It is an irrefutable reality that our society is ageing. Life expectancy is increasing, at least for most sectors of society, the large "baby boomer" generation is rapidly retiring from the workforce and many people have delayed childbearing until their thirties or forties. When we do have children, small families are the norm. This all adds up to a community of many elders who will eventually need caregivers. Who will look after the elderly as they make the inevitable transition from spritely to dependent?
Does this role fall to professionals, health care workers and institutions or will it be a private matter, handled within families?
Currently, there is a mixture of family and professional caring going on. This is not a new phenomenon - elders have always eventually shifted from giving to receiving care if they live long enough. What are new are all the other pressures on caregivers. Is it possible to maintain a feeling of kindness and compassion in trying circumstances? It sounds easy enough, especially for those adults who have made concerted efforts to live up to their own idea of compassion. The reality may well be very different from our ideals.
An adult in our society who considers themselves to have a compassionate heart will gladly care for children in their own immediate family and extend that care into their community. A compassionate person will seek to understand the challenges facing other people and take action to ease the suffering of others. This may take the form of activism, charity or simply consuming less. If they have the means they may donate time, money or energy to worthy causes. A compassionate person is very likely to make conscious choices in order to care for the welfare of people, animals and the environment. But the choices required of them are less clearcut when it comes to the care of their parents.
The term "sandwich generation" has made its way into modern language and is even in some new dictionaries. It generally refers to the middle generation who care for children under 15 and parents or grandparents over 65. Of the over 65 age group, it is the growing numbers aged 85 and over who are termed the "old old" and are most likely to be suffering with disabilities, dementia and declining health.
Despite feminism, it is still daughters and daughters in law who most often take on the role of caregiver for elderly relatives. Studies show that men have tended to do more garden work, transportation and household maintenance for their ageing parents, while the intensity of personal care including bathing, dressing and toileting has fallen to women. These gender tendencies have meant that sons have played an important part in keeping parents in their own homes, while daughters have often become intensive caregivers.
The impact on the health of a caregiver is significant. Some studies have shown dramatic decreases in health and wellbeing, particularly for those who have a live-in elderly relative. Numerous studies have shown that co-residing with an elderly parent is a strong predictor of caregiver strain. In a 2002 Canadian study of live-in caregivers, 22% reported sleep disturbance, 50% changed social activities and 43% changed their holiday plans.
Yet the impact is not all negative. A large group of caregivers reported increased self esteem due to a feeling that they could give back to their parents some of the care they had received as children. Many felt that their relationship with the parent was strengthened and this closeness provided a link to cultural and family history.
Researchers are divided about whether people suffer in the caregiving role. The difference is something intangible. Perhaps it is a subtle difference in attitude. Maybe genuine compassion changes the stress of looking after someone into a positive experience?
When we care for young children there is certainly stress, especially if there is little support available. Primary caregivers give up or postpone careers, make financial sacrifices and put their own desires largely on hold. They, too, suffer sleep disturbances and are forced to alter their social life and travel dreams. Yet the investment of time and energy is returned when they enjoy a close relationship with a young person. The child learns, grows and matures towards independence. Our society offers some support for people doing this valuable job. Now we have paid parental leave, family tax benefits, subsidised day care and a generally child friendly culture.
The situation is reversed for caregivers of the elderly, especially if the ageing person is disabled or demented. We tolerate incontinence in early childhood much more than we can in the elderly, unless we have really developed compassion. For an adult caring for both young children and an elderly parent, there are distinctly competing demands. It's not surprising this can lead to exhaustion.
When it comes to the crunch it is natural and normal to give preference to the needs of children over parents. Our sense of family obligation must flow forward to the younger generation in order to continue the family. So at what point do we hand our elders over to nursing homes or hospitals? Often it is when a crisis occurs, a fall, a broken bone, a stroke or seizure. When the demands of caregiving become more than we are equipped to handle we must reach out for help. When we seek support do we find a compassionate system? It is seldom what we would hope for and it is worsening as the demand for beds and staff increases.
Certainly, there are dedicated carers and talented medical professionals. But when the crisis is averted there is still a big question mark over what to do for the best. How do families work with medical professionals and social workers to make the best, most compassionate care decisions?
Based on surveys of families, the system as it exists currently is ill equipped to provide suitable care for a high need, but essentially well, older person. If they remain in hospital they are vulnerable to infection and often feel more disoriented and frightened than ever before. If they go home, the burden for high intensity care returns to the family members who may or may not welcome the workload. It is common to be faced with a fear that the older person will pass away at home and this can cause distress for all concerned. There are some wonderful home care services, but they are either costly or limited. Not every older person will qualify for them.
If we feel some sense of gratitude towards our parents, it is not the same as owing them anything. Parenting is done in the spirit of unconditional love, an act of giving without need for reward. And if we have felt neglected or even abused by a parent we may not even have that sense of gratitude at all. So what is the compassionate approach to elder care?
Holistic health must encompass all phases as well as all aspects of our lives. So just as we can seek to understand the needs of a newborn baby by imagining life from their perspective, we must also put ourselves in the shoes of needy older people. As complex as family relationships might be, we will all, barring tragedy, be elderly one day. How would you like to be treated?
Perhaps you will think of your adult children and grandchildren and seek to alleviate any burden from them. This might take the form of self care. Keeping physically fit will slow the degenerative effects of ageing, as will a nutritious and well balanced diet. Giving up the self harm of refined sugar, saturated fats, smoking, drinking and any other health compromising vices will help. There are so many ways to stay engaged, including participating in family life avidly. When younger people take up new technology, learn how to use it, too. Read widely and seek out thought provoking media. Continue to meet new people by getting involved in social events and recreational activities. If you have been fortunate enough to have passionate interests, continue them as long as possible. If one interest becomes unsuitable (rock climbing is probably not for the over 70s although there are bound to be exceptions), find an alternative (an indoor rock climbing wall should suffice).
A compassionate life is also a healthy life in every sense. Give without thought of reward as often as possible. If caregiving falls to you, do it as graciously as you can. If you feel resentful, search your heart for compassion and ask for help. The whole of society is responsible for each member and must support compassionate choices. Just as it takes a village to raise a child, it also takes one to nurse an elder.
Chandrika Gibson ND is a holistic yoga teacher and naturopath