Our society heavily relies on informal caregivers, who provide a bulk of the medical care in this country for free.  Yet, our society does not always value or appreciate the enormous work and effort that goes into it. There is little recognition from others that caregiving can be risky for the caregiver. And caregivers themselves sometimes feel guilty if they think of their own needs or admit that it can be so hard.

Yet, Caregiver Burnout is a real phenomenon and it needs to be understood, addressed and prevented.

What Burnout Looks Like:
Not all of these have to be present to be concerned about the potential for burnout. Some overlap with symptoms of more serious issues like depression.*
*If you feel you may be experiencing a clinical (medical) depression, download this screening quiz and seek further medical assistance from a doctor.

1. Loss of interest in socializing or hobbies once that used to bring pleasure
   
2. Sleep disturbances, insomnia, or sleeping too much
3. Feeling disinterest about, or even hostile or angry with, the family member you are caring for
4. Feeling sad or irritable
5. A significant change in appetite and body weight
6. An increase in a bad habit like smoking more, online gambling, driving recklessly, or excessive shopping
7. Mood swings that can include periods of intense anger, sadness, excessive crying, or snapping at others
8. In extreme burnout, physical violence toward a loved one
9. New or increased physical symptoms like rashes, increased allergic reactions, headaches, or other disorders which are made worse by stress.

What is it About Caregiving That Can Cause Burnout?:
The causes of burnout vary from situation to situation and person to person. Here are the top 8 issues that lead to caregiver burnout:

1. Continuous Strain: Caregivers often do too much in one day, have trouble finding breaks or time for themselves, and have physical and emotional tasks that are simply exhausting. The “constant-ness” of caregiving can leave a person unable to take care of his or her own basic needs.
2. Lack of Control: Often caregivers lack the ability to fully control their situation – yet feel fully responsible for managing it. For instance, insurance companies, doctors, and the caregiver’s siblings or other family members often have more say in what is happening even though it is the caregiver who will carry out the actual tasks.
3. Grieving: Ongoing grieving over losing the relationship a person once had with someone can take a hard toll on someone’s emotional health. This is often even more difficult for spouses or those caring for someone with dementia.  Having to experience all the gradual losses can take a toll.
4. Conflicting needs: Not only is there a daily struggle over meeting one’s own needs versus meeting someone else’s, there is also family struggle over decisions that have to be made. Any family conflicts or personality clashes that were contained from the past often come out in full force when a parent becomes ill.
5. Isolation and lonliness: Often the role of caregiving is a very isolating experience. If a loved one has mobility issues and cannot be left alone, this can seriously limit contact with other people. Sometimes the role of caregiving also interferes with the caregiver’s other relationships to such an extent that other relationships become strained or distant.
6. The loved one’s behaviors or needs: In the case of dementia or alzheimer’s disease, the caregiver may experience significant stress in dealing with the constant questions or other abnormal behavior associated with certain diseases. If a person needs significant physical care like lifting or constant physical attention, it can also become overwhelming for a person to find the stamina to keep going.
7. Financial strain. Many caregivers also lack the resources needed to get breaks, find home care help, or purchase needed supplies, ideal food, or equipment.
8. Lack of Appreciation: When caregivers work really hard to help a loved one and it goes unappreciated by the family and even sometimes the loved one, it can lead to a sense of futility or hopelessness.  While most caregivers are doing it to receive applause or praise, it is hard to do anything tiring and challenging without some encouragement.

