Dr. Mauk’s Boomer Blog

By Dr. Nanette J. Davis, Ph.D.

Caregiving has often been compared to a roller coaster ride, with its inevitable ups and downs. This is especially true as your loved one deteriorates and faces the end of life. If you’re one of the 65 million family caregivers who has been feeling overwhelmed for too long, “burnout” may have set in.

Take that first step. Identify and claim the full range of your emotions—the anger, indifference, anxiety. In a recent study, 50% of family caregivers confessed to feeling depressed and some 69% admitted that frustration drove them to place their loved one in care. You may be experiencing the following, as well:

• Fatigue
• Confusion over role reversal
• Loss of interest
• Withdrawal or isolation from friends and other support persons
• Irritability
• Illness
• Poor sleep
• Desire to harm self or others

These unwanted reactions can also be compounded by the guilt and shame about feeling this way. Here are a few suggestions that might make a big difference.

1. Make a point to engage in outside activities for maintaining a sense of health and well-being. Sure, it could feel like “one more thing” to do. But if you choose your outside activities wisely—staying away from demanding people or events—you could feel surprisingly refreshed.
2. Seek and accept outside help. Once you admit to yourself and others that you can’t do it alone, the burden suddenly lifts. Good starting points are: local organizations, social service agencies and faith communities. Don’t overlook family, friends and neighbors who may be able to lend a hand.
3. Allow your loved one plenty of opportunities to practice functional skills—as hard as it may be. Feeling as independent as possible satisfies a basic human need, even for a seriously ill person.
4. Consult with a geriatric specialist, pastor or counselor about the right course of action if your loved one has become overly dependent or has exhausted your resources—physical, emotional or financial.
5. Admit that you are juggling multiple roles, and engaging in an ever-so-delicate dance of support. The dance can go on as long as you allow the role of who leads and who follows to shift as circumstances change.
6. Pay attention to your own needs. You can achieve balance when you include time to sleep, exercise, eat and attend to your own medical needs. Time spent with family, friends or just being alone helps you bounce back, too.
7. Practice saying—maybe even forcefully—“no” when appropriate, and “yes” when someone offers to help.
8. Seek out quality respite care.
9. Enjoy an occasional movie or lunch with a supportive friend.
10. Don’t expect too much from yourself.

Continue to recognize, acknowledge and accept your difficult emotions, so you can then work on setting boundaries, letting go of control and developing coping skills. For example, meditation and yoga can be incredibly relaxing.

Your commitment to your loved one can be a renewable resource if you take the right steps and are willing to change strategies when the “same ol’, same ol’” isn’t working anymore.

You can visit Dr. Nanette’s ABCs of Caregiving blog at http://www.abcsofcaregiving.com/

The human survival instinct is strong and our spirits are made to embrace life. But what happens when your loved one is diagnosed with a terminal illness that has no cure? How do you reconcile the certain death of your spouse, parent, or child? Where can you turn when death is close or imminent?

We are fortunate to live in a society that supports excellent care for those who are coming towards the end of their life. As difficult as this journey is for persons and their family members, the appropriate level of service can provide the needed care and comfort to make the end of life a time of peace and reflection rather than pain and suffering.

Two major services are readily available to bring comfort and promote quality of life even until the end of life. These are palliative care and hospice.

Palliative care is a consultative service for those with life-limiting illnesses who may not yet meet the criteria for hospice or who do not wish to enter hospice yet. The focus of palliative care is comfort and symptom management, but patients may still continue treatments such as radiation, chemotherapy, dialysis, home health, or other therapy.  Palliative services can be provided in the acute hospital setting, in the home, or in a long-term care facility. A new program called PRIME (Progressive Illness Management Expertise) by AseraCare, focuses on symptom management, goals of care planning, medication management, and transition management. PRIME provides palliative care through nurse practitioners and social workers who coordinate care with your regular medical providers. For persons with serious chronic illnesses who experience recurring rehospitalizations, palliative care management can provide care coordination and smooth transitions to other settings, including hospice, at the appropriate time.

