First to go is the time, or even the energy and desire, to maintain friendships. Even maintaining friendships that go back years can seem like just one more thing to do when a caregiver is so swamped with demands.

So, caregivers stop seeing friends, hence friends stop asking them to do anything fun. Friends get tired of being turned down. And caregivers forget that life was once fun. They are too busy giving care to everyone else to even notice the loss.

Then there are the children at home. I had two young sons when I started going through my two decades of elder care, seven elders total. One of my sons has multiple health issues. I believe I gave my sons as much attention and care as any mother could, but I was always torn. It seemed someone always needed me. A child was sick and an elder's personal alarm was set off. What should I do? How should I handle it?

Or I'd just be having fun with my sons, and I'd get called away on an emergency. My sons got used to me telling them that we had to stop what we were doing, be it playing music, reading or a craft, because I had to run to Grandma's and see what's wrong, since her personal alarm was set off. Or I had to meet the ambulance at the emergency room, because Grandpa fell at the nursing home and broke his arm. Or I needed to reschedule my uncle's doctor appointment, because he was had gotten the flu.

Certainly, it doesn't hurt children to know that elders need care, and children need to share their parents with the older generation. Likely, my kids had a little too much of that, but they survived. However, some children have much tougher issues than mine had to face. Some have grandparents with dementia living in their home, verbally or even physically abusing them. Or a single mom and her kids find it more economical to live with the grandparents, but the grandparents end up sucking up all of Mom's time. The parent – the caregiver to generations – can't see a way out, so the family stays. But the relationships with the children are damaged.

And then there are the marriages. I hear from many caregivers who have supportive spouses, but I also hear from many who do not. The spouse feels neglected. The spouse never liked the elder, and now that the elder needs a lot of care, the spouse becomes even more resentful. The stress in the marriage can be intolerable for both sides. Marriages can and do break, under the stress of caregiving.

How much do caregivers owe their aging parents? Do they owe their health, their financial future, their family relationships? Where does "honoring your parents" begin and end?

I don't believe anyone owes their own health, their marriage or their children's emotional well-being to the elder that raised them. In most cases, the elders, if they could think straight, wouldn't want that kind of sacrifice made for their benefit. However, often they've gotten to a point where they don't recognize what they are demanding of the caregiver, so they resent not getting every need met and make that resentment well known.

This is where caregivers must take a stand. They must look for outside resources such as their state aging services for some direction. They must learn to balance their love and their time, giving as much care as possible to the elder, yet making sure that they have time, patience and energy for their children, their spouse and even their friends. If they don't do this early on, breaking the pattern will become harder, though not impossible, as time passes.

Certainly, if the elder's life is coming to a close, the whole family should gather around in support. But if elder caregiving is a long-term situation, the caregiver should look for balance. She needs to set boundaries as far as the elder care goes. If she does not, all relationships that matter will be damaged, even the relationship with the elder. The caregiver who feels she has given up everything for everyone else will find that no one got what they needed. If the elder care situation sucks the life out of all other relationships, everyone loses.

Keep Caregiving From Ruining Your Other Relationships

In the 1970s, there were ongoing debates about whether a woman could balance a family with a career. The discussions centered on being a good wife, mother and employee. The question seldom posed, in those days, was how, besides being a wife, mother and career woman, could a woman also be a good daughter?

Today, we hear about the toll elder care takes on families as routinely as we heard the former arguments in the '70s. Adult children are being faced with choices (or seemingly, assignments) they never thought about before. They are raising children or teenagers and holding down a job, when suddenly they find that their aging parents need an ever-increasing amount of attention.

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Why is elder care more of an issue now than in the past? For one thing, people are living longer than they used to and, often, they are not living with good health. Yes, we all love to point to the 93-year-old guy out there playing golf everyday, and these people exist. I know a couple of elders like that and they are a joy to behold.

However, many elders today are stroke survivors, or are suffering from diabetes, lung problems or dementia. Sometimes they have a combination of these ailments, and others, which likely would have caused death even a decade ago. Now, medical advances provide lifesaving options. Many of these people live – some even living fairly good quality lives – but they need assistance from family or paid attendants.

Another piece of the puzzle is that many people have chosen to have children at a later age, thus putting them in a position where they have young children and older parents at the same time. This can be a delightful combination, as long as the elders are reasonably healthy, but when they are not, the adult children of the elders, also parents of young children, can be faced with very difficult choices. These are the people now famously known as the Sandwich Generation.

Whatever the circumstances are that propel people into elder care, the problems that can come from it are myriad. All you have to do is visit the online caregiver support forums and you'll quickly see that many caregivers, both men and women, find themselves feeling pulled in so many directions that they can no longer find their soul.

They fear for their own health – mental and physical – as they try to take care of the needs of three generations, the most demanding often being the elders. Caregiving for a sick elder, especially one with dementia, can become so all-consuming that the caregiver's other relationships suffer.