The Hidden Health Toll of Caring for the People We Love

When we hear the word caregiver, most of us picture a fairly specific situation. We imagine someone caring for an aging parent with dementia, a spouse going through cancer treatment, or a family member helping someone who can no longer physically care for themselves. Those people are absolutely caregivers, but they are not the only ones.

Sometimes a caregiver is a mother who lies awake at night wondering whether her adult child with an addiction is safe. Sometimes it is a husband trying to keep life stable while his wife struggles with severe depression, bipolar disorder, or another mental-health condition. Sometimes it is a parent navigating doctors, therapists, schools and insurance for a child with a chronic illness, disability, developmental condition or emotional disorder. Sometimes it is a daughter caring for her parents while still raising children of her own. And sometimes it is simply a parent in one of those intensely demanding seasons of life when little people need something from you almost every waking moment.

The responsibilities look different. The circumstances are different. But the body still carries the load.

That is what struck me so strongly when I read the article about Dolly Parton that inspired this conversation. Shortly before her death, she spoke about health problems she had not paid much attention to while caring for her husband. There was something so recognizable in that statement. Caregivers become extraordinarily good at putting their own needs one position lower on the list. Then another. Then another. Eventually, they may not be on the list at all.

It made me think about a question that we probably need to ask much more often:

Who is taking care of the person who is taking care of everyone else?

Caregiving Is Far More Common Than We Realize

According to the 2025 Caregiving in the U.S. report from AARP and the National Alliance for Caregiving, approximately 63 million Americans—nearly one in four adults—provide ongoing care for another person. That number has increased dramatically over the past decade, and nearly three in ten family caregivers are part of the so-called sandwich generation, simultaneously supporting children and adults.

The health of those caregivers deserves our attention. About one in five caregivers reports being in fair or poor health, and many say caregiving makes it harder to care for their own health. Research has also documented high levels of emotional stress among family caregivers.

Other studies point in the same direction. Claims data from the Blue Cross Blue Shield Association found that caregivers had higher rates of several stress-associated conditions than a matched comparison population, including hypertension, major depression and anxiety. The study showed an association rather than proving that caregiving itself caused those conditions, but the pattern is significant.

Sleep is another issue. A systematic review involving caregivers of ill adults found poor sleep quality to be extremely common, with shortened sleep and repeated nighttime awakenings frequently reported. Research examining cardiovascular health has likewise found associations between caregiving burden and cardiovascular risk, particularly when caregiving is accompanied by high psychological stress, poor sleep, long hours of responsibility and less time for exercise or restorative activities.

None of this means that caregiving automatically makes someone sick. Caring for another human being can be one of the most meaningful things we ever do. It can deepen relationships, create purpose and bring tremendous love into our lives.

But love does not make us physiologically immune to stress.

Caring for Someone With a Physical Illness or Disability

This is probably the form of caregiving we recognize most easily. A spouse develops cancer. A parent has a stroke. Someone develops Parkinson’s disease, heart disease, chronic pain or another disabling condition. Suddenly another member of the family becomes the scheduler, driver, medication manager, advocate, researcher, cook, helper and emotional support system.

Often there is no moment when anyone officially says, “You are now a caregiver.” It simply happens.

There are appointments to coordinate, medications to remember, insurance companies to call, physical needs to manage and difficult decisions to make. All of that is layered on top of normal life: jobs, bills, relationships, homes and sometimes children who still need care themselves.

I see this in the office. I see parents bringing children in who are dealing with complicated health problems, and often I can see the worry before they ever tell me how tired they are. Their attention is completely focused on the person they brought through the door. They are watching, listening, asking questions and trying to make sure they are doing everything possible for the person they love.

What is much harder is getting them to think about themselves.

When we can, sometimes we encourage the parent, spouse or other caregiver who came with the patient to spend a little time in our massage chair while they wait. It is not treatment for caregiver stress, of course. It is simply a chair and a few quiet minutes. But sometimes even that is difficult for someone to accept.

