Understanding Caregiver Resentment & Anger

Family Caregiver Alliance describes anger at the person you are caring for as normal. It is a normal part of being around someone who needs help on an ongoing basis. It is also one of the least reported feelings in cancer caregiving. Saying it out loud sounds monstrous next to someone who is seriously ill.

The same guidance names ambivalence outright. Caregiving can feel like something you want to do on a good day, and something you want to end on a bad one. Both feelings can be present in the same week. That is not inconsistency. It is what a long, unchosen job feels like.

The triggers people report are specific and repetitive rather than dramatic.

• Refusing food, medicine, physiotherapy or the thing the team asked for.
• Refusing outside help, so the load stays entirely on one person.
• Continuing to smoke or drink.
• Directing their own fear and anger at the nearest person, who is you.
• Never saying thank you, or saying it in a way that lands as a complaint.
• The same question, forty times.
• Siblings who visit twice a year and have opinions.
• Being treated as staff by someone who used to treat you as an equal.
• The person who was difficult before the diagnosis being difficult still.

Anger is far more available on four hours of broken sleep. Caregivers with high sleep disturbance average around 5.7 hours a night, against 7.7 hours in caregivers without it. Anxiety and caregiving burden each predict worse sleep, and worse sleep then feeds both. Between 40 and 70 per cent of family caregivers show clinically significant depressive symptoms. Irritability is one of the ways depression presents.

Treat the anger as a character flaw, and the actual problem goes unaddressed. The actual problem is no sleep, no relief, no help.

Before you conclude that someone has become deliberately cruel, ask whether something is causing it.

Delirium develops over hours or days, and fluctuates. It produces agitation, suspicion and refusal to cooperate. Many episodes are caused by medicines or dehydration, and are reversible.

Steroids commonly cause irritability, insomnia and agitation, usually within the first five days of a dose. Symptoms resolve fully in around 92 per cent of patients when the dose is reduced.

Brain tumors and brain metastases can change judgement and impulse control directly. And uncontrolled pain makes anyone unbearable.

None of this makes the behavior easier to live with. But it changes what you do about it. Report it rather than argue with it.

Leave the room. Anger fed by a live argument escalates, particularly with someone who is confused. Ten minutes elsewhere works better than any technique tried in the room. Agree a timeout signal in advance, while everyone is calm. That works better than improvising during a bad hour. Arguing with a confused person about facts never works, and reliably makes it worse. Say the thing out loud afterwards, to someone who is not in the family.

Feeling anger is normal. Shouting happens in most households under this kind of strain, and it is not the same as abuse.

This is not acceptable, regardless of provocation or exhaustion:

• hitting, pushing or restraining
• withholding food, fluids, medication or pain relief
• threatening
• humiliating
• taking money or property

If any of that is happening, it needs to stop and be reported. The Eldercare Locator, on 1-800-677-1116, connects to local Adult Protective Services. If you are frightened of what you might do, say that plainly to the oncology team or hospice nurse. It is treated as urgent, not as a confession.

Anger usually falls when the hours fall. Under the Medicare hospice benefit, inpatient respite covers up to five days at a time on an occasional basis, with a 5 per cent co-payment. Home health aides, adult day programs and paid overnight help exist. An oncology social worker can convene a family meeting, so the split of work is discussed with someone neutral in the room. CancerCare offers free counseling and caregiver groups on 800-813-4673.

• Call 911 or go to an emergency department if you are close to hurting the person you care for and you cannot get out of the room safely.
• Call or text 988 now if you are thinking about ending your life or hurting yourself. The 988 Suicide and Crisis Lifeline answers day and night, and it is free. If you have already acted on those thoughts, or you have a plan and the means at hand, call 911 instead.
• Call your care team the same day if the person turns confused, suspicious or agitated over a few hours or days. That pattern is delirium. It is often caused by a medicine or by dehydration, and many episodes can be reversed.
• Call your care team within a day or two if the change in temper began after a steroid was started, or if pain looks poorly controlled. Both are common drivers of behavior that reads as deliberate cruelty, and both can be adjusted.

• AARP — Feeling Angry as a Family Caregiver? You Are Not Alone
• NCI — Delirium and Cancer Treatment (PDQ)
• Medicare — Hospice Care Coverage (inpatient respite)
• Eldercare Locator — 1-800-677-1116
• CancerCare — free counselling and caregiver groups