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Caring for Others Takes Its Toll

Northwell Health survey finds 41 percent of tri-state women are most stressed about aging parents

The balancing act of women | Photo credit: Kate Sudar/The Well

Who Cares for the Caregiver?

To say Teresa Gonzalez is busy is an understatement.

A mother of three, Teresa wakes up at 4:45am and commutes for over an hour to be at the office by 7:30. She works as an executive assistant to a globe-trotting partner in an investment firm and holds a second title as a training associate. This is the job that pays the bills, but she’ll fill several more roles before her day is done. She’ll cheer on her 6-year-old daughter at gymnastics class or a dance recital. She’ll then transform into a party planner for her sorority, working with a committee to plan an upcoming event. Teresa will also find time to plan workout routines for the Jazzercise class she teaches twice a week, sort out scheduling and carpooling details for her family’s busy life, and double-check that her 70-year-old mother—who lives with her—ate that day and remembered to turn off the oven. These days, mom sometimes forgets to do these things. Looking after her mother is becoming a bigger job—and a more stressful one.

Stress, it turns out, impacts not just our emotional well-being, but our physical health, too. To find out more about what is burdening women, Northwell and its Katz Institute for Women's Health partnered with NRC Health on a stress survey. The results are eye-opening: 43 percent of tri-state women report that balancing work and their personal lives causes them the most stress right now. In fact, they are significantly more prone to stress compared to men and women nationwide. What seems to tip that balance most? Caring for aging or ailing parents—41 percent rate this as their single greatest stressor.

In addition, respondents anticipate that their stress about elderly relatives’ health will only increase over the next five years.

“We’re in a whole new world,” notes Dr. Maria Torroella Carney, chief of geriatric and palliative medicine at Northwell Health. “Caregiving has evolved in this millennium like never before, and no one has any experience or guidance on how to do this.”

Modern breakthroughs have made it possible for people to live longer lives. But with longevity comes more complicated health issues that can be difficult to treat and have dramatic effects on a person’s daily life. This puts stress on women, who are often the ones making caregiving decisions. “Never before in society have we had this many people who are living so long and surviving illnesses that people used to not survive,” Dr. Carney says.“Medical technology gives families a lot of options, but it means they have more complex health decisions to make. Now treatments and care, previously administered in a medical setting, are being pushed out of the hospital and into the home."

"Providing care today is not what it used to be," she adds. "It’s very stressful.”

The Sandwich Boom

More than 43 million adults provide care at home for other people. And, like Teresa, 6.5 million of them are caring for both children and older adults, according to the National Alliance for Caregiving. The Alliance reports that caregivers are diverse—all genders, ages, races and socioeconomic categories—but the typical one is a 49-year-old woman who works outside the home. On average, they spend 24 hours a week taking care of their loved one—making it, in truth, an unpaid, part-time job.

Teresa experiences this firsthand. “This year has been extra stressful,” she says. When a job opportunity forced the family to relocate, she was the one to help everyone transition, especially her mother. It changed her mom’s routine, doctors and access to transportation—all details that Teresa must now manage. It’s a big reversal from when her mom was a helpful partner in raising the kids. But now Teresa cares for her mother and youngest child while providing some financial support to her oldest daughter who is starting her own career and her son who is in college.

When Worry Takes a Toll

Being responsible for not only your children but aging parents can tax your health. At Teresa’s yearly physical, she learned her cholesterol was elevated. Her blood sugar levels, measured in A1C, bordered on prediabetic. Her body mass index, or BMI, was 35. Despite regular, vigorous exercise, her weight stubbornly refuses to go down. Stress saps her energy. Things finally came to a head when she became too tired to even get out of bed. She was diagnosed with mild depression, which came as a surprise. She didn’t get help at first, thinking she could muscle through it.

“You suffer in silence,” she says about putting herself last on the list.

“We think we should be superwomen and handle everything ourselves,” says Dr. Jennifer H. Mieres, professor of cardiology and senior vice president of Northwell’s Center for Diversity, Inclusion and Health Equity. “We face it all with stoic acceptance, but we shouldn’t.”

What Exactly is Stress?

Chronic stress has real, physical consequences. “A wealth of studies are showing that stress has an effect on our physical health,” explains Dr. Rachel Bond, associate director of the Women's Heart Health Program at Northwell Health, Lenox Hill Hospital. “It’s not just in your head. It’s not an indication of weakness or incompetence.”

The stress response evolved in humans as a protective mechanism that induces the fight-or-flight response. Adrenaline pumps. Heart rate increases. Senses become more acute. “It was meant to be temporary to get you out of a deadly situation,” Dr. Bond says. “Now, hundreds of events that pose no threat can trigger the stress response. Chronic stress wears down the body.”

Indeed, caregivers report that their own health has gotten worse since they took on the work of caregiving, according to the National Alliance for Caregiving. Chronic stress can depress your immune system, exacerbate chronic conditions such as asthma, increase your risk of diabetes, and lead to the buildup of plaque in your arteries.

Stress has been shown to trigger health symptoms, though many people don’t realize that’s what is at the root of their ailments. “Women get bloating or IBS. Their skin breaks out. They might have difficulty concentrating or sleeping,” says Dr. Bond, but they don’t always attribute these symptoms to stress. As a result, women power on without getting checked or making lifestyle changes to try to relieve some tension. In fact, most survey respondents report that they delay health care because they think the issue “is not serious.”

Save Yourself from Stress

One key is to not try to get rid of that overwhelmed feeling. “Don’t stress yourself out trying to eliminate stress,” says Dr. Bond. “Focus on healthy coping.”

Fortunately, there are proven ways to reduce stress. And no, watching TV or movies isn’t one of them, despite that being the No. 1 way stress survey respondents say they relax. Almost any kind of physical exercise, including yoga and tai chi, will reduce stress and improve overall health. Studies also suggest that meditation can ease stress and lower the risk of heart disease. The American Heart Association released a statement citing insight, mindful, zen and transcendental meditation as showing heart-health benefits.

Keep in mind that stress reduction is very individual. Find exercise that you truly enjoy. Overall, commit to self-care, which is neither self-indulgent nor selfish, the doctors agree. “When you take better care of yourself, you will be better able to take care of everyone else,” Dr. Bond assures.

After her health degraded to the point she had to stay in bed, Teresa started a regular journaling practice where she could get out her emotions. “That helps,” she says. “When you don’t have someone to talk to, writing it down is a way to release.”

Already a fitness instructor, she tried something new when her doctor recommended yoga classes. “It’s perfect! I release so much stress that I don’t even know I’m holding. I come home and sleep so much better.”

She has also learned how to set limits on her time. This year, she became a leader in her youngest daughter’s Girl Scout Daisy troop, but keeps meetings to just regular Sunday gatherings. “I’m getting better at setting boundaries. That was the hardest thing for me—not being able to do everything for everybody,” she says. “But ‘no’ is a complete sentence and I’m comfortable using it. A friend told me I was different now that I say ‘no’ and actually mean it.”

“It’s a new thing for me, but I like it.”

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Published February 13th, 2018

Who Cares for the Caregiver?