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How Common is Caregiver Stress & Burnout
There are estimatedly over 200,000 family caregivers in Singapore, caring for one or more of their loved ones with long term health issues ranging from disability, limited activities of daily living (ADL) to chronic diseases such as dementia and post-stroke side effects.
According to a survey by the Palliative Care Centre for Excellence in Research and Education, family caregivers in Singapore is commonly between 45 and 60 years old, female, married, working full-time and spending 6.7 hours daily on caregiving duties. Singles taking care of their loved ones are also found to be under concerning level of stress, as they lack the support from a partner. Caregivers, after all, are not immune to stress and illnesses themselves. In many cases, caregiving can cause lack of care to oneself, chronic stress, anxiety and depression.
In this article, we discuss caregiver stress and burnout, signs and symptoms, causes and strategies to cope with and prevent caregiver stress. Beware that caregiver stress can worsen at times of additional responsibilities, such as major holiday periods and when the caregiver faces a health issue or extra workplace or financial obligations. Read to the end of our article for strategies to avoid caregiver stress during holiday seasons and other high-pressure times.
1. What is caregiver stress and caregiver burnout?
Compared to professional caregivers, family caregivers face a multitude of stress causing factors, including 3 main ones below:
- Lack of professional training and skills to handle caregiving tasks
- Financial burden, often resulting from 2 factors at the same time: the cost of care and the lost income when caregivers sacrifice their full-time paying job for the caregiver role
- Other family responsibilities on top of caregiving, such as taking care of children, other family members and the household.
Other emotional factors add to the stress. It can be despairing to witness a loved one’s condition worsening despite the caregiver’s best efforts. Some caregivers feel guilty when they leave their family members at home without adequate care. Stretched out for years or even decades, it comes as no surprise that caregivers can suffer from chronic stress. When the stress feels too much to take, caregiver burnout happens.
Caregiver stress refers to the chronic stress that is specific to one in a caregiver role. The key factor here is its chronic and long-term nature. Normal stress goes away when the stressor is removed. But for many caregivers, stress induced by caregiving responsibilities often goes on daily for many years, snowballing into chronic stress.
Caregiver burnout refers to episodes when chronic stress climaxes into feelings of physical and mental exhaustion, inability to cope, and sometimes hopelessness. It can be triggered by a particularly stressful event directly or indirectly related to the caregiving responsibilities.
Left unmanaged, caregiver stress may develop into mental illnesses such as depression and anxiety disorder. Read more about how chronic stress can cause anxiety disorder here.
2. Signs and symptoms of caregiver stress and caregiver burnout
In general, caregiver stress and burnout manifest with signs and symptoms similar to those of general stress and burnout.
Common signs and symptoms of caregiver stress:
- Feeling constantly tired or lethargic
- Feeling impatient or resentful towards the care recipient, and/or other family members for not sharing the caregiving burden
- Easily irritated or angry
- Feeling unmotivated to complete usual daily tasks, including caregiving tasks
- Difficulty concentrating
- Difficulty sleeping and/or getting out of bed in the morning
- Losing appetite; or binge eating/drinking/smoking
- Tendency to withdraw from social activities and/or neglect self-care
- Tendency to catch a cold or flu or experience flare ups of chronic conditions more often
Common signs and symptoms of caregiver burnout:
A burnout often exhibits the same signs and symptoms of stress but at an aggravated level. Additionally, caregiver burnout can involve:
- Feeling exhausted or out of energy, even after a rest
- Feeling overly frustrated or cynical with the care recipient
- A sense of helplessness, being isolated, all alone or trapped in the situation
- Losing sense of satisfaction or achievement even when you do a good job caring for the loved one
- Feeling guilt, not doing enough or being a failure as a caregiver
Caregivers sometimes do not recognise the signs and symptoms themselves. They need other family members and friends to gently step in, help them relieve the caregiving burden and overcome the stress.
3. Causes of caregiver stress & burnout
Caregiver stress and burnout is most commonly associated with a lack of social support, excessive responsibilities from caregiving and other duties, and inadequate self-care.
The following factors can also put a caregiver at additional risks for stress & burnout, according to the Singapore Survey on Informal Caregiving:
- Caregivers who work full-time
- Caregivers who are of younger age
- Care recipients who suffer from memory, behaviour or mental health problems (such as dementia, depression, etc)
- Long hours of caregiving, especially caregiving during night time
- Relationship between caregiver and care recipients: a caregiver who is spouse of the care recipient is more likely to experience stress compared to children caring for parents, grandparents or other relationships
- Caregivers who do not have support from a domestic helper or other family members
- Other personal factors relating to caregivers such as their socio-economic circumstance, self-esteem, etc.
4. How to prevent & manage caregiver stress
Given the common causes of caregiver stress & caregiver burnout above, preventing and managing caregiver stress calls for 3 key adjustments:
- Leaning in social support
- Finding ways to reduce responsibilities for caregivers in and outside of caregiving
- Practising self-care
Usual stress management techniques are also very helpful, such as exercise, healthy eating, limiting stimulants, learning relaxation techniques, etc.
Below are 6 most useful tips to avoid caregiver stress & burnout.
4.1. Make Time For Self-Care
Self-care does not necessarily mean a trip to the spa. It simply means setting aside time to do things you enjoy each day. If this has not been an usual part of your daily schedule as a caregiver, it is a good idea to start out with small increments of time for yourself. Take a walk, watch a movie, call a friend, do a workout, or listen to music. Your loved one might need space, too. Self-care also includes ensuring that you are eating at proper meal times and getting quality rest as much as you can.
4.2. Monitor Your Own Health
A caregiver’s health is crucial because the quality care can only be achieved when the caregiver is well him/herself. Also, getting sick more frequently can be a sign of caregiver stress. If you have a medical condition, ensure you take medications and go for check-ups regularly.
