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When Caregiving Stops, Depression Can Linger

Leslie Eckford - October 29, 2018 09:53 AM

Rose and Howard had been married for 40 years. According to Rose, it had not been a happy marriage, but for various reasons, they had stayed together. Rose thought after she retired from her job as a teacher, she would find a way to move out on her own. Around that time, however, Howard began to have problems remembering everyday things. Soon, he became confused about getting around town. Howard stayed home more, sitting quietly in his chair. His doctor diagnosed Alzheimer’s disease. Seemingly overnight, Rose’s life was focused on taking care of Howard. It was difficult, tiring work. Many nights were filled with Howard’s confusion and agitation. Neither of them slept much. Over the years of his illness, Rose found that the worse Howard’s condition became, the more feelings of anxiety and stress she had.

After Howard passed away, Rose thought that finally she would have her own life back. She would feel better and get back on track. But, even after a year had gone by, Rose felt more depressed and alone than ever before.

There is growing concern for the mental health of family caregivers. The challenges to family members and spouses doing the hands-on, 24 hour a day care are many. It is a thankless job of physical labor, dealing with daily changes, and lack of sleep and resources. The caring individual is often so aware of the needs of others that they do not maintain care of themselves. As a result, his or her own health can suffer, sometimes resulting in clinical depression.

Like Rose in the story above, we may assume that things get better after caregiving is over. It seems logical that the caregiver’s good health and contentment will return. Yet, there is growing evidence that for some people, depression can continue for years after that role ends.

Depression can be sneaky, particularly when combined with grief. Not everyone who has depression is aware of what they are dealing with. Here are some of the signs and symptoms of depression:

•    a feeling of exhaustion or daily fatigue

•    Sadness

•    lack of interest

•    Guilt or shame about the caregiving experience

•    changes in appetite or sleep

•    hopelessness about the future

•    Thoughts of death and suicide

It may be easier to assume at first these signs of depression are connected to grief. But, over time, as these symptoms become a part of daily life, depressed mood is more likely to be the culprit.

Even though a former caregiver may say that she is feeling better, it may not be completely true. Some studies show that they can have more physical ailments and more frequent doctor visits following the death of their loved one. Research from the College of Nursing at Dartmouth, for example, found that sleep disturbances were likely for former caregivers. They may feel more loneliness and find themselves worrying about their caregiving experience. They may think that being a caregiver was the only purpose of their life.

What can be done to help reduce the damage of depression? A depression screening is a good starting point for discussion. The primary focus should be on the caregiver. Here are some points to consider:

•    Gently remind them that they need to care for their own health and well being now.

•    Encourage them to discuss their overall health with their health care provider. Are they getting good nutrition, adequate exercise and taking steps to improve sleep? These are essential.

•    Get support from friends, family, spiritual counsel and caregiver support groups. Sometimes, after the death of the person receiving care, people assume that support is not needed anymore and drop contact.

•    Seek mental health counseling. This can be individual counseling or group therapy with others with similar life issues. It can include psychiatric medical care to provide antidepressant medication if needed. It takes time and care to re-align and rediscover thoughts about life purpose and new life goals. Professional help can ease and direct the process.

A neighbor was concerned about the changes that she saw in Rose after Howard died. She gently persuaded Rose to call the local community mental health agency and even drove her there for her appointment. It was not easy for Rose. She felt embarrassed and didn’t think that she needed anyone to know what she was feeling.  But, with her therapist’s help, Rose began to take small steps and actions. Eventually, her mood began to lift and she began to feel hope about her life.

Leslie Eckford is an RN and LCSW with a specialty in geriatric mental health and elder care. She is the co-author with Amanda Lambert of Beating the Senior Blues: How to feel Better and Enjoy Life Again (New Harbinger, 2002) and Aging with Care: Your Guide to Hiring and Managing Caregivers at Home (Rowman and Littlefield, 2018). She and Lambert co-manage MindfulAging.com .

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