Janet Byron* knows that when her husband's Parkinson's progresses to the point that he needs significant care, she probably won't be the one providing it.

That's because Ms. Byron, 54, knows herself well enough to know that she's too much of a "control freak" to deal day in and day out with the unrelenting, often uncontrollable, effects of a chronic disease. She also knows that giving up her career as a pharmaceutical executive would be so devastating to her sense of self that she probably wouldn't be much good to her husband anyway.

In one way, at least, Ms. Byron is lucky. She has the money and the knowledge of the health insurance system to ensure good care for her husband. Most women don't. And that's why 75 percent of "informal" caregivers for patients with degenerative neurological conditions like stroke, Parkinson's, Alzheimer's and multiple sclerosis are women.

Caring for someone with a progressive, debilitating condition can be so stressful and damaging to the caregiver's own health that they are sometimes called the "hidden patients." The cascade of stress hormones that results from the chronic, unremitting stress of caregiving can devastate a person's immune system, leaving them vulnerable to a variety of illnesses. Overall, one analysis found, family caregivers for someone with dementia have a 23 percent higher level of stress hormones and a 15 percent lower immune response than people who aren't caregivers.¹⁴

Caregivers also have increased rates of heart disease, hypertension and depression. And, several studies find, women caregivers tend to have more health problems than male caregivers.¹⁵

"Caring for someone with Alzheimer's is enormously stressful," says Carol Lippa, MD, professor of neurology at Drexel University's College of Medicine. "They are often abusive, or, at best, unappreciative of the caregiver and the fact that the caregiver has put her entire life on hold." That's why it's so important that caregivers take care of their own needs. Among the steps to take:

• Join a support group. Numerous studies find support groups, even online or telephone support groups, can help caregivers better cope with the stress of their lives.¹⁶ Dr. Lippa particularly recommends local chapters of the Alzheimer's Association (see Resources). "There are a lot of practical things they can share with you to make the management easier so you can keep your loved one at home longer," she said.
• Find respite care. This could be another family member, a paid attendant or adult day care. If you can find a way to carve out two hours a day for errands, exercise or just a nap, you'll do more to reign in those damaging stress hormones than any medication.
• Learn about your loved one's condition. Many hospitals or local chapters of national organizations provide printed and electronic information about conditions such as stroke and Alzheimer's. Studies find the more you know about the condition, the better able you are to cope.¹⁷ And, the more you know, the better you can supervise the care you arrange for your loved one.
• Get some form of daily physical exercise. You may think you don't have time, but even a 10-minute walk by yourself will provide such a lift in terms of mood and energy that it will feel as if you've gained time.
• Maintain a social network. Studies find that maintaining social relationships with friends and family while caregiving is one of the greatest buffers against the damaging effects of caregiver stress, improving overall health.^18,19
• Consider psychotherapy. Not only will it give you a safe place to unburden yourself, but your therapist can help you learn new ways to view and manage the challenges of caregiving.
• Focus on things you can control. Active coping, in which you solve problems related to specific situations rather than just giving in, can significantly reduce levels of distress, poor health habits and the risk for depression in caregivers, several studies find.¹⁵X

*Not her real name.

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