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For a dozen years, Larry Bocchiere, 68, didn鈥檛 find it especially difficult to care for his wife, Deborah, who struggled with breathing problems. But as her illness took a downward turn, he became overwhelmed by stress.

鈥淚 was constantly on guard for any change in her breathing. If she moved during the night, I鈥檇 jump up and see if something was wrong,鈥� he said recently in a phone conversation.听 鈥淚t鈥檚 the kind of alertness to threat that a combat soldier feels. I don鈥檛 think I got a good night鈥檚 sleep for five years. I gained 150 pounds.鈥�

As her chronic obstructive pulmonary disease worsened and heart failure set in, Deborah was taking 24 medications each day and rushing to the hospital every few weeks for emergency treatments.

鈥淭oward the end, I couldn鈥檛 stay in the same room with her for too long because I couldn鈥檛 stand to watch her being so sick,鈥� Bocchiere said. His wife died in 2013.

For many years, Larry Bocchiere cared for his wife, Deborah, who struggled with chronic obstructive pulmonary disease. When a spouse is seriously ill, Bocchiere says, 鈥渨e lose our best friend, our love, our future. But your children, friends, relatives 鈥� they don鈥檛 get it.鈥�(Courtesy of Larry Bocchiere)

Marriages are often shaken to the core when one spouse becomes sick or disabled and the other takes on new responsibilities.听

鈥淵ou have to rewrite the relationship鈥檚 expectations. And the longer you鈥檝e been married, the harder that is to do,鈥� said Zachary White, an associate professor of communications at Queens University of Charlotte. With Donna Thomson, he鈥檚 the author of 鈥�.鈥�

Compared to adult children who care for their parents, spouses perform more tasks and assume greater physical and financial burdens when they become caregivers, an shows. Symptoms of depression as well as strains on relationships are more common.

Communication often becomes problematic, as husbands and wives feel disoriented and uncertain about how to respond to each other. Especially early on, illness tends to 鈥渉eighten emotion and short-circuit communication,鈥� write Barbara Kivowitz and Roanne Weisman in their book, 鈥�.鈥�

Both women were cared for by their husbands (Kivowitz suffered from chronic pain; Weisman had a stroke). 鈥淲e were gobsmacked by how much illness took over the relationship,鈥� Kivowitz said earlier this year in a .

Complicating these issues is isolation. 鈥淲e often hear about family members who won鈥檛 get involved or are overly critical of the well spouse but never pitch in or visit,鈥� said Robert Mastrogiovanni, 72, president of the , which offers support groups to members. 鈥淎nd then there are lifelong friends who drop out of the picture.鈥�

Most of the time (55%), older spouses are caregiving alone as husbands or wives come to the end of their lives, without help from their children, other family members or friends or paid home health aides, according to .

The risk is that marriages will be undermined by illness and essential emotional connections lost.

鈥淭he well spouse can go from being a partner and a lover to a nurse and a caregiver, which is an entirely different kind of relationship,鈥� said Mastrogiovanni, who cared for his wife, Kathleen. She had multiple sclerosis for 50 years before she passed away last year.

Or spouses can become distant as they struggle with feelings of loss, fear, and, frequently, misunderstanding and anger.

鈥淗e wouldn鈥檛 talk to me. He would seem like he was angry at me, but I didn鈥檛 really understand,鈥� said Terri Corcoran, 69, whose husband Vincent had Fragile-X associated tremor/ataxia syndrome, a neurodegenerative disorder.

It took five years for Vincent to get a diagnosis. During that time, Corcoran said, 鈥淚 felt like I married someone I didn鈥檛 know. It was devastating. It took me a long time to realize his brain was impaired.鈥�

Terri Corcoran鈥檚 husband, Vincent, had Fragile-X associated tremor/ataxia syndrome, a neurodegenerative disorder. Although Vincent couldn鈥檛 talk, Terri says she would sit with him and talk to him about what she was feeling: 鈥淗e would put his arms around me, and I would say 鈥業鈥檓 doing the best I can. I know this isn鈥檛 your fault, but it鈥檚 really hard.鈥� And I always ended up feeling better.鈥�(Courtesy of Terri Corcoran)

How can older couples navigate these challenges and protect their relationships 鈥� an essential source of comfort and support 鈥� when illness strikes? Several experts offered suggestions:

Reset expectations. Couples need to face what is being lost as a result of illness and, at the same time, focus on what remains intact.

