Janet Cromer’s journey as a caregiver for her husband began with a traumatic event—a heart attack on an airport tarmac. In a little over an hour, Janet’s husband, Alan, lost the ability to read, write, walk and talk. All memories of his life, marriage and family had vanished.

The ensuing seven years were a rollercoaster ride of highs and lows for the Cromers. Like many caregivers, Janet waged a constant war against anxiety, depression and burnout. As a psychiatric nurse, she understood that the emotional hurdles she experienced during Alan’s extensive rehabilitation weren’t entirely unique to her. She decided to write a book, Professor Cromer Learns to Read: A Couple’s New Life after Brain Injury, to help other families navigate the many ways in which caregiving alters one’s life, identity and relationships.

Stress Abounds in the Caregiver Combat Zone

When juggling the medical, financial and emotional aspects of a loved one’s care, there never seems to be enough time or energy for caregivers to get ahead of their responsibilities and enjoy some down time. Much attention is focused on the overall concept of caregiver stress, but little consideration is given to the varying physical and mental reactions people have to this high-pressure environment.

According to Robert Motta, PhD, director of the Child and Family Trauma Clinic at Hofstra University in Long Island, New York, the most common manifestations of caregiver stress are compassion fatigue and burnout spawned by chronic feelings of anger, sadness, anxiety and guilt.

But, if a caregiver is exposed to a jarring traumatic experience, such as witnessing a loved one die suddenly of a heart attack or seeing them struggle with an excruciating ailment, they may develop symptoms of post-traumatic stress disorder (PTSD). PTSD is an anxiety disorder marked by flashbacks, nightmares and hyper-vigilance that occurs after a person experiences a traumatic event.

Although PTSD is commonly associated with survivors of disasters, first responders, combat veterans, and victims of abuse or violence, symptoms can also strike those in the trenches of caregiving. “The sudden loss of a loved one is similar to experiencing death in war,” explains Dr. Motta.

Seeing an elderly loved one fall down the stairs or caring for someone who is prone to angry, violent outbursts can also result in a heightened “fight or flight” reaction to trauma, Cromer says, and further trauma may eventually lead to full-blown PTSD.

But, while anyone can develop PTSD, it’s important to understand that this mental health condition doesn’t present the same way in each person. The exact cause can vary. Certain people may not think twice about a particular occurrence, whereas this same event might trigger PTSD symptoms for someone else. Risk factors for PTSD include long-lasting or repeated trauma, anxiety, depression, temperament, and having a job that, like caregiving, increases one’s risk of exposure to further trauma.

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Survival Strategies for Caregivers on the Front Lines

Although she did not develop PTSD herself, Janet Cromer did struggle with depression while caring for her husband. His confusion and frustration occasionally manifested in dangerous outbursts. “The unpredictability of his moods put me on edge,” she admits. “He soon forgot his bad behavior, but I had to actively calm myself down to keep us both safe.”

While Cromer’s background in nursing and mental healthcare did put her ahead of the learning curve in some regards while caring for her husband, she still had difficulty managing her stress levels from time to time. She shares the following advice with fellow caregivers who may be teetering on the edge of burnout or experiencing symptoms of PTSD.

6 Strategies for Managing Stress and Preventing PTSD

  1. Regularly scan yourself for symptoms. “Recognize the symptoms of PTSD and get help early,” Cromer advises. She believes her willingness to seek out professional assistance is what helped her overcome depression while caregiving.
    Self-awareness takes some practice but try to be on the lookout for symptoms of PTSD. These include reliving a traumatic event in ways that interfere with daily life (flashbacks, nightmares and intense reactions to circumstances that mirror the dangerous event), being easily excitable, feeling emotionally numb or detached, and having trouble recalling the specifics of the traumatic event.
  2. Always have backup. When caring for an aging loved one, few things are as important as a strong support system. According to Dr. Motta, having a group of friends and/or family members that you can vent to is invaluable. But, while these people are important sounding boards, they may have some difficulty fully understanding what you’re going through if they haven’t had some sort of hands-on caregiving experience of their own.
    This is where caregiver support groups come in. Both in-person and online groups are a great way to connect with fellow caregivers who can relate to what you’re going through, offer advice and give you a shoulder to lean (or cry) on. Cromer believes so strongly in the benefits of social support that she co-founded a group for families affected by brain injuries. “The group provided me with understanding, friendship and updated skills for the ‘new normal’ that I had been trying to navigate on my own. Over time, I learned valuable lessons about my own strength and resilience and how to ask for (and accept) help.”
  3. Fortify your mind and body. Engage in some type of stress-reducing activity every day, whether it’s praying, punching a pillow, meditating, exercising or journaling. “Even ten minutes can lower your anxiety and clear your mind,” Cromer assures. Self-care is a crucial part of striking a “healthy” balance while caregiving. Implement a no-excuses policy when it comes to engaging in practices that promote your physical, mental and emotional wellbeing. Eat right, exercise often and take time every day to do at least one thing you love.
  4. Set your boundaries and stick to them. One of the trickiest aspects of taking care of a loved one is learning how to set boundaries. Many caregivers tend to overindulge their loved ones initially, especially after a sudden health crisis, because they want to be helpful and minimize pain and hassle. However, if an elder gets used to this, you may quickly find yourself at their beck and call around the clock, even when they are perfectly capable of handling these tasks themselves. This is particularly common with elders who have historically been manipulative, abusive or lazy.
    “Don’t do anything for the sick person that they can do for themselves, and do not let anyone bully or threaten you,” urges Cromer. If you get into this routine, you’ll likely find yourself exhausted and you won’t be doing your loved one any favors either. Their recovery or rehabilitation may be hampered by your attentiveness, and they may end up losing what functionality they have left.
  5. Beware of friendly fire. For caregivers, having the ability to empathize with a care recipient is crucial. But, there is a point where compassion can run a little too deep and lead to secondary traumatic stress (also known as compassion fatigue). Witnessing a loved one’s mentally and/or physically painful situation can take such an emotional toll on some caregivers that it affects their quality of life and ability to provide care. Respite, counseling and caregiver support are crucial for avoiding the cumulative effects of secondary trauma.
  6. Don’t hesitate to bring in reinforcements. In addition to self-care, every caregiver must build respite into their loved one’s care plan. Regular breaks are the best defense against caregiver burnout, PTSD and other physical and mental health issues that can arise from the stress of caregiving.
    It doesn’t matter if you ask a next-door neighbor, friend or family member to watch your loved one for a little while each week, if you take them to adult day care, or if you hire in-home care. Do whatever is in your power to regularly extricate yourself from your caregiving bubble so you can do something that rejuvenates you and brings you joy.
  7. Have an escape plan at the ready. Cromer advises being honest and realistic when it comes to the kind of care you are willing and able to provide. “The time may come when the level of care a loved one requires will exceed your capabilities and endanger your health and possibly your other relationships,” she says. Many people aren’t sure what their breaking point is until they reach it. Being self-aware and proactive about this issue can help you prepare and avoid scrambling to find elder care solutions at the last minute.

Courage and perseverance helped Cromer and her husband cope with his injury and its consequences. It was a struggle, but eventually they were able to re-define their relationship and find meaning and even joy in their new reality. Their journey together ended when Alan passed away in 2005.

Cromer now travels around the country, advocating for caregivers and speaking about the unique struggles they face. Her fundamental piece of advice for those who are taking care of ailing loved ones is to “appreciate that you are human and give yourself credit for all of the wonderful forms of care you provide.”