Lesson for Caregivers: You Can't Do It All

Monday, 13 Jan 2014 03:33 PM

By Dr. Small

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Evelyn didn’t think that stress was an issue for her. Sure, her life was busy — she had two teenage kids at home and worked part time at her husband’s law firm — but she knew how to handle almost anything that came her way.
 
She had a handle on all of her everyday stressors — work and home issues, the kids’ schooling, even annoying household repairs that came up all too often. Evelyn was the kind of person who got things done, whether it was helping her boys with a school project, co-chairing her husband’s fundraiser, or covering for another paralegal at the office.
 
But things changed quickly when Evelyn’s mother fell and broke her hip. The added burden of caring for her mother now took up all of Evelyn’s time. She often had to leave work to drive her mother to doctor’s appointments and attend to nearly every detail of her recuperation. Evelyn couldn’t even spare a half-hour in the morning to take her usual power walk with her neighbor.
 
She found herself snapping at her husband over nothing, and developed headaches almost every afternoon. Sleeping through the night became a problem — she lay awake for hours worrying about her kids, her mother, her job, and her husband, and during the day she had no energy.
 
Soon, Evelyn began having trouble remembering all the things she needed to do. Twice she’d lost her cell phone. But she really got worried when she forgot it was her turn to drive the carpool. The boys were embarrassed and upset. Eventually, Evelyn contacted me for help.
 
I told Evelyn that she clearly had too much on her plate. She was experiencing physical symptoms — headaches and insomnia — as well as psychological ones, including anxiety, irritability, and memory loss. Though taking care of her mother was proving to be too much, Evelyn refused to ask her brother for help. Despite the stress, she felt pride in doing it all.
 
I tried to help Evelyn gain some perspective and find realistic strategies for stress management. Her breakthrough came when she finally asked her brother for assistance. She was relieved and surprised at how eager he was to pitch in. This gave her time in the morning to get back to her daily walks, which improved her mood and gave her a chance to talk about some of her feelings — her neighbor was very sympathetic.
 
The physical conditioning and mood lift also made it easier for her to sleep at night. Her headaches improved and her memory got back to normal. In just a few months, Evelyn learned new ways to manage her stress so that both her physical and emotional symptoms resolved.
 
Psychological symptoms often arise when we can’t react to the fight-or-flight response from the stress hormones released in our brains. Some people become anxious and tense, while others get depressed.Evelyn experienced several symptoms of depression, including insomnia, fatigue, irritability, poor concentration, and indecisiveness.
 
Caregiving is a high-stress job. Approximately 50 percent of primary caregivers of Alzheimer’s patients develop clinical depression that should be treated by a physician.

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Gary Small, M.D., is a professor of psychiatry and aging, and director of the UCLA Longevity Center at the Semel Institute for Neuroscience and Human Behavior. Dr. Small, one the nation’s top brain health experts, is author of The Mind Health Report newsletter.
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