The importance of the family Caregiver in the lives of our older loved ones cannot be understated or undervalued. Family caregivers, most of whom are unpaid, are making tremendous personal sacrifice, they are truly unsung heroes. So much so that this year’s Rose Bowl parade included a float dedicated to Caregivers.
The 80-plus population is projected to increase by 44 percent between 2030 and 2040, while the number of caregivers aged 45–64 is projected to increase only 10 percent. According to the AARP Public Policy Institute in 2010, there were 7 caregivers to adults 80+ years of age. That number is expected to decrease sharply to 4 by 2030, and to decrease even further to 3 by 2050.
Concomitant with the increase in our older population, there will be an increasing number of those persons in need of care.
What impact will that have on both our older adults and especially their Caregivers?
A sudden dreaded phone call that mom or dad has fallen and broken his/her hip and is now hospitalized, or has had a heart attack or stroke, may thrust some people into a situation for which they are not anywhere near prepared.
While many people may take on more of an assisting role, which at the incipient care stages may constitute helping with errands, shopping, doctor appointments and mail related issues, what the caregiver often does not realize, is the demands will most likely increase over time. The increasing demands have an impact on other areas of a person’s life: their job, and personal/family relationships. The caregiver, squeezed or sandwiched between the needs and demands of the one for whom they are caring, and their job and family/personal responsibilities is in a situation ripe for stress, burnout, fatigue, and even guilt (i.e., Am I doing enough?, I want to do more, but I can’t) all of which are detrimental to a person’s physical, emotional and psychological health and well-being.
The difficulties of the caregiving situation are rooted in areas going beyond the responsibilities themselves. Family history and its complicated relationships play an important role in the dynamic. In addition, the older person is most likely experiencing personal challenges associated with their reduced/loss of physical or cognitive ability, loss of independence and autonomy, dependence on a person for whom they were the primary caregiver who is now caring for them. How the older person copes/struggles with the feelings of loss, grief, anger, and frustration while looking at their life far different from the one they knew, may result in redirecting them onto the person closest to them, their family member caregiver. Not an enviable or satisfying position for the person on either side of the equation. The emotional toll this takes on the caregiver, in addition to the actual caregiving responsibilities, are not to be underestimated.
As a result, it is important that Caregivers have tools to practice “IMpathy” ™: self-care, self-kindness, self-compassion and self-forgiveness. Taking the time to acknowledge and address one’s own needs can have tremendous positive effect on one’s overall health and well-being. All of these are important ingredients for resilience. What exactly is resilience? It is defined as the capacity to recover quickly from difficulties, and the ability to spring back into shape and, according to Matsen (2001) it is a skill set that can be learned.
A program developed by Dr. Tilip Jeste aimed at Seniors in ALF’s found them to have improved scores in coping skills when completing a Raising Your Resilience (RYR) Program. The program addresses topics such as gratitude and ageism, with activities that emphasize values such as empathy, compassion and self-compassion. This is great news for the older adult. But what about the caregiver?
How can one achieve or practice resilience?
According to a 2015 article by Paula Davis-Laack, JD, MAPP in the Journal of Aging Life Care there are four core principles in the practice of resilience:
1. Being a flexible, accurate, and thorough thinker under stress.
2. Being more mindful, incorporating more positive emotions into your day, and practicing self-care .
3. Identifying what gives you meaning during your day and having goals that extend beyond yourself.
4. Developing high-quality connections with others and being able to draw on support networks when you need them.
There is ample research that supports the benefits of engaging in a daily personal resilience practice. It lends itself to developing healthy coping strategies which influence the ability to tolerate change, stress, uncertainty and other types of adversity.
One of the factors to be considered is that using personal resilience contributes to a more productive and positive outlook. This is based on the fact that the person practicing resilience develops a strong belief that his/her efforts make a difference and positively impact the situation. The practice also lends itself to having a greater ability to adapt to challenges, adversity and the inevitability of changing life circumstances. Concomitantly, these coping strategies can reduce the negative impact of stress and adversity on physical, psychological, emotional health and well-being and more broadly positively impacts both personal and professional life.
The importance of resilience and resilience training has been recognized and adopted by businesses In the public and private sector, formal nursing training programs, the medical profession and the US military. The American Medical Association described wellness as “consisting of multi-dimensional variables that interact to positively impact levels of health and emotional and social functioning.” They determined that physicians who attended the online resilience training in 2015 were likely to be less stressed, engage better with their patients and provide quality care.
Since 2009, The US Army has been teaching and training resilience skills to its soldiers and their families in a Master Resilience Training course run by the Army’s Comprehensive Soldier and Family Fitness Program. A 2013 study by Griffith and West, found that after soldiers had participated in the program for four years, those who received resilience training reported higher overall emotional fitness, good coping, engagement, friendship, and lower levels of catastrophizing. Most significantly, they found that after participating in a resilience program, diagnoses related to substance abuse and mental health issues were reduced by up to 60% and over 95% of participants said they found themselves using skills they learned in the training program both on the job and in their personal lives. They’ve also developed a resilience course specifically designed for upper echelon military leaders.
