Items in Caring Currents tagged with Relationships

Men, Women, Illness, and Caregiving: A Recipe for Divorce?

Melanie Haiken — Fri, 20 Nov 2009 08:00:00 -0000

A new study published this week in the journal Cancer has doctors, patients, and families talking -- and asking hard questions -- about what happens in a couple when it's the wife, rather than the husband, who becomes ill.

Here's what researchers found when they followed 515 patients with cancer or multiple sclerosis over a period of five years.

• A woman is six times more likely to end up separated or divorced soon after a diagnosis of cancer or MS than a man who becomes ill with the same disease.
• In couples in which the woman fell ill, the divorce rate was more than 20 percent.
• In couples in which the man got sick, the divorce rate was just 2.9 percent.
• The older a woman was at the time she got sick, the more likely she was to end up alone.
• However, the longer a couple had been married, the less likely they were to end up divorced.

The researchers at Seattle Cancer Care Alliance, Huntsman Medical Center, and Stanford University were studying a phenomenon that has already been documented in numerous other studies. It's called "partner abandonment," and sadly, it's very real. The researchers who designed the study, Marc Chamberlain, a neuro-oncologist at Seattle Cancer Care Alliance, and physician Michael Glanz, of Huntsman Cancer Center, said they'd previously noticed in their practices that divorces occurred almost exclusively when women became ill.

(And yes, many news outlets covering this story are linking it to the story of John Edwards and his wife Elizabeth, and his cheating while she battled breast cancer. It's easy to see why they made the link, though cheating isn't leaving.)

The researchers also studied the effect that divorce or separation had on the MS and cancer patients, and found that their ability to effectively pursue treatment was affected by the loss of their relationship. Women who end up separated or divorced while being treated for cancer or MS were more likely to suffer from depression, were hospitalized more often, were less likely to join a clinical trial, and were less likely to complete radiation treatment, than women whose partners stayed with them as caregivers. They also found that women whose partners left them were less likely to die at home.

All of these facts resonate with those of us in Cancer World; I previously wrote a post about the challenges I watched a single friend face while battling breast cancer without a partner.

Rather than focus just on the disheartening aspects of this research, I think it's important to talk about why men leave, and what we can do to help them take on and succeed as caregivers. The study's authors, who are both men, commented that men's decision to leave a sick spouse can be partly explained by their lack of ability, compared to women, to make the rapid shift in commitment to being caregivers to a sick partner. The caregiving role simply doesn't come as naturally to men as it does to women, and it's easy for men to feel overwhelmed and ill equipped to handle such an enormous change in their lives.

So what can we do about that? To start, here are some tips about how to support a woman with breast cancer, many of which can be generalized to other types of cancer and other illnesses.

But what I'd really like is to hear from those of you, women and men, in the midst of illness and caregiving. What makes some men panic when suddenly finding themselves caring for an ill spouse, and how can we help prevent this from happening? A wonderful, devoted husband commented on Wednesday's post about mammograms, detailing his wife's breast cancer diagnosis and treatment, and the fact that a mammogram may have saved her life. Caring.com's Editor in Chief, Jim Scott, helped found Caring.com after caring for his wife until her death from cancer in 2007. And there are many more stories like these. With some support and education, we can help other men step into this role, and avoid the fears and temptations that have made John Edwards a household name for abandonment.

What Every Caregiver Knows: Love Is a Verb

Paula Spencer — Thu, 12 Nov 2009 08:00:00 -0000

Even though my father just died, I'm not going to repeat the relationship-building advice that caregivers hear so often: to tell your sick or aging mother, father, husband, wife, grandparent, other relative, or friend, now, while you can, and at every opportunity --- hurry, hurry, hurry! --- how much you love them.

Because if you're a caregiver, they know. Say the words because you can't help saying them, not because you feel you're supposed to.

Full disclosure: This is coming from someone infamous in her family for loathing to say, "I love you." I'm not averse to the sentiment –- far from it! –- only to the thinning of its meaning when the words are tossed off too casually, too robotically, too often, as has become the modern norm. (Pet peeve: The perfunctory "Byebyeloveyou!" at the end of every phone call.)

