Caregiver Stress Levels Relate to Caring for Aging Parents
By Pamela D. Wilson, MS, BS/BA, NCG, CSA
Caregiver stress and anxiety levels, experienced by adult children caregivers, mirror responses to traumatic experiences. Stress levels differ based on the two types of support provided. The first type of support is less intensive and is described as social and practical support. The second type of support is intensive hands-on physical care that is necessary when the health of an aging parent declines. Both types of support benefit the caregiving spouse. The resulting levels of stress and anxiety for social and practical support versus providing hands-on physical care is very different for adult children and spousal caregivers.
Social and Practical Support Allows Life to Happen
Stress and anxiety levels experienced by family caregivers increase with the type and frequency of interactions. Aging parents requiring only social or practical caregiving assistance are usually more independent. Health is usually stable. Parents are able to drive and take care of daily needs. Memory is good. There are no major daily concerns that cause worry.
Social and practical support includes some emotional support like helping with routine decision making when requested. A social outing to church, an errand, or providing a ride may be regular activities. Small practical assistance around the house like changing a light bulb, moving a heavy piece of furniture, or helping with a small repair is another type of assistance that falls into the category of social and practical support.
Helping with social and practical projects result in positive feelings for adult children. Taking mom or dad shopping may be an enjoyable experience. Contrast this with the caregiver stress and anxiety that may be experienced taking mom or dad to a serious medical appointment.
Participating in social and practical activities with aging parents may also provide a sense of purpose for adult children caregivers. Enjoyable activities support establishing stronger relationships and trust.
When grandchildren are in the family, the inter-generational aspects of activities and visits become more interesting and enjoyable. Aging parents in retirement, may have more time to spend with and enjoy grandchildren. They may even be able to serve as sitters to allow adult children breaks from parenting responsibilities.
Caregiver Hands-On Support is More Stressful
Adult children providing hands-on physical care for aging parents are usually also involved with medical decisions and coordinating care. Changing health conditions are worrisome because of the unpredictability of situations. Stress and anxiety experienced by the spousal caregiver may transfer to adult children.
When mom or dad as a caregiver becomes anxious, this behavior may strain relationships with adult children or result in declines in health. Double worry then exists about the aging parent needing care and the aging parent caregiver.
Medical care needs, like a change in prescription medication, may require an adult child to stop at the pharmacy after work and then visit the home of the parent. This type of task is more relevant when the diagnosis of the aging parent is Alzheimer’s disease. The time comes when an individual with Alzheimer’s Disease cannot be safely left alone for any reason.
Time sensitive tasks and needs more significantly affect emotions. Higher levels of stress and anxiety occur. A hyper-sensitivity is always present to listen for the ringing of the phone that may represent an emergency situation for the parent.
The contrast between physical hands-on care and social and practical support relates to time sensitivity, scheduling, and frequency. Social support is occasional and flexible. A social event may be delayed if something comes up. Mom and dad serve as companions and social support for each other.
Hand on care is time sensitive. A medical appointment, bath, or setting up a medication reminder cannot be delayed. If work projects or other needs arise, the adult child juggles schedules and makes it all happen.
Aging Parents: Balancing Support and Care
As parents age, the level of emotional and physical support required increases for both parents. Engaging in social and practical activities may become a distant memory. Hands-on physical care may be the new norm. Medical diagnoses that were once non-threatening have progressed to result in constant worry and anxiety.
As with all care situations, having the conversation of care must occur. Begin by identifying needs and support. Progress to discussing the involvement of family members and how each might join to offer support and care. Attempt to discuss equal care and support by all family members. Talk about longer term possibilities like hiring in home assistance and a possible move to a retirement community.
While it is common for the most efficient adult child to take on the majority of responsibilities, this is not a fair partnership. Adult children who accomplish more often have a high sense of control over their lives and are extremely organized. The result is that other family members rely on the “efficient one” to complete all of the tasks without offering to assist. While it appears that the efficient child caregiver makes juggling life look easy, this is not true. Significant amounts of effort and planning are contributed.
