Eldercare Stress What's Different for Male Especially Black Men

Part 2 of a series. Read Part 1 here.

If you're a man who's caring for an ailing loved one -- wife, mother, father, grandparent -- consider yourself warned. You're vulnerable--especially, according to research, if you're African American-- to some different experiences from your female counterparts, just by virtue of being a guy. And these have the power to add to your stress level, or reduce it, research shows.

Women still outnumber men when it comes to family caregivers. But the number of men caring for an older adult has doubled in the past 15 years, from 19 percent of caregivers in 1996 to 40 percent by 2009, according to data from the Alzheimer's Association and the National Alliance for Caregiving (NAC). More men than women provided long-distance care in that time period, too.

The face of caregiving is apt to increasingly be a bearded one, thanks to smaller family sizes (which makes the role fall more often to men), the tight economy (making men less able to outsource the role), and skyrocketing diagnoses of Alzheimer's disease (which affects women more than men, making many men spousal caregivers).

There's also a growing proportion of men ages 60 to 74 in the population -- prime caregiving years.
Individual exceptions abound, of course. But generally, the following Venus-and-Mars differences between the genders influence the nature of the stress to which caregivers are uniquely vulnerable.

WHAT CAN HURT MALE CAREGIVERS

Men tend to be less socially prepared for the role.

Nurturing -- the young or the old -- has traditionally been women's domain. Sheer inexperience can raise stress levels. Topping the list of stressors, studies show, is difficulty dealing with problem behaviors (like incontinence, medical devices (like respirators or catheters), and the basic activities of daily care (like bathing or feeding).

For any caregiver these are tall orders, but as a group, men are less likely to have any background in performing them. Older men also have less practice managing household tasks like cleaning and cooking, which often must be juggled on top of caregiving.

At the same time, men are traditionally conditioned -- especially by midlife and beyond -- to view themselves as experts. Unfortunately, caregiving forces them to check that mind-set at the door as they venture into a new world in which they tend to lack competence or even basic knowledge.

This means: Some caregivers have a steeper path right from the start. Slowly but surely, however, cultural shifts are making men more inclined to act as caregivers rather than farm out the role to sisters, wives or paid help. Just as the image of dads as hands-on caregivers has evolved in recent generations, the same is apt to be true for male caregivers. But for the oldest generations, who may not even have cooked and cleaned through their adult years, this can remain unfamiliar--and uncomfortable--territory.

Men tend to be less likely to ask for help.

Men tend to try to go it alone. Only 20 percent of the callers to the New York City Alzheimer's Association help line are men--half the potential users.

That may be representative of their underuse of other kinds of services intended to help caregivers. Men are also less likely to speak to co-workers about caregiving responsibilities than women, according to the 2003 Met Life Study of Sons at Work conducted by the NAC and Towson University, even though working caregivers split evenly between men and women.

This means: Men may miss out on resources that can ease the caregiver burden, or delay their use longer than necessary. They risk never even learning about employer-offered services, like caregiver assessments, flex time, and paid or unpaid leave. The message men need to hear: Getting help isn't a sign of weakness but a success strategy for improving the quality of care you can give.

Men tend to avoid talking about their feelings.

"Men tend to block their emotions," says I-Fen Lin, a sociologist at Bowling Green State University, who has researched gender and relationship differences among caregivers.

This means: Although this style has some benefits, it can also be isolating. Many men's idea of one of the circles of hell is to sit with a bunch of other people and talk about their problems, but support groups are one of the best ways to reduce caregiver stress, says geriatric psychiatrist and internist Ken Robbins of the University of Wisconsin.

Yet men attend support groups for caregivers in smaller numbers than women, missing out on an important opportunity for local-resource sharing and learning practical information about a disease such as Alzheimer's.

Men skimp on self-care.

Caregivers of both genders tend to put their loved ones' needs before their own, but men are, as a rule, notoriously worse about self-care. They tend to have more vascular risk factors than women, even before entering the stress of caregiving. A 2010 University of South Florida study in the journal Stroke found that caregiving spouses who are under high stress were at a higher risk of stroke -- men more so than women, and African-American men most of all.

This means: Caregivers risk compromising the level of care they can provide, or having to move a loved one from home care, if they become sick themselves.

Many available caregiver resources directly or indirectly target women.

Imagery and language suggesting most caregivers are women can be a turn-off to male caregivers. They reinforce an outdated image that male caregivers are anomalies or outsiders -- and therefore men avoid tapping into sources of help.

This means: Community resources have to work harder to reach out to male caregivers. When the Virginia Department on Aging developed male-caregiver outreach programs with three area agencies on aging, they realized that a major hurdle was getting men to accept support.

Among the most effective methods of awareness and education that they found were to offer male caregiver workshops, cooking classes (presumably male spousal caregivers needed to learn this skill), and newsletters and flyers that were specifically targeted to men.

What helps male caregivers

American culture still sees male caregiving as a novelty.

The flip side of outdated packaging for brochures and speaker series about caregiving support is that it reveals that male caregivers are still, in fact, a minority -- which oddly, may work in their psychological favor.

"Male caregivers usually have more positive feelings about the caregiving experience than women," says sociologist Lin. "Not because they enjoy it more -- but because in the U.S., we assume women will take care of the elderly. So if they do, they're taken for granted. We don't have high expectations of male caregivers, on the other hand, so friends and relatives give them more praise and positive feedback for what they do."

This means: The applause men may get compensates for a lot of the stress they're experiencing, Lin says, which can reduce their overall perception of stress.

Men tend to view caregiving as a problem to be solved.

One of the key gender differences in caregiving is in approach. Men tend to be problem solvers, Lin says. "They focus on tasks, whereas women focus on relationships."

This means: Setting feelings aside to work on discrete problems -- how to keep someone with dementia busy, how to make bathing safer and more comfortable -- helps a caregiver avoid getting bogged down by thoughts of loss, fear, and frustration. This is a huge reason that men are more likely to view caregiving positively than women, Lin says.

Men tend to respond more positively to support groups that are billed as being "educational" rather than just "supportive," found occupational therapist Nira Rittenberg, who designed a support group for Alzheimer's families with the University of Toronto. They like grabbing onto the idea of learning management tactics, rather than wasting time talking about how problems make them feel.
Men tend to hire help more often than doing hands-on care.

Women put in more hours at caregiving and do more hands-on care, according to the NAC. Helping with the activities of daily living -- getting in and out of bed, bathing, toileting -- is extremely stressful work. Male adult children usually contribute in other ways, such as driving, doing home maintenance and managing doctor visits and finances.

That's not to say men don't provide firsthand care -- only that, as a gender, they do less of it. Husbands, however, do about the same amount of hands-on care as caregiving wives.

This means: Doing less hands-on care seems to be physically and emotionally protective. In the University of South Florida stroke study, African-American men were the most vulnerable group of all.

"What we think is happening here is that this subgroup of highly strained African American men probably lack supports from family and other services," says lead researcher William E. Hailey. Being less able to hire out help for demanding care tasks than their white counterparts, and less likely to have breaks, their vascular health suffers more.

Men tend to see caregiving as a "job" and a "duty."

For many men, caregiving is a series of discrete tasks to get through, an extension of their role as son or husband. Male spouses, especially, tend to view caregiving as a natural expectation of marriage, a chance to "give back after she took care of me all those years."

This means: Compartmentalizing caregiving as a responsibility, rather than seeing it as something that's taking over your life, automatically downsizes it to a more manageable scope and helps men view it with a more positive mind-set. This mind-set can be protective against stress, Lin says, especially for caregiving husbands.




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