“Doctor, my mom needs help, but she won’t accept it and she won’t listen.”
Sound familiar? It’s a complaint I hear all the time from families worried about older parents and aging relatives.
And it’s a very real issue that we must address. For better health and wellbeing in older adults, it’s not enough to identify the underlying health and life problems — although that is a key place to start.
Because even if you’ve correctly identified the problems and learned how the experts recommend managing them, older parents often seem, well, resistant. Understandably, this causes families a lot of frustration and stress.
Here are four actions I always recommend that families take when older parents are resisting help.
1. Consider the possibility of cognitive impairment
In other words, is a problem with brain function contributing to this resistance?
Now, let me emphasize that you should not assume that your parents are in their wrong mind just because they are making health or safety decisions that you don’t agree with.
That said, because it’s very common for the brain to become vulnerable or damaged as people age, decreased brain function is often a factor when an older person resists help. This can affect an older parent’s insight and judgment and can also affect how well they can process your logical arguments.
It’s important to spot such cognitive impairment. Some of the impairment is often reversible. For example, older adults frequently develop delirium when ill or hospitalized, and an older person may need weeks or even months to recover to their best thinking abilities. Cognition can also be dampened by certain conditions, like hypothyroidism, or by medication side effects.
In other cases, the problem is underlying dementia such as Alzheimer’s. Sometimes it hasn’t yet been properly recognized or diagnosed. Or it may be that a senior has been diagnosed with early dementia, and the challenge is figuring out whether it’s progressed to the point at which it’s a major factor in resisting help.
What to do: Get help spotting underlying cognitive problems. You can help a parent’s brain function at its best by avoiding brain dampening medications and encouraging a restorative low-stress environment. If your parent is cognitively impaired, you may need to get help assessing decision-making capacity. And avoid relying too heavily on logical arguments if signs of impairment are present.
2. Make sure you’ve heard and validated your parents’ emotions
Here’s something you may have noticed in your own life: Logical arguments often fail to convince the people we have emotional relationships with. This is true even when they are younger and presumably have good mental faculties.
That’s because people are not rational about many things, especially when it’s an issue that stirs up certain emotions in them. And issues that touch on aspects of our identity, self-worth and autonomy – all of which come up when we’re concerned about older parents — are especially prone to trigger emotional responses.
All people care about having their emotions validated. People also want to feel connection, love and self-worth.
Whether or not your parent might be cognitively impaired, it is crucial to remember this. In fact, if there is potential Alzheimer’s, it can be even more important to help a parent feel heard and validated because this will reduce stress and help the brain function better.
What to do: Try to understand the emotions your parent might be experiencing, and use active listening to help your parent feel heard. You may need to invite your parent to share his or her feelings by saying something like, “I really care about you, and I’d like to make sure I understand more about what you’ve been feeling about this situation.” If you can afford it, consider investing in a few sessions with a relationship therapist or another person trained to facilitate family conversations. It can be especially productive to work with someone experienced in helping families address aging issues, like a geriatric care manager.
3. Review your parents’ goals and what trade-offs they might be willing to make
As families and doctors, we often prioritize safety and longevity. In other words, we want to prevent falls, injuries, illnesses, new medical problems and catastrophes of any kind.
We also usually want our older parents to live as long as possible. Perhaps we can’t bear the thought of being without them. Or it might seem wrong to not want a person to live as long as long as they can. Furthermore, it often seems like our parents want to live as long as possible.
But here’s the thing. For most older adults, the goals of safety and longevity bump up at some point against the goals of autonomy and independence. Most conflicts that older adults have with their families end up revolving around this dilemma.
Unfortunately, there is usually no easy answer to this question. Once an older person becomes more vulnerable in body or mind, you cannot have perfect safety as well as perfect independence.
But when the trade-offs are identified and goals discussed, it’s usually possible to help everyone feel better.
Common goals that I hear from my older patients include:
- Living in their own home for as long as possible
- Dictating the terms of their daily life
- Living their usual life for as long as possible
- Minimizing pain, illness and suffering
- Spending quality time with family and loved ones
- A good quality of life, which generally means more enjoyable activities and fewer stressful or burdensome activities.
Safety is important, but don’t fall into the trap of assuming it should always be your family’s No. 1 priority. Because when faced with a trade-off between safety and autonomy, most older adults choose autonomy.
This is especially true of people with dementia. And even though they may have lost the insight and judgment abilities needed to properly weigh the risks, their preference for independence is still very important for optimizing their quality of life. In fact, an approach called “positive risk-taking” is now being advocated as a way to make communities more dementia-friendly.
What to do: Ask your parents to discuss their goals regarding medical care and their living situation. You will want to have a frank talk with the doctors beforehand to ensure your parents understand their health problems and what declines or crises they should plan for. Be sure to talk about the pros and cons of the available options, and try to find out what kinds of trade-offs your parents might consider acceptable.
Remember, most families eventually face a trade-off between safety and independence. Being Mortal, by Dr. Atul Gawande, is a good book that explores how several families, including that of the author himself, navigated these dilemmas.
4. Distinguish what you need from what your parents need
When we get anxious about our parents’ safety, or their reluctance to accept help, what is it we really need and want? What fear or desire is driving us?
I try to explore this with families when there’s conflict or resistance because I find it helps untangle sticky situations. Some common underlying issues include:
- A need to minimize guilt
- A fear of conflict with other siblings
- A fear that a parent is going to decline further and require more help
- A desire to know that a parent is happy and comfortable
- A desire for control and for knowing what will happen next
- A fear that what is happening to our parents might eventually happen to us.
People being people, we all have a tendency to try to address our needs by wanting other people to do something differently, or by trying to keep things from changing.
But as the relationship experts have been telling us for decades, the best approach is to accept that things change and to focus on what we can do differently. We shouldn’t try to meet our own needs by controlling what others do.
What to do: List your fears, frustrations, desires and goals regarding your parents’ wellbeing and health. Notice the ways in which they are distinct from what your parents’ own fears and desires might be for themselves. Look for ways to address your fears and desires while respecting your parents’ preferences. This often means giving up the idea that your parents have to do this or that. Relationship counseling can help.
There Are No Silver Bullets
Now, I won’t sugarcoat this. Even when you get informed, are thoughtful in your approach, and obtain the right kind of assistance, helping older parents through this stage of life will be a challenge. Of course you will worry about them. And they will probably never be entirely free of reluctance to make changes and accept help.
But over the years, I’ve seen that some families get stuck in a rut of conflict and frustration, whereas others find ways to move forward more constructively.
It might feel like an extra effort to do these things. But by investing in your ability to better navigate these difficult situations with your parents, your family will get closer to what we all want: less stress for ourselves and better quality of life for our parents.