If anyone understands the challenges of caring for the elderly, it’s Elizabeth A. Crocco, M.D., medical director of the University of Miami Health System Memory Disorders Clinic. She sees the toll that aging and illness takes on patients and caregivers. And as Chief of the Division of Geriatric Psychiatry at the Miller School of Medicine, she knows that cognitive decline makes taking care of an older person even harder.
Most of this burden falls on women. The Alzheimer’s Foundation’s 2021 Alzheimer’s disease Facts and Figures Report says that approximately two-thirds of dementia caregivers are women. According to the 2015-2017 Behavioral Risk Factor Surveillance System (BRFSS) surveys, 63% of people caring for someone with dementia for more than five years were also women.
“The data shows it’s mostly middle-aged women caring for their kids and elderly parents while working full-time. There is significant data showing that caregivers are stressed out. Add a pandemic to that, and you get exponential levels of stress.” The report confirms her point. It stated that female caregivers might experience slightly higher burden levels, impaired mood, depression, and impaired health than male caregivers. It’s thought these differences arise because female caregivers spend more time caregiving, assume more caregiving tasks, and care for someone with more cognitive, functional, or behavioral problems.
These issues hit close to home for Dr. Crocco. When it was time for her mother to stop driving, “She told all of her friends I was the one who took away her driving, but my family had to be objective. Caregivers must evaluate what’s dangerous and what’s not when looking at a parent’s situation.” Those decisions are more complex when stress and exhaustion take hold. However, Dr. Crocco believes that anyone managing or providing care must value their well-being.
The importance of me time
“It sounds like a pat answer, but carving out time for self-care is essential. Women need to take time for quiet and relaxation – maybe a half-hour in the morning or a walk with a friend in the evening,” Dr. Crocco says. Need a more extended respite to refill your reserves of patience and compassion? Ask a family member to stay with your elderly relative for a few days while you take a vacation.
How do you practice self-care when you’re pulled in multiple directions by work, home, and family?
Delegate. “You must ask for help. You have to be able to say, ‘I’m burned out. I need help.’” Think about where you can find help inside and outside your family. It’s essential, Dr. Crocco says, to recognize that some family members are better at certain tasks than others. “Not everyone has the availability or proximity to help with daily care. They can do other things, from handling paperwork, bills, and taxes to scheduling doctor’s appointments and ordering grocery deliveries.”
Ask your neighbor
Thinking outside the family box, ask your relative’s doctor for resources or consult a physician, like Dr. Crocco. Other possibilities include your church, synagogue, mosque, neighbors, friends, or community organizations such as the Alliance for Aging, Meals on Wheels, assisted living, or adult daycare facilities. The Memory Disorders Clinic refers families to resources if their relatives are patients. “We also refer caregivers to therapists who understand dementia and Alzheimer’s disease,” Dr. Crocco says. A therapist who understands cognitive decline can discuss your challenges and help you develop solutions.
Depending on your workplace, you might be eligible for unpaid leave from your job to handle caregiving responsibilities under the federal Family and Medical Leave Act. If that’s not an option, ask your supervisor if you can work remotely when necessary.
Practicing tough love
Dr. Crocco understands elderly patients who want to age in place, but she says it’s not always practical. “People should remain independent in their own homes as long as possible. But it’s often challenging for a physically or cognitively elderly parent to understand that it takes an army of people to achieve that. And it places a tremendous burden on their adult children and families.”
She hopes most people will make arrangements while their judgment is still good. “I tell my two sons, ‘When I become infirm, put me in an assisted living facility and visit me once a week.’” Every adult should have their affairs in order.
It’s especially important for older adults to have a trust or will, a healthcare surrogate, power of attorney, a co-signer on bank accounts, and similar forms. Unfortunately, not everyone plans ahead. Older, cognitively-impaired individuals may have faulty judgment. As with Dr. Crocco’s mother, they may balk at significant lifestyle changes. Many fall victim to scams or may refuse to accept the help they need to maintain health. “You have to make it clear this is a burden on you and may not be realistically feasible. When the parent’s judgment becomes impaired, the most authoritative member of the family needs to say to them, ‘We need to do this,’ and provide the necessary resources, such as adequate transportation, that are comfortable for both.”
A return to routine
The pandemic made a tough job more challenging, as work, school, and eldercare duties overlapped. With vaccines comes greater freedom and a gradual return to more normalcy. Resources such as adult daycare facilities are reopening, which provides a much-needed respite, especially for caregivers who work from home. “Having a schedule is important. You have to stick to a routine and make time for yourself,” Dr. Crocco says.
It’s not always convenient for caregivers to practice self-care, but by doing so, they bring a better version of themselves to the task. Stepping away, even for a half-hour, might be just what you need to see beyond the burdens to the blessings.
Nancy Moreland is a regular contributor to UMiami Health News. She has written for several major health care systems and the CDC. Her writing also appears in the Chicago Tribune and U.S. News & World Report.
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