Dorothy Adams cares for her husband.
She cares for him nearly 24 hours a day, seven days a week, holidays included.
That does not leave Mrs. Adams, 69, much time to care for herself. But she doesn't complain -- she is helping the man she promised to love and cherish when they married more than 53 years ago.
Arthur Adams, 74, had an operation five years ago that left him unable to walk and dependent on his wife for almost every need. The former mechanic also lost his sight to glaucoma.
"He was a very active man before the operation," Mrs. Adams said. "He went to work and took care of his family. Now he can't do anything by himself."
And as a result, she added, "I am pretty much confined to home."
Mrs. Adams is her husband's primary caregiver, and she is not alone.
Nationally, "the care of 80 percent of older people is provided by family members or friends," said Susan Coller, manager of the year-old Eldercare program for the Maryland Office on Aging.
According to statistics gathered by Ms. Coller's office, nationally, one in five working adults over age 30 cares for an older relative or friend. The statistics also show that those 45 and older are more likely to be providing financial support to an adult than to a child.
And with America graying, no one expects these numbers to decrease. The 1990 census, for example, reported more than 500,000 people 65 or older living in Maryland, compared with about 400,000 a decade before. Nationally, the 1990 census counted more than 31 million people 65 or older, up from about 25 million in 1980.
Taking care of an elderly person is something people generally don't talk about, Ms. Coller said. "It is the hidden responsibility. People talk about their children, but they don't talk about caregiving."
But it is important for caregivers, who often feel stressed and guilty for not doing more, to express their feelings and remember to take care of themselves, health care professionals say.
Janice MacGregor looks after her 83-year-old mother, who still resides in her own home.
She described her mother, Alberta MacGregor, as "very independent and healthy," but she has had nine surgeries in five years. And when her mother does get sick, she said, it "goes quickly from a cold to pneumonia."
Yet, the elder Mrs. MacGregor wishes to remain in her Roland Park home, where she raised her family. That means additional ** responsibility for Ms. MacGregor, who lives in Stoneleigh. Although she does get some help from her sisters, "you have another whole house to run," she explained.
The hardest part for Ms. MacGregor is when something unexpected arises with her mother. "I have young kids [11 and 13] who have their own schedule of activities," she said, "although my daughters are very understanding and helpful.
"I am committed to keeping her in her home," Ms. MacGregor said of her mother.
Increasingly, there is support for Ms. MacGregor and other caregivers. About a year ago, the Maryland Office on Aging -- which was formed in 1975 and has an annual budget of more than $20 million and offices in every county and the city-- received a $100,000 federal grant to help corporations reach out to their employees who are caregivers.
The Eldercare corporate program provides various activities for corporations, including lunchtime seminars on aging issues, setting up caregiver support groups and presenting caregiver fairs where people can get information on a wide range of health and aging concerns. The fairs address such topics as structuring daily activities and anticipating future needs.
The corporations that have signed on include C&P Telephone and the Social Security Administration, Ms. Coller said.
Caregivers can also turn to adult day care centers where elderly charges can be dropped off while relatives work or take care of chores. These centers -- some are affiliated with hospitals, others are independent -- are also a benefit to seniors citizens who are on their own and not able to get around much.
Caregivers "are terrific, special people doing a heavy-duty job," said Edward Sabin, a professor at Towson State University whose specialty is gerontology.
They are also people -- because of their love for the person being cared for -- who sometimes refuse to turn over their caregiving responsibility to others, said Dr. Susan J. Denman, the medical director of the Johns Hopkins Geriatric Center.
A lot of elderly people need 24-hour monitoring, Dr. Denman said. "Often that means that the caregiver is not sleeping. Or they have to sleep with one eye open."
For Sylvia Yeager, 52, nighttime can be "very difficult."
Mrs. Yeager has been taking care of her mother for 18 years, ever since her father died. While she works, her 81-year-old mother, Sylvia Senger, attends an adult day care center at the Francis Scott Key Medical Center. "Things were fine until six years ago," Mrs. Yeager said, when her mother was diagnosed with dementia.