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Posted: January 31, 2008

Stepping Back from the Brink

Taking Positive Steps Before You Reach the Breaking Point

When Elizabeth Weir of Phoenix invited her mom for a two-week visit, she never imagined it would turn into 10 years of caregiving. Almost immediately after arriving, Elizabeth’s mom became seriously ill and spent most of the next year in and out of the hospital. Elizabeth, who was single and worked full-time, instantly became her mother’s sole caregiver.

Over time, the demands of caregiving took their toll on Elizabeth’s mental and physical health. As she describes it now, “I was totally unprepared for handling the responsibility all on my own. Eventually I paid for it with my health -- I had chest pains and heart palpitations. I couldn’t breathe, couldn’t sleep, and my eating habits were poor.

“One Christmas Eve morning, I lay in bed trying to relax before I faced the day. I had just gotten a new job that was very demanding. Mom was in the hospital with another bout of congestive heart failure. As I lay there, the hospital called to say they were sending Mom home for the holiday. At that moment, this did not seem like good news because when she came home, all the responsibility would be mine again. My hands and feet went numb, my heart raced, and I was freezing cold, yet I was sweating. The room began to spin and I could barely move.”

Discount Prescriptions
How Stress Drives Our Health

Elizabeth had stepped right to the brink of a very scary place -- the edge of mental and physical breakdown. It turned out that she was having a severe panic attack, but it could have been much worse, with a heart attack, stroke, or complete mental collapse real possibilities. Fortunately, she called friends who realized that she needed help and stepped in to ease the load.

According to psychologist Dr. Bernard Katz of Long Island University in New York, emotional and physical responses like Elizabeth’s are not at all unexpected. “Anyone can be overwhelmed by caregiving responsibilities,” he says. “We can feel depleted, sad and unable to give anything more.”

Lisa Gonzales, director of the adult day facility at Open Hands in Santa Fe, New Mexico, agrees. She says, “We see this all the time -- caregivers who are stretched to the breaking point and thinking they should be able to do everything without help.”

Staring at Depression

Studies show that between 40% and 70% of caregivers have symptoms of depression, with between 25% and 50% meeting the criteria for a diagnosis of major depression. And, caregiver mental health directly impacts physical health: caregivers report serious chronic conditions such as heart disease, cancer, diabetes and arthritis at nearly twice the rate of non-caregivers. Ultimately, caregiver stress can become a matter of life and death -- older caregivers who experience caregiving related stress have a 63% higher mortality rate than non-caregivers of the same age.

Another alarming effect of caregiver mental health is that depressed spousal caregivers are far more likely to engage in harmful behavior to their loved one than those who are not depressed.

None of us wants to harm a loved one, to endanger our own health, or to find out too late that we had reached our breaking point. Like Elizabeth, most of us don’t see it coming, even though the signs have been there. Recognizing those signs, assessing our own stress level, and implementing preventive strategies can keep us away from that brink, or help us step back to safety when we see we are headed toward it.

Recognizing the Signs

The following list of symptoms can help you spot the danger signs of caregiver burn-out. Even if you only exhibit one or two of these symptoms, they should sound a warning bell that you need to take preventive action.

Assess Your Stress

Once you know the signs of severe stress, the next step is to see where you fall on the “stress spectrum.” The internet site WebMD has developed a simple online test that takes less than a minute to complete and will yield an instant evaluation of your stress level and the potential impact to your health.

Taking an online test is only a superficial assessment, though, so talking to your doctor promptly about your symptoms is highly recommended.

Taking Preventive Action

If your stress level is high or even moderate, or if you simply feel overwhelmed by your caregiving responsibilities, it’s time to implement measures to manage stress day-to-day. Here are some strategies that may help:

Ask for and accept help. Don’t try to be super human; no one can do it all alone.

Take care of your mind and body. Make time for exercise and relaxation. Even if it is just a 20-minute walk, moving your body and getting fresh air will rejuvenate you. Sitting quietly and clearing your mind for 15 minutes can also work wonders for your mental state.

Express your feelings. Find an outlet for talking about your feelings, whether it’s by writing about them in a journal, talking with a friend, or joining a support group.

Maintain your own social contacts. Enjoying time with friends and doing things you enjoy restores a sense of normalcy to your life and give you a much needed break.

Help your loved one have contacts other than you. Arrange for visitors, friends and family to spend time with your loved one, or arrange for him or her to attend an adult day care facility.

Get respite. Hire someone to stay with your loved one when you need a break, or make use of volunteer programs that provide visiting services.

Get counseling. It’s hard enough for many of us to ask for help, let alone seek professional counseling. But talking with a counselor is a safe way to express your feelings, feel supported, and get professional advice about coping skills.

Quickly Seek Counseling

Lisa Gonzales of Open Hands is a strong proponent of professional counseling to help caregivers cope. She says, “I think the biggest role we play at times is to convince caregivers that it is okay to ask for help and to help them find it. One of our biggest priorities now is to get a counselor on staff for them to talk with regularly.”

Just knowing that you aren’t alone and that your feelings are in fact normal responses to your situation can be a big relief. But keeping yourself on an even keel requires implementing coping strategies and finding healthy outlets for your feelings. If you recognize these feelings and the symptoms described here in yourself, it’s essential that you reach out for help for your own sake and that of your loved ones -- don’t wait until you’ve reached your breaking point.


Melissa A. Goodwin is a freelance writer and photographer living in Santa Fe, New Mexico. She has years of experience working with volunteer caregiving programs that help seniors and family caregivers. She can be reached at

The National Mental Health Association: Coping with Stress Checklist

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