May 282010


 How Your Attitude Affects Your Caregiving


 Is your caregiving stress made worse (or better) by your true nature? Let’s look at three caregiving pairs:


Caregiver One knows her father is dying of cancer but buries any worry or fear under a radiant hope and energy. She gives Dad pep talks, researches care and comfort strategies, quizzes doctors about experimental cures. Through ups and downs, she remains doggedly convinced that he might just defy the doctors and pull out of it.

Caregiver Two, too, knows her parent is dying. She blinks back tears in his presence, feels helpless. When he has a setback, she can’t help blaming herself — and wondering what she might have done differently. She’s having trouble eating, sleeping, and dragging herself through the fraught-filled days.

Caregiver Three has been watching his loved one fade away, too. He’s grieving the loss even as he cherishes the good memories. He’s exhausted by the endless grind of caregiving but has arranged his schedule so that he can (with twinges of guilt) get to the gym three times a week and keep a weekly card game with an old friend. He cries at night, and by morning reminds himself sadly, “It is what it is.”

Which type of caregiver are you: Optimist, pessimist, or realist? The answer may color your stress level as a caregiver.

If you’re a Pessimist…

Pessimistic caregivers (like Caregiver Two, above) tend to have a negative outlook, blame themselves more when things go wrong, and don’t give themselves enough credit for things that are going right. They have the highest stress of the three basic outlooks, and higher rates of depression. One study of spouses caring for people with Parkinson’s found that caregivers who felt pessimistic early in the disease tended to have poorer health both then and as much as 10 years later.

Often pessimistic caregivers once had brighter world views that have been dimmed by extended caregiving. Studies show that caregivers of people with Alzheimer’s are, as a group, more pessimistic than non-caregivers. The good news: Outlooks aren’t carved in wet cement; they’re changeable for the better as well.

What helps:

  • Exercising. Interestingly, it’s been proven to help pessimists regulate stress hormones, which they’re especially vulnerable to in stressful times.
  • Seeking out the companionship of others. Same effect as exercise. So if you’re feeling isolated (common among spousal caregivers), reach out. It’s not a betrayal to seek out healthy, empathetic people with whom you can talk or vent.
  • Being kinder to yourself. It’s really hard, but it’s important to avoid knee-jerk self blame or thoughts that you’re not doing “enough.” You’re good! Force yourself to focus on all the things you do well — like taking on the act of caregiving in the first place.

If you’re an Optimist…

Optimists (like Caregiver One, above) expect good things, rather than bad ones, even in dire situations. They’re inspiring to be around, and suffer less depression than pessimist caregivers. But surprisingly, while pessimism is definitely harmful to health, optimism hasn’t been shown to be necessarily protective for caregivers.

There are benefits, though: Research in 2009 on more than 100,000 optimistic women over 50 (not just caregivers) found they were 30 percent less likely to die of heart disease than pessimists. They smoked less, had lower blood pressure, and less diabetes. A 2010 study looking at law students (who might have sleeplessness in common with caregivers if nothing else!) found that having optimistic expectations boosted their immune systems.

One catch for optimist caregivers is that they risk treading in denial. They may delay comfort care measures or hospice longer than is prudent. And some research has found they can be more numbstruck with grief after their care receiver’s death because they’re less likely to do any preparatory grieving (consciously or not) while still actively caregiving.

What helps:

  • Planning for contingencies. People who are “unrealistic optimists,” as researchers call them, tend to plan only for the short term and don’t always make carefully considered choices.
  • Trying not to be superstitious. Know that it’s not “jinxing” anything if you explore the what-ifs of worst-case scenarios. (What if you can’t provide 24/7 home care? What if a treatment doesn’t work; then what?) You can have high expectations and be realistic.
  • Not forcing the optimism. Not feeling particularly sunny? Don’t force it. Fake optimism isn’t going to ward off depression; dealing with your feelings truthfully is the healthier road.

If you’re a Realist…

Realists (like Caregiver Three) exist somewhere in the boring — but resilient — happy medium between optimism and pessimism. They do the best they can and then surrender to hope or higher powers.

There’s an old saying: “The pessimist complains about the wind; the optimist expects it to change; the realist adjusts the sails.”

Some days I think we caregivers are all three basic types rolled into one, depending on our family member’s mood and how much sleep we’ve had….

How about you?