The more challenging the patients’ needs, the more complex, demanding, and stressful the caregiver’s role might be. Caregiving for patients with brain-related issues such as dementia, Alzheimer’s, brain injuries, memory loss, mental illness, or any of these combinations along with physical disabilities may be more stressful than for clients with less complex needs.

Stress and decreased time for personal needs are two major challenges that caregivers face. Stress may be constant as caregivers must flex and adjust to sudden changes and abnormal situations to accommodate their patients’ needs. A client with a history of head trauma or vertigo may have unexpected falls or accidents that require quick emergency room visits. Clients with addictive behaviors, head trauma issues, or mental health issues may require crisis stabilization or rehab center visits, especially if they sneak substances, choose not to take medications as prescribed, or self-medicate with multiple over-the-counter medications – despite the caregiver’s oversight.

There may not be a routine schedule each day – just routine tasks to get done between doctor and pharmacy visits. Constant change and stress often leaves little time for handling personal needs. Patients with brain-related issues may also exhibit unpredictable behaviors, agitation, angry outbursts, or inappropriate behaviors, which might include verbal or physical abuse from clients who are combative and resistant. Add to that stress and constant change, the wait times in doctors’ offices, a lot of driving to and from health-care facilities and pharmacies, and caring for the patient, and the caregiver may feel overwhelmed and/or exhausted.

Caregiving can often be undervalued by those who have never served in that role. So another stressor comes if caregivers are ignored by health-care providers, thinking that the caregivers are not credible. Some caregivers do have college degrees and health-care experience, plus some spend many hours a day with their patients. So it is wise for health-care providers to listen closely and give careful consideration to the caregiver’s observations and suggestions about their clients’ needs. As you know, a team effort brings greater success for everybody involved.

Caregivers need to have good communication skills and interpersonal skills; a lot of patience and stamina; and knowledge of health-care terms, medical conditions, and medications, because they often need to work through family situations, crises, and life-threatening events related to their client’s care, which may also involve law enforcement officers and attorneys.

Often caregivers find themselves working hard, receiving low pay, no vacation days, holidays, or sick days, and no health or dental insurance, with little ability to afford it. They also may have limited free time to spend with friends or to handle personal affairs.

Psychologically, whether paid caregivers or family caregivers, the challenges they face can easily result in burnout. Caregivers need to plan time for self-care so they do not slip into a state of mind where they feel discouraged, trapped, stuck, hopeless, or depressed.


The caregiving challenges just discussed can significantly affect a person’s physical, psychological, dental, and financial health, as well as his or her vocational well-being. Physically and psychologically, the stress can create high cortisol production, which can bring with it increased weight gain, fatigue, a depressed immune system, adrenal fatigue, lack of energy, interrupted sleep, hormonal imbalances, difficulties thinking clearly, and/or major depression.

According to Drs. Janice Kiecolt Glaser and Ronald Glaser, the “stress of family caregiving for persons with dementia has been shown to impact a person’s immune system for up to three years after their caregiving ends, thus increasing their chances of developing a chronic illness themselves.”7

Zarit in the Assessment of Family Caregivers: A Research Perspective, states that “40% to 70% of family caregivers have clinically significant symptoms of depression with approximately a quarter to half of these caregivers meeting the diagnostic criteria for major depression.” With limited free time and being tired, the caregiver’s ability to handle personal needs and cultivate friendships may decrease, which may then contribute to isolation and depression. The impact of stress is especially significant in some caregiving situations. “Family caregivers experiencing extreme stress have been shown to age prematurely. This level of stress can take as much as 10 years off a family caregiver’s life.”

A caregiver’s dental health may also decline under these stressful conditions with the outcome being a neglect to floss regularly, brush well, eat healthy, and make self-care a priority. These may contribute to increased caries or the development of periodontal disease.

The physical and psychological impact of someone caregiving at home may also bring financial and vocational stress. Being tired from caregiving duties may limit how well the person performs at work, which may cause work hours and paychecks to shrink.

With the need for caregivers increasing, you can expect to have more patients and co-workers who are caregiving. Your awareness and sensitivity to their needs will increase patient satisfaction, patient loyalty, and referrals to your office, as well as improve efficiency and create a more pleasant work environment.

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