When I hear, or say, "I love you," I want the words to be fully intentional. For me, there's nothing casual about them. (Okay, contributing factor: I'm one of those reserved people who's missing the emotion-burbling gene!)

I'm a bigger believer in telling by showing. It's the old "actions speak louder than words." If you love someone, you're there for him or her. You do things without questioning or rationalizing. You perform acts of love because you want to, not out of obligation. You don't expect thanks. You don't even expect notice (although it's wonderful not to be taken for granted; love is always nicest when it's reciprocal).

You do what must be done, in ways large and small. You cancel prior lunch plans to take coughing Mom for last-minute x-rays, as my high school best friend did this week when I was in town for my dad's funeral. (We squeezed in breakfast.) You take Dad into your home, as my brother and sister-in-law did for the last two years of his life. (Angels among us.) You do all that caregiver stuff – you don't need me to detail it. You're living it.

Don't let anyone make you feel like a repressed throwback to another era, or a curmudgeon who risks "missing out" on anything, if you don't speak up with the sweet nothings. You're already expressing "I love yous" aplenty.

I did say those three not-so-little words to my Dad last week. My brother held the phone up to his ear, and they popped right out. Dad said them back, in a voice as firm as it was faint...his last words to me. By morning, he'd lost consciousness to heavy morphine, as I'd been forewarned he would. Two days later, he died.

Do I regret not having this wonderful exchange more often? Not at all. That wouldn't make have made those final words more meaningful.

I had a similar experience telling my mom that I loved her on the day she signed herself into hospice two years ago. Ironically, she died before a Woman's Day magazine column I'd written on this subject was published, though I'd told her about it. As with Dad, the relative rarity of my words underscored them.

Some people say they hand out "love yous" in abundance because you never know when one might be the last. I respect that. But I doubt I'd recall an autopilot "love youbye" with the same intensity as, say, that last exchange with my Dad or the one on that hard hospital day with my Mom (which I realize I was lucky, in each case, to have).

I do tell my remaining loved ones how I feel, though not every minute of the day or even every day. And I don't care whether they parrot the words back to me, or not. What's critical is that, whether by words or deeds, each side leaves the other in no doubt about where we stand.

Forgetting Faces: What It's Like to No Longer Be Recognized by Your Dad

Paula Spencer — Tue, 20 Oct 2009 07:00:00 -0000

What could be more elementally human than recognizing people -- the loved ones who feature in all your family memories, the friends you wave to on the street, the special face you wake up to every morning? I can't imagine what it must it feel like when Alzheimer's or another dementia turns those once-familiar faces into blanks.

But I well know about being on the receiving end of a blank stare. I've experienced the strange sensation of not being recognized by your own parent.

Intellectually, you understand the day might come. You know it's not unusual that recognizing people will become a challenge for someone with later-stage dementia. But the first time you're called by another name, it jolts. The gulf between you seems to widen.

The first time Dad introduced me as his "sister," my heart sank. It was a confirmation of what I'd long suspected, that he only vaguely got who I was. He seems to register me as family (as opposed to a total stranger), but can't quite place me. He definitely has no idea where I live, how many children I have, or what I do. I can't remember the last time he used my name. (Except to ask me, "Did you see what Paula wrote in this magazine?")

It sounds horrible to put into words, but the experience has made me feel more detached from him. I still adore him and treat him exactly the same. But he feels more "kidnapped." Each visit, I brace for worse. Last week, he mistook my sister-in-law, his primary caregiver whom he sees all the time, for a doctor or a nurse.

