TOP TIPS FROM PAULA SPENCER SCOTT
All over the world – despite differences in their cultures, resources and family structures – people are asking the same question: How do we balance our ageing parents’ need for care with their desire to stay independent? Geriatrician Leslie Kernisan (MD, MPH), founder of ‘Better Health While Aging’, teamed up with award-winning author Paula Spencer Scott – and their book, ‘When Your Aging Parent Needs Help,’ is the result: a practical, step-by-step guide for anyone facing an ageing parent’s decline.
Below are some top tips from Paula Spencer Scott on how to address those concerns in a way that’s both helpful and respectful to our beloved oldies.
What do you recommend when someone realises that their ageing parent needs help?
We suggest a four-step process to get started:
1. Collect information:
Make note of how things stand, your concerns or suspicions. What changes have you noticed in your loved-one – in their memory or judgment, their personality or capabilities?
This is beyond simply repeating a story, forgetting what they’ve had for lunch, or getting confused about where they’ve parked – which we all do at times! We’re talking about genuine confusion about something they’ve always been clear about … forgetting the month or year … or repeatedly missing appointments. Also note any signs of poor judgment or personality changes – things like crossing the road unsafely, or developing paranoid or suspicious thinking.
2. Evaluate how they’re coping with life tasks:
Are they struggling to take care of themselves – such as washing, dressing, or feeding themselves? Have they been getting confused when paying bills, driving, or managing their medication? Have they had an increase in falls or accidents?
3. Check in with others (family, friends, neighbours) who know your loved-one well:
Have they noticed any changes, or got other concerns? Keep your questions neutral and avoid making them feel disloyal to your loved-one:
Hey, I noticed that my Mum seems to be finding her garden more of a chore these days – has she said anything to you? … or … My uncle doesn’t want me to worry, but I’m away so much, and he’s got the whole house to manage since my aunt passed. How do you think he’s doing now that he’s on his own?
4. Watch for any ‘red flag’ safety issues:
Repeated falls, hospitalisations, or accidents … cooking incidents that have resulted in a fire … a major financial loss or expenditure suggesting poor judgment on their part … or any signs that they may be the victim of bullying or elder abuse.
Safety issues like these may signal that you should accelerate the process and intervene more quickly.
How do ageing parents typically respond to attempts to address their needs?
Two common defensive reactions by older people are to stonewall their kids – or simply brush off their concerns. They’ll insist that there’s no problem … they’ll refuse your suggestion to see a doctor … they’ll resist any changes to their habits or routines (such as giving up their driver’s license, which is a very precious source of independence for so many adults) …
These reactions tend to stem from one of two reasons … First: capacity. If they’re struggling to see what’s going on, they truly might not see an issue, or they may be unable to logically assess the situation. Second: a communication clash. Maybe it wasn’t the right way or the right time to bring things up – and if that’s the case, you’ll need to adjust your approach and try again. Here are some ideas:
Start with “I noticed…” I noticed another scrape on the car – are you worried about that?
Ask something hypothetical, without making it about you and them: “What would you do if … ?” Do you ever think about what you’d do if you couldn’t keep up the house anymore?”
Make it more about you: “I’m worried about …”
Invite their feedback, instead of jumping to your own solutions and ignoring their opinions. Remember how we hated that kind of intrusion into our independence as young people? That’s how our parents feel when we do it to them!
Put yourself in your parent’s shoes. Imagine how what you’re saying will sound to them.
Be as neutral as possible, because your concern/emotion over the situation can add stress to the conversation.
Stay grounded in kindness and do your best to remain open-minded.
It’s vital to initiate these conversations from a place of concern and respect. We can be so action-oriented that we can neglect that basic respect. These are all things that can help shift your efforts from confrontation to cooperation.
If you can’t get anywhere discussing things with your parent, but you still remain concerned about their wellbeing, their GP can be a valuable resource. You can ask to tag along on your parent’s next visit … you can suggest that they approach their doctor to review their health and/or medications … or you could even send a letter to their GP expressing your concerns. Because of privacy issues, you’re unlikely to be able to have a back-and-forth dialogue with the GP, but at least you’ll increase their awareness – so they can evaluate any changes in your parent with that in mind.
If you have specific safety concerns for your older parent, what can you do?
Practical things you can do to help address safety issues:
Look into a driving assessment if you’re worried they’re no longer safe to drive.
Set up financial safeguards and auto bill paying to reduce the risk of poor decision-making with money.
