单项选择题
With parents living routinely into their 90s, a second round of caregiving has become a predictable crisis for women in midlife. Nearly 50 million Americans are taking care of an adult who used to be independent. Yes, men represent about one third of family caregivers, but their participation is often at a distance and administrative. Women do most of the hands-on care. The average family caregiver today is a 48-year-old woman who still has at least one child at home and holds down a paying job.
It starts with The Call. It’s a call about a fall. Your mom has had a stroke. Or it’s a call about your dad-he’s run a red light and hit someone, again, but how are you ever going to persuade him to stop driving
When that call came to me, I froze. The shock plunges you into great fear, denial, and even crazy action. You search out doctors. They don’t agree on the diagnosis. You google the Internet. The side effects scare you. You call your brother or sister, hoping for help.
It begins to dawn on you that your life is also radically changing. This is a caregiving role that nobody applies for. You don’t expect it. You aren’t trained for it. And, of course, you won’t be paid for it. You probably won’t even identify yourself as a caregiver. So many women tell me, "It’s just what we do."
There are many rewards in giving back to a loved one. And the short-term stress of mobilizing (动员 起来) against the initial crisis stimulates the body’s positive responses. But this role is not a sprint (冲刺). It usually turns into a marathon, averaging almost five years. Demands intensify. Half of family caregivers work full time. Attention deficit is constant. But most solitary caregivers who call hotlines like Family Caregiver Alliance wait until the third or fourth year before sending out the desperate cry: "I can’t do this anymore!"
The caregiver becomes exhausted, but can’t sleep. Lasting stress turns on a steady flow of cortisol (皮 质醇). Too much cortisol shuts down the immune-cell response, leaving one less able to ward off infection. Many recent clinical studies show that long-term caregivers are at high risk for sleep loss, immune-system deficiency, depression, anxiety, and loss of concentration.
Sick elders seldom say thank you. On the contrary, they often put up fierce resistance to the caregiver’s efforts. "A major component of psychological stress that promotes later physical illness is not being appreciated for one’s devoted work" explains Dr. Esther Sternberg, a stress researcher and author of The Balance Within: The Science Connecting Health and Emotions. She places caregivers at the same risk for exhaustion as nurses, teachers, and air-traffic controllers.
Once the caregiver gets so stressed out emotionally that her own health declines, she can no longer provide the care. The only option left is to place the family member in a nursing home-the last choice of everybody, the most expensive for taxpayers, and guaranteed to leave the caregiver burdened with guilt.
It doesn’t have to be this way. From hundreds of interviews with caregivers and my own experience of 17 years in the role, I can suggest some survival strategies:
Ideally, have the conversation with your brothers and sisters before the crisis with Mom and Dad. Make it clear that you cannot do this alone. If the crisis is already upon you, hold a family meeting-in person-but don’t set yourself up as the boss. Ask a neutral professional-your parent’s primary doctor or a social-worker-to act as mediator (调解人). Everyone will be informed of the diagnosis and care plan at the same time. Ask your brothers and sisters to come prepared with "What I can do best." One may contribute money, another has more free time. Everyone has to feel valued.
Download a free Internet-based care calendar that is totally private and can function as the family’s secretary, coordinating dates and tasks to be shared.
Join a support group. Learn from veteran caregivers, who are eager to offer practical solutions and know out of instinct what you need emotionally. Regular exercise is vital to prepare the body for more refreshing sleep. Ask for appointments for your physical examinations or tests at the same time and place where you take your family member.
You must take at least one hour a day-but every day-to do something that gives you pleasure and refreshment. Take a swim. Call a friend for coffee. Window-shop. Try a yoga class. All this allows your nervous system to reset.
You will also need longer breaks every few months. Gall your local Area Agency on Aging and ask where you can take your family member for a rest. Rehab (康复) facilities often have some beds for the purpose. Under Medicaid (医疗补助制度), the caregiver is entitled to three or four days away every 90 days.
When it becomes clear that your loved one does not have long to live, the caregiver who survives must begin the effort of coming back to life. There is danger in remaining so attached to your declining loved one that you lose your "self."
This is the time to refill your emotional attachments (喜好). Reach out for old friends, grandchildren. Take a class at the local community college. Join a book club or a baseball league. Meeting new people is a natural remedy to late-stage caregiving. New attachments are a bridge to your new life.
A. The middle-aged male caregivers.
B. The middle-aged female caregivers.
C. The middle-aged people who have loved ones dying.
D. Working people who have children and elders to care for.