Little wonder I've become very interested in this phenomenon. I can't imagine what the experience of losing this connection to a spouse must be like. Here's what some others have told me about their experiences:

Others' impressions of being "forgotten":

From a wife: "I just pretend like he still knows me. The thing is, every once in awhile he clicks back in, and I know he knows me."
From a son "It used to bother me a lot when my mother would call me by my brother's name, but now I just ignore it. I figure I still recognize her and that's all that matters."
From a daughter: "I can't bear it, so when I visit I say who I am right away, so I don't have to be asked. That way I can go a whole visit pretending that I'm remembered."
From another daughter: "He thinks I'm my mother, who's been dead for several years. I correct him and correct him – I can't help it, and it seems cruel to pretend to be my late mother. But it's hard on me."
From another wife: "I've never been lonelier in my life."

If recognizing people has become a problem for your loved one and you've been forgotten, I'd love to hear what it felt like and how you deal with it.

10 Signs of Caring Too Much

Paula Spencer — Thu, 15 Oct 2009 07:00:00 -0000

Compassion fatigue -- a.k.a. caregiver burnout -- is what happens when a well-intentioned caregiver crosses a hard-to-see line from One-Who-Helps to One-Who-Needs-Help. And it can happen to anyone. It happens precisely because you care so much.

Are you at risk of caring "too much"? Here are ten warning signs:

1. You use words like "always" and "never" with regard to caregiving.

Beware falling into absolutes: "I promised Mom we'd never put her in a nursing home." "I'm sorry I can't go to lunch because I always feed Sam by myself."

Being overly rigid can put you at risk for burnout.

2. Your friends seem to have stopped calling.

You may be feeling isolated or annoyed that your old circle no longer seems to check up on you and how you're faring. But is it possible that you've turned them down so often because of your caregiving duties, or that caregiving concerns so dominate your life and conversation, that they got the message you're just not interested in them?

A social life is a two-way street.

3. The last time you felt happy was…uh…um…let's see…

Nobody ever said looking after a sick or aging loved one was a romp in a field of wildflowers. But if your everyday life has lost even its grace notes, so that you find no pleasure in it, you're at risk.

Every day needs at least one happy petal or two.

4. Everyone assumes you'll step forward; nobody asks.

Have you become the default go-to girl (or guy) in your family? When the sick person is your spouse, this is logical. (Even then, you need a support system to pitch in.) But it's a different matter when the family member being cared for is a parent, grandparent, or other relative -- and the entire burden of responsibility seems to have settled on your shoulders whether you've volunteered or not.

As Caring.com Family Advisor Carol O'Dell is fond of saying, "People take as much advantage of you as you let them."

5. You're overweight or out of shape.

True, it may not be your caregiving that's to blame. We could sit around and make a long list of culprits for poor health that includes everything from our car culture to a conspiracy of corn syrup to unfortunate genes. But the fact remains that poor self-care is a big red flag for caregiver burnout. Being selflessly focused on others by definition means you're not focused on yourself. And yet you need to be the #1 person you look after, in order to be shipshape (or at least functional!) to look after others.

If you don't like what you see when you look in the mirror (or sit listening to the doctor's concern in the exam room), give yourself permission to be selfish..

6. You can't remember the last time you took a vacation.

Vacations are really hard when you have a disabled or impaired person to consider. And not being able to even remember the last break you had is a sure sign you're due for one. It doesn't have to be three weeks in France. Start small if you must: a simple overnight at a friend's house or a local B&B. Just do something.

To stop caregiving stress, stop caregiving sometimes.

7. All conversations turn to caregiving.

Maybe you remember when your kids were babies and you'd hire a babysitter – and proceed to talk about the kids all evening? Not a great idea. Or worse, you call home to check up! If every conversation with your partner or other family members concerns one subject, it's a warning sign that topic is monopolizing your life.

Diversify!

8. You have no hobbies.

You say you have no time for hobbies? Your hobby doesn't have to be a conventional one like stamp-collecting or bird-watching. It just needs to be an outlet away from caregiving. Reading trashy novels uninterrupted, taking up knitting, joining a book club, taking adult ed courses, being a matinee-movie addict, or enjoying your children and grandchildren all count, too – anything that takes you away from caregiving for bursts of time.

Bonus points if it takes you out of the house, too.

