For more information about Tina Savla and her research, including the FACES-AD study, visit her web page at https://sites.google.com/site/tinasavla/home.