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Caregiving Q&A With Barry Jacobs

Clinical psychologst and family therapist answers your questions about caring for a loved one

Comment From Sarah: My husband has been very depressed since his heart attack. How do I deal with his depression and irritability?

Research shows that about half of all heart attack survivors will develop depression afterward. Irritability is a common symptom of depression, particularly among men. I suggest that you have your husband evaluated by his cardiologist or family physician, specifically for depression and anxiety. Psychotherapy and/or medications may be very helpful.

Comment From Anne: I'm caring for my mom (she had been living with me but is now in a nursing home) and my brother, who lives in a different state, is completely unhelpful and isn't even there for me emotionally. I'm so frustrated and angry at his total disconnect. What can I do?

There are gender issues in family caregiving. Oftentimes, the brunt of caregiving responsibility for an aging parent falls to the oldest or youngest daughter; the sons seem to get away scot-free. Not only is this unfair; it makes sisters more likely to burn out and eventually weakens the bonds between siblings.

I recommend writing your brother a calm but firm letter. (Yes, the old-fashioned kind with an envelope and stamp; it will get his attention.) Tell him that you love him but need more of his help. Enclose some of the tips on long-distance caregiving on the AARP website. Ask him to step up to do more for you, if not for Mom. Give him a list of specific tasks to choose from — e.g., visiting and providing respite, paying for certain expenses. Tell him that the stakes are high; your relationship with him will be irreparably harmed if he doesn't heed your cry for help. Hope he responds, even in some small way.

Comment From Bonnie: Is there an accurate method to determine if I am going to get dementia and/or Alzheimer's?

The diagnosis is generally made today on the basis of clinical symptoms — for example, memory deficits or problems with reasoning skills. There are other methods in development that test the blood or spinal fluid to help make the diagnosis. These methods are not currently widely available.

Please speak with your family physician with your risk factors for dementia and steps you can take to preserve your thinking skills, such as remaining physically fit, keeping your blood pressure at a healthy level and lifelong learning.

Comment From Sylvia: I'm exhausted. All my energy goes towards caring for my parents. I feel burned out. What can I do?

Caring for aging parents can feel like you're running a marathon. Unless you've paced yourself well and taken in plenty of replenishment along the way, you can deplete yourself long before the race is finished. I'm concerned, Sylvia, that you haven't run your race in a sustainable way and now you're tuckered out.

Your caregiving plan needs to be altered — by increasing the amount of support you use and decreasing the responsibilities you have — or I doubt you'll be able to continue for as long as your parents need your help. That will not be in their interests or your own. I suggest that you talk with your local Area Agency on Aging to identify community resources. You may also want to be evaluated by your family physician to ensure that your burnout isn't deepening into a debilitating depression.

Comment From Dinah: How to caregive with a spouse who doesn't really want to be ill but knows he is. Still going to work but also getting chemo.

Many people who are undergoing treatment for a life-threatening illness try to play down the effects of that illness and its treatments in order to cope better emotionally. This is particularly true for men who are proud and need to save face by not showing what they consider to be weakness. I really wouldn't challenge your husband on this coping style unless you think that he is not caring for himself well enough (or allowing you to care for him) and thereby putting himself in harm's way. Otherwise, I'd recommend doing what you can for him without asking him if he needs help. It sounds like he is lucky to have someone as concerned and conscientious as you in his corner, Dinah.

Comment From Melba: My husband is in the very severe stage of FTD. Very few people call or visit and it is very lonely. He is under hospice care. How do I enjoy any activity when he is the love of my life and he is not here.

Melba, I'm sure it is very hard to enjoy life without your husband. Many caregivers don't feel like they deserve to be happy if their loved ones have been diminished or have died. But I'm sure your husband, if he were in sound mind, would want you to still participate in living, not just go through the motions of existing. Time does heal. You may yet learn to be happy with a new kind of life.

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