9. You can't sleep through the night.

Two common causes: You're up tending to a sick person (or Alzheimer's wanderer, or someone else who gets by on just a few hours of sleep a night) or you're sick with stress or a physical problem yourself. A sleepless night or two go with the territory of caregiving – but if it's become your lifestyle, it's a problem you need to correct.

Sleep isn't optional!

10. You dread waking up in the morning.

We all have this experience, usually when we're in the midst of a health crisis that seems like a bad dream (but isn't). Health nightmares can go on for years, unfortunately. But when the crisis has passed and you've sunk into a new routine – and you still feel heavy-hearted and hopeless, your body is crying out for you to enlist some support.

Nobody – not even the most well-intentioned, big-hearted, and selfless among us -- is meant to endure a tough situation all alone, day after day, year after year.

If three or more of these warning signs are flashing for you, what can you do? Start here:

Use the Caring.com local eldercare directory to free up time for you.
Find a forum of like-situationed others to vent to.
Congratulate yourself for having taken the first step toward improving the situation: Realizing the problem, and deciding you're worth a fix.

Caring for a Spouse? 5 Reasons Stressed Spousal Caregivers Miss Out on Help

Paula Spencer — Thu, 01 Oct 2009 07:00:00 -0000

Stress and isolation are risks for all caregivers, but those who are caring for a spouse can be especially vulnerable. Factors unique to being a spousal caregiver raise the odds that someone in this situation will miss out on helpful resources –- and in turn raise his or her own risk for depression, disease, and even death.

(Though research shows that risks vary by age, gender, and the spouse's condition, they exist whether the spouse is caring for a husband or wife with dementia, cancer, heart disease, stroke, or other illnesses and disabilities.)

Obviously not everything about caring for a husband or wife who's ill is grim. But the grim parts can be as dangerous as they are often overlooked.

If you're a spousal caregiver, please consider the following factors that point to a need for giving in to more help, not less. And if one of your parents is looking after the other, these factors are worth being aware of as you look for ways to be helpful:

1. Spouses don't just have a close relationship with the person in need –- they have an intimate relationship.

Marital intimacy magnifies everything: The impulse to shoulder the burden of care alone, the need to do everything imaginable to protect and heal one's beloved, the grief over the changing relationship, the desire to keep the situation private.

Net result: Magnified work, magnified stress, magnified grief, magnified isolation.

2. Spouses don't always think of themselves as caregivers.

My late mother took care of my dad singlehandedly as his dementia progressed, but I don't know that she ever self-identified as a "caregiver." To her, what she did was an extension of the feeding, cleaning, and general nurturing she'd always been responsible for in their marriage.

Net result: The murky line between spousal duty and caregiver duty leads a spousal caregiver to avoid even looking for resources that can help with such basics as cooking, cleaning, and help with the activities of daily life. They risk falling into the "it's my job" martyr syndrome.

3. Spouses tend to cover for one another.

Spousal caregivers tend to see themselves as they always have: part of a tight marital unit. Outsiders aren't privy to really knowing what goes on inside a marriage. Short visits home often masked my dad's declining condition because, I later realized, my mom arranged his life to make things as easy as possible for him. Near the end, she did all the driving, cooking, shopping, bookkeeping, and life planning for the two of them, without mentioning it. It made it easier for the rest of us not to really notice (or should I say to willfully ignore?) how bad his cognitive abilities had become.

Net result: A conspiracy of silence that leaves adult children, neighbors, friends, and others -- sometimes even trusted physicians -- in the dark, and unable to lend a hand.

4. Spousal caregivers endure a shifting balance of power.

This happens with adult children of aging parents, too, as roles reverse. But whereas children and parents never have truly "equal" relationships, equality and balance are the very basis of a good marriage. When sickness or disability throws balance out of whack, it can be stressful for both parties.

Net result: Added stress and confusion –- and a tendency to withdraw.