Dr. John Rolland, an adjunct professor of psychiatry at Northwestern University鈥檚 Feinberg School of Medicine and author of 鈥�,鈥� tells of a couple in their early 70s he鈥檚 counselling. Both were working when the wife started having symptoms of Parkinson鈥檚 disease five years ago.

In retirement, the couple had planned to do a lot of biking, hiking and adventure travel. Now her mobility is limited, he鈥檚 down in the dumps and tension has invaded the relationship.

Rolland鈥檚 advice: Figure out what you can do together and what each of you can do separately. He helped them see that they can share some cherished activities 鈥� reading books together and attending the theater 鈥� and add new ones, such as cooking. And the husband can still go biking, without worrying about making his wife feel bad, so long as they communicate openly about respecting each other鈥檚 needs.

Divvy up responsibilities. Couples need to retain a sense of balance in their relationships, to the extent possible. Often this is threatened as one spouse becomes less able to function and the other takes on more responsibilities.

Kivowitz has a practical suggestion: Create a list of everything that needs to be done in your household, then divide up tasks. If there are things that neither of you wants to do, brainstorm ways to find help.

In her video, she describes how she and her husband Richard did this. Kivowitz signed up for laundry, meal preparation, keeping medical records in order, researching her condition and arranging help at home. Richard took on grocery shopping, getting medications, dealing with insurance, paying bills, financial planning and working to keep the household afloat. Neither wanted to do housecleaning 鈥� a task that could be given to someone else.

Robert Mastrogiovanni cared for his wife, Kathleen, who had multiple sclerosis for 50 years before she passed away last year. They are pictured here at their wedding in 1968.(Courtesy of Robert Mastrogiovanni)

Include the ill spouse. Avoid assigning the ill spouse to a passive role of being 鈥渃ared for.鈥� To the extent possible, set boundaries around caregiving and maintain reciprocity in the relationship.

Rolland tells of a woman with polycystic kidney disease whose husband helped administer home dialysis three times a week: 鈥淭hey would go into a room where all the equipment was kept, and, when dialysis was over, close the door and focus on being a couple.鈥�

When Mastrogiovanni retired from an accounting job with the government, he and his wife bought a van with a ramp and travelled all over the country. When she could no longer feed herself, they鈥檇 still go out to restaurants where he鈥檇 feed her by hand 鈥� something the couple鈥檚 therapist had encouraged.

When joint activities are no longer possible, just being with someone can express closeness and solidarity.

Although Corcoran鈥檚 husband couldn鈥檛 talk, she鈥檇 sit with him and talk to him about what she was feeling: 鈥淗e would put his arms around me, and I would say 鈥業鈥檓 doing the best I can. I know this isn鈥檛 your fault, but it鈥檚 really hard.鈥� And I always ended up feeling better.鈥�

Expand your network. If friends and family members don鈥檛 seem to understand what you鈥檙e going through, find people who do. Well and ill spouses may need to find support in different places.

Bocchiere, who鈥檚 chairman of the Well Spouse Association, said that when a spouse is seriously ill, 鈥渨e lose our best friend, our love, our future. But your children, friends, relatives 鈥� they don鈥檛 get it.鈥�

The first time he went to one of the association鈥檚 support groups and listened to other spouses tell their stories, 鈥淚 was home,鈥� he said.

Make meaning. 鈥淎t some point,鈥� White said, 鈥測ou have to be able to make meaning of what you鈥檙e going through as a caregiver and incorporate this into a new sense of identity.鈥�

For many people, meaning revolves around the notion of 鈥渇idelity鈥� 鈥� commitment to their spouse, their vows and the 鈥渨e鈥� of their relationship, he said.

Corcoran converted to Catholicism the year that her husband was diagnosed and found solace in her faith and her church. 鈥淚 kept praying that our marriage would have meaning,鈥� she said.

Learning that people from her church saw her marriage as 鈥渓oving鈥� gave a deep sense of satisfaction. Ultimately, Corcoran came to understand 鈥渢his is a cross my husband and I were carrying together.鈥�

Kivowitz has observed a profound shift in herself and others, from 鈥渃aregiving as a set of daily responsibilities鈥� to caregiving as an expression of compassion.

鈥淢easure success,鈥� she said, 鈥渂y how well you connect, love and feel loved.鈥�

We鈥檙e eager to hear from readers about questions you鈥檇 like answered, problems you鈥檝e been having with your care and advice you need in dealing with the health care system. Visit to submit your requests or tips.