Hospice is a supportive and comprehensive service for those who are dying. The National Hospice and Palliative Care Organization states that the foundation of hospice and palliative care is the belief that “each of us has the right to die pain-free and with dignity, and that our families will receive the necessary support to allow us to do so”. Generally, to qualify for hospice a patient is expected to live 6 months or less. Hospice uses an interdisciplinary team of physicians, nurses, social workers, home health aides, chaplains, bereavement counselors, trained volunteers and others to provide comfort and support to the dying patient and family. These services are covered by Medicare, Medicaid, and most private and commercial insurances. Hospice care can be provided wherever a patient lives, with 24-hour on-call availability.

End of life decisions are often difficult for families to discuss, but palliative care and hospice programs provide the help that is needed to have these conversations. Their aim is to help provide quality of life until death, helping people “live until they die”. If your loved one may qualify for assistance, don’t delay in seeking this support. It may be the best way you can help your family member have a peaceful end of life.

With the birth of my daughter’s second child, I began to reflect on the important role that grandparents can play in the lives of their grandchildren. Here are five essential tips for older adults who want to have a lasting influence in the lives of their children and grandchildren.

Visit often. For those of us fortunate enough to live near our children and grandchildren, it is easy to see them often. Grandparents may even be the caregivers while parents are working. Visits don’t always have to be planned. Sometimes the best family time is a spontaneous invitation to dinner and a movie. However, sometimes distance can prevent regular visits. Some grandparents make it a goal to see their distant grandchildren once every 6 weeks or every few months. Be sure to take advantage of technology for your time together. Set a regular time to Skype or do Face-time. Don’t miss out on the subtle changes in those early years while babies are growing. Exchanging pictures may help, but they don’t replace the in-person experience. You may even think of relocating to be closer to family. For older grandchildren, be sure to have their cellphone number. Text them often and exchange pictures to stay involved in their lives and let them know you are available to them. Even small connections throughout the week (but without being annoying to teenagers of course) can make a difference in your relationship with your grandchildren.

Offer to help in practical ways. Working parents with young children will need a break at times. Ask how you can best help. Offer to keep the children for an overnight while mom and dad have a special dinner or weekend getaway. Many grandparents like to take their grandchildren on trips without the parents. Places like amusement parks, the zoo, or day trips to the water park or national forest all provide good diversion and quality time with Grandma and Grandpa while giving parents a rest. For even more quality time, take the older grandchildren on a cruise, camping in the mountains, or to a resort without their parents. For the mom with a newborn, take meals to the house (if you live close), do her grocery shopping or laundry, or send her a new bathrobe to show you are thinking of her. A favorite role model of mine sends the grandchildren a “baby shower in a box” with all sorts of goodies when she can’t be present due to distance or health concerns.

Plan special activities. Special activities need not be expensive. This could mean a trip to the park with Grandma or a special morning walk each week with Grandpa. My father used to take every grandson on a bow-hunting trip when they turned 12 years old. This was a rite of passage for every boy in the family. Grandpa would mount their first deer head for them and buy them a special hunting knife to commemorate the occasion. The girls in the family would take a trip to a Disney resort while the men were hunting. Grandchildren remember these events forever.

Attend special events. How fortunate are the kids whose grandparents are able to attend basketball and volleyball games, swimming tournaments, and Grandparent’s Day at school! Take advantage of being able to attend those dance recitals and school plays. If you live far, plan your visits to be able to attend some significant events like graduations, wedding showers, or school performances. This makes lasting memories with your family.

Be a constant in their lives. My parents divorced when I was 9 years old, and my paternal grandparents were the one constant in my life at that time. When a child’s world is jolted by change, grandparents can be that steadying influence that doesn’t change. They provide stability and security in an unsteady world for a child. The most important thing to remember is to be there. You don’t have to be the all-star parent or grandparent, but your children will remember that you were there for them when it counted the most.