5. Spousal caregivers can feel isolated by their unique circumstance.

Socializing can feel awkward if your friends in couples remain healthy. Like widowed spouses, spousal caregivers may find themselves feeling like others can't relate, or being left out of a former couples-based social life. As part of a "hidden subculture," spousal caregivers find it hard to connect with others in their shoes. They may even feel disloyal about confiding in friends or strangers about their predicament.

Net result: Still more damaging isolation.

Resources that can help:

The Well Spouse Association. If you can possibly travel, or live in the Washington DC orbit, this unique support community for spousal caregivers is holding a conference coming up Oct 23-25 in Annapolis, Maryland.
The Caring.com Relationship Forum often features supportive discussions amongst those caring for a spouse.
Local eldercare resources exist that are both specific to spousal caregivers and about eldercare generally. Experienced pros know how to help people in the difficult situation of caring for a spouse –- a situation that's isolating but by no means isolated.

Sex and Alzheimer's: Love Stories, Sad Stories, and Lots of Questions

Paula Spencer — Tue, 22 Sep 2009 07:00:00 -0000

Sexual urges don't stop just because Alzheimer's or another dementing illness invades the brain. Sometimes this is a blessing; some long-married couples say that the mind and body long remember the behaviors of sexual intimacy, even when short-term memory is on the fritz, which helps reinforce their closeness despite the disease-related adversity. Sometimes, on the other hand, sexuality coupled with dementia can cause big problems.

Few of us care to think about our parents having sex at any age or in any circumstances. But when the circumstances include dementia, certain issues might sidle up to a caregiver anyway. Reading this terrific legal overview in the Washington Post about an Alzheimer's rape case is a great reminder to family caregivers that sex is a fact of life (sometimes a thorny fact of life) all through life.

What are the most common minefields?

A consenting couple, in which one party has Alzheimer's, but both enjoy the sexual relationship.

Potential minefields: Symptoms can ebb and flow, meaning a partner who seems like "her old self" one night might have a hard time with reading nonverbal body language and respond appropriately the next. As the ongoing demands of the disease take their toll on intimacy generally, a caregiver may feel more frustrated, less close, to the spouse, even when the sexual relationship persists.

Worth mentioning again: This is not universally true for all couples. But what is true is that the "balance of power" within the relationship is shifting in one direction, and the caregiver is more aware of these changes than the person with dementia, as time goes on.

Consensual sex between partners who live in assisted living situations is a hot button issue in long-term care. Whether one or both parties have dementia, who is to say when sexual activity should cease? Sexual communication is important to a relationship and worth respecting. And yet semi-communal living situations can afford little privacy, or make (often young) staffers who are mentally unprepared for this reality feel awkward.

The person with Alzheimer's wants sex; the spousal caregiver, not so much.

Potential minefields: Changes brought by the disease as the person becomes more child-like and dependent can curb the spousal caregiver's desire. He or she may feel guilty about this reality. At the same time, disinhibition is a common side effect of Alzheimer's; the person may make aggressive sexual advances or strip as a function of the disease, rather than desire. It can be hard for a stressed caregiver to know the difference.

The spousal caregiver wants sex; the person with Alzheimer's is past the point of consent (or isn't the object of desire).

Potential minefields: When within the bounds of marriage can intercourse be called rape? The definitions can get murky.

In the case of the spouse who no longer seeks the sexual companionship of his or her partner with dementia, weighing one's moral and practical appetite for an affair can become an issue. Given that people can live for a dozen years or more with advanced dementia, satisfying sexual needs can become a real issue for spousal caregivers.

The person with Alzheimer's wants sex (or seems to) with oh, anybody.

Potential minefields: Sexual desire is a biological urge, but a hallmark symptom of dementia is a lack of judgment. So the person risks acting on perfectly natural urges -- though in ways that may or may not be appropriate. Or the person may embark on a sexual affair that, because of the disease's other effects, is otherwise an imbalanced one; for example, the father who wants to wed the nurse he becomes attracted to (who may be in love with him – or his money; how's a family to be sure?).

