How caregiving changes relationships

Coffee and newspaper
Posted 09 September 2019 by Fallon Health

By Brenda J. King, Psy.D.

For the first 30 years of their marriage, Tony teased Christine* about taking too long to get ready in the morning. It became a joke between them. She’d take out multiple outfits to show, and he’d exaggerate his impatience, tapping his foot and pointing at his watch.

In the last two years, the morning ritual changed. Christine slowed down more, getting stressed about the choice of outfit and struggling to use the right brushes for her makeup. She marveled over her earrings and necklaces as if she had never seen them before—if she remembered where to find them in the first place.

Frustrating changes

Tony felt increasingly resentful. He wanted her to stop being so slow and indecisive, and get back to being independent and fun. Why was she acting so helpless? His response was to rush her.

Their playful banter turned to yelling and crying. The result was that Christine’s anxiety skyrocketed, increasing her confusion and slowing her down further. Too many days were ruined with this cycle of Tony’s frustration feeding Christine’s anxiety and her anxiety raising his frustration level—until they sought medical help and she was diagnosed with dementia.

That cycle—frustration and anxiety fueling each other—is very common in families of those with dementia, particularly in the early stages before a diagnosis is made. It can feel like your loved one is intentionally trying to annoy you. And that can make you feel impatient and argumentative. The person with the decline can be defensive and aggressive in responding. The combination makes the early stages much worse.

Most of the time people with dementia understand that they’re losing their abilities and their knowledge. All of a sudden they don’t know what to do with a key or how to get somewhere they have been going regularly for years. And naturally they become very fearful and anxious about what is happening to them.

Adapting to changing roles

Learning to accept dementia-related changes—and the anxiety they produce—can go a long way. It did for Tony and Christine. 

Tony started having an extra cup of coffee in the morning and reading the paper or paying bills while Christine was getting ready. And he stayed on the alert for the first signs of Christine needing his help. He learned to gently guide her toward making her own decisions as much as possible, rather than making a binary choice between hovering or ignoring her. That helped him avoid focusing too much on the increased time she needed.

By shifting his behavior to adapt to changes in Christine, Tony decreased her anxiety level.

You can look for new ways of managing the changes in your situation:

  • Notice when stress tends to peak
  • Identify ways to alleviate frustration and anxiety triggered by that stressful time
  • Make use of memory aids—Post-it notes and alarms or timers can be helpful
  • Plan the day in advance to reduce your loved one’s feeling of being overwhelmed

A therapist can be helpful in identifying ways to do this for your particular situation. Look for someone who is willing to listen, who looks at the possibilities for shifting tasks and understands how important it is to accept changing relationships.

Most importantly, accept that things don’t have to be perfect. Sometimes good enough is good enough.

*Names and identifying details changed to protect anonymity.

Dr. Brenda King is Director of Behavioral Health Services for Fallon Health’s Summit ElderCare program, a Program of All-Inclusive Care for the Elderly (PACE).

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