Reduce hazards in the house if falls are a concern: limit clutter … put in grab-bars … rearrange furniture to clear the way for walking …
What tips can you offer for communicating when a parent has obvious cognitive decline?
Converse with them – especially early on. Go slowly … use simpler language … and try to catch them at a good time of day. People who have dementia are often much brighter and clearer in the morning, when they have more energy – so that’s a better time to communicate with them about more important matters.
Be wary of becoming confrontational or argumentative. Enter their world; don’t correct them or argue about what’s real and what’s not. Don’t try to win them over with logic.
Remember the importance of body language – communication is so much more than the words we say! We communicate through our posture … expression … tone of voice … So, focus on remaining calm and friendly, and smiling with your eyes, instead of letting any frustration or tension show.
People with dementia rely particularly heavily on that nonverbal language – because words become harder for them to track and follow.
How do the goals of ageing parents and their adult children differ – and how do you find a balance?
What the family in this situation usually wants is some reassurance that their parent is okay. We want to know that we don’t have to worry about our ageing parents. And we don’t want to feel guilty because we’re not doing right by them. We want a quick resolution – for them to be safe, happy, comfortable.
But ageing parents are often not thinking in those terms at all. What they want is control of their own lives. They want autonomy and independence. They want to live as they’ve always done as adults. They want to appreciate quality time. Yes, they also want happiness and safety – but they may be more willing to trade off some of that safety for these other things that are so important to them.
We often take for granted that what WE want for them is what THEY want for themselves. We sometimes kind of want to wrap our parents in bubble-wrap to keep them safe … “Don’t get up, Mum!“ … “Don’t do that – we’ll take care of it” … “Will you be safe?” But that’s not much fun – and your parent doesn’t necessarily want that.
It’s really important to think about your parent’s point of view. And if you get to a point where you’re at loggerheads over how to move forwards, we recommend a tactic called the ‘ME-VERSUS-THEM’ exercise:
Think about what’s motivating you in a situation, and break it down … What are your priorities here? What are your real concerns? And what does success look like to you?
Look at how you think your mother or father might answer those questions based on things they’ve said in the past … their personality … what you know about how things are going now. What are THEIR priorities? What are their concerns regarding this issue? And what does their vision of success look like?
Compare how your perspectives differ, and consider which of your priorities you can loosen-up on in order to respect some of theirs.
Compromise can get you further when you’ve reached an impasse – although change often happens more incrementally than we’d like.
What are some of the limits a family should respect when caring for ageing parents?
Your job as a caring, loving, concerned adult child is to understand your parent’s situation and their point of view. This is critical. Beyond that, you can research possible solutions … encourage the most suitable options, with as much compassion as you can muster … and then support the choices they make.
Generally-speaking, unless your parent is significantly impaired, most people ultimately retain enough capacity to make a choice about their situation. And you need to respect that choice.
This is also vital: As you get deeper into this journey of helping your ageing parents, take care of yourself and the others in your life so that you can be there for the long haul. Some people become consumed with this process. And feeling constantly thwarted and frustrated in your efforts can feel devastating.
You have to accept that you can’t fix everything – and you can’t control everything. You can’t, as a general rule, make your parent do something they don’t want to. And you can’t expect that helping an ageing parent is a ‘one-and-done’ situation. Ageing – and life! – happens on a continuum, so expect to go through cycles of planning and experimenting over and over again.
Given the cyclical nature of this process, how can family members feel they’re seeing some progress?
We recommend following an ABCDE process:
A is for ‘Assess’ – information-gathering, researching, and examining what we know about the situation.
B is for ‘Brainstorm’ – coming up with all the possible solutions we can think of.
C stands for ‘Choose’ – you pick one or two of those potential solutions to start with (even if you’ve come up with five or ten options).
D is the ‘Do’ step – where you implement your chosen solution.
And E is for ‘Experiment’ – evaluating how that option is helping the situation.
Let’s take an example – concern over your elderly mum driving. First you assess the situation (A), and discover that she now lacks the physical strength to turn the wheel easily, or the agility to move her head to do shoulder-checks, etc. So then you brainstorm (B), coming up with ideas – like, telling her GP of your concerns … looking into a driving assessment … or offering to drive her for groceries each week (because that’s the only place she drives to these days). You choose (C) to offer your chauffeuring services. And then, when she accepts your offer, you make sure to follow through (D) and do it, taking her for her weekly shop. Finally, you get to experiment (E), which involves checking that your solution is working.