4.3. Ask For and Accept Help
Taking on too much responsibility is a common pitfall for stress. Asking for and accepting help are not indications that you cannot handle caregiving properly for your loved one. It is in fact an appreciation that long-term caregiving can be stressful by nature, and you are not in it alone. Help can come in several forms, some examples of which are listed below:
- Respite care: this can happen on an informal basis, when a friend or relative, or family member stands in to help with caregiving for you to take a break or run non-caregiving errands. It can also be paid services, with a professional caregiver coming to your home or you sending your loved one to a daycare center.
- Professional nursing care: It is also a good idea to consult with your loved one’s doctor to determine if/when professional nursing services may be needed, for instance in the case of an advanced stage dementia patient. This helps to ensure your loved one receives adequate care while relieving you from extra stress due to unfamiliar nursing procedures.
- Help with other responsibilities outside caregiving, such as housework, fetching kids to and from school, etc. When help is offered, be specific about what help is required, such as cooking, cleaning, laundry etc.
- Equip yourself (or your domestic helper if you have one) with caregiver training
Finally, no less important than getting help is to let go of expectations and control over people who help you. Insisting on having things done your way may cause you additional stress.
4.4. Stay Connected with Others
Lack of social support has been associated with caregiver’s stress and burnout. Avoid bottling in and practise sharing your feelings and emotions with family and friends. You can also join a caregiver support group to connect with those going through the same situation with you, sharing a listening ear or caregiving tips. Check out the following caregiver support groups in Singapore:
- Caregiver Welfare Association
- Caregiver for Elderly Facebook Support Group
- Support Group for Stroke Caregivers under Singapore National Stroke Association
- Support Group for Dementia Caregivers by Dementia Singapore
- Support Group for Cancer Caregivers by Singapore Cancer Society
- Other cancer support groups as detailed in our Home Care Guide for Cancer
4.5. Get The Necessary Appreciation
We all need to feel appreciated for our contributions. Caregivers however may not be thanked enough for their stressful work, because family members take it for granted, or because the care recipient is unable to express their feelings, for example in the case of dementia or stroke.
As a family member or employer of a caregiver, express gratitude and appreciation to the caregiver for their long-term effort and sacrifice. As a caregiver, find support from friends and loved ones who are appreciative, and give yourself the necessary appreciation.
4.6. Learn Stress-Reduction Techniques
A number of techniques can help keep chronic stress and burnout at bay, such as:
- Schedule time to exercise regularly
- Maintain a healthy diet and limit consumption of stimulants such as alcohol, nicotine and caffeine
- Consider picking up calming activities like deep breathing exercise, meditation or yoga to alleviate stress
- Ensure sufficient and quality sleeping time. Prolonged lack of quality sleep can endanger our heart’s health, among other negative effects, as covered in our article here.
5. Bonus: Tips to avoid caregiver stress during holidays
Holidays are occasions to take time off, plan for gatherings and celebrate. For caregivers, holidays often mean extra holiday planning and preparation stress on top of the usual caregiving. Sometimes celebration brings about the feeling of guilt without the ill loved one, or makes the caregiver miss the good old days when the family could celebrate together.
These feelings and emotions are natural. But letting them grow into caregiver stress is not. As the holiday season approaches, we are sharing holiday coping tips to help you avoid caregiver holiday stress, in addition to the daily caregiver stress management practices above.
5.1. Let go of unrealistic holiday expectations
It is unrealistic to host elaborate gatherings every day, visit multiple relatives while making sure your loved one takes medication and has 5 nutritious meals at the right intervals. Plan for what is realistically achievable, with your well-being as priority.
5.2. Delegate holiday responsibilities, caregiving and non-caregiving
Enlist others to help with holiday preparations or caregiving tasks. Friends may be busy with their own holiday planning, but perhaps your kids or spouses who are having off days themselves can help with decorating or picking up shopping. Getting respite care to help with holiday errands can be a good idea too.
5.3. Anticipate and prepare for stressful situations
Unexpected events can easily evolve into an emergency or ‘crisis’ without preparation. Do remember to check in with your loved one’s doctors if they are on holiday, and who to contact if they are. It might also be helpful to get extra prescribed medications ready for precaution.
5.4. Spend time with the person being cared for
Neglecting the care recipient during the holidays due to too much social responsibility can cause the caregiver to feel guilty and irresponsible. Manage this feeling by scheduling time to be with your ill loved ones, share holiday experiences with them even if they are not able to be out and enjoy it themselves.
5.5. Know that holiday is not just for celebration but also for rest
Holiday celebrations can disrupt our daily routine with extended or late-night gatherings. It is important to plan for down time to rest and relax during the holidays, so that you do not feel like you need to take time off with another holiday after the holiday.
6. Takeaway message
As the nation ages, we can expect the number of family caregivers, and the support they need, to keep growing. Though informal, they are an essential component of the healthcare network.
We hope the article provides helpful advice to caregivers to cope better with your caregiving responsibilities. Of all the coping strategies, self-care and getting help are the most critical. As Winie Trazona - Ninkatec’s resident caregiver - shared to other caregivers in her blog article, “Be strong and know your limits too. Take care of yourself while taking care of the patient. Be an encouragement to others. Be kind. Being a caregiver is rewarding.”
To read more sharing and tips on caregiving, check out our collection of articles curated for family caregivers here, including financial assistance and support for caregivers and care recipients, and various useful guides for caregivers including NG tube feeding, managing urinary catheter, preventing pressure sore, caring for a wound or stoma care at home.
To get respite care, nursing care support or caregiver training to your home, contact Ninkatec Care Team through the form or chat below.
