Everybody says the same thing when a friend is going through a difficult time: "Let me know how I can help." But such offers are often difficult to accept — primarily because they're not specific.

It's much easier to accept concrete offers, such as:

• "I'm going to the grocery store. May I pick up a few things for you?"
• "I've got a couple of hours free tomorrow afternoon. May I sit in for you while you run a few errands?"
• "I made an extra big meatloaf so I could share it with you. I brought enough to last you for several meals."
• "Do you need some laundry done? I can come over today and do it. Or maybe I could help you sort medical bills, or do dishes."

Even a card or phone call means a lot. Often visits are even better. Sometimes a caregiver just needs a little contact with the outside world. It's all too easy to become enmeshed in the duties required to care for a person with Alzheimer's. Caregivers can feel trapped in their own house.

You may even want to arrange an outing, to give everyone a change of scenery. A picnic lunch at a park might be fun. If appropriate, try to include the person with Alzheimer's in the conversations. He or she may not be able to participate, but may appreciate the attention.

Caregivers also need the chance to just talk. A sympathetic ear is more valuable than you might realize. Don't expect to solve problems; just offer support.

Some people have a difficult time accepting help. They may believe they should do everything themselves. This attitude can be harmful not only to the caregiver, but also to the person with Alzheimer's.

Signs and symptoms of caregiver stress include denial, anger, social withdrawal, anxiety, depression, exhaustion, sleeplessness, irritability and lack of concentration.

Be gently persistent in your offers of help. Remind caregivers that they can't take care of someone else if they don't take good care of themselves first.