At a minimum, 22 million Americans have cared for a loved one with illness or disability during the past year. If you're one of them, the holiday season may pose exceptional stresses. Why should the holidays, usually associated with joy and good cheer, be especially taxing for caregivers?

One reason is that the holidays are a time of reminiscence when families may reflect on the losses an aging parent or chronically ill loved one has experienced over time. Memories of friends no longer living or activities no longer possible can be painful and cause an ill or elderly person to feel despondent. As a caregiver, you yourself may be reminded of the demands and constraints thrust upon you and long for a happier time.

Holiday family gatherings, usually happy occasions, can also have their stressful side. For example, siblings who get together at this time may disagree about what approaches to take with an aging parent. The primary caregiver may resent implied criticisms of how he or she has been managing the care. Old interpersonal frictions and conflicts can resurface.

At any time of year being a family caregiver can be demanding. Primary caregivers, three-quarters of whom are women, spend an average of 18 hours a week providing care. One in five spends over 40 hours a week. This kind of commitment takes its toll on families and personal lives.

For the two-thirds of caregivers who are employed outside the home, adjustments in work schedules and income loss are facts of life. Some must quit their jobs to devote themselves full-time to caregiving. Add to all this the planning, correspondence, shopping, food preparation and other tasks we take on during the holidays, and it is no wonder that some caregivers even dread the arrival of the season.

There are positive steps you can take to reduce stress and preserve the holiday spirit. Most important is to scale down expectations and simplify holiday planning. Make a checklist of just the essentials. Consider eliminating traditional but time-consuming seasonal activities. Recognize your own limitations and accept help-don't try to be superhuman.

Besides reducing your own stress, keeping things low key is also less disruptive for your loved one, especially if he or she has dementia. Unaccustomed activities often provoke agitation or disorientation in this setting. Elders with dementia do best if their regular routine is preserved as much as possible. Avoid large noisy gatherings and encourage visiting family members to share quiet time in small groups with your loved one.

Finally, recognize that while feeling stressed during the holidays is common, sustained sadness may be a sign of clinical depression. Be attentive to warning signs like apathy, loss of interest in activities that were once enjoyable, withdrawal from activities, impaired appetite, sleep disturbance, feelings of worthlessness and inability to concentrate. Symptoms like these are more than just holiday blues. They require professional intervention.

December, 2003