Understanding and realigning one’s “giving nature”, as well as adopting practices to build resilience on a daily basis, will help with coping, and the inevitable stress, burnout and fatigue that can be associated with the caregiver experience.
The first example is based on a landmark 2013 book by Dr. Adam Grant entitled Give and Take. Inherent in the caregiving experience is the notion that the needs of the other person should take priority over our own needs. This is actually a fallacy. Grant eloquently discusses three different people types; givers, takers, and matchers. He describes givers as falling into a variety of categories, among them being “selfless” and “otherish” givers and advocates that people should be more “otherish” givers. Selfless givers are what the word implies, they give their time and energy selflessly, without regard to their own needs. However, attending to one’s own care needs is vital when caring for another person. The familiar instructions on an airplane prior to takeoff comes to mind and rings true, “when the oxygen mask descends, place it on your own nose and mouth before attempting to help the person next to you.” Paying attention to your own care needs is essential in order to help the other person, and in the case of being a caregiver, to avoid burnout. Herein lies the meaning of being an “otherish” giver. “Otherish” givers find a way to be mindful, and balance giving with their own self-interest and self-care.
This notion may rock your fundamental beliefs about caregiving and may require considerable practice.
After all, most people view compassion as being a positive personal attribute directed towards others. It is generally thought of as bestowing kindness, caring, tenderness, understanding, and empathy. Conversely, the notion of caring for one’s self, or selfcompassion may seem counterintuitive, for some it may even carry a negative connotation. (i.e., self-pity, self-serving, self-indulgent, self-centered, just plain selfishness).
We would never have thought that Sister Teresa, the noblest and selfless giver among us, should practice self-compassion. It would have been an oxymoron, utter cognitive dissonance. But to the contrary, it is a form of self-preservation. Considering our busy lives, and for the caregiver sandwiched and squeezed between responsibilities particularly, the negative impact on the caregiver’s health and well-being cannot be underestimated. According to the modern researchers, Kristin Neff and Chris Germer, self-compassion is one of the most valuable resources we have to help us with coping and personal resilience.
Mindfulness techniques are also a great way to build resilience. Mindfulness is simply becoming aware of what’s happening in the present moment and helps to thwart against negative reactions. There is a quick, mindfulness technique known as STOP that anyone can learn and utilize. It is based on the 2010 work of Stahl and Goldstein and is a tool to help calm emotions during stressful moments and situations.
In short, the technique is as follows:
• Stop what you’re doing. Pay attention to how you’re feeling and what you’re thinking to stop the tendency to react negatively. This is essentially momentary mindfulness.
• Take a deep breath or employ a breathing relaxation technique at this moment. This can help you relax instead of becoming absorbed by your own anxious feelings. A helpful practice might be to say a peaceful thought out loud or in your mind repeatedly until the negative thought or feeling disappears.
• Observe what you are experiencing in your mind and body as well as emotionally.
• Proceed after you’ve identified the source of stress by essentially asking yourself, “what is the most important thing for me to pay attention to?” In this way you can proceed with what you were doing albeit with more mindfulness, a sense of balance and intention, as opposed to being more reactive.
You can find out more information about the valuable STOP technique in Bob Stahl’s and Elisha Goldstein’s Mindfulness-Based Stress Reduction Workbook.
There are other breathing techniques associated with Mindfulness. (i.e., Abdominal or Diaphragmatic breathing, Basic Calming Breaths, Dr. Andrew Weil’s 4-7-8- breathing technique, and alternate nostril breathing) Yoga is a practice that incorporates mindfulness and breathing techniques to help find an inner calm. It is recommended as a way to practice self-care. There are short downloadable Yoga programs you can practice in your own home which can help you learn or understand these techniques.
It is worth remembering that, though mindfulness may be an important ingredient to resilience and self-compassion, it doesn’t address one of the core principles of selfcompassion which is to essentially embrace one’s self with warmth and tenderness. As you may literally physically embrace another person during their painful experience, this is the time to direct that same feeling inward…. so go ahead and give yourself a BIG HUG!!! Studies have shown that when we go through major life crises self-compassion appears to make all the difference in our ability to survive and even thrive.
Most of us intuitively treat our friends and loved ones with warmth and compassion during their most difficult times. However, we don’t readily think about directing those qualities towards ourselves. Quite the contrary, we tend to be hard on ourselves in our most difficult and challenging times. When we exercise “IMpathy” ™: self-compassion, self-kindness, self-caring and self-forgiveness, we are essentially asking ourselves the following question: “What do I need and how do I fulfill that need?” Mindfulness would be the ability to be aware of, recognize and connect to the difficulty; accepting that this situation is part of the human experience, connecting with what comes naturally to us when we are kind towards others, and redirecting it towards ourselves. In doing so, the Caregiver can develop lasting healthy patterns that will help them through the daily challenges of the Caregiver experience.