Guilt By Association?

"Don't feel guilty." That was the advice my aunt gave me about caring for my mother after her fall and hip-replacement surgery.

"I don't feel guilty," I said. "Why should I?"

After my mother's accident (see first post), I did everything I could to attend to her needs--physical, emotional and practical. Everything reasonable, that is--especially given that I live 200 miles away from her and have a family of my own to care for. I traveled to help her after her initial fall; I was back the following week when we discovered she would need immediate hip-replacement surgery. I consulted with her doctors and other medical personnel, spent days in the hospital with her, advocated for her care, and researched and visited rehabilitation facilities to make sure she was in the best during her four-week recuperation. With my brother, we arranged for her home care. I took over bill paying, doctors' consultations and accompanying her to doctors' visits.

I resented even the suggestion that I might have something to feel guilty about.

Yet, I still lose sleep at night worrying about her, and worrying that I'm not doing enough.

The fact is that my mother, though still mentally alert and gaining back her mobility, is very needy. So are a lot of older parents. Though I can reason through the situation and my place in it, nagging thoughts nevertheless get to me in times of stress or fatigue or frustration: Am I doing enough? Am I doing the right thing? Am I being a "good" daughter?

Expectations
When I talk with friends about this blog, I am constantly surprised by the intensity of their own stories about aging parents, and the frequency with which this theme of personal inadequacy comes up--like almost always.

"I was a bad daughter," my neighbor tells me. Never mind that she saw to the care of her always difficult and demanding mother, who became even more so in her declining last years until she died at 93. When she developed dementia, my neighbor struggled with impatience and resentment toward her that had begun in childhood. She often felt she was failing her mother: "I actually thought sometimes she was faking her dementia," she told me. Only when her once "meticulous mother" refused to bathe did my neighbor stop taking her mother's behavior personally.

"We have been very neglectful," says another friend, a son who, with his three brothers, is planning an intervention for his father, who suffers from Alzheimer's and needs a full neurological workup. Neglectful? Each son lives hours away by car or plane, has young children and careers in full bloom. Each confers with the others, and has had long discussions with their mother about what to do about dad, who no longer recognizes grandchildren. Their father, who is mentally, physically and verbally combative especially on the subject of doctors, has stormed out of appointments, and has attracted police attention because of fender benders (yes, they've been unable to keep him from driving) and for wandering, seemingly lost.

Why is it that when it comes to caring for an older parent--no matter how good or troubled the relationship--so many adult children feel that they can never do enough, even when the facts speak otherwise? Why do feelings of guilt, inadequacy and depression often result?

Balance
Those feelings, says Barbara Kane, a therapist specializing in older people and their families, and co-founder of Aging Network Services in Bethesda, Md., are "rooted in a deep sense that's cultivated early in childhood, that your parents did everything in the world for you when you were growing up." Adult children, she says, feel they owe their parents the same--even when they haven't been the best of parents ("when you are little," she explains, "you feel that they are"). Those thoughts, she adds, often translate into an irrational message we tell ourselves: "I should give everything at the expense of myself."

But that is a no-win place to be. If you do it, you become resentful, exhausted, depressed. If you don't do it, you are plagued by guilt. The key, says Kane, who co-authored the book "Coping with your Difficult Older Parent: A Guide for Stressed-Out Children" (HarperCollins, 1999), is to develop perspective and to keep a balanced life. And to know and fend off the triggers--often parent-issued--that can provoke guilt. Only then can you focus on how your parent is suffering and the best ways to help.

It is also important for adult children to be realistic about what they can accomplish in their parents' care, says Douglas Wolf, professor of aging studies at Syracuse University . Guilt, he says, can result from the realization that, despite your energy and effort, your parent remains sick or needy. "We blame ourselves in a latent way for something that we can't be blamed for: The end-of-life decline is untreatable," he says.

Doing Good
Being a caregiver to an aging parent is bad for one's mental health, says Wolf. But so is not providing care to a needy aging parent. Wolf coauthored studies based on thousands of responses from the federally funded Health and Retirement Study and found that mental health declines are the same for adult-child caregivers and non-caregivers alike. (His research is published in the Journal of Gerontology: Social Sciences, 2006, and The Gerontologist, 2003, both published by the Gerontological Society of America .)

But it's not quite the damned-if-you-do, damned-if-you-don't scenario it sounds like: The often overlooked difference, Wolf says, is that those who do care for their aging parents reap altruistic benefits, even if it doesn't always feel good while you're doing it.

"Here's someone who means a lot to you, whose life has taken a turn for the worse. Yes, it becomes stressful and depressing to deal with, but at the same time, there are good things that you experience," he says. "Your parent appreciates it, you benefit from being able to help, and you have the satisfaction of knowing you did something. Non-caregivers don't get that."