Tips for Working With Older Caregivers
Flexibility and understanding are the watchwords for fitness professionals.
Adults over 50 who are caring for aging parents are not like other fitness clients of similar age.
For starters, caregivers tend to be less healthy. A study by the insurance company MetLife noted that “adult children 50+ who work and provide care to a parent are more likely to have fair or poor health than those who do not provide care to their parents” (MetLife 2011). Another study showed that 17% of caregivers felt their health had gotten worse as a result of their caregiving responsibilities (Feinberg et al. 2011).
The MetLife study estimates that 10 million adults over the age of 50 are caring for their parents. They’re taking care of “instrumental” activities such as grocery shopping, transportation and finances, and they’re helping out with basic activities of daily living such as dressing, bathing and feeding. When all the additional support (housework, paperwork, errands) is factored in, the “opportunity costs” can be exorbitant—particularly when viewed in terms of the caregivers’ loss of leisure and personal time.
All of this exposes adult caregivers to declining health, chronic diseases and depression, the MetLife study reported. Fitness professionals who understand the unique needs of older caregiver clients will be better able to provide targeted, appropriate services.
Physical Needs of Older Caregivers
John Poole, 54, of Stratford, Connecticut, illustrates what those of his age group are going through. Before he became fully involved in the full-time care for his 97-year-old mother, Pool was very fit and athletic, with a regular exercise program that included rowing, running and skiing. While he has given up these activities due to his caregiving responsibilities, he still needs to stay healthy and to remain strong enough to perform some of his caregiver tasks. Poole names three of his chores that require specific strengths:
Completing pivoting transfers.
These transfers involve moving a person “from one horizontal surface to another—for example, from wheelchair to power stair lift, or from wheelchair to car seat, or bed to commode, or wheelchair to shower bench,” he explains. “These [movements] require good upper-body control and lower-back strength. I must have control all the way through so the transfer goes smoothly and my mom doesn’t get dropped onto the target surface in the last phase of the transfer because of lack of strength or improper technique. I know that technique is important, but you still need strength to maintain control.” Poole also needs leg strength so he can take on his mother’s full body weight during transfers, as she is unable to assist.
Pushing a wheelchair up ramps.
“Wheelchair ramps can get steep, especially the portable ones. The key is to maintain control and not fade before you finish. Unlike transfers, pushing a wheelchair up a ramp can also require some brute strength and endurance.”
Carrying and storing gear.
Poole mentions that caregivers also need to deal with all the gear their charges need, such as wheelchairs, walkers and portable ramps. “You generally need to be strong enough to lift a collapsed wheelchair up off the ground to about waist height, sometimes higher, and place it in the trunk or rear seating area of a car. Then you have to lift it out again, without hurting your back.”
Effects of Chronic Pain and Stress
Caregivers are more susceptible to pain due to chronic stress, Stanford University health psychologist Kelly McGonigal, PhD, writes in an article about caregiver back pain at Next Avenue, a website for Americans over age 50. “The stress that caregivers experience activates the nervous system, both causing pain signals to reach the brain more rapidly and amplifying those signals,” McGonigal notes. “This makes low-level pain you might be able to naturally suppress when you’re not under stress impossible to ignore” (Roberts-Grey 2012). Fitness pros assessing caregiver clients need to be on the lookout for chronic muscle tension and stress-related chronic pain.
Pamela Hernandez, an ACSM CPT and ACE health coach based in Springfield, Missouri, has some exercises to suggest. “Caregivers need to focus on stability in the core, including the erector spinae and multifidus muscles. Workouts should focus on correct form and muscle engagement in movement patterns like pushing, pulling, squats and balancing.” A few of her favorites are bird dog, stability ball roll-out, Superman, plank and windshield wiper (see the sidebar).
Compassion Is Critical
Having empathic, flexible trainers is paramount. As Hernandez explains, “Caregivers often have less of a support system in place to make things happen, because
are the support system for everyone else.”
Stephanie Felder of Philadelphia admits she feels sandwiched between raising her young children and caring for her aging father. If she’s not feeling motivated, it’s because she’s thinking about her father’s needs. “Any trainer who works with me should be genuinely interested in helping me achieve my goals. I am not looking for a friend, but for someone who is understanding and motivating. Be aware that I may have to change my scheduled time to take my father to a doctor appointment—or that if I am not focused, I may just be tired.”
Part of being compassionate includes accommodating stressful schedules. Dan Ritchie, 2014 PFP Trainer of the Year and owner of Miracles Fitness in Lafayette and West Lafayette, Indiana, advises that time is an imperative for caregiver clients. “For caregivers, their 30 minutes in the gym might be all they get that day for self-care,” asserts Ritchie, who suggests using that time to be kind and patient, understanding that these clients are enduring tremendous stress. “And it’s not stress they can avoid or reduce. You need to be a source of stress relief, escape and enjoyment. They need to leave rejuvenated, not crushed. This is a place for an empathetic trainer, not a drill sergeant.”
