Family Caregivers: Exhausted, Stressed—and Abusive?

Bearing the responsibility for an aging parent or spouse can become an increasingly thorny task—and not necessarily because of the need for more and more complex care. Caregivers themselves can sustain emotional, mental, and physical blows that may go unattended in the name of duty to their loved one. Sleep is lost; stress mounts steadily; and something just might give. In the case of caring for someone with dementia, says research published today in the British Medical Journal , sometimes that lapse comes in the form of psychological—or even physical—abuse. More than half of family caregivers surveyed in the study reported some abusive behavior toward the person they cared for.

To be sure, the definition of abuse in the BMJ study covers a considerable range, including using a harsh tone, screaming or yelling, threatening to stop caring for the person, handling the person roughly, and fearing being on the verge of hitting or hurting the person. The most common forms of abuse reported were verbal, and more than a third of family caregivers said abusive behaviors occurred "at least sometimes" in the previous three months.

One take-home message is that the burden felt by caregivers is real and can manifest itself in a constellation of ways. Phyllis Brostoff, president of the National Association of Professional Geriatric Care Managers, who has worked with the elderly and their families for 40 years, talked with U.S. News about ways to cope with caregiving.

Acknowledge what's going on. It's not always apparent to caregivers how they're being affected by their responsibilities or their loved one's changing condition. Particularly in cases of early dementia, when someone's mental faculties may initially wax and wane in and out of lucidity, a caregiver may feel irritated at having to answer the same question multiple times. "Sometimes the person doesn't realize they're being [verbally] abusive," says Brostoff. Adjusting to and mourning the decline of someone you rely on can be very sad and emotionally taxing, she adds. So if you find yourself feeling as if you hate the person you're caring for, says Brostoff, take it as a sign to get some assistance.

Do the work, bu t reap the reward. Plenty of family caregivers acknowledge the challenges, stress, and exhaustion of caring for a loved one. In fact, more than a fifth of caregivers report exhaustion at day's end, while more than a quarter report that taking care of their family member is hard on them emotionally, according to stats on the Family Caregiver Alliance website. But caregivers also report an immense gain from having the chance to nurture that person in a time of need, notes Brostoff. "Most people feel it's well worth their while to do the work, to rediscover the relationship, to give up old [hard] feelings, and find a new approach to their parent or spouse." Tap into some of that joy.

Understand you don't need to be a martyr . "In our society, male caregivers often get more praise for doing it," while women are simply expected to do it, notes Brostoff. Indeed, caregivers are often ranks of working, middle-aged women with young children of their own. With the responsibilities of a young family, plus caregiving duties, they don't always recruit free or affordable outside help, or they don't have the conversations to enlist other family, neighbors, or friends to share the load. Don't be the martyr—whether you are male or female—and do what you can voluntarily, out of love, and allow yourself to call on help. Doing it out of duty, or feeling you have to do it all, she says, can breed resentment, feeling overwhelmed, and feeling that you've got no choice in the matter.

Call in professional reinforcements, for the sake of your health and sanity . The Family Caregiver Alliance notes that those who experience chronic stress could be at increased risk of loss in cognition, including loss of short-term memory, attention, and verbal IQ. Help does exist, though it can take effort to find it. Outside of getting family, friends, or neighbors to assist, your local Area Agency on Aging is one place to look for relief. The website of the National Association of Area Agencies on Aging also has a range of online resources, including the Eldercare Locator, which has a database of resources by ZIP code. For a fee that varies by area, consultation with a geriatric care manager (locate one near you on the group's website: National Association of Professional Geriatric Care Managers) can be extremely helpful, as well. If a nursing home becomes a consideration, using Medicare's online Nursing Home Compare tool is a helpful starting point.