Disinhibition ties in, too; others may perceive disrobing or making sexual comments as advances whether they are or not. Hired or family caregivers around this hypersexual behavior can be very uncomfortable.

A non-spousal caregiver or other person takes advantage of the person with Alzheimer's. (Or is it consensual?)

This is the crux of the fascinating case in the Washington Post feature. Sexual abuse is unconscionable, as in headline-making cases of nursing home workers accused of fondling or having intercourse with residents with such late-stage disease that it can't possibly be consensual. But what's rape in cases where the person can't exactly remember what happened and may or may not have been in agreement at the moment? What constitutes "taking advantage" of someone who's basically mentally impaired? Are the definitions different morally, ethically, and legally?

They're all tough questions nobody likes to think about. Spousal caregivers encounter them first, but so might any of us. They're potentially strange bedfellows, sex and Alzheimer's. Are you ready?

Patrick Swayze's Last Wish

Melanie Haiken — Tue, 15 Sep 2009 07:00:00 -0000

Patrick Swayze lost his battle with pancreatic cancer Monday night, after waging a brave battle during the 20 months since he announced his diagnosis. It may be Swayze's romantic turns in Dirty Dancing and Ghost for which he's best remembered, but cancer patients will never forget how Swayze turned his own battle into a public plea for help for all those affected by this terrible disease.

It's his own words that provide the best memorial for Swayze, who was only 57. "I keep dreaming of a future, a future with a long and healthy life, a life not lived in the shadow of cancer, but in the light," he said in the live television event "Stand Up to Cancer," which aired in September, 2008.

In February of this year, Swayze published a straight-talking op-ed piece in the Washington Post titled, "I'm Battling Cancer. How About Some Help, Congress?" He urged senators and representatives to vote for the maximum funding for the National Institutes of Health to fight cancer as part of the economic stimulus package.

In his op-ed, he finished by saying "My hope is that one day the words "a cure" won't be followed by the words "is impossible.""

A diagnosis of pancreatic cancer is essentially a death sentence; most people diagnosed with this virulent cancer have only months to a few years to live from the time they find out they're sick. Like Randy Pausch, another hero of Cancer World who battled pancreatic cancer, Swayze fought hard. He had brutal chemotherapy and experimental treatments at Stanford, with his beloved wife and partner of 34 years, Lisa Niemi, flying him up from Hollywood in a private plane. Meanwhile, despite debilitating side effects, he continued to act, launching a demanding new action series, The Beast, even as his disease progressed.

To many of us with cancer in our lives, one of the most frustrating and enraging aspect of Swayze's cancer battle was watching how rumors of his death dogged him from the time he was diagnosed. Only months after his diagnosis, when he still appeared quite healthy, tabloid headlines had him just "weeks away" from death. And in mid-May a rumor that he had died swept through Twitter and other social media and was picked up by major news media before Swayze's representatives squashed it.

Struggling to live life to the fullest while in the shadow of death is something cancer patients and their loved ones know all too well. Finding joy and strength with a terminal diagnosis hanging over you is difficult enough. Doing so while the world wrongly anticipates and trumpets news of your death, as Swayze did, is an act of supreme grace. "Hope is a very, very fragile thing in anyone's life," he said. "And the people I love do not need to be having that hope robbed from them."

In the end, the cancer won. But Swayze didn't let cancer have the last word. As Swayze said in his brave and memorable last interview with Barbara Walters, "Yeah, I'm scared. Yeah, I'm angry. Yeah, I'm asking, `Why me?'" -- emotions all of us dealing with cancer can identify with.

But, he added, "You get busy living or you get busy dying."

The tabloid headline Swayze envisioned for himself: "Swayze's Kicking It," did not come to pass. But as he put it so aptly: "I like to believe, and I always have, that I've got a lot of guardian warriors sitting on my shoulder, including my dad, saying `you let us do the work, and we'll finish it for him.'"

So, fellow cancer-warriors, let's get to work.

Share Your Thoughts on a Patrick Swayze Tribute Page

Prolonged Grief, a New Psychological Disorder?