They are so accustomed to thinking, They need the care. I don’t.

That is one of the ideas I wish we could change.

It doesn’t have to be either/or.

It can be both/and.

The person you love can need care, and you can need care too.

Dementia: When the Caregiver Can Never Quite Turn Off

Dementia caregiving deserves special attention because of its intensity and duration. Millions of Americans provide unpaid care to someone with Alzheimer’s disease or another form of dementia, and the responsibility often continues for years.

There is also a special kind of vigilance involved. A caregiver may be listening at night for someone getting out of bed. They may worry about falls, wandering, driving, medications, eating or changes in behavior. They may be slowly taking over responsibilities their spouse or parent once managed independently while simultaneously grieving changes in a person who is still physically present.

That means the caregiver’s nervous system may never quite receive the message that the shift is over.

Sitting down is not necessarily the same thing as relaxing. Going to bed is not necessarily the same thing as sleeping. Even when nothing is happening, part of the brain may remain attentive to what could happen.

Research consistently finds higher rates of anxiety, depression, poor sleep and reduced quality of life among many dementia caregivers. Again, this does not mean that every dementia caregiver will become ill. It means that the load is real enough that caregiver health needs to become part of the conversation.

Addiction Creates Caregivers Too

This is one of the groups I especially want us to recognize.

When someone has a substance-use disorder, we understandably focus much of our attention on the person struggling with the addiction. But addiction rarely affects only one person. There may be a spouse trying to keep a household functioning, a parent constantly waiting for the next phone call, grandparents stepping in to raise children, or family members dealing with finances, treatment programs, legal problems, relapses and emergencies.

Perhaps one of the most difficult pieces is unpredictability. Is the person using today? Are they safe? Will they come home? Will there be another relapse? Should I help? Am I helping too much? If I set a boundary, what happens next? If I don’t answer the phone, will something terrible happen?

That kind of uncertainty can keep a person in an almost constant state of vigilance.

Research supports what many families already know from experience. Studies of family members of people with substance-use disorders have found increased stress and caregiver burden, poorer mental health, impaired quality of life and, in some studies, more physical health problems. A U.S. study examining caregivers of people with substance-use and/or mental-health disorders found that this group was more likely than several other caregiver groups to report poor general health, poor physical and mental health, activity limitations and depression.

Another recent study of people affected by another person’s alcohol or drug use found that large numbers reported emotional exhaustion, family conflict, stigma-related distress and feeling trapped in a caregiving role.

That sounds an awful lot like caregiving.

It may simply be caregiving that nobody has named.

Caring for Someone With a Mental or Emotional Health Disorder

Another enormous group of caregivers hides in plain sight: the people supporting someone with a significant mental or emotional health condition.

This could be the parent of a teenager experiencing severe depression or anxiety. It could be the spouse of someone with bipolar disorder. It may be parents supporting a child with an eating disorder or a family caring for someone with schizophrenia, psychosis or another serious mental illness. Sometimes another family member gradually becomes responsible for keeping life stable enough for everyone else to function.

This work may be less visible than changing a dressing or helping someone into a wheelchair, but that does not mean it is less demanding.

You may be watching moods and monitoring medications. You may be trying to recognize whether depression is worsening, looking for signs of a manic episode or assessing whether someone is safe. You may be coordinating appointments with physicians, therapists or schools while simultaneously trying to keep the rest of the household functioning. Some families spend years learning how to tell the difference between something that needs immediate intervention and something that needs patience, boundaries or space.

Then there is the emotional component. When you love someone who is suffering, it can be incredibly difficult to emotionally separate their experience from your own. You may feel responsible for making things better even when there are parts of the illness you simply cannot control.