Strict policies for no-shows, cancellations or frequent appointment changes may not be appropriate for caregivers. Decide in advance how flexible you can be with last-minute changes and whether you need to make an exception to your standard policy.
Ritchie emphasizes the importance of recognizing that doctor appointments, sickness and emergencies can arise with little warning. “Caregivers have legitimate reasons to cancel and reschedule on short notice,” he declares. If you’re prepared to accommodate such changes, you can turn these people into long-term, loyal clients. You can’t have the typical conversation about being on time and consistent if the clients simply cannot control their schedules.
Engagement, Wellness and Self-Care Needs
Meg Root, a wellness coach and speaker from Corona, California, urges trainers to take a holistic view: “It takes skill and know-how to work with people in challenging situations, and to make it fun and inspiring versus being just a workout,” she shares. “Encourage caregivers to walk every day and eat healthfully. Talk about ways they can stay engaged in life and in the activities they enjoy. I have a theory that ‘engagement’—more than some other measures of fitness—is the key to a long life.”
Staying engaged also helps alleviate depression. Knowing that depression is common among caregivers can help fitness pros serve these clients more effectively (Covinsky et al. 2003). Sometimes, by sharing statistics and information you can help people to normalize their feelings. For example, in the Covinsky study, 32% of caregivers had six or more symptoms on the 15-item Geriatric Depression Scale. The good news is that exercise decreases depression, so focusing on the benefits may also increase caregivers’ sense of well-being. For example, one study found that progressive resistance training was an effective antidepressant that also improved strength, morale and quality of life (Singh, Clements
Helping Clients Put Themselves First
Cathy Sikorski of Pottstown, Pennsylvania, is an elder law lawyer who has been a caregiver for seven people over the past 25 years. Her advice for trainers: “Be aware of the fact that I will often put others before me. You should encourage me to know that this is a mistake in fitness and general health. My ideal fitness pro would challenge me gently, as my life as a caregiver is already full of challenges, but this person would help me to realize that even in the seemingly stagnant life of caregiving, fitness routines can actually be a desperately needed breath of fresh air.”
Colin Milner, CEO of the International Council on Active Aging, in Vancouver, British Columbia, agrees. “Help them understand that their health must come first. Almost 50% of older caregivers say their own health and well-being comes second to caring for the health needs of loved ones. The problem is that if the caregivers’ health is poor, they will be unable to provide care.”
Helping clients cope with guilt is another challenge for trainers. The Caregiver Guilt Questionnaire finds that for many caregivers, a high score for feeling guilty correlates to depression (Roach et al. 2013). Normalizing the guilty feelings by sharing information and statistics might help caregiver clients give themselves permission to accept and internalize the importance of self-care. When dealing with clients who show symptoms of depression or extreme guilt, you will want to have some counseling and psychological referral resources on hand.
Sikorski discloses, “As a caregiver, I concede that sometimes, but only sometimes, fitness or exercise for that day will take a back seat, and I will give up the guilt about that. This does not address those who are really in the trenches with caregiving 24/7. I believe that they are constantly attempting to figure out how to fit in any kind of fitness, as well as dealing with the guilt of that and so many other things. Clearly, we need to find ways to help them—with others coming in to share their duties and give them time to get and stay fit.”
Working with caregivers can be very rewarding, because they really need your services. In the end, a combination of offering “gently challenging” exercises, as Sikorski puts it, and planning for last-minute changes will make you a fantastic partner for this group.
Covinsky, K., et al. 2003. Patient and caregiver characteristics associated with depression in caregivers of patients with dementia. Journal of General Internal Medicine, 18 (12), 1006-14.
Feinberg, L., et al. 2011. Valuing the invaluable: 2011 update—the growing contributions and costs of family caregiving. AARP Public Policy Institute. Accessed Feb. 10, 2015. http://assets.aarp.org/rgcenter/ppi/ltc/i51-caregiving.pdf.
MetLife. 2011. The MetLife study of caregiving costs to working caregivers: Double jeopardy for Baby Boomers caring for their parents. MetLife, Mature Market Institute. Accessed Feb. 10, 2015. www .caregiving.org/wp-content/uploads/2011/06/mmi-caregiving-costs-working-caregivers.pdf.
Roach, L., et al. 2013. Validation of the Caregiver Guilt Questionnaire (CGQ) in a sample of British dementia caregivers. International Psychogeriatrics, 25 (12), 2001-10.
Roberts-Grey, G. 2012. Keep caregiving from taking a toll on your back. Next Avenue. Accessed Feb. 10, 2015. www.nextavenue.org/article/2012-05/keep-caregiving-taking-toll-your-back.
Singh, N., Clements, K., & Fiatarone, M. 1996. A randomized controlled trial of progressive resistance training in depressed elders. The Journals of Gerontology: Series A 52A (1), M27-M35. http://biomedgerontology.oxfordjournals.org/ content/52A/1/M27.short.