Two years ago, Ruth Maxey was raising six children, including twin granddaughters, a niece and the girl's three siblings.
She was also in her 60s.
It got to be too much, and in January 2011 Maxey had a stroke, not long after she retired from a demanding job as a hospital administrator. She has high blood pressure, which is a risk factor, but "I'm sure the job and raising the kids and the rippin' and runnin' had something to do with it," she said.
After her stroke, the three oldest children moved in with their grandmother in Rockford, and Maxey focused on raising the other three, including her two grandchildren, whose mother had died of complications from childbirth.
"I guess all would be good if I was 35 and I had the energy to keep up with them," said Maxey, 64, who decided to retire to focus on the kids. "I don't have the energy, but I love them."
Raising children can be taxing at any age, but it can put even more physical and emotional strain on an older person. Poor health, in turn can make it more difficult for some grandparents to perform caregiving duties.
Some research has found that grandparent-caregivers experience depression, high blood pressure and other health problems at higher rates than their peers who are not raising children.
"Considering the changes related to aging — hearing loss, vision impairment, gait abnormalities, cognitive decline, among many others — grandparents face significant emotional and physical challenges as they try to 'keep up' with toddlers, tweens, teenagers and pre-adults," said Dr. June McKoy, a Northwestern University geriatrician.
Most people assume that their full-time child-rearing responsibilities will end once their children are grown and out of the house, but millions of grandparents across the country find themselves nurturing another generation.
Their numbers have risen steadily over the years. Among the reasons: an illness, death, addiction, mental illness, incarceration or military deployment on the part of one or both of the child's parents. The prolonged economic downturn also has taken a toll on some families.
Of course, not all grandparents wind up caring for children under such difficult circumstances.
"With some families, what you see is shared parenting across the generations and a family adapting in a very positive way, such as helping a young parent going to school care for the child until the parent can assume more of the responsibilities," said James Gleeson, an associate professor at the Jane Addams College of Social Work at the University of Illinois at Chicago.
And some grandparents say their grandkids help them stay active.
Grandparent caregiving crosses income, racial and other demographic categories, Gleeson said, though African-Americans are two to three times as likely to be raised by a relative other than a parent, compared with other racial and ethnic groups. About a third of grandparents caring for grandchildren are single.
Nationwide in 2011, about 7 million grandparents lived with a grandchild younger than 18, and about 39 percent of them were primarily responsible for meeting their grandkids' basic needs.
In Illinois, grandparents were living with their minor grandchildren in more than 270,000 households. In 99,000 of them, an older adult had taken on primary responsibility for meeting the basic needs of at least one grandchild.
Daxa Sanghvi, caregiver specialist at the Kenneth Young Center in Elk Grove Village, said participants in a support group she facilitates for grandparents raising grandchildren often share concerns about the impact of caregiving on their health.
Sanghvi said many of the grandparents say they are stressed out and that conflicts about the grandchildren sometimes arise between them and their spouses.
"They have no time, no energy, and emotionally they are really deflated," she said. "They are not even thinking about themselves because they are going, going, going."
Many of the grandparents she works with are sleep-deprived and "trying to do so much it affects their emotional state as well as their physical state," Sanghvi said. "Sometimes they don't even realize how much it is affecting them."
One of those grandparents, Suzanne Kowalski, was so absorbed with taking care of two of her grandchildren that she ignored a dimple on her left breast that turned out to be a sign of cancer. By the time she sought medical care and got diagnosed a year later, in September 2011, it had spread to her lymph nodes.
"Had I not been raising the grandkids, I would have gone to the doctor at least a year earlier because I wouldn't have been so financially strapped," she said. "My energy level would not have been so low. … I was giving all my attention to them."
Kowalski — like other grandparents interviewed by the Tribune — said she doesn't regret taking the children in.
"Every choice I made was my choice and I would do it again," said Kowalski, who lives in Mount Prospect. "I believed they didn't deserve any less than my full attention. In hindsight, I could have taken better care of myself so I could be better for them. But you live and you learn and sometimes you learn when it's too late."
In March, after eight years, she decided to turn over custody of the children to their father, her son-in-law.
Without the kids, Kowalski says, she is paying more attention to her health.
"I'm living and eating differently now," she said. "If they were living here, I wouldn't be doing that because I always put the kids first. Now I'm first."
Many grandparents living on a fixed income can't afford health care for themselves because they spend what they have on their grandchildren, McKoy said. This is especially true for African-Americans and Latinos, who tend to have lower incomes to start with.
McKoy said some of her grandparent-patients ask for less expensive medications because they can't afford the ones she would usually prescribe.
Resources are available to help, said Sarah Stein, manager of community programs at AgeOptions, a nonprofit Area Agency on Aging. AgeOptions and other agencies offer services to support older adults raising children, including counseling, support groups, resource referrals, limited financial assistance, and help with legal matters such as guardianship and adoption.
Despite the challenges, most grandparents feel a sense of reward raising their grandchildren and report high levels of satisfaction for keeping the family together, said Gleeson, who has conducted research on grandparents who are raising their grandchildren.
And most studies report that the children do well socially, academically and in other ways, he said.
Maxey, who lives in south suburban Dolton, said families must do whatever they can to stick together and support each other.
"Never in my wildest dreams did I think I would be raising my grandchildren," she said. "(But) what else would I do? They are here and I love them. They are truly a blessing."