It is more stressful to care for a frail spouse than for an elderly parent, according to a new nationwide survey conducted by The Associated Press-NORC Center for Public Affairs Research. The vast majority of spousal caregivers unexpectedly find themselves handling the complex medical tasks of nurses, such as managing medications and wound care.

Few Americans have made their wishes for end of life care known, and most 40 and older say they will count on family members to care for them as they age, according to the survey of more than 1,400. Respondents were far more likely to discuss funeral plans with friends and family than their preferences for assistance with daily living.

“Caregiving may start with driving a loved one to the doctor or helping with household chores, but progress to hands-on care, such as bathing. Increasingly, family members are handling tasks once left to nurses, such as the care of open wounds or injections of medication,” according to the AP report. “With a rapidly aging population, more families will face those responsibilities.”

Nearly 15 percent of respondents said they have cared for a spouse or partner.

“The traditional vows are through sickness and health, for richer or poorer, for better or worse,” said 62-year-old Raymond Collins of Houston. “At the age of 25 and 32, you say those things and you’re high on love and healthy, and life is all in front of you. The meanings of those words are pretty much lost, even when you concentrate on them.” Collins retired early to spend time with his wife who was diagnosed with multiple sclerosis 15 years ago. She is now in a wheelchair.

Although Collins said he often felt angry and frustrated by his responsibilities, his marriage was ultimately strengthened in ways he did not expect. “Your relationship changes. Life as you know it becomes different,” he said.

Findings Reflected In Similar Study

According to recent findings published by the United Hospital Fund and the AARP Public Policy Institute, spousal caregivers are significantly more likely than other family caregivers to perform complex medical tasks while being far less likely to receive vital support.

Spousal caregivers tend to be older, less educated and less financially stable than non-spousal caregivers, such as adult children or siblings. The average age of a spousal caregiver is 64, a decade older than non-spousal caregivers, according to the 2011 survey. Nearly 50 percent of spousal caregivers have only a high school education or less, and more than half have incomes of less than $50,000.

“The challenges spouses who are caregivers face are daunting,” said Susan Reinhard, senior vice president and director of the Public Policy Institute and co-author of the report. “Nearly three-quarters of the spouses they care for were taking five or more medications, which are not easy to coordinate. Some of these medications were administered in non-pill forms, including injections and infusion pumps, with greater frequency than one might expect.” Nearly half of spousal caregivers provide care for three years or more.

The AP-NORC Center survey found broad support for tax breaks to help encourage saving for long-term care or for purchasing long-term care insurance. In 2009, there were an estimated 42 million unpaid caregivers in the U.S., providing an estimated $450 billion worth of unpaid care to adult and aging relatives and friends, according to AARP.