At this point, you might realise it’s not working for your Mum to be so dependent on your schedule and availability. So you’re back to step B to brainstorm some other options – like engaging a shuttle service, or getting groceries delivered, or having a neighbour take her on shopping day each week.
Of course, it’s still possible that your mum isn’t ready to give up her car. But you’ve moved the needle a bit on that point – you’ve had the conversation and made some headway. This process allows you little-by-little gains when you might otherwise have got nowhere.
How important is documenting things? What should people keep track of?
It sounds a little crazy, right?! Like, now I’m writing down conversations with Mum and Dad … But really, the whole ageing process can be a long haul – and you can’t necessarily anticipate the timing. It can be hugely helpful to just jot down things like conversations with the doctor … observations or discussions … dealings you may have with the Transport Agency. And note the date each time.
You think you’ll remember all these details, but – especially in a stressful time – things tend to run together. By writing it down, you’ll have all the contact info and everything else right there, and you’ll find it easier to track what’s been done and when – which will give you (and others) a way to look back and get a sense of the arc of things: We noticed this in March, and now it’s August … Looks like there’s been a significant change in these few months …
Does some cognitive decline or confusion mean that our parent is on a fast-track to full dementia?
In short, no! There are medical conditions, or drug interactions, or other factors that might cause people to appear moody or deeply confused, or to act in illogical ways. And even after ruling those possibilities out, there are lifestyle changes we can all make to help improve or maintain cognitive function.
You’ll want to tread carefully – your parent will likely resist any attempts to overhaul their lifestyle drastically! – but there are simple things you can do. You can invite them to join you on a daily walk. You can make sure they can regularly attend clubs and community or church activities. You can commit to spending more time with them yourself – because many people benefit greatly from increasing their social contact.
A medication review might help, because some of their prescriptions may have outlived their usefulness or be causing unwanted side effects. Cutting back on alcohol can help: alcohol obviously increases confusion, and our tolerance for alcohol can lessen as we age – but again, you have to be diplomatic when suggesting changes like that!
Beyond that, consider what you might do to lower the stress levels of your parent’s life. Anything you can do to improve their quality of life – even simple things like having someone else help with weeding the garden and mowing their lawn – will also help them mentally.
In your book you offer some ‘workarounds’ for common obstacles we’re likely to encounter when helping an ageing parent …
One thing to consider when your parent’s refusing to address something directly is what we call a ‘SIDE-DOOR APPROACH’. You can float a solution as a temporary measure, or just a casual suggestion – not a drastic, permanent change to how they’re doing things. It might be something like them trying a meal service while you’re away … or giving them a voucher for house-cleaning as a birthday present … or “I got this great two-for-one deal from a gardening service. They’re cleaning up my yard, and they’ll do yours too!”
A non-threatening offer like this gives your parent an opportunity to try something out without the pressure to continue – or to make a big decision up front. And they might find that they actually like having that help.
When your ageing parent is completely resistant to help, we advise ‘WATCHFUL WAITING’. Assuming you’ve been through the steps (ABCDE), you’ve tried different approaches, and you’ve remained calm and compassionate – watchful waiting is just pausing. It’s not doing nothing; you’re continuing to respect your parent’s dignity and building goodwill within the relationship … and you can continue checking in and doing your research until you can do more.
Watchful waiting isn’t easy. It requires patience and the understanding that you can’t force the process.
Any closing tips for our readers?
Sometimes your attempts to help or intervene are well-received or even welcomed – but not always. And if you’re finding it a tricky thing to navigate, you’re most certainly not alone.
To anyone who finds themselves in this situation, I’d like to say: if you’re even thinking about this, your heart is in the right place! Your years with your ageing loved-one haven’t necessarily been all hearts and roses. Many relationships with parents, step-parents, grandparents, great-aunts/uncles have been fraught over the years – and yet you’re showing up for them, willing to engage in spite of all the challenges.
In addition to our book (which includes extra online resources such as printable checklists), I’d also recommend Dr Kernisan’s website, ‘Better Health While Aging.’ It’s full of articles and programmes and solutions to specific problems that you might find helpful.
TO LEARN MORE, CHECK OUT DR KERNISAN’S WEBSITE – WWW.BETTERHEALTHWHILEAGEING.NET HER BOOK WITH PAULA SPENCER SCOTT – WHEN YOUR AGING PARENT NEEDS HELP – IS AVAILABLE AT ALL GOOD BOOK RETAILERS.
