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North Carolina Division of Aging and Adult Services



    Understanding How We Age

    What is old? What is normal aging? While children seem to grow at predictable rates, aging among older people is far more difficult to predict. Most older adults will never get Alzheimer's disease and will not die in a nursing home, but like most stereotypes, the myths about aging have some basis in fact.

    Talking, moving, and even thinking a bit more slowly are common as the body ages. The changes begin much earlier than at age 65. Starting at about age 30, the body begins to lose about one percent of its function per year. The human body is so adaptable that most people continue to function relatively well despite the decrease in efficiency unless they suffer from disease. Even with chronic diseases such as arthritis, diabetes, or high blood pressure, many older adults remain mentally and physically active.

    The process of aging causes countless changes in the body which begin to affect an older person's physical and mental abilities. Skin becomes thinner and drier. The brain, the heart, the immune system, and other systems become less efficient. Cell loss in specific areas can lead to a reduction in the ability to smell, hear and feel sensation.

    There is a difference between being old and being sick. A changing body is a fundamental part of aging, but disease is not. Everybody will experience some problems as they age, and many problems can be cured or controlled medically. People who age successfully are those who learn to accept changes and adapt. They are the ones who learn how to handle losses they can't control and recognize that there is still much they can control.

    While forgetfulness happens at all ages and is more common as the brain becomes less efficient, memory loss caused by strokes or Alzheimer's disease is not normal. About 10 percent of people ages 65 to 74 and about 45 percent of those older than 85 are affected by these conditions.

    Depression and emotional problems are not normal at any age. They can be caused by illness, improper medication, chemical imbalance or life situations. For the most part they are treatable.

    Many older adults endure unnecessary discomfort and pain simply because their physicians and family members look upon their aches and pains, incontinence, confusion, or depression as "normal" aging.

    Family Caregiving

    Over one million North Carolinians are age 60 and older and this age group is expected to double in size between 1990 and 2010. Not only do we now have more older adults, but they are living longer. As they age beyond 75 many begin to experience some type of physical or mental limitation. Nearly half the older population will report being limited in the amount or kind of activity they perform at some point, and eventually they will need some form of assistance.

    This assistance most often comes from family members referred to as "caregivers." Families provide informal care for nearly eighty percent of frail older adults. Caregivers often help their family member by finding, managing or providing necessary assistance with housekeeping, finances, meals, bathing, dressing, shopping or transportation.

    Caregiving responsibilities may result in physical, financial and emotional strain on the caregiver and the family. Stress can result in depression, anxiety and illness. While caregiving can be a successful and satisfying experience, it can sometimes be overwhelming.

    It is important for caregivers to take breaks and temporarily leave their caregiving responsibilities in other competent hands. Without that break, the loss of energy may create tension between the caregiver, the older adult, and other family members.

    Many families caring for older persons develop a pattern over time. Usually one family member, often a spouse or daughter, provides most of the care, becoming the "primary caregiver." This person becomes increasingly stressed and burdened. This can continue for a long time until the primary caregiver experiences a crisis. To avoid these problems, family members could meet to develop a long-term strategy which includes: a list of small and large tasks divided into time, money and labor categories so everyone can share in the caregiving responsibility; and regular family meetings, either in person or by conference call, to discuss the condition of the person being cared for and to renegotiate caregiving responsibilities as needed. The caregiver could develop a network that includes support from both family and outside sources.

    Strategies for Employed Women Caregivers

    Families provide informal care for over 75 percent of frail older adults. Although men are assuming more caregiving responsibilities than previously, three-quarters of family caregivers are women. The average caregiver is a 45-year-old married woman, most likely the daughter of the person for whom she cares. Thirty-one percent of women over 18 will care for both children and parents over their lifetime, which often makes it difficult to balance work and family. According to the U.S. Department of Labor, at a time when caregiving responsibilities may hit the hardest, more than half the women ages 45 to 64 work outside the home.

    Caregivers often help their family member by locating, managing and offering appropriate assistance. Typical tasks include assistance with housekeeping, finances, preparing meals, help with eating, bathing and dressing, shopping or transportation.

    These caregiving responsibilities can create physical, financial and emotional strain on the caregiver and her family. Some women end up in the difficult situation of providing care to both their children and elderly family members at the same time. The stresses of juggling dual caregiving roles can be overwhelming.

    Several strategies can help you, if you are a caregiver, to set some realistic expectations:

    -Talk with your spouse, your children, your employer and parents about how you feel about your caregiving responsibilities. Ask for suggestions.