Research reflects that burden. Studies of caregivers of people with serious mental illness consistently find elevated levels of caregiver burden, depression, anxiety, psychological distress, financial strain and reduced quality of life. Research involving parents of children with diagnosed mental-health conditions has similarly found substantially greater parenting stress and depression compared with parents whose children do not have those conditions.

One systematic review of parents caring for children with mental-health problems identified themes including fear, guilt, stigma, disruption within families, unmet support needs and something researchers described as a self-care paradox: parents recognize that they need to care for themselves, yet the demands of caring for their child are precisely what make caring for themselves so difficult.

I think many caregivers would understand that immediately.

Sometimes the person who looks perfectly functional at work, church, school pickup or the grocery store spent the previous night talking someone they love through a crisis.

You cannot always see caregiving from the outside.

Parents of Children—and Adults—with Significant Support Needs

There is another kind of caregiving that frequently gets absorbed into the word parenting.

Parents expect to care for their children. That is part of being a parent. But some parents provide a degree of medical, developmental, behavioral or therapeutic care that goes far beyond what we generally think of as ordinary parenting responsibilities. They may spend years coordinating occupational therapy, physical therapy, speech therapy, medical specialists, school accommodations, behavioral interventions, medications and insurance appeals. They may be managing major sleep disruptions or behaviors that require constant supervision.

And sometimes that responsibility does not end when the child turns eighteen.

I have seen this particularly with parents of adults who have significant support needs. I have watched a mother bring her adult child with autism into the office and immediately make it clear that her child’s needs come first. You can see how carefully she watches. You can see the worry. You can sometimes see years of responsibility written across her face before she says a word.

And when you suggest that perhaps we should also take a look at her, or that she could use a few minutes in the massage chair while she waits, the answer can almost reflexively be, “No, no. Take care of him.”

It isn’t because she doesn’t understand that she has needs. It is because somewhere along the way, caring for herself began to feel less important than caring for her child.

But her health matters too.

Her sleep matters. Her blood pressure matters. Her back matters. Her emotional health matters. Her nervous system matters.

Taking care of herself does not take something away from her child.

Once again, it doesn’t have to be either/or. It can be both/and.

We should also be thoughtful about how we talk about this. The person receiving care is not a “burden.” The responsibility can be heavy. Navigating inadequate services can be heavy. Chronic uncertainty can be heavy. Sleep deprivation can be heavy. Worry can be heavy.

Acknowledging that does not diminish the love within a family. In fact, I think pretending caregiving is never difficult sometimes makes caregivers feel even more alone.

You can love someone beyond words and still be exhausted.

And What About Parents of Young Children?

This part requires some nuance because parenting healthy young children is not generally classified in research as family caregiving in the same way that caring for someone with dementia, disability or chronic illness is.

But from the standpoint of stress physiology, it would be a mistake to assume that ordinary parenting cannot create a significant load.

The U.S. Surgeon General’s advisory on parental mental health reported that 33% of parents described high levels of stress compared with 20% of other adults. Even more striking, nearly half of parents said that on most days their stress felt completely overwhelming.

Anyone who has lived through the early years of parenting probably understands how that can happen. Sleep may be interrupted for months or years. Someone needs to be fed, changed, comforted, watched or transported. There is constant sensory input. One task is rarely completed before another begins. Jobs, relationships, finances and household responsibilities continue while a child’s needs are layered on top.

We do not need to pathologize parenting to admit that it can be physiologically demanding.

Sometimes the caregiver who needs care is simply the mother or father who has been “on” every day for years.

The Sandwich Generation: Caring in Two Directions

Then there are the people taking care of everyone.

Their children still need them. Their parents increasingly need them. Their job needs them. Their spouse needs them. Their home needs them. Somewhere in the middle of all of those responsibilities sits their own health, frequently waiting for a quieter season that may not come.

Nearly three in ten family caregivers now fall into this sandwich-generation category. Interestingly, research suggests that simply having children and aging parents does not automatically mean someone’s health will suffer. What appears to matter more is the intensity of care—the actual hours, responsibilities and emotional demands involved.

