Family members caring for an elderly person

Additional information

Family members play a key role in the care of chronically ill older adults. While neighbors and friends may also provide assistance, nearly 90% of the help in the home (physically, emotionally, socially, and economically) is provided by family members. One in six Americans care for a family member age 50 or older. About 38% of people age 80 and older and 76% of people age 90 and older need regular help with self-care and household chores. Family members who help with these routine needs can often postpone or even prevent the need to place an older person in a nursing home or similar facility.

The amount and types of care provided by family members depends on economic resources, family structure, quality of relationships, and other demands on family members' time and energy resources. Some family members provide minimal care (e.g., periodic visits to the elderly person). Others provide ongoing, comprehensive care. On average, caregivers spend about 22 hours a week caring for an older person. Sometimes care is required for a short period of time, such as when an older person is recovering from surgery. Often care is required for many months or years.

While society tends to view family members as having an obligation to care for each other, the boundaries of this obligation vary according to culture, specific families and individual family members. Family members' willingness to care may be supported by the following factors:

• Support services, such as assistance with learning new skills, counseling services, and family psychological counseling services;
• Supportive services such as personal care (including assistance with grooming, eating, and dressing), home care, adult day care, and nutrition programs.

Supportive services may be provided on a regular basis or as respite care (to rest the caregiver) for a few hours or days.

Due to changes in demographics and societal values, there are fewer family members willing and able to care for ailing elderly relatives. Examples of such changes are:

• Increased life expectancy: as a result, the number of very old people is increasing. Thus, the children of such people who are potentially able to care for them are also likely to be elderly.
• Late childbearing: combined with increased life expectancy, late childbearing contributes to a generation of people caring for both their children and their parents at the same time.
• Smaller family size: fewer (and older) children help care for older family members.
• Increased social mobility and divorce rates: Family members are more likely to live geographically distant from each other, and family ties may weaken as a result. However, 80% of people aged 65 and older live 20 minutes away from one of their children.
• Increase in the number of working women: Women used to be able to take care of elderly parents, but now they may not be able to do so because of their busy jobs.
• Increase in the number of dependent and very sick elderly due to advances in chronic disease management.

These factors point to a growing need for home health care services provided by someone other than family members, friends or neighbors.

Stresses associated with caregiving

While caring for an elderly person can be very satisfying, there are also negative consequences associated with it. Family members may be subjected to considerable stress and subsequently experience health problems, isolation, fatigue and frustration, sometimes leading to feelings of helplessness and exhaustion ("burnout syndrome") or mistreatment of the older person. The degree of impact on the caregiver may be greater when the older person has a serious illness and/or severe disability and requires more care.

Caring for an older person can also be a heavy financial burden. Couples in which one partner cares for the other are often disproportionately poor. Sometimes the working family member has to quit a regular job or reduce work hours to be able to care for an older person.

The COVID-19 pandemic posed more challenges for family caregivers because it required isolation and discouraged formal caregiving. Family caregivers reported significantly more stress, anxiety, depression, sleep disturbances, fatigue, food insecurity, and concerns about financial status. They had fewer opportunities to interact with others and have a normal social life.

Caregivers and/or older people can discuss opportunities for assistance with health care providers, and health care providers should offer assistance, including in:

• Ensuring that caregivers are connected with social workers;
• Coordinating interdisciplinary care;
• Referring them for needed services such as counseling (individual, family and/or group) and education about the older person's medical condition and available treatments;
• Ensuring that older persons receive all benefits to which they are entitled, including financial support, education, and respite care (temporarily replacing a full-time caregiver while they are on vacation);
• providing immediate and ongoing emotional support;
• recommendations from organizations that provide practical assistance with daily tasks.

These measures often provide the necessary support and encouragement for caregivers. Caregivers can obtain useful information and/or learn care principles and techniques from physicians, nurses, social workers and other health professionals.

Family members can also take the following steps to prepare themselves to care for an older adult and avoid burnout syndrome:

• Be mindful of their own physical, emotional, spiritual, financial and rest needs
• Seek help with caregiving or emotional support from other family members and friends when appropriate
• Find outside groups that offer emotional support (e.g., support groups) or assistance in caring for the older person (e.g., psychological counseling, home health care, elder day care, meal programs, and respite care)
• If a family member is hostile or difficult to communicate with - learning ways to not take their behavior personally and to deal with emotional tension.