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How to identify and minimize caregiver burden

Most of us have heard of caregiver burnout or are familiar with the trials and tribulations involved with providing care for a loved one. While we may be aware of these unique “occupational hazards,” many family caregivers feel that they are powerless to change their situation and therefore turn a blind eye to their emotional, physical and even financial difficulties.

However, this denial only provides a cozy little space for burnout to take root and grow.

According to AARP’s 2015 Caregiving in the U.S. Report, 38 percent of caregivers consider their situation to be highly stressful. Furthermore, nearly half of this high-stress group provides more than 20 hours of care each week.

Even if you believe you are on top of your loved one’s needs and meeting your own, it is crucial for you to periodically take an objective look at your circumstances to prevent pushing your limits too far. You may be meeting many of these needs, but are you providing the best possible care? At what costs?

“Some people do not realize the extent of their stress and burnout, so they do not realize that they need to take action or look into things that can help them,” says Barry J. Jacobs, Psy.D., a licensed psychologist in the state of Pennsylvania and author of The Emotional Survival Guide for Caregivers: Looking After Yourself and Your Family While Helping an Aging Parent. “This puts those caregivers at greater risk for fatigue and depression and, ultimately, for being unable to continue their caregiving duties.”

Below, Dr. Jacobs provides insights that may help family caregivers better gauge the amount of strain they’re experiencing and become more proactive in helping themselves find a healthy middle ground between sacrifice and selfishness.


Ignoring Signs of Burnout Can Have Serious Consequences

While it may be a well-worn cliché at this point, Dr. Jacobs finds that the marathon metaphor is still the most powerful way of helping caregivers realize they need to prepare themselves for the long haul.

“Caregivers, like marathon runners, must learn the lay of the land, find a sustainable pace and accept replenishment along their journey if they have any hope of gamely persevering from start to finish line,” he explains. “With this metaphor in mind, we can say that the family member who accepts this role blindly is akin to the misguided runner in crocs and jeans with no clue about how far they have to travel. They simply are not equipped to successfully complete the race and are likely to stumble and fall within the first mile.”

Much the same can be said for caregivers who wantonly ignore signs of burden and burnout. “Even as they eye the next uphill stretch ahead of them, marathoners have to constantly scan their bodies for muscle cramps and strained ligaments that could be their undoing. This awareness of their limits is crucial. When pain becomes too sharp, they know they must throttle back on their pace. Caregivers, too, need to be on alert for physical symptoms, such as headaches and neck and back pain, and emotional symptoms, such as persistent irritability and hopelessness, either of which could undermine their capacity to give care,” urges Dr. Jacobs.

“When they don’t watch for these signs and try to push through, they make themselves more, not less, likely to badly falter over the long, grinding course.”


How Caregivers Can Gauge Their Stress Levels

Dr. Jacobs considers a demoralizing sense of dread to be a telltale sign of intensifying stress and resentment. “It is a serious issue if you are going to bed each night in anguish over the next day’s chores and waking up each morning with a feeling of heaviness and a reluctance to get going. Caregivers who are full of dread have come to hate their daily caregiving routines, even if they still love the person for whom they’re caring. Ironically, many of them rigidly resist all suggestions for altering those routines as if any change would be tantamount to giving up altogether,” Dr. Jacobs points out. “These caregivers will struggle unhappily month after month until the day that they simply can’t physically or emotionally force themselves out of bed anymore.”

Another sign he cautions caregivers to pay attention to is constant yelling. “I’m not talking about the caregiver who becomes frustrated on occasion and sharply rebukes their care recipient,” elaborates Dr. Jacobs. “As I point out to many of the guilt-ridden individuals who come to me for counseling, people occasionally yell in families in which no caregiving is taking place. That is simply called normal family life.”

“What I’m concerned about here is the caregiver who frequently loses control of their emotions and winds up saying and doing hurtful things much too often.”

Dr. Jacobs believes that both of these examples are indicative of caregivers who need to immediately change their care plans to reduce their burden or even cease caregiving altogether. “They must find alternative means for ensuring that their loved one is well cared for,” he encourages. Resuming their duties may be a possibility, but depression and acting out, while not uncommon, point to an unsustainable care plan and an environment that is toxic to both the caregiver and care recipient.


An Objective Assessment of Caregiver Burden

Because it can be so difficult for caregivers to get a clear read on their mental and physical wellbeing without feeling guilty or a sense of failure, Dr. Jacobs recommends a quick and easy self-assessment to help readers get started. “The two that I most often recommend are the Zarit Burden Interview, which is available in both short and long forms, and the Caregiver Self-Assessment Questionnaire, which was devised by the American Medical Association,” he notes.

With both of these, caregivers are asked a series of questions about their experiences and the state of their health. Each response is scored and then the total scores for each test can be interpreted to indicate the degree of a caregiver’s burden or distress.

“The results they yield are generally reliable and valid indicators, which provide caregivers with insight into their own coping. On the basis of these tests, I’ve seen caregivers decide that they need more help than they were previously willing to accept,” Dr. Jacobs recalls. “This can be helpful for steadfastly independent caregivers or those who cannot afford or do not wish to see a therapist for insights into their situation.”

Whether caregivers use these quantitative tests or just rely on gut-feel, they need to frequently reflect on how they are doing. “The savvy marathoner heeds their bodily warnings and adjusts their stride and pace accordingly,” reiterates Dr. Jacobs. “Similarly, the savvy caregiver heeds physical and emotional signs and seeks greater support when needed in order to sustain their vital work.”


A Free Self-Assessment Packet for Caregiver Burnout

Burnout can sneak up on the healthiest, most devoted and best prepared caregivers. Make sure you do your part to sustain yourself and preserve the integrity of your care plan. This is especially true for sole caregivers who may not have an adequate support team to offer help or draw attention to their mounting responsibilities.

Countless caregivers join support groups for encouragement and assistance and many others opt for formal therapy or counseling to help make sense of the complex emotions this role elicits. Unfortunately, the latter option costs money and, of course, takes precious time.

This is where proven self-assessment tools can help caregivers come to terms with what they are truly feeling and realize the importance of seeking out assistance.

Caregivers can download this Zarit Burden Interview Packet to assess their stress levels and learn about their implications at www.agingcare.com/documents/caregiver_burden_assessment.pdf. The results page of this packet also features tips for minimizing stress and finding sources of respite.

  • Carol Bradley Bursack