Caring for elderly parents is an honour and a blessing but it can just as equally become a trial and a challenge. When roles are reversed and children find themselves in the place of caregivers, they often find the patience and love their parents had bestowed upon them is not so easy to emulate.

Caregiving can be an emotional rollercoaster. It can be a highly rewarding experience where children get the opportunity to demonstrate their love and commitment to their parents but if, as is usually the case, it requires juggling careers, raising young families and other responsibilities, then it can also lead to enormous mental and physical strain.

Health care professionals varyingly describe this as the ‘caregiver burden’, ‘caregiving syndrome’ or ‘caregiver stress and depression’, which is a ‘multi dimensional response to the physical, psychological, emotional, social and financial stressors associated with the caregiving experience’. It is also an important predictor for negative outcomes of the care situation - for caregivers themselves as well as for the one who requires care.

Caregivers often report exhaustion and a feeling of ‘burnout’. This can happen because providing the best care possible might require putting one’s loved ones’ needs before their own. They develop poor eating habits and suffer from sleep deprivation. They don’t exercise enough and neglect their own illnesses, ignoring the need to make medical appointments for themselves because it would require extra time, money or effort. Inevitably such behaviour takes its toll. In addition to the physical consequences it can also lead to emotional problems. Caregivers may develop feelings of sadness, anger and loneliness, as well as resentment and guilt.

It is a well-established fact that family caregivers are more likely to have a chronic illness, e.g. high cholesterol or blood pressure, and they are at an increased risk for depression. Studies show that an estimated 46 to 59 percent of caregivers are clinically depressed.

This can be avoided to some extent if caregivers are aware of these risks and make an effort to take care of themselves. We are all familiar with the emergency flight instructions where passengers are told that in case of a drop in oxygen levels, those who are travelling with children must put on their oxygen masks before putting them on their children. This goes against all parental instincts, but it is important advice. We can only help others when we ourselves are in a position to do so.

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So caregivers must understand that it is not selfish to focus on their own needs and desires -- in fact it is an important part of the job. We may feel that our culture and traditions provide a much stronger support network and that we are not as vulnerable to these problems as those in the west may be. However, with changing trends, longer life spans, and financial vulnerabilities, we too are increasingly having to deal with these issues, and rather than going into denial and hiding behind false cultural superiority, it might be better to accept that the issue exists and learn whatever we can from the experience of others. People in the west recognize this problem and have developed what is referred to as the Caregiver’s Bill of Rights.

This provides a list of rights that caregivers need to be aware of, including the right to take care of themselves without feeling guilty, to recognize their own limits of endurance and strength, to be able to ask for help; to understand that it is okay to sometimes feel angry, sad or upset, and to be able to express those feelings without being judged.

It is also equally important for caregivers to learn coping mechanisms and self-care practices. There are many stress reduction techniques that caregivers can practice. Praying is a regular part of many people’s lives already but other things like yoga or meditation can also be helpful. Regular exercise, even if it is for ten minutes at a time, can be extremely beneficial. Relaxing activities like reading a good book, going for a walk, gardening, listening to music or taking a warm bath can all provide a well-deserved break. It is essential for caregivers to take care of their own physical and emotional health needs, to take time off and get proper rest and nutrition and to do this without undue guilt. Seeking support, talking to a trusted friend or relative, can also be cathartic.

For many caregivers these may seem impossible ideas and luxuries that they cannot afford to think about. However, it is important to understand that many barriers are mental and psychological more than anything else. A daughter-in-law who is the primary caregiver of an elderly parent could feel that going out with friends would be an unforgivable act and something that she would be taunted for and never allowed to live down, but this could easily be managed if the son were to share her duties, acknowledge and appreciate the hard work she puts in, and lets her have some time for herself. A family may be facing financial strains because of health-related expenses but discussing this in a rational and unemotional way may lead to a fair distribution and sharing of the burden. Learning how to manage time and money, delegating and sharing duties, planning properly, setting small, realistic goals and having a practical mindset can make even impossible tasks seem more manageable.

In the final analysis it is important for caregivers to be compassionate and kind to the elderly in their care because they owe it to them, but also to treat themselves well. The ultimate comfort children can give old parents is to show them that they are serving them with joy, because part of the equation is also that many parents become withdrawn and do not voice their needs out of guilt.

While some elderly patients can knowingly or unconsciously become cranky, demanding and making caregivers feel guilty (in which case it is important to understand and resist any manipulation), most feel they have become burdens on their children and, in extreme cases, may even wish for death to release their children from the forced duty of having to take care of them. This burden can be lightened when parents see that their children are healthy and relaxed. So even if they only do it for the ones they serve, family caregivers should look after themselves.