Primary Care Providers: Spotting the Signs of Caregiver Burnout

By Nancy Wurtzel

By 2030, one in five adults will be 65 years or older.  This graying of America means more women, and to a lesser degree men, will be stepping into the role of informal caregiver for their aging family members.

According to a 2015 report published jointly by National Alliance for Caregiving (NAC) and the American Association of Retired People (AARP), more than 34 million Americans provided unpaid care to an adult age 50 or older during the previous 12 months.  Half of these caregivers were over age 50, while 10 percent were over age 75.  These numbers may be higher since many caregivers do not self-identify.

This landmark research presents an updated portrait of family caregivers, including how their duties and responsibilities affect their physical and mental health.

The financial contribution of these unpaid caregivers is also significant.  Annually, family caregivers provide services totaling $375 billion a year, an astounding figure that is almost twice as much as what is spent annually on homecare and nursing home services combined.

It’s important to note caregiving is not a one-size-fits-all role.  It often begins with light duties, such as grocery shopping, errands, and occasional housekeeping chores.  The caregiver’s commitment usually increases over time.  With lifespans increasing, caregiving can eventually evolve into round-the-clock personal care with no end in sight.  Additionally, many caregivers are providing unpaid care for more than one family member.

This intense level of care was highlighted in a study sponsored by the AARP Public Policy Institute and the United Hospital Fund.  “Home Alone: Family Caregivers Providing Complex Chronic Care,” highlights the role of family caregivers and details how this commitment has increased and shifted in recent years.  It concludes caregiving “has dramatically expanded to include performing medical/nursing tasks of the kind and complexity once only provided in hospitals.”

Perhaps in response to taking on such a stressful role, 17 percent of caregivers will describe their health as being fair or poor.  By comparison, 10 percent of the general adult population describes their health using similar terms.

Caregivers are often so consumed with the role of caring for family members; they neglect their own emotional and physical health.

To combat caregiver burnout, AARP created the online Caregiver Resource Center with helpful information, tips, and ideas to assist family caregivers.

Health care professionals, especially primary providers, are on the front line for identifying caregiver distress.  Often, this stress manifests very much like symptoms of depression.  The caregiver may look tired or worn out, avoid making eye contact and show little interest.  If a caregiver opens up about their experience, a common theme is feelings of being overwhelmed, alone, and afraid.  Many caregivers are used to holding in their emotions; they may tear up or cry when they let their guard down.

Conversely, other caregivers might display signs of impatience or irritability, almost as though they have a chip on their shoulder.  An attitude that “no one understands what I’m going through” might be apparent.

Either way, if stress goes unfettered, the situation could become dire.

Here are some warning signs of a caregiver at the breaking point:

• Complaints of chronic insomnia or interrupted sleep
• Significant weight gain or loss
• Refusal to address their health care needs
• Visible, near uncontrollable anger
• Talk of losing patience with the person under their care
• Conveying feelings of dread and total helplessness
• Expressing the belief he or she is not able to continue
• Stating he or she, or the person under their care, would be better off dead

Voicing concerns and feelings are often a big first step for your patient/caregiver.  Simply identifying the feelings will often “open the floodgates of emotions,” which then allows for change.

During the patient office visit, make referrals to local resources, such as support groups, senior centers, care agencies, adult day programs, social workers, private care aides, respite care options, local aging agencies, meal programs, local chapters of AARP, and more.

Give the patient a “prescription” to make changes.  Point out that caregiving is a marathon, not a sprint. Emphasize the following three points:

1) There is no shame in asking for help

2) Good health is both physical and mental

3) A healthy caregiver must maintain their wellbeing.

Watch and gauge the patient’s reaction and schedule a follow-up visit if deemed necessary.  Take appropriate action if you believe the patient is a danger to himself or to others.