The Caregiving Boomerang

Article excerpt

Byline: Gail Sheehy

The most devoted family caretakers are at risk of dying first themselves. Survival strategies from the author of 'Passages.'

Fifty is the gateway to the most liberating passage in a woman's life. Children are making test flights out of the nest. Parents are expected to be roaming in their RVs or sending postcards of themselves riding camels. Free at last! Women can graduate from the precarious balancing act between parenting and pursuit of a career. Time to pursue your passion. Climb mountains. Run rapids. Rediscover romance. You have a whole Second Adulthood ahead of you!

That has been the message of my books since I wrote New Passages 15 years ago. What I didn't see coming was the Boomerang.

With parents living routinely into their 90s, a second round of caregiving has become a predictable crisis for women in midlife. Nearly 50 million Americans are taking care of an adult who used to be independent. Yes, men represent about one third of family caregivers, but their participation is often at a distance and administrative. Women do most of the hands-on care. The average family caregiver today is a 48-year-old woman who still has at least one child at home and holds down a paying job.

It starts with The Call. It's a call about a fall. Your mom has had a stroke. Or it's a call about your dad--he's run a red light and hit someone, again, but how are you ever going to persuade him to stop driving? Or your husband's doctor calls with news that your partner is reluctant to tell you: it's cancer.

When that call came to me, I froze. The shock plunges you into a whirlpool of fear, denial, and feverish act-ion. You search out doctors. They don't agree on the diagnosis. You scavenge the Internet. The side effects freak you out. You call your brother or sister, hoping for help. Old rivalries flare up. You haunt the corridors of the hospital, always on duty to prevent mistakes.

It begins to dawn on you that your life is also radically changing. This is a caregiving role that nobody applies for. You don't expect it. You aren't trained for it. And, of course, you won't be paid for it. You probably won't even identify yourself as a caregiver. So many women tell me, "It's just what we do."

We'd like to think that siblings would be natural allies when parents falter. In countless of my interviews with family caregivers, I hear the same stories: Brothers bury their heads in the sand. The farther away a sister lives, the more certain she will call the primary caregiver and tell her she doesn't know what she's doing. A major 1996 study by Cornell and Louisiana State universities concluded that siblings are not just inherent rivals, but the greatest source of stress between human beings.

There are many rewards in giving back to a loved one. And the short-term stress of mobilizing against the initial crisis jump-starts the body's positive responses. But this role is not a sprint. It usually turns into a marathon, averaging almost five years. Demands intensify. Half of family caregivers work full time. Attention deficit is constant. But most solitary caregivers who call hotlines like Family Caregiver Alliance wait until the third or fourth year before sending out the desperate cry: "I can't do this anymore!"

The hypervigilant caregiver becomes exhausted, but can't sleep. Chronic stress turns on a steady flow of cortisol. Too much cortisol shuts down the immune-cell response, leaving one less able to ward off infection. Many recent clinical studies show that long-term caregivers are at high risk for sleep deprivation, immune-system deficiency, depression, chronic anxiety, loss of concentration, and premature death.

Ailing elders seldom say thank you. On the contrary, they often put up fierce resistance to the caregiver's efforts. "A major component of psychological stress that promotes later physical illness is not being appreciated for one's devoted work," explains Dr. …