When One Older Adult Is Caring for the Other

How you can help, even when you're not the primary caregiver
Caring for the caregiver of an older adult

If an older adult experiences a health crisis and the person he's living with -- whether it's his spouse or someone else -- is healthy, your role in the caregiver equation is an essential one. As long as the healthy older adult is willing and able, she'll likely be the primary caregiver -- but she's still going to need your support.

In her book How to Care for Aging Parents, Virginia Morris points out that when a parent falls ill or is diagnosed with a serious disease, everyone tends to focus on that parent. But the healthy older adult also needs your attention -- now and in the days and months ahead.

It's natural for loved ones to be concerned about the patient. If your friend or relative has just been diagnosed with cancer or suffered a stroke, your first concern is bound to be for him, ensuring that he get the best possible care. This will be his housemate's primary concern as well, and she's apt to neglect her own health and emotional needs as she focuses on him. The best way for you to help is by caring for the caregiver as well as the patient.

  • Consider the healthy person's experience. While the patient faces a physical crisis, the healthy person faces a crisis almost as profound. If your father has just received a terminal cancer diagnosis, for example, your mother must come to grips with the fact that she's losing her life partner. She could face years of caregiving -- and the prohibitive financial pressures that go with it. You can't change this reality, but your empathy and reassurance will help her face the difficult times ahead.

  • Promote nutrition, sleep, and exercise. When a loved one has a health crisis, it's easy for caregivers to forget to take care of themselves. Check that the healthy person is getting enough sleep; eating regular meals; and exercising whenever possible. If the patient is hospitalized with a heart attack and she doesn't want to leave his side, offer to stay with him for a few hours so she can go home to shower and take a nap. See that she gets out for a brisk walk in the fresh air. Bring her special foods or protein shakes if she's skipping meals, and consult her doctor is she's having trouble sleeping. Remind her that she won't be any help if she gets sick, too.

  • Expect some denial. Don't be surprised if the healthy person seems to be in denial about the gravity of the patient's health condition. It's likely that she hasn't yet fully absorbed the impact of the blow she's received. Gently remind her that she doesn't have to make any major decisions until she learns more about his prognosis.

  • Encourage her to discuss her feelings. The healthy person is probably in shock and struggling to understand the nature of the patient's condition. She may also be beginning to think about what's in store and to comprehend the devastating loss she's suffered. In a quiet moment, check in with her about how she's doing and offer to be a sounding board if she wants to talk through her grief, her fear, or her plans. Help her tap into resources like eldercare services and hospital support groups.

  • Let her talk even if it hurts. You may find that it's painful to listen as she expresses fear and grief over the patient's condition. Resist the urge to change the subject or end the conversation. She needs to express her feelings, and you're likely to find that sharing yours comforts you both.

How you can help an older caregiver day to day

When the health crisis has passed and the patient is in a stable situation, either at home, in the hospital, or in a nursing facility, the healthy older adult will need you more than ever.

*Offer to help -- and keep on offering. You may find that the caregiver declines your offers of help, either because she prefers managing on her own, doesn't want to inconvenience you -- or a combination. Try proposing a few specific tasks that you could take over to ease her burden a little. For example, suggest that she give you a grocery list every week so you can pick up provisions for her when you do your own weekly shopping. Or bring a meal by once or twice a week so she won't have to worry about cooking.

If she likes to run her household her own way, she may be more open to help with the patient's care. Offer to take him to medical appointments, make arrangements for his treatments, or simply have lunch with him once a week so she can do errands. If you live far away, visit frequently and arrange to stay for a few days at a time to give her regular breaks.

If the caregiver continues to refuse help, bring up the subject a little later. She may be more willing to accept help after she's settled into a caregiving routine and the patient's condition is improving.

*Stay in close touch. Whether you live down the street or across the country, it's important to stay in close touch with the healthy older adult. Call regularly, and if she's a family member, set up family conference calls if you and others live far from each other. Visit as often as possible to give her company and support.

*Keep channels of communication open. Make sure the caregiver knows you want to hear how she's doing. When you call or drop in, don't just ask how the patient is. Find out how her day went and what her concerns are. Try to draw her out and encourage her to complain, grieve, or express anger if she wants to. Communicate your appreciation for all she does for him, and let her know that you think she's doing a good job.

What to watch out for: Signs of burnout in an older caregiver

Caregiving is extremely stressful and exhausting. According to the Family Caregiver Alliance, depression among caregivers is twice that of the general population, and burnout rates are also high. As the caregiver's caregiver, you should watch out for these red flags so you can help the healthy person avoid burnout:

*Symptoms of depression. Depression symptoms can include sleep problems (sleeping too much or too little), loss of appetite or overeating, lack of interest in usual activities, unexplained physical problems, and irritability.

*Health problems. If she starts to have health complaints, it could be a symptom of exhaustion, depression -- or both.

*Resentment. As the primary caregiver, it's normal for her to feel occasional frustration toward the patient, but excessive or irrational resentment could be a sign of burnout. For example, if he has Alzheimer's and she seems to constantly nag and criticize him for forgetfulness or clumsiness, that could be a sign that she's overwhelmed and exhausted.

What you can do:

  • Take signs of burnout seriously.
  • Make sure the healthy person gets enough breaks and support.
  • Arrange for regular respite care.
  • Help her find a caregiver support group.
  • If the patient is her husband, suggest that she consider joining Well Spouse, an organization that provides information and resources for the spouses of those with serious health conditions.
  • If the caregiver is overwhelmed or exhausted, brainstorm with her about whether it's time to hire a regular in-home caregiver or make other living arrangements. Your local agency on aging or a geriatric care manager can help you sort through available resources and options.


Connie Matthiessen

Constance (Connie) Matthiessen, senior editor, has worked as a healthcare and environmental journalist at the Center for Investigative Reporting and has written for WebMD, Consumer Health Interactive, the Washington Post, the San Francisco Chronicle, BabyCenter. See full bio