As Clare M. Wohlgemuth, RN, and Heidi P. Auerbach, MD, geriatrics clinicians at Boston Medical Center, shared the challenges and expectations they faced caring for ailing parents, they began to sense their experience was not unique. “We both had similar kinds of feelings under clinically different scenarios,” Wohlgemuth says. So they set out to explore the experiences of other geriatrics health care providers and conducted what they believe to be the first study of its kind.

They found that geriatrics health care professionals feel more complex stressors than others when caring for an older family member. The full findings appear in a recent issue of The Gerontologist.

Identifying themes

Wohlgemuth and Auerbach recruited 16 geriatrics health care professionals – 12 nurses, 3 physicians, and 1 social worker – to participate in 60- to 90-minute interviews. Participants were either actively in a caregiving role or had been in a caregiving role as long ago as 10 years ago.

Interview questions were designed to garner information about how the caregiving situation began, the personal and emotional impact on the professional, the experience of having a role as a caregiver and as a family member, family relationships, and the professional impact of caregiving.

“When we started to ask the questions we found out very quickly that those experiences and emotions immediately came back,” Wohlgemuth says. “They instantly appeared in the people being interviewed. They were able to tell their story and feel the emotions they felt then.”

After they finished the interviews, Wohlgemuth and Auerbach identified three major themes:

  1. dual role advantages and disadvantages
  2. emotional impact of dual roles
  3. professional impact of family caregiving

Dual role advantages and disadvantages

The study found that there are advantages and disadvantages to individual geriatrics health care professionals also acting as the primary caregiver for their own family member. The study’s participants  found their dual roles “inevitable and all encompassing.” The participants also did not feel that it was easy to separate their two roles.

The study categorized the advantages and disadvantages of the dual role into subthemes:

  • benefits of professional expertise
  • challenges and conflicts from professional expertise

Several participants described their own expertise as an advantage in caring for an older family member. They were able to use their skills and knowledge to improve their caregiving role. According to the study, these skills included the following:

  • accessing medical knowledge of relevant health problems
  • providing personal care
  • navigating the health care system to locate suitable providers, home services, or long-term care facilities
  • initiating discussions on advance directions
  • recognizing illness trajectory
  • advocating for the best care possible

“The people we interviewed put intense stress on themselves – from ‘I should know it,’ ‘I should know what  to do,’ ‘They’re all looking to me,’ to ‘How am I going to fix this?’,” Wohlgemuth says. “I think that was very surprising and eye opening that there might be this extra level of stress that comes from multiple directions, including internally.”

Emotional impact of dual roles

Participants described multiple emotional effects of acting as caregiver and as a health professional. They described a sense of reward, but also feelings of emotional exhaustion, guilt, and stress, which are feelings common to all caregivers. Uniquely, they described the emotional impact of feeling like they were always on duty, that they had to hold back emotions for the good of their family, having the burden of knowing too much, and of feeling a sense of appreciation for the health care providers who acknowledged them as a family member in addition to a caregiver.

Professional impact of caregiving

The study participants also described the ways that their own personal experiences enhanced their professional lives. They had new insight and empathy for patients’ caregivers, were able to advocate more fully for their patients, and were better able to understand how to help support caregivers.

“The clinicians that we interviewed felt enlightened and energized to be able to have true empathy and understanding in their approach to caregivers and patients,” Wohlgemuth says. “For example, trying to help and intervene and do some anticipatory planning in light of that caregiver and older person’s trajectory. Everyone felt like it added another dimension to their clinical practice.”

Addressing unique stressors

Acknowledging geriatric health care professionals’ unique experiences in caring for their own family members, the study suggests potential interventions tailored to address their unique need, including the following:

  • developing a support group specific to provider-family caregivers
  • creating a peer sponsorship program
  • mobilizing existing caregiver support resources
  • developing educational programs for health care providers who care for older family members

For more on the study, read Advantages and Challenges: The Experience of Geriatrics Health Care Providers as Family Caregivers, or contact:

Clare M. Wohlgemuth, RN
Nursing Director, Geriatric Services
Boston Medical Center
Clare.wohlgemuth@bmc.org