Shay Jacobson, RN, MA, NMG, LNCC, CNLCP
Martha Kern

angry_stick_figure_1600_clr_5356

“I’m not moving!”

“I’m fine!  I don’t need any help.”

“I have a driver’s license and I’m not giving up my keys!”

Almost everyone who has approached a client or elderly family member about the possibility they may benefit from caregiver support or a facility placement has heard these exclamations.

The near universality of these objections seems to indicate there are fears, misconceptions and mindsets that beset the elderly and create in them a staunch position of defiance where care is concerned. No matter how difficult their struggle, no matter how lonely and isolated they have become, they will emphatically insist that all is well.

If we are to understand and address the phenomenon of senior resistance, we must first try to understand the experience of being elderly.

What’s It Really Like to Be Old?
People who are not elderly imagine being old, and especially being retired, as a time of great leisure.  The children are raised and on their own, the workaday grind is over, and our days are generally unfettered by all the mid-life responsibility that once plagued us. We can choose among opportunities to read, garden, fish and travel.

In truth, the senior years are like a foreign land none of us have ever visited.  We can’t know exactly what it’s like until we arrive there, and our experience of this alien place may be unlike that of others we know.  The singularity of our aging experience may, in fact, create a sense of terrible loneliness.

Apart from the very real and well-recognized issues of pain, loss of dexterity, decreased mobility and the plain fact that even simple tasks take a long time to complete, there are other pressing issues about which we rarely hear:

  • Even if our cognition is for the most part intact, we may find that our ability to process information and conversation slows down. It’s harder to follow what’s happening in a real-time conversation or busy environment.  Our slowness to grasp a question and formulate an answer may lead others to believe we’re “not all there”.  They may think twice about talking to us again, especially if they are hurried younger people accustomed to fast-paced dialog.
  • Departure from the workplace, though a great relief in some ways, is a scourge in others. We don’t often recognize what a social hub the average workplace can be.  Without it, we lose connection to others and become isolated.  We also lose our identities, in some cases, and our opportunity to contribute to the larger whole.
  • No longer significant players in the family apparatus, we may rely more on friends for social contact. The longer we live, however, the fewer our peers. Opportunities for engagement and acknowledgement are rare.
  • We likely experience ageism. In public, we are virtually invisible. People don’t strike up conversations with us in elevators as they may assume we’re hard of hearing or demented. Even medical students confess that they are far less likely to aggressively treat pneumonia in an 85-year-old woman than they are in a 10-year-old girl.
  • If we maintain an interest in working, even if only part-time, it’s difficult to find employers who are willing to hire us. From a senior employee they anticipate inflexibility, slow work pace, a lesser aptitude for learning new tasks, and a lack of technical proficiency.
  • Understandably, our elderly selves may experience grief over all we’ve lost, depression, boredom, anxiety about the future, and a general disappointment in the whole proposition of being older/retired. Chances are, the way we’ve always imagined ourselves as elderly adults is far rosier and more functional than the reality in which we find ourselves.  We may even feel we’ve failed somehow.

The Intervention
Against the backdrop of all this difficult emotional terrain, imagine a senior’s internal alarm when a professional or family member comes along and suggests a caregiver or a facility placement.  While having help and companionship sounds wonderful to the younger person proposing it, the senior to whom these suggestions are addressed may hear entirely different messages.

When we endorse the idea of a caregiver to a senior, they may process it as such:

  • There will be a terrible loss of privacy;
  • I’ll be alone here with a stranger;
  • People will see me with this person and know I’m weakening;
  • Even the simple tasks I can still do, and which make me feel normal, will be done by someone else.

The suggestion of a lovely facility placement may also be processed in a negative manner:

  • I’ll be in a strange place;
  • My deficits will be made public – I won’t be able to hide them anymore;
  • I won’t have any control;
  • I’m going there to die.

Strategies to Address the Senior Mindset
Certainly, not every senior feels the same way about everything. It’s important to remember, though, that as we suggest care to them, we may very well be talking to someone with some of the perspectives and objections outlined in this article.  If resistance is encountered, be patient and choose your moments carefully.  Try to bring the subject up organically, naturally, and do it when the situation is relaxed.

Other approaches and insights:

  • Try to avoid solving a problem that the senior does not perceive as a problem. You may be focusing on safety, for example, when the person you are talking to feels perfectly safe alone at home.
  • Talk to them about what they most want. Solicit their opinions, identify their deepest desires and then help them achieve those goals.  Show them how many choices they have and involve them in making that choice. Solve a problem they actually perceive as a problem!  If they fear a loss of independence, assure them that they can still do the things they like/want to do for themselves.
  • Focus on the positive rather than using scare tactics. If the goals are to prolong independence and increase social connectivity, emphasize how an assisted living facility counts on residents to be able to do many things for themselves and has musical programs, gardening classes and outings.
  • Start small. Try one short caregiver visit and offer to stay for the first hour or so.  Then schedule another to make a specific dish Dad likes and hasn’t had for a while. If a facility is being considered, try a one-week respite stay.  Treat it as a “vacation” and do everything possible to make sure it goes well.  Share a meal with them and help them connect with others in the dining room.
  • Enlist help. Hire a care manager to perform an assessment while assuring the senior that this objective assessment may well show they are right – they are very capable and independent and don’t need much help at all.  Ask friends and neighbors to casually mention, as possible, that someone they know recently hired a lovely caregiver, or that Mrs. Smith just moved to the new assisted living in town.
  • Let it “bake”. As much as we want to avoid a crisis, it may take a setback or a “scare” of some kind to make something new and unknown appear slightly more attractive than the negative thing that just happened.  Be patient and let the senior come to their own realization about how things are and how much better they might be with support.

Remember that a senior is not a version of you in an older body.  Seniors have very particular problems and worries that color their perspective and the manner in which they perceive your suggestions.  Although they always knew they would eventually get old, they never imagined it would be like it is.  Contemplate their losses, their lack of connectivity and the invisibility they may be experiencing, and try to use care options to correct these very real problems.

More depth on this topic, and specific ways we can avoid some of the negative aspects of aging if we plan ahead, are offered in our CEU presentation on this very subject.  Please call 630-953-2154 to schedule a presentation, or email contactus@lcius.com.

© Lifecare Innovations
Resources:
http://www.newyorker.com/culture/cultural-comment/what-old-age-is-really-like

https://www.psychologytoday.com/blog/21st-century-aging/201311/what-is-it-really-be-old

http://www.todaysgeriatricmedicine.com/archive/winter08p16.shtml

http://www.aplaceformom.com/senior-care-resources/articles/moving-elderly-parents

http://www.seniorhomes.com/p/impacts-of-aging/

http://www.carefecthomecareservices.com/blog/elderly-loved-one-resists-care/