That distinction makes sense.

It isn’t the family tree that stresses the nervous system.

It is the load.

The Body Doesn’t Care Whether We Call It Caregiving

This may be the most important point.

Your nervous system doesn’t ask whether what you are doing technically qualifies as “caregiving.” It responds to what it experiences: interrupted sleep, constant vigilance, uncertainty, responsibility without control, emotional conflict, financial pressure and the inability to completely relax because someone may need you at any moment.

It also responds to years of pushing your own needs to tomorrow because somebody else’s needs seem more urgent today.

When that pattern continues long enough, it can become chronic stress. Sleep can change. Muscle tension can increase. Blood pressure can rise. Mood can change. Exercise disappears. Meals become whatever is convenient. Preventive medical appointments get postponed. The things that normally help regulate us—movement, friendship, quiet, hobbies, sunlight, rest—can gradually disappear because there simply isn’t enough time or energy left.

This is one reason I think we need to change the way we talk about caregiver health. When someone comes into our lives caring for another person, we naturally ask, “How is your husband?” “How is your mom?” “How is your child doing?”

Maybe we need to make one more question just as normal:

“And how are you doing?”

Not as a courtesy. As a real health question.

Self-Care Cannot Become One More Job for the Caregiver

There is an important caution here. When someone is already overwhelmed, the last thing they need is another person handing them a long list of things they should be doing.

Exercise more. Meditate. Eat perfectly. Get eight hours of sleep. Journal. Take a bath. Schedule a massage.

Suddenly “self-care” becomes one more category in which the caregiver feels as though they are failing.

Sometimes what a caregiver actually needs is help. They may need respite care, family participation, counseling, medical care, community resources, financial support or someone else to take responsibility for a while. No breathing exercise can replace adequate support.

At the same time, there are moments when very small pauses can matter, particularly for a nervous system that rarely receives permission to come off duty.

I recently wrote about what I call the 60-Second Recharge—tiny ways of interrupting that constant state of doing, even if you cannot leave your responsibilities behind. It might be sixty seconds of slower breathing, stepping outside, relaxing your shoulders, closing your eyes, feeling your feet on the ground or simply doing absolutely nothing for one minute.

A sixty-second break is not a solution to caregiver burden.

It will not fix an addiction, cure dementia, create respite care or make a difficult family situation disappear.

But sometimes it is a beginning.

It is one minute in which the caregiver’s own nervous system receives the message:

You are here too.

And perhaps that is the larger shift we need.

You Are Part of the Family You Are Caring For

Caregivers become remarkably good at overriding themselves. They can function on too little sleep, postpone appointments, ignore headaches, skip meals, stop exercising and tell themselves they will deal with their own health once everything settles down.

Except sometimes everything doesn’t settle down.

The addiction doesn’t resolve next month. Dementia progresses. A child’s needs continue. Depression relapses. A parent becomes less independent. Another crisis happens.

Suddenly, “I’ll take care of myself later” has turned into five years.

If you are caring for someone with a physical illness, you are a caregiver. If you are supporting someone through addiction, you may be carrying a caregiver’s load. If your family revolves around managing someone’s serious mental or emotional health condition, you may be a caregiver. If your child’s medical, developmental or behavioral needs require extraordinary amounts of your time and attention, you are providing care. If your adult child continues to need substantial support, you are still providing care. If you are caring for children while simultaneously keeping aging parents afloat, you are carrying a lot.

And if you are in a season of parenting where somebody needs you from the moment you wake up until long after you hoped to be asleep, your exhaustion deserves to be acknowledged too.

The circumstances are different and the needs are different, but none of these people should become invisible simply because they are the strong one.

The person you love deserves care.

And so do you.

We spend an enormous amount of time caring for the person who is struggling. Maybe we also need to start asking:

Who is caring for the caregiver?