Aging Well: Tackling tough talks from afar

Useful reading

"How to Talk to Your Senior Parents about Really Important Things: Specific Questions and Answers and Useful Things to Say," by Theresa Foy DiGeronimo.

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This is the second in a three-part series about caring for aging parents or relatives long-distance.

Last week: Creating a care plan.

Today: Overcoming barriers of resistance.

Next week: Caregiver health and support.

Caring for an aging parent or relative living far away can be among the most challenging situations a person faces.

While many resources are available to help caregivers organize a care plan, there is no road map guiding them through what often is the most difficult part of the process - communicating with the older person to achieve a safe and comfortable solution.

Respecting the parent or relative's preferences and helping that person realize assistance will allow them to remain independent longer are keys to a successful long-distance caregiving situation, according to aging experts.

Good communication

Susan Collins, assistant professor of gerontology at the University of Northern Colorado, shared her insight into how long-distance caregivers can overcome their parent's or relative's resistance to help.

She emphasized that caregivers remember the person they are caring for is an adult capable of making or being involved in decisions.

"Accepting needed help does not make people dependent, but taking away the ability to make their own decisions makes them feel dependent," she said, noting that her advice applies mostly to older adults who do not have dementia, though those with dementia can make some choices.

Considering a parent or relative's perspective can help the caregiver plan a thoughtful approach. Many older adults needing care have experienced recent losses - a spouse, friends, income, driving or other abilities, etc. - that make them feel they are no longer in control of their lives.

"Including the older person in the decision-making process is a crucial way to assure that even if the elder is not thrilled with having to adapt to caregiving arrangements, he or she at least feels they have some control over how that is to be carried out," Collins said.

Of course, discussing emotional matters with family can be like walking on egg shells. Giving the planned conversation a lot of thought can reduce caregiver anxiety and possibly lead to a more effective exchange. Long-distance caregivers may want to discuss the most important matters in person with their parent or relative.

In his online article, The Do's and Don'ts of Communicating with Aging Parents (www.ec-online.net), gerontology expert and author Mark Edinberg offers suggestions for tackling emotionally laden conversations.

For example, using "I" statements to communicate views, perceptions and feelings can help the caregiver avoid sounding authoritative. The caregiver still can be assertive in his or her beliefs while leaving the conversation open to the older person's perspective.

Edinberg also recommends caregivers be clear about the topic of conversation and avoid letting their frustration or concern turn into judgment or defensiveness, which can make the other person ambivalent to their efforts.

Family dynamics

Past relationships between the caregiver and older person play a strong role in how an older person may react to suggestions for help.

If the older parent has, in their mind, retained the role as family decision-maker, for example, the caregiver will want to present information about outside assistance as information only, then step back to let the older person make his or her own choice, Collins said.

For example, a caregiver can inform their parent/relative about a program offering assistance with household chores and then give that person the contact information.

If a caregiver senses the older person wants help but is somehow embarrassed by that, the caregiver may want to be more direct by asking if the older person wants the caregiver to actually make the call.

Older parents or relatives might be more apt to accept help from a geriatric care manager, who will access their needs and coordinate services. Formal assistance may be more comfortable for some older adults who prefer to not depend on their child or long-distance caregiver to "take care" of them, Collins said.

The best approaches to care situations involving older adults can require a lot of patience on the part of the caregiver, who also must be realistic about how much control they have over the situation. If an older person who is not cognitively impaired refuses all suggestions for help, family and friends may have to settle for staying in close touch with that person while respecting their decision.

Collins noted that cognitive impairment, such as the onset of Alzheimer's disease, warrants more direct action from the caregiver, who should contact the Area Agency on Aging in the older person's area to see about arranging assessment and case management for that person.

There are legal steps that can be taken, such as obtaining guardianship or conservatorship over the older person, if the caregiver feels that person is in danger of hurting themselves. However, courts very rarely grant this kind of authority in cases involving older adults who are cognitively healthy, Collins said.

One of the best ways to encourage older adults to accept help is to focus on how assistance may allow them to stay independent longer. By accepting help with cooking or cleaning, home adaptation, physical therapy, transportation or other assistance, older adults recovering from illnesses or who have chronic conditions can reduce their chance of falls and major disability, she said.

"Rather than focusing on and expressing their own fear about what might happen to the older person, the caregiver should focus on ways that as much independence as possible might be maintained or regained," Collins said.

Tamera Manzanares can be reached at tammarie74@yahoo.com.

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