Aging Parent Appreciation is a Gift (Not a Given)
Aging parents may not say thank you for the assistance of adult children. In some situations, the support is expected. Comments are made by parents if children are not available to drop everything and show up. Guilt trips about that “one thing” are constantly repeated.
One parent or another may have been more demanding during his or her lifetime. These behaviors become more evident as children become more involved. It may have been that one spouse covered for the other during the marriage so that the children were less exposed to these difficult behaviors.
In situations where parents do not show appreciation, offering care may become burdensome. Feelings of resentment by adult children toward aging parents may occur. The best that can be done is to set very firm boundaries about who will complete which tasks while placing time limitations.
It is easy for a 2-hour project to expand to 8 resulting from new requests and the changing demands of an aging parent. Saying no to to an unreasonable parent is okay.
Alternate Care Discussions Must Occur
Discussions about outside care should be incorporated into the original discussion as an eventual next step. In home caregivers can serve as substitutes for many of the tasks that adult children are requested to complete. The exception would be if an adult child is serving as medical or financial power of attorney. These tasks cannot and should not be assigned to in home caregivers.
A realistic discussion about progression of illness is practical about the future possibility of moving to a care community. Parents who are demanding and seek to place guilt on adult children create drama when significant changes are discussed
The goal of future planning discussions is to avoid unexpected crises situations. Some drama today versus more drama later may be more manageable. A reference to the prior discussion can be made. For example, “Mom and dad, we talked about this happening a year ago. It’s now time.”
As a professional fiduciary every time I planned a vacation, crises situations would erupt at the 11th hour. My phone would ring with emergent situations during my vacation. There was always some type of emergency for which my decision-making power as guardian or medical power of attorney was required. This is the challenging part of accepting responsibility for another person.
These type of emergency situations are no different in the realm of family caregiving. Parents, knowing that adult children may have a planned vacation, may create last minute drama or reasons for the vacation to be canceled. The same applies to participation in social activities and events. If your parent creates drama when you plan your own life, limit the information provided to avoid these types of situations.
When Caring for Aging Parents Becomes Too Much
Caring for aging parents can be a blessing that includes mixed feelings: reward, joy, happiness, or frustration, stress, worry, and anxiety. Caring for a difficult parent can be unpleasant and raise levels of stress and anxiety to unbearable states. Learning coping skills to manage through difficult situations is helpful. Gaining confidence in caregiving abilities is important to reduce self-doubt.
As a caregiving advocate there were situations where I stepped in to become the direct contact for the aging parent when family relationships were strained. In most situations, because I was not family, establishing a relationship and coordinating care was not difficult. Family baggage does not exist with a stranger.
There were other situations that were extremely difficult. Aging parents reacted angrily to having an “intruder” in the family and hoped that their behaviors would change the plan of adult children for intervention. With time the situations worked out.
These clients became my favorites because they were so difficult. By learning and empathizing with the foundation for the anger, behaviors, and suspicions, I was able to establish positive relationships with the resistant parents.
Parental refusals, anger, and denial may not be diffused by aging children. Persistent attention from a professional caregiving advocate or a care manager may ease the situation while ensuring support and care for the aging parent and the spousal caregiver. This outside support eases the situation for adult children allowing relationships to return to more of a social support than a hands-on requirement. .
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© 2018 Pamela D. Wilson, All Rights Reserved.
Pamela D. Wilson, MS, BS/BA, CG, CSA, a National Certified Guardian and Certified Senior Advisor, is a caregiving and elder care expert, advocate, and speaker. Pamela offers family caregivers programming and support to navigate the challenges of providing, navigating, and planning for care. She guides professionals practicing in estate planning, elder and probate law, and financial planning to create plans to address unexpected concerns identified in her past role as a professional fiduciary. Healthcare professionals are supported by Pamela’s expertise to increase responsiveness and sensitivity to the extensive range of care challenges faced by care recipients and caregivers.