This holiday season, I'm hearing the same story from friend after friend who's been visiting aging parents. Sometimes it's mom, sometimes it's dad, sometimes it's a retired spouse, but the general outline is always the same: Health problems, dementia, hearing loss, the loss of a spouse -- for various reasons an older family member has become depressed and is becoming more and more isolated. Their friendships and interests are fewer and fewer, their time hanging more and more heavily on their hands. Suddenly it's all up to the adult child or spouse who's providing care: Include mom or dad or hubby in your social plans or they'll sit home alone.

"I can't leave the house without my mom getting really upset, asking where I'm going and when I'll be back," says Karen, who's mother moved in with her a few years ago. "I end up feeling so guilty it doesn't seem worth it, so I don't see my friends. Now I'm becoming isolated too."

Another friend, Julia, is having a similar problem with her husband, James, except in this case James wants her to make social plans for both of them. "I used to have all sorts of regular plans with my girlfriends; we'd go walking, we'd go to lunch, we'd have our book club," Julia says, exasperated. "Now James is always asking, `So, what are we doing today?' and it's like I'm supposed to be his social secretary. It's putting a real strain on our marriage after all these years."

Often, health problems like dementia or hearing loss play a role in the situation. In Julia's case, her husband has hearing loss but won't wear a hearing aid. "He can't follow conversations if there's background noise, so he doesn't like big social gatherings or going to restaurants, and he complains and gets grumpy if I plan dinners with other couples. But then he also gets upset if I go out without him with my friends. The result is that we're trapped at home together, and I'm going stir crazy," Julia says. "I think he's really depressed, but he won't admit it."

Two different friends both e-mailed me last week saying they'd hit the breaking point and have decided to have "the conversation," insisting that the person they're caring for do something to give them a break.

"I'm working up my courage to tell my mom she has to go to adult day care whether she wants to or not," Jennifer wrote. "I've broached the subject before and she refused, but this time I'm going to tell her she doesn't have a choice. I have to have a break I can count on or this living situation isn't going to work.

But how to broach this difficult topic? On behalf of the friends asking my advice, I consulted a couple of experts. Their answer? A difficult conversation is going to be difficult; don't expect otherwise. But there are some ways to ensure that your discussion accomplishes what you want it to, and doesn't get sidetracked by guilt and recriminations.

1. Be straightforward. Don't beat around the bush, use euphemisms, or expect your parent or other family member to "get" what you're saying without your spelling it out. They probably won't, and you'll just go around in circles.

2. Don't make statements about the other person. If you start your conversation with an observation such as, "I've noticed you spend an awful lot of time alone," or "I'm worried that you're becoming depressed," the whole topic will likely derail into an argument about whether your opinion is accurate. You can't win when you're discussing your perceptions about the other person, who of course feels that he is the authority on himself.

3. Be kind, but don't soft-pedal. State what you need, using what psychologists call "I statements": I need some time alone each day. I need one night a week to go out. Whatever it is, put it out there and make it clear with your tone that you believe what you're asking for is reasonable.

4. Try to avoid the denial trap. With issues like dementia and depression, denial comes into play. Your parent or spouse may not know he or she is depressed, may not be able to recognize the signs of dementia. As those who've dealt with alcoholism and addiction know only too well, denial is like a series of booby traps. Before you know it, you're mired in a contentious argument while your loved one vehemently denies any memory problems or insists that he's "just tired" and that's why he never goes out. If you need to discuss dementia or depression symptoms, do so, but in a separate conversation. (And it may help to have a doctor or therapist involved.) Keep the conversation about time and social scheduling focused on this topic alone.

5. Don't back down. If the conversation starts to become heated or emotional, table the topic without back-pedaling. Say something like, "Well, it seems like we're not going to resolve this right now, but we'll need to discuss it again soon. I can't go on like this, and we have to come up with a solution." Then set a general timetable to discuss the topic again.

Remember the caregiver's mantra: Your needs count, too. It can feel really hard to push for time apart, but if you don't get it, your stress level will skyrocket and you won't be any good to anyone.