Jennifer Axelson, LCSW, CLCP, MSCC, CCM
The things we worry about, and the secrets we keep, evolve as we move through life’s many stages. We might like to think that by the time we’ve raised our children, left the world of full-time employment, and relaxed into retirement, there would be few reasons to worry or withhold information from others.
Seniors do, however, worry. Seniors also harbor secrets.
The fierce desire to run their own lives, make their own decisions, go where they want to go and live the way they want to live may inspire the withholding of information. The worry is that if loved ones or service providers know about certain issues, they might try to fix them…and fixing the issue might involve a loss of control on the part of the senior, a reduction of independence, a slow slide down the slippery slope of enfeeblement.
It’s difficult to address and assuage fears if we don’t know what they are and impossible to solve problems that have been hidden. Not all seniors worry about and hide the same things, but awareness of the possibilities makes us better advocates and enables us to watch for signs that a worry or problem is dictating behaviors or jeopardizing safety.
The Specters of Vulnerability and Loss
Many of the principle worries occupying the minds of seniors revolve around events that could shine a light on reduced function and lead to a loss of independence. Many fret about these unpleasant specters:
Memory loss – They’ve all seen people lose their cognitive function and become mere shadows of themselves. Forgetting even minor things can spark fear that cognitive decline is underway.
Falling – It’s not the fall itself that inspires fear, perhaps, but rather the ugly consequences. A walker or wheelchair might be introduced, along with the dependence and loss of mobility they represent. Complications from falls can even lead to death.
Declining health – Chronic illness, multiple prescriptions, sensory impairments, poor balance and other factors remind seniors daily that their bodies are no longer as reliable as they might once have been. And with declining health may come that core dread, loss of independence.
Loss of familiar comforts – It’s not just “home” that might be lost. Leaving the workplace also removes a familiar and comfortable environment, and family is often busy and largely unavailable due to mid-life obligations. It can be a lonely experience to let go of these familiar touchstones.
Not being able to drive – Perhaps more than any other single factor, driving represents independence. Giving up the car keys leads to dependence on others for basic needs and potential inability to remain at home.
Death of a spouse – Marriage offers companionship, comfort, and a sometimes-necessary division of labor within a household (i.e. one spouse can write legible checks while the other has pretty good skills in the kitchen). Surviving one’s spouse is a lonely proposition and may require a renegotiation of one’s daily routine and lifestyle.
Loss of dignity – Debilitating disease, sensory impairment, incontinence and other hallmarks of old age may feel like failures and encourage a sense of humiliation and embarrassment.
Running out of money – This fear may be the most paralyzing of all. Limited income and unknown longevity/future expenses prompt a corresponding fear of spending. Many seniors resist new expenditures, no matter how small, and exercise excessive frugality.
In keeping with the protection of independence at all costs, seniors sometimes fail to disclose events or habits they suspect might trigger unwanted intervention. Watch for signs of these possibilities:
Falls – If no bones are broken and no bruising is visible, seniors may not report falls. Doing so could result in the introduction of assistive devices they prefer not to use. Canes, walkers or wheelchairs may be avoided because they create an impression of disability. In senior communities, there may even be a perceived pecking order revolving around the degree of one’s outward independence. The more able you are, the higher your status.
Pain or dizziness – Troubling new symptoms may be kept secret so as not to incite alarm and questions about safety. Again, a new medical problem could cause a cascade of unwelcome interference from family or service providers.
Driving mishaps – Tickets and/or accidents could easily lead to questions about one’s ability to drive. Tickets can be quietly paid and minor dents in the car can be explained away as someone else’s doing (someone hit the car in a parking lot and left).
Gambling – Trips to the casino are commonly organized at senior centers, and casinos target older people with discounted meals to bring them in the door. Gambling outings may allay boredom and provide a social outlet. Unexplained financial shortfalls, however, may point to an emerging problem or possible exploitation by others (i.e. a “new friend” is taking the senior out gambling and financing their own bets at the senior’s expense).
Financial abuse – It’s not at all uncommon for financial abuse to go unreported. Some victims are unaware of the abuse, but others know about it and choose to keep it secret. It’s embarrassing to admit one has been “scammed” and the victim doesn’t want to appear incapable of managing money appropriately.
Alcohol or drug abuse – Substance abuse at any age can stem from the desire to solve another problem – loneliness, anxiety, pain, mental illness and other issues can be made temporarily better with alcohol or prescription drugs. Whether it’s a continuing habit or a new problem, alcohol and prescriptions consumed abusively can cause changes in mood or personality, increase falls and pose serious issues behind the wheel.
The Elephant in the Room
Broaching a difficult topic with a senior should always begin with a respectful acknowledgement that they are adults who have lived full lives and are free to make their own choices. Unless they are adjudicated incompetent, assume they have a good reason for withholding information. Avoid dismissing their concerns as unfounded or foolish.
When a senior seems to be harboring worries or concealing a secret, concerned loved ones and service providers can try a variety of approaches to elicit more information and make it “safe” to talk about the hidden issue:
Be honest and be an ally – Acknowledge your feeling that there may be ideas or events they’re not talking about. Tell them you don’t want to invade their privacy or take away their free choice…but you do want to help solve problems and keep them as independent as possible. Take their side. Tell them you think you understand how they might feel but you’d like to know more.
Share a confidence – Set the tone for candor and intimacy by talking about a problem or worry with which you have struggled. When possible, offer a confidence that parallels the secret you suspect they are keeping (i.e “Sometimes I think I should cut down on my drinking” or “I’ve been worried about money lately”).
Speak in the abstract – Imagine how you might feel in a situation like theirs and speak from that perspective. “I imagine I’d be worried about falling and needing help if I lived by myself. I would want a way to call for help”. If they deny the need, ask if they would accept an emergency pendant because it would make you feel better.
Talk about how someone else solved a problem – “Mrs. Johnson decided not to drive anymore. She’s saving a ton by not paying for car expenses, and she has worked out an arrangement with a cab driver who takes her where she wants to go.” Though rather indirect, this approach allows the senior to speak hypothetically if they’re not ready to speak more personally about an issue.
Ask others to be involved – Suggestions that come from a known and trusted professional – an attorney, doctor or pastor – are sometimes received less defensively than they are from adult children. Expertise in a given area, such as financial management, can make a friend the ideal candidate to assure a senior that they are on track to outlast their resources or to tell them about all the benefits available to those who need assistance.
Remind them that preparation can take the place of worry – If a senior is truly worried about memory loss or outliving a spouse, for example, acknowledge that these are not things we can control. But we can plan for them, just in case. Talk about how an estate plan will set things in place, just as they want them, should they lose cognitive function. Discuss options for remaining safe at home and having a plan in mind should various scenarios occur. Once everything that can be done in advance is done, the penchant for worry might be reduced.
As advocates, it’s important for us to accept that the seniors we serve are adults. We must treat them as such. Their trust and respect must be earned, and these elements may lead to more open communication. Seniors have to feel that they can tell the truth about their worries and mishaps without being “railroaded” into something they don’t want. Treat them as partners, collaborate, and listen. Understand that your clients or loved ones may choose not to recognize or act on the preventative measures you recommend and understand, too, that late in life you might worry, withhold information and feel exactly as they do about doing things your own way.
© Lifecare Innovations