When Caregiver Stress Becomes Extreme

Q. My aunt Rae, 84, was the primary caregiver for my Uncle Leo, who suffers from dementia. Leo would wander, so Rae couldn’t leave him alone, and she missed the conversations she and Leo used to have. Rae became resentful and depressed because she had to forego her dreams of world travel and didn’t even spend time with friends anymore. She became so stressed about her situation that she attempted suicide, but thankfully she was unsuccessful.

Rae was good at putting on a happy face, so the family did not perceive the severity of the caregiver burden she was experiencing. Rae did not leave a note, but later stated that she fully intended to kill herself. While recovering in the hospital, Rae expressed relief at not having caregiver responsibilities. Uncle Leo was moved to a nursing home and Rae was given medication and attended therapy sessions to help with her depression. She began to do more of the things she loved and felt much better about her situation.

The scenario described above could have taken an extremely sad and scary turn. My mother (Rae’s sister) is a caregiver for my father, and she sometimes sounds depressed when I speak with her on the phone. What are the signs of extreme caregiver burnout, so we can step in to help if needed, and what can be done to help relieve some of the stress?

A. Currently, there are close to 66 million informal or family caregivers who offer assistance to senior loved ones in America. Their efforts are vital to the lives of people struggling with illness, disability, or the changes that often accompany aging. Family caregivers, such as these, often wrestle with stress as well as exhaustion, anger, guilt, grief, and other emotions, and sometimes others don’t realize how extreme the stress is until it’s too late.

Studies of men and women responsible for the long-term care of relatives show higher rates of illness, suppressed immune response, slower healing, and even earlier death among caregivers. Additionally, research reveals that ongoing stress endured by older adults caring for spouses with Alzheimer’s disease has a negative impact on the caregiver’s own mental functioning, sometimes prompting suicidal thoughts.

Suicidal thoughts among over-burdened caregivers

Sadly, thoughts of suicide are not rare for overly stressed caregivers. Research cited by the National Center for Elder Abuse shows that 20% of caregivers “live in fear that they will become violent” towards themselves or the loved one they are caring for.

Even though these feelings are fairly common in overburdened caregivers, they are certainly a dangerous red flag. Acknowledging negative thoughts and taking steps to ensure they do not become destructive actions is crucial.

Why Suicidal Thoughts Among Caregivers Happen

A report published in the Journal of the American Medical Association (JAMA) cites cases of elderly caregivers who are so distraught that they try to commit suicide just to get out of the situation.

Caregiver burden can manifest in many ways, including physical ailments, mental illness, social isolation, and financial problems. Caregivers get depressed. Then they neglect their own health or they miss doctor appointments because they can’t extract themselves from their caregiving role. They just don’t have support, so self-care such as exercising, getting enough sleep, or engaging in a social life all fall away.

These are some warning signs of extreme caregiver stress that you should look out for in loved ones:

· Feelings of sadness, tearfulness, emptiness, or hopelessness

· Angry outbursts, irritability, or frustration, even over small matters

· Loss of interest or pleasure in most or all normal activities, such as sex, hobbies, or sports

· Sleep disturbances, including insomnia or sleeping too much

· Tiredness and a lack of energy, so even small tasks take extra effort

· Changes in appetite — often reduced appetite and weight loss, but increased cravings for food and weight gain in some people

· Anxiety, agitation, or restlessness

· Slowed thinking, speaking, or body movements

· Feelings of worthlessness or guilt, fixating on past failures, or blaming yourself for things that aren’t your responsibility

· Trouble thinking, concentrating, making decisions, and remembering things

· Frequent or recurrent thoughts of death, suicidal thoughts, or, of course, actual suicide attempts.

Taming Extreme Caregiver Stress

If you sense that your mother is considering harming herself or your father, or is having other dark thoughts, immediate treatment is critical. Call 911, take her to the nearest emergency room, contact a private mental health provider, or contact the National Suicide Prevention Lifeline at 800-273-TALK (8255), text “help” to the Crisis Text Line at 741-741 or go to

If your mother is expressing extreme caregiver stress and sees a doctor and/or therapist for help/treatment, below are some tips you can suggest to her for taming caregiver stress:

Join a support group to talk out frustrations with other people in your situation and to get helpful ideas. Some caregiver support groups are available online. Others are run by local hospitals, senior centers, and community groups.

Consider getting extra help with some household tasks. The Eldercare Locator at can help you find varied services for older adults and their families; it’s run by the Administration on Aging. The Rosalynn Carter Institute for Caregiving, at, also provides recommendations for evidence-based caregiver support programs.

When someone offers help, accept. Keep handy a list of small tasks people can do, such as calling regularly, cooking an occasional dinner, shopping, and running errands. You can dole out tasks or ask people to check off what they can do.

Protect your own health. Research suggests that a caregiver’s immune function is often suppressed by the stress of caring for others. Boost your resistance by eating well, getting enough rest and exercise, and pursuing activities that bring you pleasure. Take advantage of regular respite care from professionals, family, and friends to give you much needed breaks.

Accept that circumstances change quickly. Periodically reassess what you can offer and what assistance you need. If it’s getting too hard to fulfill certain needs, ask family members for help or consider other options, such as hiring paid caregivers to take on these tasks. If necessary, consider another living arrangement that would help you meet your needs and those of your loved one.

Accentuate your spiritual connectedness to something greater than yourself, be it to God, Spirit, community, or nature.

Remember that you’re doing this not solely out of obligation. Focusing on the love you hold for your loved one can help dial back stress when things become frustrating and overwhelming.

Do things that you find to be relaxing. This can mean yoga or meditation, or hobbies such as knitting, baking, walking, swimming. Do whatever relaxes you most!

Sleep well. Aim for a refreshing amount of sleep. While this will differ for everyone, generally it’s about eight hours. Create a short, easy bedtime routine. Stay away from your smartphone, tablet, laptop, and any source of blue light (such as blue light emitted from a TV or cable TV box) as all light, and especially blue light, interferes and interrupts the natural sleep cycle.

For more helpful tips, please see the infographic below on “Ways to Reduce Stress for Caregivers” from (Graphic with the full article is located at

Do You Know a Caregiver Who is Overly Stressed?

If you have a loved one who is feeling extremely stressed due to caregiving, spend some time together (and make sure he or she gets professional help, if needed). Help her whenever you can to lighten her load, suggest she get help with her duties so she has time for herself, and explore other options with her. Perhaps more care is needed for your father than she can provide.

If nursing home care is imminent or on the horizon for your father, please contact us for an appointment for a no-cost introductory consultation to discuss Medicaid Asset Protection at:

Fairfax Elder Law: 703-691-1888

Fredericksburg Elder Law: 540-479-1435

Rockville Elder Law: 301-519-8041

DC Elder Law: 202-587-2797

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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.