    -Explain to your employer or supervisor, if possible, that you may need flexible work scheduling at certain times.

    -Get information about the medical condition of the older adult you are caring for from the person's physician and other knowledgeable service providers.

    -Ask for help. Seek out and use community services, both for yourself and the person you are caring for.

    -Plan some "time-out" for you and your spouse.

    -Make time for yourself. You won't be good in any of your roles, as spouse, parent or employed caregiver, unless you stay physically and mentally healthy.

    Men Providing Eldercare: Special Issues, Concerns and Resources

    Families provide informal care for about eighty percent of frail older adults. While most caregivers are women, a growing number are men. Recent studies suggest that as much as 28 percent of caregivers for older adults are male; husbands (13%) provide care most frequently, and sons (7%) are the next most involved.

    Male caregivers are often surprised at their ability to take on a role that is unfamiliar to them. They help by finding, managing or providing appropriate assistance with housekeeping, finances, meals, bathing and dressing, shopping and transportation.

    Caregiving responsibilities may create overwhelming physical, financial and emotional strain on the caregiver, however. While there are few services targeted solely to male caregivers, men are usually welcome in existing support groups. Men may also be more likely to use technology to establish a phone-based caregiver network or to access a computer bulletin board to receive information and support.

    Many support services, such as in-home aides, respite care, housekeeping and errand services, may be available to all caregivers of older adults. Two things men should keep in mind:

    Ask for Help: Sources of help include family, friends, church members, social clubs, councils on aging, home health agencies and social service departments.

    Be Specific: Decide what type of help is needed. Develop a schedule of who (family, friends or agency service staff) will help and how often (daily, weekly or monthly) they will help.

    As the baby boomers come of age and as their numbers make further demands on community services, men will find themselves more and more in the caregiving role. Unless your community identifies specific supports for male caregivers, the best strategy is to tap into existing services.

    Dividing Responsibilities in Family Eldercare

    The chances are that you or someone you know is caring for an older relative. Approximately 80 percent of caregiving is provided by a family member who often helps by finding, managing and offering appropriate assistance. Typical tasks include assistance with housekeeping, finances, preparing meals, help with eating, bathing, dressing, shopping or transportation. These responsibilities may become overwhelming and take a toll on the family.

    Family conflicts can be minimized or avoided altogether, if both parents and adult children acknowledge the influence of their own personalities, confront their changing relationships and determine their individual abilities to handle responsibilities. To prevent or minimize potential conflicts, a family discussion about caregiving responsibilities, including financial and legal planning, and roles for long-distance relatives, should start while parents are still healthy.

    All potential family members who may be involved with providing care, and perhaps a trained counselor or friend, clergyman or social worker, should meet. Consider the following questions at this time:

    Who will assume primary responsibility for decisions about care when it is needed? Is everyone satisfied with that plan? What information is needed before duties can be divided? What are the financial and legal ramifications? Who will pay for what? What extra financial burdens will be placed on the elder's or caregiver's budget?

    Disagreements about caregiving are common, but all family members' opinions should be heard and respected if possible. Siblings often want to offer assistance, but sometimes their offers of help are refused. It is easier for the primary family caregiver to ask for specific help and not expect siblings to read his/her mind. Families may avoid serious conflicts if they remain flexible about responsibilities and the roles they are willing to assume. Learn about community services which can help the family.

    Managing the Responsibilities of Work and Caregiving

    Caring for an older family member is becoming more common. Families provide informal care for about 80 percent of frail older adults, and the primary caregiver is most often a woman.

    These days women caregivers are likely to be executives or valued senior employees. More than half the women age 45 to 64 (the time when caregiving responsibilities hit hard) work outside the home. About one-fifth of the work force has substantial eldercare responsibilities, and many more expect to take on such tasks in the future. This might mean moving a parent with Alzheimer's disease into the house or making long-distance calls to arrange for a handyman or a ride to the doctor. Usually this means employees find themselves distracted, overwhelmed or exhausted.

    A growing number of corporations are helping workers to care for their older family members. Companies such as NationsBank, SAS Institute, and Duke Power in North Carolina, see such efforts as the key to successfully managing an aging work force.

