Caregiving crisis

If a traditional caregiving scenario were captured on time-lapse video, Katherine Lyman contends that early scenes would depict an adult daughter accompanying her aging parent to a doctor's appointment looking "put together" and on top of things. Just a few years later, however, the daughter would appear drastically different — "really disheveled, because she isn't taking care of herself."

"I cannot tell you how many times I've leaned forward, looked the daughter in the eyes, and asked, 'How are you coping with all of this? What are you doing to let off steam? It's great that you're keeping all these plates spinning, but it comes at a cost,'" recounts Lyman, a geriatric nurse practitioner at Harvard-affiliated Beth Israel Deaconess Medical Center.

Increasingly, that cost is caregivers' own health and well-being. Indeed, the story of caregiving in the United States is becoming something of a cautionary tale as troubling forces collide.

More caregivers are on tap than ever, with 43 million Americans providing unpaid assistance to a family member or another loved one. Nearly three-quarters are 50 or older themselves, while more than 75% are women, according to the Family Caregiver Alliance. Meanwhile, an estimated 73 million Americans will be 65 or older by 2030, potentially fueling the need for additional caregivers.

Longevity is perhaps the biggest contributor to the brewing storm, Harvard experts say. "A lot of us are living into our late years and living very well and independently, but not all of us," Lyman says. "Those years may come with increased infirmity or cognitive impairment, or both."

Spectrum of responsibilities

As people age, several core issues tend to prompt the need for spouses, adult children, or others to step in to help. Let's dub the problem areas the three M's: mobility, memory, and medications. Yet caregiving is far from a one-size-fits-all proposition, with duties falling on a spectrum from occasional to relentless and minor to suffocating.

"It runs the gamut from actually living with the person to living in a different state and putting cameras in different rooms to check on them," says Dr. Suzanne Salamon, clinical chief of gerontology at Beth Israel Deaconess Medical Center. "Some caregivers come periodically, fill pill boxes, take people to doctor's appointments, or take them shopping. But caregiving can also be financial: paying the bills, organizing the taxes, or taking over as power of attorney."

Whether they're popping in a few times a week or handling daily bathing, dressing, and toileting — or something in between — caregivers often wear many hats, Lyman notes. "You become not just their caregiver, but their confidante, psychiatrist, chef, grocery shopper, laundress, chauffeur, and pharmacist," she says.

Health fallout

Such comprehensive responsibilities can exact an underappreciated physical and mental toll — especially if your loved one's deterioration is prolonged — and create a downward spiral that affects both caregiver and recipient. Six in 10 caregivers work part or full-time, spreading themselves even thinner.

Copious research has focused on the mental health fallout. Between 40% and 70% of caregivers deal with significant symptoms of depression. And those who are women fare worse than men who take on such duties, reporting higher levels of depression and anxiety.

Similarly, a wide range of studies point to caregiving's physical consequences, especially pain. Caregivers are prone to headaches and often suffer back injuries or cope with arthritis, Dr. Salamon says.

A Sept. 1, 2023, study published by The Gerontologist that gathered data from nearly 2,000 caregivers (average age 62) showed just over half suffered pain of some kind. About 30% said their pain limited the ways they could provide care.

Caregivers also face an increased risk of heart disease, and women caring for a spouse are more likely to report having high blood pressure, diabetes, and high cholesterol, according to the Family Caregiver Alliance.

"Many caregivers in their 50s, 60s, and 70s have their own health issues," Dr. Salamon says. "It gets more stressful as time goes on and the patient and caregiver both get older."

About 10% of caregivers acknowledge their own health has suffered as a result of their responsibilities. But that doesn't mean they're vigilantly attending to it. Nearly three-quarters reported not having gone to a doctor as often as they should, while more than half had missed medical appointments, according to the Family Caregiver Alliance.

"People start losing weight, not eating properly, and not paying attention to themselves," Lyman says. "Their health takes a back seat, and so do their interests."

Finding help

Even as they feel the strain, caregivers are often loath to seek support. "They're good at giving help, but lousy at asking for it," Lyman says.

Still, it's crucial to make that leap. Harvard experts offer these strategies for caregivers to preserve body and soul:

Look into respite care. Some assisted living or nursing facilities provide temporary care so family members can take a vacation. Adult day programs can provide a daily break. "Sometimes they only run from 9 a.m. to 1 p.m., but that can be huge," Lyman says. "And some provide transportation."

Call your local Agency on Aging. Some offer housekeeping services to eligible older adults, while others coordinate volunteers who can pinch-hit and "stay for a few hours so the caregiver can get out and be free for a little while," Dr. Salamon says.

Sniff out informal help. "Ask friends who drive if they can pick Mom up and bring her to the senior center or to her hair appointment," Lyman suggests.

Explore houses of worship. Local religious groups may have cadres of helpers. "Some have volunteers who pick up people who want to go to their service and take them home afterward," Lyman says.

Consider therapy. Nearly four in 10 caregivers describe their responsibilities as emotionally stressful. Talking to a therapist can bring relief.

Tap into telehealth. Schedule virtual visits with doctors or therapists to get the care you need. "You don't have to leave Mom unattended," Lyman says. "You can go into the next room and shut the door for a half-hour or hour."

Image: © laflor/Getty Images