In last week’s post, we explored the specific parts of the Caregiver’s Journey–the beginning, middle and end stages–what can be expected at each stage and ways to cope.? Today, we’ll specifically look at the burnout that can be experienced by some caregivers.? What are the risk factors?? How do you know if you’re feeling burnout?? What can you do to prevent burnout?? This is the second in a three-part series on care-giving.

The information in this post is a partial summation of? information that was presented by Dr. Virginia Wesson, Psychiatrist and Dr. Rhonda Feldman, Psychologist.? ?Both Drs. Wesson and Feldman?see?patients, and their families, at The Cyril & Dorothy, Joel & Jill Reitman Centre for Alzheimer?s Support and Training.

A Story…

Dorothy and Marion (both aged 74) have been together for 40 years.? Ten years ago, when they retired from their careers (Marion was a teacher, Dorothy an operating room nurse) they had plans to travel.

Shortly after Marion left her job, she developed a cough that wouldn’t go away.? She lived with it, but became concerned when she started to experience a tightness in her chest and shortness of breath.

Rather than visiting the doctor, Marion decided that maybe a change of climate would be helpful, and the couple planned a trip to Arizona to visit friends.? “Perhaps the heat and rest would improve Marion’s symptoms”, Marion thought.? Unfortunately, there was no change in her health.? In fact, once out of her home environment, Marion became easily tired and was unable to join Dorothy and their friends on day trips.

When the pair returned home, Marion agreed to seek medical advice.? She was diagnosed with the Chronic Obstructive Pulmonary Disease (COPD)–a chronic inflammatory lung disease that causes obstructed airflow from the lungs.

Marion and Dorothy were shocked by the diagnosis.? Both had been smokers at various times in their lives, but had quit ten years earlier.? However, one of the causes of COPD is smoking and the habit had left its mark on Marion’s lungs.

At the beginning, after the shock wore off, the couple found ways to cope with the changes in Marion’s health and her decreased energy level.? Long-distance travel was out of the question, and with Marion’s new medication, they were able to make the most of day and weekend trips.? Because they were both retired, Dorothy found it easy to take over some of Marion’s tasks.? The women were able to cope in this first stage for a long time, adjusting as Marion’s health slowly deteriorated.

Risk Factors for Burnout

As explored in last week’s post, burnout often starts to appear during the middle stage of the care-giving journey.? In the beginning, the illness is a consideration in lifestyle decisions, but not a main component.? However, as the illness becomes more severe, it becomes a major factor in how the person who is ill and their caregiver function on a daily basis.

As the caregiver continues on this path of support, they may be at risk for burnout depending on:

• the severity of the illness or behaviour of the person they are supporting
• if they feel able to handle situations that arise
• the type of relationship the caregiver has had in the past with the individual (i.e. it is often easier to take care of someone with whom you have had a loving relationship)
• degree of knowledge about the illness
• level of quality support (informal, formal and professional).? The more support, the less risk for burnout.

Based on what we know about Marion and Dorothy, we can assume that Dorothy may not be at a great risk for burnout, if she is careful.? When Marion was first diagnosed, both women did a lot of research into COPD.? Because of Dorothy’s connections in the health care field, she was able to put supports in place well in advance of them being needed.? The couple had been in a loving, stable relationship for a number of years and were committed to supporting each other through the illness journey.

However, not every caregiver has the resources that Dorothy was able to access.? What are the symptoms of burnout?

You May Be Experiencing Caregiver Burnout If…

• You have developed a new health problem.? If we don’t practice self-care, taking care of a loved one can stress our immune system, causing our own health to suffer.
• Depression.? At times we can feel that the situation is hopeless–especially if we know that our ‘person’ isn’t going to get better.? Feelings of being overwhelmed, overtired and under appreciated can all lead to depression.
• Anger.? While anger is a normal response to life not turning out as we had wished, excessive anger is a warning sign of burnout.
• Substance Use.? Care-giving is difficult and we all have our own ways of coping or self-soothing.? However, using substances as a way to make yourself feel better is not a healthy way of self-care.
• Social Isolation.? Social isolation can be a vicious circle.? We may have to stay home all the time in order to be there for our ‘person’–especially if there are no supports in place to give us a break.? However, the more isolated we become, especially if depression sets in, the less time we want to spend out in the world.
• Loss of Relationships.? This is directly related to the degree of social isolation you may be experiencing.
• No interest in self-care.? If you are not eating well, taking time to exercise or spend some time doing activities that you enjoy, burnout may be the reason.

The Story Continues…

Through forethought, planning, good communication with Marion and lots of support, Dorothy was able to avoid experiencing serious burnout.? Of course there were days or weeks when she felt overwhelmed, but because she felt that the care she was providing for Marion was important, she was able to get through the rough patches.

By this time, Marion was housebound due to exhaustion.? Her medication wasn’t as effective as before and for various health reasons she wasn’t a candidate for surgery that is sometimes an option for COPD patients.? Due to her lack of energy, Marion spent a lot of her day sleeping.

If someone had asked Dorothy how she was doing (we don’t often ask the caregiver, but instead focus on the person who is ill), she would have responded that she is able to handle the medical piece because of her nursing training, and the house chores as they can afford to hire help when needed.? Her biggest heartache is that she misses Marion (the ‘old’ Marion).? She misses having someone to go out with and share experiences with.? Marion isn’t psychically absent, but she sleeps most of the time, so isn’t always available.? Dorothy wonders when she stopped being Marion’s partner and became her full-time nurse.

This sense of loss is common for caregivers.? Even if they have support for the practical things, the grief experienced around this is often lonely and hard to explain to others.

What’s a Caregiver To Do?

Does the above list describing burnout sound like you?? Can you relate|?? If so, there are things that you can do.

• Ask for help from other family members, friends, medical supports, etc.? As humans we often feel that we can do it all by ourselves, or that no one else is able to take care of our ‘person’ as well as we can…and we can’t and other’s can (though it may look different from how we would take care of them).? Do yourself and them a favour and get some support.
• Check into support groups for the type of illness/condition that your loved has.? Many groups, such as the Alzheimer’s Society and Hopespring Cancer Support Centre offer support groups for patients and their caregivers.? Your medical supports may be able to provide advice on where to look or check out the web.
• If you are feeling housebound due to your care-giving role,? and are computer savvy, there are on-line support groups available.
• Let your doctor know that you are struggling–especially if you are feeling depressed, using substances or other unhealthy means as a way to cope.? There are things they can do to help by suggesting medication or referrals to other professionals.
• No matter where you are on the care-giving journey, counselling is always an option as a tool to help you cope with negative emotions (such as anger) that can come up, inappropriate ways of coping, feeling socially isolated.? Having an impartial third party to talk to about what is going on, can release some of the stress and pressure that you feel.

The Story Still Continues…

Marion and Dorothy are still living in their home.? Marion’s health continues to decline, and Dorothy has come to terms with her ‘new’ relationship with her.? At Dorothy’s request, family members have started taking on a more active role in Marion’s care.? More and more household duties are being done by paid help or family members.

Dorothy is still grieving the loss of the ‘old Marion’ and recognizes that this is reality. She is thankful that she is able to provide so much care for her partner.

And now, let’s lighten the mood.? For those of us who are trying to figure out summer plans for our children, here’s a classic camp song from Alan Sherman…Enjoy!

Part 3