Paula Spencer — Wed, 12 Aug 2009 19:35:37 -0000

Say it's been two years since your father died and your mom still won't socialize or quit talking about wanting to join him. Or you can't shake a sense of meaninglessness to your life as the anniversary approaches of the death of someone close to you. Sounds like prolonged grief disorder, psychiatrists might say.

Prolonged grief disorder (PGD) -- previously called complicated grief – may soon be a recognized mental disorder. Researchers at the Dana-Farber Cancer Institute in Boston developed and tested standard criteria for identifying the condition, based on the input of a team of experts in bereavement and mood/anxiety disorders. That's a major hurdle on the way to inclusion in the next edition of the Diagnostic Statistical Manual of Mental Disorders (DMV-5), the psychiatric care bible for diagnosing problems. The research was done with widows and widowers but is thought to be applicable to the general population.

None of this is to say that grieving is unhealthy or unnatural. To the contrary: Mourning is a necessary process that also happens to be hard and horrible, and takes many different shapes, depending on the individuals and their relationship. But with prolonged grief disorder, the grief reaction is so prolonged and causes such psychological distress as to create substantial disability. Laypeople tend to say someone is "paralyzed with grief" or "unable to move on."

Wait, you may be thinking. Is this just medicalizing grief? The psychiatrists make a persuasive case that the answer is no. For one thing, along with poorer quality of life, the health risks associated with prolonged grief disorder include increased rates of suicide, cancer, immunological dysfunction, hypertension, heart problems, and other adverse health behaviors.

And the good news: Talk therapy geared to this prolonged grief can successfully treat it. (Not a new "instant-fix" pill.) Not to make the griever "get over" the loved one, but to allow him or her to be able to cope with the loss in functional, healthful ways. That's why diagnosis is so important. It can steer those in need to the right kind of support.

What to watch out for

Warning signs of prolonged grief disorder include yearning to be reunited to the extent that it causes physical or emotional suffering, as well as at least five of the nine following symptoms still being experienced six or more months after the loss:

Emotional numbness
A stunned, dazed, or shocked feeling
A feeling that life is meaningless
Bitterness or anger over the loss
Mistrust of others
Difficulty accepting the loss
Avoidance of reminders of the deceased
Difficulty moving on with life
A feeling that part of oneself has died

Some people don't begin to have symptoms until six months after the loss; they have higher incidence of thinking about suicide and lower quality of life. Others experience acute symptoms immediately that continue for a year or more; they also tend to experience major depression, post-traumatic stress disorder, and generalized anxiety. People in both situations have a 10-times higher risk for a depressive disorder than those whose grief runs a more conventional course or who are treated.

Final food for thought:

Is our current "way of death" contributing to an uptick in prolonged grief disorder? There's no data (because this isn't yet a recognized disorder). But that's what Canadian doctor Stephen Workman theorizes in a related commentary in the journal Public Library of Science. He notes that the modern emphasis at the end of life on hope, survival, and high-tech "fighting" to prolong life, even in final-stage disease where the prognosis is clear, may leave families all the more unprepared for eventual death.

Workman writes: "I remember a middle-aged man whose father was dying; each day shorter of breath and one day closer to death. His son was continually requesting treatments his father did not want or need. “How long do you hope for your father to live?” I asked.

“I don't ever want my father to die," [the man said].

Therein lies a rough road.

Save Money -- And Strengthen Family Ties -- With A Multi-Generation Vacation

Melanie Haiken — Fri, 17 Jul 2009 07:00:00 -0000

On a recent trip I was struck by the number of three-generation families I saw vacationing together. And I noticed the ways in which this arrangement works well to give everyone some much-needed relaxation while keeping costs down, as well.

I chatted with some of the families I met, and heard over and over again how the current economic crisis is leading people to try new solutions, such as combining family resources for a vacation.

I've also heard from many friends that financial troubles are preventing them from flying home to visit family over the summer, as they typically do. And, of course, this is sad for everyone.