Possible Complications of Burnout:

Unchecked, Caregiver Burnout can lead to decreased health. Some of the consequences below lead to more stress and burnout, compounding the problems:

1. Poor health. When stressed, people tend to eat carelessly and overeat. Caregivers who are pressed for time are unlikely to use what little time they have to exercise or sleep – even if they really need to. The tendency to not take good care of themselves leads to a reduced immune system (meaning more susceptible to colds, etc.) and prolonged stress can trigger other diseases like inflammation, cardiovascular problems, lower back pain, etc. If faced with a health concern or a cold, this can further create a sense that things are overwhelming and lead to more stress. Caregivers report having chronic conditions at nearly twice the rate of non-caregivers. Also, since caregiving is often a full-time job, the caregiver may not be employed elsewhere and may lack health insurance and/or the funds to obtain good medical care when needed.
2. Persistent aches or pains. Headaches, cramps or digestive problems that do not ease even with treatment are the most typical issues.  The cause is usually stress, back strain from lifting, and a less than ideal diet.
3. Elder abuse. While most caregivers never do anything to harm their loved ones, unfortunately, somewhere between 5-10% do. While stress and burnout do not cause violence toward others, they can lead to mood disorders like depression. Mood disorders are associated with an increased likelihood of becoming abusive.
4. Earlier Nursing Home Care:  Many caregivers site that the decision to place a person in a nursing facility came about primarily because of their own health – not the health of the person being cared for.  If burnout occurs, a person becomes less capable of handling the tasks required of care.  So, if a caregiver feels guilty for taking time for self-care, he or she should recognize that self-care is a vital part of caring for someone else as well.
5. Addiction:   Prolonged stress can lead a person to increase negative habits or use substances like alcohol to relax  While stress does not cause addiction and only a small percentage of family caregivers are addicted, it is a possible complication of being in a stressful situation for long periods of time.
   
6. Depression: While caregiving does not cause clinical depression, the strain of burnout can triger a depressive illness. Some people find it hard to admit depression because some still think it is like sadness and should be able to be overcome with a simple change of attitude. However, a true depression is a real illness and needs attention. Take our depression screening to see if this may be an issue for you. It is just a screening and not a diagnosis. If you feel you have symptoms of depression, you should consult a psychologist or physician who specializes in mood disorder.  The symptoms of depression can include:

• Persistent sad, anxious or "empty" feelings

• Feelings of hopelessness and/or pessimism

• Feelings of guilt, worthlessness and/or helplessness

• Irritability, restlessness

• Loss of interest in activities or hobbies once pleasurable, including sex

• Fatigue and decreased energy

• Difficulty concentrating, remembering details and making decisions

• Insomnia, early–morning wakefulness, or excessive sleeping

• Overeating, or appetite loss

• Thoughts of suicide, suicide attempts

What Can You Do to Prevent or Deal with Burnout?:

Of course the first step is to recognize the problem and then find ways to reduce the stress. Getting help from others is important.

Here are some ideas to get you started:

1. Find support right away. This can be from a relative, a doctor, a friend, a support group or social agency, or even an online forum like SageForum. The more varied the support, the better.  Also, read tips on avoiding isolation.
2. Take up mild exercise. Even a short 10 minute walk every day can reduce the physical symptoms associated with depression and anxiety symptoms of burnout. The important thing is to get started and keep doing it. Increase your level of activity only after you have established a good routine.
3. Listen to your mother. She always wanted you to sleep well and eat well. This advice is still important. The physical toll of stress is high and you need the rest and nourishment to protect yourself.
4. Find respite care. Try your local AAA and look into respite or adult day care. Even if you only use it temporarily, it can be a real life-saver. If your local AAA does not provide day time activities for seniors, they may be able to make appropriate referrals.
5. Get organized. We offer tips and tools to help with this. Getting efficient and organized in and of itself can make your day-to-day routine less stressful.
6. Simplify your surroundings. Spend some time organizing your home life and your caretaking routines. The less clutter and excess you have to deal with, the easier the job.
7. Seek out counseling. If you are in a difficult caregiving situation or you are dealing with family issues that seem emotionally overwhelming, it can really help to have a confidential support person to share your problems with. Sometimes, if you talk to others in your family, it can make matters worse. Having an outside perspective can help you gain confidence and clarity. Most insurance covers mental health counseling and your AAA may be able to help you locate free non-profit sources of counseling in your area if you don’t have insurance.
8. Accept and love yourself. This is easier said than done – but you are doing an honorable job and you need to really appreciate all that you do. Having a positive attitude about yourself and your role can significantly reduce the level of stress.

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