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Caring for Your Spouse When You're not so Well Yourself

Tom and Betty have been married for nearly 50 years. They have three grown children and one grandchild. They live in the same small house they've lived in since the kids were small.

Betty taught school and Tom was an engineer. They're both retired, and they're still independent. Tom has had more health problems recently than Betty. He has peripheral arterial disease in his legs, and that gives him some pain. He has to have his legs wrapped every day, and Betty says it takes her an hour, even though it shouldn't take an hour. He's a bit overweight, and has a hard time sticking with an exercise routine, especially with the leg pain, so he doesn't get around as well as he'd like to. In the past few years, his daughter Karen has noticed that he seems to be more frail.

Betty has been Tom's main caregiver all along, but now she's getting tired too. She cooks and takes care of the house, in addition to taking care of herself and her husband. She had a knee replacement a few years ago, and she's recovered from that pretty well, but still, it's harder for her to take care of Tom and the house than it used to be. But she doesn't like to admit that.

"They're so stubborn," their daughter Karen says. "The other day, I got a call from my mother saying, 'Karen, don't be worried, but I thought your father had a small stroke this morning. But he's fine now, and we had a doctor's appointment this afternoon anyway, so we just waited, because he got over it pretty fast. I just made sure he went upstairs and took a nap.' "

This kind of thing drives Karen crazy, she says. "I said 'Mom, don't wait to tell me things like this until the end of the day. If you think Dad's having a stroke, call 9-1-1, call the doctor, and then call me right away.' She thinks I'll get in trouble if I leave work, and she doesn't want to bother me, " Karen says. "And what really doesn't make any sense is that his doctor's appointment was with an orthopedic doctor. That's a bone doctor, which has nothing to do with the fact that he might have had a stroke. But they go to so many doctors all the time that it all kind of runs together in their minds.

"The truth is, my mother's so worried about not making trouble for everybody else that she doesn't always make the best decisions. Sometimes I ask her if they'd like to go to an assisted living facility, and she always says no. They're thinking about selling the house and moving into a condo so everything's all on one floor, but that's as far as they'll go."

It turns out that Tom didn't have a stroke after all, although his doctor isn't sure exactly what did happen to him, according to Betty. But, says Karen, "They need outside help. I have a friend who's a nurse who works part-time, and I've offered to hire her to help them out with some driving and with helping Dad wrap his legs, because it takes my mother so long. But they won't let me do it. They don't need the help, they say."

Does this scenario sound familiar? Are you caring for your spouse, even though caring for yourself is already a little challenging? Do you have aging parents who need help but don't want to admit it?

Taking care of a sick spouse raises the risk of death, according to a large study published in February of 2006 in The New England Journal of Medicine. The research indicated that the danger arises in two phases. In the first weeks or months after an illness begins, the caregiver's stress level goes up. The immune system then goes down, and infections become more common. Behavior patterns can change too. For example, if you're worried about your husband or wife, you may not pay attention to your driving as well as you used to. Or you may start to drink alcohol.

After a time, the effects of the stress become less severe as you get used to the situation. But often, isolation may set in, as fewer people come to visit. Isolation can lead to loneliness and depression, which also are detrimental to overall health.

Reaching out for help-essential

Accepting help is crucial for the health and well-being of everyone in the family. If it's getting too hard to take care of everything on your own, ask for help from your children, neighbors or professional caregivers, if that's possible. Don't worry about causing trouble for others. In the vast majority of cases, your friends and family want your life to be as easy as possible. So reach out for help and take the help that's available to you. Your friends and family will thank you for that.

The New England Journal of Medicine, 16 February 2006

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