Caregiver Stress and Burnout

Why caregiving is stressful

About 1 in 5 US adults provides unpaid care to a family member or friend. Caregivers often juggle personal care, medicines, appointments, finances, household tasks and a job, while watching someone they love decline. Stress is greatest when:

• caring for someone with dementia, including Alzheimer's disease, with behavior changes, wandering and sleep disruption
• caring for someone after a stroke or with advanced cancer
• providing 20 or more hours of care a week, or living with the person
• the caregiver has little choice about taking on the role
• there is little help from family or services
• the caregiver has their own health problems or is older
• money is tight or work is affected

Signs of caregiver stress and burnout

Emotional signs

• feeling overwhelmed, constantly worried or on edge
• irritability, anger or resentment, followed by guilt
• sadness, hopelessness or crying easily
• losing interest in things you used to enjoy
• feeling isolated or trapped

Physical signs

• exhaustion that does not improve with rest
• trouble sleeping, or sleeping too much
• headaches, body aches and stomach problems
• frequent colds and infections
• weight changes

Behavioral signs

• withdrawing from friends and activities
• neglecting your own health, meals and appointments
• using alcohol, smoking, food or medicines to cope
• becoming impatient or harsh with the person you care for

Burnout is the point where stress has become chronic and you have little left to give. Some caregivers describe "compassion fatigue," feeling numb or detached.

Health effects of caregiver stress

Long-term caregiving stress is linked to:

• depression and anxiety, which affect a large share of dementia caregivers
• high blood pressure and heart disease risk
• weaker immune responses and slower wound healing
• poorer sleep, insomnia and chronic fatigue
• missed preventive care

Many caregivers also report positive experiences: closeness, purpose and feeling they are doing something meaningful. Stress and reward often exist together.

How to cope with caregiver stress

Accept help and share the load

• Make a list of specific tasks others can do, such as shopping, driving to appointments or sitting with the person for an afternoon, and say yes when people offer.
• Hold a family meeting to divide responsibilities.
• Use respite care: adult day programs, in-home aides or short stays in a care facility give you planned breaks.

Find services and support

• Area Agency on Aging (find yours through the Eldercare Locator, 1-800-677-1116) for local services, meals, transport and respite.
• Disease-specific organizations, such as the Alzheimer's Association 24/7 Helpline (1-800-272-3900).
• Caregiver support groups, in person or online.
• Social workers and care managers at hospitals and clinics to help with planning and benefits.
• Workplace options: the Family and Medical Leave Act may allow unpaid job-protected leave.

Look after your own health

• Keep your own medical, dental and screening appointments.
• Aim for regular sleep. If night care is disrupting sleep, ask about overnight help.
• Eat regular meals and stay hydrated.
• Move every day, even 10-minute walks.
• Limit alcohol and do not smoke.
• Take short breaks daily for something you enjoy.

Manage the emotional strain

• Accept that you cannot do everything perfectly, and that difficult feelings are normal.
• Learn about the person's condition. Understanding dementia behaviors, for example, makes them less distressing.
• Try stress-reduction techniques: breathing exercises, mindfulness, prayer or journaling.
• Talk to a counselor or therapist. Cognitive behavioral therapy and caregiver skills programs reduce depression and burden.
• Plan ahead for legal, financial and care decisions, which reduces crisis stress later.

When to get professional help

See your doctor if you have symptoms of depression or anxiety for more than 2 weeks, are not sleeping, are using alcohol or medicines to cope, or your physical health is declining. Treatment for depression and anxiety works for caregivers, and getting help is part of being able to keep caring.

If you feel you can no longer provide safe care, it is not a failure to arrange more help or a move to assisted living or a care facility.

Frequently asked questions

What are the signs of caregiver burnout?

Signs include constant exhaustion, poor sleep, irritability, feeling hopeless or trapped, withdrawing from friends, losing interest in activities, frequent illness, neglecting your own health, and becoming impatient with the person you care for. Burnout develops gradually and is a sign you need more support.

How do you cope with caregiver stress?

Accept help and share tasks, use respite care, join a support group, keep up with your own health appointments, sleep and exercise, and talk to a counselor. Local Area Agencies on Aging and disease organizations can connect you with practical services.

Can caregiver stress make you sick?

Yes. Long-term caregiving stress is linked to depression, anxiety, high blood pressure, weaker immunity and poor sleep. Caregivers often skip their own medical care. Looking after your own health is essential, not selfish.

What is respite care?

Respite care is short-term care that gives a regular caregiver a break. It can be an in-home aide for a few hours, an adult day program, or a short stay in a care facility. Medicare hospice benefits, Medicaid programs and local agencies may help cover costs.

Is it normal to feel resentful as a caregiver?

Yes. Resentment, frustration, guilt and grief are common and do not mean you love the person less. They are signals that you need more support or rest. Talking about these feelings with a support group or counselor can help.