In a recent programme aired on Channel NewsAsia, caregivers in Singapore were interviewed on their caregiving experience, and the challenges that they face. Watch it here
It is estimated that there are over 210,000 caregivers and counting in an ageing Singapore, with some 70 per cent of them aged 40 and above. Also, among carers of stroke survivors, 40.2 per cent have depressive symptoms, according to a 2017 study by the Institute of Mental Health and the National University of Singapore. Carers of cancer patients are also at greater risk of developing depression than the general population, according to a Singapore Medical Journal study. (Ng, 2019).
Taking care of a loved one for a prolonged period of time is not an easy task. Whether it is taking care of an elderly parent, a child with special needs, or spouse who is ill, caregiving can take a physical and emotional toll on the caregiver over time. When working with patients and their families as an occupational therapist, I have met caregivers who experience the symptoms of burnout. Some of them have depression and anxiety, and yet are unwilling to seek professional help out of the guilt and shame they experience. Unfortunately, this also compromises on the care that they provide for their loved ones, and often relationships are strained.
What is "Caregiver Burnout"?
Caregiver burnout is defined as ‘a state of physical, emotional and mental exhaustion. Usually, it is accompanied by a change in attitude, from positive and caring to negative and unconcerned.’ (Cleveland Clinic, 2019). Caregivers who are burnt out may experience stress, fear, anxiety, guilt and depression. If unaddressed, this can negatively impact their work, sleep, and relationships with others as well.
Caregiver burnout is defined as "a state of physical, emotional and mental exhaustion. Usually, it is accompanied by a change in attitude, from positive and caring to negative and unconcerned."
What are the symptoms of caregiver burnout?
Symptoms (Beckerman, 2018) are similar to those of depression and anxiety and may include the following:
Withdrawal from family and friends
Loss of interest in hobbies
Feelings of wanting to hurt yourself or the person for whom you are caring
Changes in sleep pattern and appetite
Feeling irritable, depressed, hopeless and helpless
Emotional and physical exhaustion
Excessive use of alcohol or sleep medication to cope
What contributes to burnout?
According to Fisher (2018) and Mackenzie (2018), the reasons contributing to burnout may vary but some of the common reasons are:
1. When there are unrealistic expectations
Caregivers may expect unrealistic positive outcomes and improvements through their dedicated caregiving. However this would not be possible in progressive degenerative illnesses such as Alzheimer’s disease or Parkinson’s disease, or long term illnesses or disorders such as stroke, congenital disorders from birth, traumatic brain injury, intellectual disabilities or serious mental health problems.
2. When there is role confusion
Caregivers may have difficulty separating their role as a caregiver from other roles such as spouse, child, friend, parent or other close relationships.
3. When there are conflicting or unreasonable demands
Sometimes, caregivers may see caregiving as their exclusive responsibility. They may feel guilty sending a parent to an eldercare facility such as a daycare or even nursing home, even when they are unable to cope. They may also face immense pressure trying to juggle the needs of everyone: their other family members, the care recipient, and also themselves. This may lead to anger and resentment over time.
Sometimes, caregivers may see caregiving as their exclusive responsibility. They may feel guilty sending a parent to an eldercare facility such as a daycare or even nursing home, even when they are unable to cope.
4. Where there is a sense of lack of control
Caregivers can get overwhelmed by the lack of finances (as they are unable to work while caring for the loved one), resources and skills to manage the daily caregiving tasks. Because a large part of the time is spent providing care, caregivers may feel ‘trapped’, that they are unable to have time for themselves to do the things they enjoy. When they actually do go out and have a breather (which is an important part of self care), they may end up feeling guilty for spending time away from their loved one, and blame themselves for it.
5. When there is simply just too much to do
Caregivers may barely have time to rest! They may have to stay up through the night at times too. It can simply be too much of a burden to bear, especially if the caregiver is isolated and the support network is not strong enough.
Caring for yourself
Taking time to care for yourself as a caregiver is important. Think of yourself as a tree. In order to grow well and bear fruits, a tree needs to have adequate sunlight, water, and nutrients. It also has roots that grow deep into the ground to draw water and nutrients. Roots also help to stabilise the tree during stormy weather. How healthy are your “roots”- your support structure and network? What steps do you take to remain rooted, so that you can have space to breathe and grow? Here are some tips (Mayo Clinic, 2020) to care for yourself and to prevent caregiver burnout.
1. Set realistic expectations
Balance the demands of work, family, friends, caregiving. Remember, you can’t do everything! Recognise your limits, and that providing good care for someone does not mean you have to be there all the time. Be aware that there are some things that are beyond your control as well, and accept that.
2. Pace yourself
It is therapeutic, and also needful for you to take breaks and recharge yourself. Incorporate things that you enjoy into your daily or weekly schedule, such as going for a walk or jog, listening to calming music, reading a book, meeting up with friends for tea or coffee. When you are more relaxed and refreshed, you can be more present for others as well.
3. Join a caregiver support group
Joining a caregiver support group can allow you to connect with other caregivers who face similar challenges as what you may be experiencing. You could also learn more skills and knowledge that may ease some of the stressors in caregiving. Being in a group removes the isolation you may feel, and creates opportunities for connection with others in the same journey of caregiving.
4. Tap into community resources
Home help and interim care services may help to alleviate caregiver stress and provide additional companionship and support for your loved one.
5. Talk to someone
Don’t bottle up those negative feelings you may have. It is common to experience a myriad of emotions when you are overwhelmed, such as anger, grief, guilt, depression, anxiety etc. Share with people whom you are close to, and let them know how they can support you along the way. Caregiving is not an easy journey and you don’t have to walk alone. Talking to a counsellor would be helpful as well, and we are here for you if you need someone to talk to.
If you like to learn more, join us for our free webinar "Overcoming Caregiver Stress" on 23rd July, Thursday, 7.30pm. Sign up here.
Beckerman, J. (2018). What Is Caregiver Burnout? Retrieved April 13, 2020, from https://www.webmd.com/healthy-aging/caregiver-recognizing-burnout#1
Cleveland Clinic. (n.d.) Caregiver Burnout Prevention. Retrieved April 13, 2020, from https://my.clevelandclinic.org/health/diseases/9225-caregiver-burnout/prevention
Fisher, M. (2018). Causes and Symptoms of Caregiver Burnout: Called to Care: Johns Hopkins Bayview Medical Center in Baltimore, MD. Retrieved April 13, 2020, from https://www.hopkinsmedicine.org/johns_hopkins_bayview/community_services/services/called_to_care/causes_symptoms_caregiver_burnout.html
MacKenzie, J. D. (2018). Caregiver Burnout: What Are the Risk Factors & Causes? - CCNH. Retrieved April 13, 2020, from https://www.cc-nh.org/caregiver-burnout-risk-factors-causes/
Mayo Clinic (2020, March 19). Practical solutions for caregiver stress. Retrieved April 13, 2020, from https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/caregiver-stress/art-20044784
Ng, D. (2019). When carers are burnt out, who cares for them? Retrieved April 13, 2020, from https://www.channelnewsasia.com/news/cnainsider/when-carers-caregivers-burnout-who-cares-them-ageing-elderly-11504380
About the Author - Kingslin Ho
Kingslin is part of our counselling team in Grace Oasis. She has worked as a senior mental health occupational therapist in both hospital and community settings in Singapore. She has experience working with adolescents, adults and elderly with a variety of physical and mental health issues such as stroke, Parkinson's disease, dementia, mood and anxiety disorders. Kingslin believes in not only supporting her patients but also their families and caregivers in their caregiving journey.