    Company sponsored resources for caregivers sometimes include:

    -Access to information and referral services.
    -Flex-time or job-sharing for employees who need to be at home during certain parts of the day.
    -Personal leaves of absence to be used for caregiving responsibilities.
    -Employee Assistance Programs to discuss family issues in a confidential manner and provide help in
    finding assistance for older family members.
    -A geriatric care manager or social worker who is available to consult with families.
    -Work-site support groups.
    -Newsletters or caregiver manuals.
    -Seminars for caregivers.
    -Training for supervisors.

    To assess your employer's interest in eldercare programs, talk with your manager or human resources director to see what policies the company has in place. Or, try networking informally with co-workers to see if others are caring for older family members. A good book for working caregivers is: Kerri S. Smith, Caring for Your Aging Parents: A Sourcebook of Timesaving Techniques and Tips.

    What If Your Parent is Sick, But Won't Admit It?

    Although no one likes to imagine a time when their parent might not be able to do daily chores and activities, there is a great likelihood that people over age 65 will need some help with the daily tasks of living at some time in their lives. What can you do if you think your parent needs help but he/she rejects all of your attempts to offer or arrange assistance?

    Sometimes elderly parents may reject your efforts to help with their finances, claiming that you are meddling in their private affairs. Your father may insist that he is able to live in his two story house, even though he frequently falls. Your mother may make regular doctor's visits but fail to follow her physician's instructions about diet and medications.

    This can be a really tough issue. There are no clear guidelines for families to follow. Imposing your standards on your parents may backfire, so take some time to step back from the situation and think about your approach. It's important to remember that people have the right to refuse help and make bad decisions, as long as they have the capacity to understand the consequences. As a son or daughter, you can talk to your parent about your concerns, but you can't force him to change.

    If you believe that your parent is truly at risk, then start small. Requests or demands for sweeping changes will inevitably be met by resistance. Instead, suggest that your parent attend a meeting with a minister, physician or other respected authority to discuss your concern about his/her welfare. Assertive communication is another good strategy. You might say, "Dad, I am very concerned about your health. I worry about the choices you are making, and I would like your permission to talk with your doctor. Maybe the three of us could sit down together."

    If your attempts to help continue to fail, then accept your parent's decisions. Many experts think it is more important to maintain a relationship with your parent than it is to win an argument. However, respecting a parent's right to choose becomes more difficult as he enters the gray area between being fully capable, intermittently confused, and the early stages of dementia. It is never too early to begin learning about care options and alternative living arrangements. Asking a social worker to become involved in the situation is a practical first step. A certified social worker may help you confront your own personal motivations and provide practical strategies for working with your parent.

    Eldercare at a Distance

    If you find yourself in the position of being a long-distance caregiver to an older family member, you may find it difficult to assess his/her needs, locate and monitor appropriate services, and stay in touch with other family members.

    Talk with the older adult about his or her needs. Find out exactly what he/she wants from you and encourage him/her to take the lead in arranging services if possible. It's OK to disagree, but respect their decisions and keep lines of communication open.

    Find a trusted observer. Long-distance caregivers may find that information from a local family member is not always objective. Sometimes it is good to also have a neighbor or family friend, such as a member of the clergy, serve as your eyes and ears.

    Keep the family involved in decisions. The immediate family may benefit from holding occasional meetings or conference calls during which everybody's wishes are heard and respected. A discussion of the older adult's capacities and community resources that may help him/her to remain independent should include the older adult if possible. Don't overlook fairly obvious resources like friends, neighbors, or church members.

    Ask the older adult for permission to talk with his physician. This will allow you to be a member of the "team," and help reinforce the plan of care.

    Seek help early. If you're the primary caregiver, your employer may offer nationwide access to information and referral services on eldercare, or you may be able to locate a nurse or social worker in the older adult's community to help arrange and monitor services.

    Call the National Eldercare Locator at 1-800-677-1116 for referral to help in all states. Check to see if there is a local directory of aging services by calling the County Aging Services Department or Council, the County Department of Social Services, Health Department or library reference desk. Information and publications about aging and elder care are available from the North Carolina Cooperative Extension Services in each county. The Aging Services Directory can provide you a starting point. You can also call the nearest Area Agency on Aging. Another resource may be North Carolina's Care-Line, a statewide information and referral service, at 1-800-662-7030. A good book on long distance caregiving is Long Distance Caregiving: A Survival Guide for Far Away Caregivers, by Angela Heath. (American Source Books, 1993.)

    You can be a caregiver without taking over. One major risk of long-distance caregiving is overly aggressive or intrusive helping.

    Be realistic about your limitations. Long-distance caregiving can become overwhelming, even if you plan ahead and have a good relationship with the older adult and other family members.