So here, after many conversations, are some ideas for how multi-generation families can join together to help everyone afford a vacation, even in tough times:

• Pick a central or accessible location based on cost. One family I met was divided between Oregon and the San Francisco Bay Area; they selected Mt. Shasta, in rural northernmost California, for an affordable meet-in-the-middle vacation.

• Go camping in a trailer-friendly campground. Several families I know have come up with this ingenious plan: Mom, Dad, and kids camp, while Grandma and Grandpa stay in an RV. Meals can be shared to decrease the work, but everyone has their own private space to retire to.

• Choose a bargain-basement destination with promotional prices. Hard times have hit the travel industry, too, and many hotel-rich towns, like Las Vegas, are offering rock-bottom prices to avoid high vacancy rates. Do a little research, and you can find a getaway where everyone can have a nice room with at least one meal included for half the usual cost.

• Do a house trade. A popular option for years in university towns, this is one of the hot trends everywhere this summer. You can use one or more of the many home exchange websites, but you can also take advantage of your own local network. Ask around to find out if anyone you know will be away during the time your family members would like to visit; you'd be surprised how many people appreciate mature, responsible housesitters. Or you can plan the trip based on when a friend or neighbor's house will be available. Your parents or other family members may be able to do the same for you in their town.

• Rent a big cabin and split the cost. Like anything else, costs tend to come down in proportion to how many people go in on them together. Every year in my family, we rent one big cabin with four or five bedrooms, and all the siblings, spouses, and kids pile in together. We've become adept at choosing locations where a big cabin rents for $1000 to $1500 a week; split this among four families, and you have a week-long vacation $250 or $350 a week.

Many people told me they'd discovered unexpected benefits to the cost-cutting. One older woman, whose three-year-old grandson was using her as a buoy in the pool, told me it was a rare pleasure for her to get that kind of unstructured time with him.

Another family group, a brother and sister vacationing with their parents, their spouses, and all the kids, told me that sharing a cabin had allowed everyone to afford two weeks at the lake instead of one. And a couple dining together at a cafe while their parents babysat told me it was the first "date" they'd had in six months.

So don't let the financial doldrums keep you from seeing family this summer, and please share your tips for making multi-generation vacations easy and affordable.

Close Ties to a Caregiver May Slow Dementia Progress

Paula Spencer — Thu, 16 Jul 2009 07:00:00 -0000

Here's news that may console you on those inevitable "bad days" when you feel a bit trapped by the demands of caring for someone with Alzheimer's disease or another form of dementia: A close relationship to a caregiver can slow the progress of Alzheimer's, researchers say.

In the September issue of The Journals of Gerontology, researchers at Utah State University, with colleagues at Duke, Johns Hopkins, and Boston University, report that the quality of the caregiver-recipient relationship can influence the course of Alzheimer's: Higher levels of closeness were associated with slower cognitive decline. For this long-term study, researchers followed 167 pairs for an average of 20 months. The effect was greatest among spousal caregivers with close relationships, but held among all positive caregiver-recipient pairs.

Next their research will try to tease out what specific kinds of interactions and activities seem most helpful. But for now, it's reinforcing data that the time and effort caregivers invest matters. Having someone you trust and love to rely on makes life that much less taxing for anyone, but particularly someone already challenged with cognitive difficulties, like Alzheimer's. It makes sense that spousal caregivers provide the highest benefit; if the marriage is good (and, as in most cases with Alzheimer's, long), it stands to reason that there's a built-up storehouse of emotional closeness. This study says adult children and other relatives can fill this role, too.

Interestingly, this is a benefit that many caregivers may not be aware of. After all, having a close relationship with the person who has Alzheimer's doesn't make the disease go away or get better; it merely slows the rate of decline. Slower-than-otherwise decline can seem invisible, even if you feel good about providing basic care and a safe haven to someone you love.

Rest assured, though, that your presence and caring is likely making things much better for the person's quality of life than it would be otherwise. That's huge. That's something to feel great about.