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IN THE FAMILY WAY

Parents who are also caregivers struggle with suicidal ideation, new CDC study shows

We need to be more open about the stress of caring for aging parents, because our mental health depends on it

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If you’re caring for young kids and aging parents — while feeling completely frazzled, if not worse — you’re not alone.

According to new research from the Centers for Disease Control and Prevention, parents-caregivers (people taking care of both kids and aging adults) had significantly worse mental health than adults not in these roles. Among parents-caregivers surveyed, approximately 50 percent reported serious suicidal ideation in the past month. People with caregiving responsibilities for children and adults had eight times the odds of serious suicidal ideation compared with non-parents/non-caregivers.

“Sometimes people in a caregiving role have difficulty asking for help themselves, because they’re the ones used to providing the help and not receiving it,” says Dr. Elizabeth Rohan, one of the authors. “What’s alarming is the severity,” particularly in terms of suicidal ideation, she says.

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The better news is that people with someone to rely on for support had lower odds of experiencing adverse mental health symptoms. But, as I know firsthand, it’s really uncomfortable to open up. My mom was seriously ill over the past six months, and she died a week ago. (Yes, thank you for your concern, I took some time off!)

Talking about her death has been easier — even cathartic — because people can relate to it. It was harder to discuss her decline, because: I didn’t want to bore or burden people; I didn’t want to violate her privacy; and even close friends can’t fully empathize until they’ve experienced it. Unlike camp signup or the first day of school, a parent’s decline happens on an individual timeline. Until you’ve witnessed that decline and absorbed the heartbreak it entails, it’s very hard to commiserate. It’s easier to keep quiet.

Meanwhile, we get bereavement days for funerals; people encourage us to take time off after a death. Taking a mental health day because you’re busy trying to decipher a medication list for a confused mom who used to always answer the phone on the first ring isn’t as widely understood.

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For those of you in the same position, here are some ways to feel less alone.

Identify yourself as a caregiver. “One of the first steps for caregivers is to identify as a caregiver, because most people don’t even see themselves in that category. You’re being a good daughter or son. But this is a life passage,” says Jody Gastfriend, principal at Boston-based Health Management Associates and author of “My Parent’s Keeper: The Guilt, Grief, Guesswork, and Unexpected Gifts of Caregiving.”

“There may be stigma in saying that caregiving is hard,” says Rohan. “It’s OK for a caregiver to say, ‘This is really hard, and I’m really struggling.’ … Just because you’re a caregiver doesn’t mean you can’t ask for help.”

If you can afford it, hire a geriatric care manager. Newsflash: Aging is expensive. Care managers can cost between $140 to $200 per hour in the Boston area. However, they can also be a huge help in terms of outsourcing. They are concierges of the senior world, who can assess an elder’s needs, coordinate care, and make referrals to other geriatric professionals for adult kids who haven’t a clue (and who does, until it’s our turn?). Most of all, they can be an objective judge of a parent’s needs.

Just don’t think hiring a manager is a way to fast-track an unwilling parent into a nursing home.

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“One thing that’s important for adult kids to know is, if they hire a care manager, the client is always the elder. Even if you hire me, and you pay me, I will always do right by the client,” says Kathy Kemp, a geriatric care manager who runs Sage Advice, based in Arlington.

On that note, make sure your care manager is accredited by the Aging Life Care Association, which requires members to adhere to a code of ethics in making recommendations.

Don’t berate yourself if you feel clueless. It’s hard for people who are competent in other areas of life to suddenly feel paralyzed navigating doctors’ appointments, assisted living facilities, wills, and worse.

“It’s not a shortcoming. How in the world would you know?” says Kemp. “When something happens and the adult child has to become a caregiver in some ways, or feels like they should, it’s new territory. Do not be embarrassed to seek help. Find your people,” she says.

Who are those people? Two great, free resources in the Boston area are Working Daughter, a caregiving resource site and support group with a strong social media presence; and Caregiver Nation, a Facebook group run by family caregiving agency Seniorlink.

Nationally, visit the Family Caregiver Alliance and the National Alliance for Caregiving.

Lower your standards. “You don’t have to be perfect or even good. Have your goal be ‘good enough,’” Kemp says. “A big piece of my work is helping people manage their anxiety and frustration, especially if they have their own children. This week it may need to be about your kids. Mom is on hold. It’s not going to last forever. It may feel like it, but it won’t.”

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Deb Comen, a primary caregiver for her father, agrees.

“Let go of perfection,” she says. Make time for self-care. “Hire someone to help if you can. Or reach out to friends or neighbors. You need to take care of you. Stress can be debilitating, affecting hormones, digestion, brain function. Never forget that you matter, too, and it’s OK to have limits of what you’re capable of dealing with.”

Remember: Delegating is not a sign of weakness.

“Map it out and figure out the things you really don’t have to do,” suggests Gastfriend. “If you make a list of those things, you’ll find there are really quite a few that you can outsource to another family member or friend, whether it’s transportation, errands, grocery shopping, or meal prep.”

Have proactive conversations early and often. If you’re lucky enough to have healthy parents, start asking about their short- and long-term aging goals now. It’s harder to make quick decisions when you’re mired in crisis. Ask about their wishes, and determine what thresholds would be required for a change, such as difficulty driving at night or navigating stairs.

It’s awkward, I know: Adult kids don’t want to look greedy or manipulative when talking about things like finances or health.

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“Sometimes the easiest way is to say, ‘Hey, I read this book, or I read this article, or I heard from a friend,’” says Gastfriend. “Try as best you can to be a care partner and not a care enforcer. When adult children slip into that role of feeling they need to be the protector of their parents, it becomes more of a role reversal — which is not ideal for caregiving, because your parents are still your parents, even if they make decisions that you don’t think are in their best interest.”

If you’re worried about breaking the ice, visit The Conversation Project an online guide to having health and end-of-life conversations with seniors.

Know your why. “Why have you chosen to do this? This can serve as a valuable touchstone when things are challenging,” says Comen.

Most of all, remember that, when you feel alone, almost all of us will be here someday — and the temporary stress is often the price you pay for the benefit of having loved someone enough to care.

But take care of yourself, too.


Kara Baskin can be reached at kara.baskin@globe.com. Follow her on Twitter @kcbaskin.