Tips for Communicating with Older Adults

Michael hands the store clerk $40 to pay for groceries and the clerk gives the change to his young caregiver. The waitress looks beyond Shirley and asks her niece, "what does she want to drink?" Leo's doctor interviews him during an initial visit but directs his eye contact to Leo's son. Anyone who spends time with an older individual can offer a similar anecdote about how the elder is ignored with the assumption that he or she isn't capable of speaking or acting on his or her own behalf. Even people who should know better often dismiss an elder without thinking.

Most elder people age very well and remain very capable, even with some of the inevitable decline that comes with aging. Nonetheless, too many of us attach incorrect labels and stereotypes to graying hair and lined skin.

Older people generally don't see themselves as old and don't want to be identified as "seniors." Like all of us, they're rather be identified with their interests, experiences and philosophies of life. We don't approach all "40-somethings" in a prescribed way or expect them to confine themselves to the company of other people in their forties. Yet, we often expect the elderly to act in a certain way and to be content around people their own age. Older people are as diverse a group of individuals as are young people.

How does one resist the temptation to focus on age and to instead see the person with a rich history and many capabilities and sensitivities? How do we politely but firmly inform an unenlightened salesperson or care provider that they need to regard and interact with the elder?

Often, directing eye contact toward the elder can communicate that the elder is the one who is central to the interaction. When an elder's input is ignored by another, ask the elder questions to elicit his or her involvement and give the message to others that the elder should be involved. If a subtle approach does not work, ask that questions and interactions be directed to the elder.

An older person may require more time to process information and respond, but most often, if given time, they can do so. Hearing deficits may require direct face to face communication and low, slow speech. A bit more time and consideration is likely to be all that is required to keep older individuals involved in their environment and their decisions.

Finally, many of us encounter elders who have significant impairment of thinking, who perhaps don't recognize their loved ones, and/or who are unable to let us know their thoughts and feelings. It can be frustrating and sad to visit these elders as a personal connection can be elusive. It is easier for family and caregivers alike to act upon those individuals rather than to interact with them. In such instances, address the elder during discussions, offer explanations, and use touch to offer a sense of inclusion. Look into that person's eyes and ask caregivers to look into their eyes. Begin care or a quiet visit with the silent greeting "hello in there."

With practice, your visits with elders can begin to serve as a model for all of your personal interactions.

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Helping Elders Make Changes

You can't expect him to change; he's always been that way." Most of us ascribe to that old saw, "you can't teach an old dog new tricks." While lifelong patterns are difficult to change, an open mind and open heart on your part can offer older adults who seem "set in their ways" a sense of their own continuing possibilities and potential.

Research tells us that most elders, even those who are infirm, want to continue living. Living involves change and growth, and often incurs some emotional or physical discomfort. Most of us are reluctant to ask an older adult to take that on. But one doesn't have to insist upon change to be open to it. In encouraging another to grow, we are encouraging the person to live fully until he or she dies.

Most older people don't feel old. Even as bodies and minds become less than reliable, elders see themselves and want to be seen as willing to take on challenges. Helping them explore possibilities and options is life giving and provides the unspoken message that we consider them capable and worthy. Doing so can also be freeing for the caregiver.

Unless suffering from cognitive decline or mental illness, older people are capable of taking on the challenges that the loss and decline of aging present. They may need help, as we all do during periods of vulnerability and stress, but they can maintain a sense of themselves and their choices. Lessons can be learned at age 70 or 80 or 90 - ask anyone that age.

Some guidelines to consider are:

Avoid assumptions that close off choices.

Because mother can't knit the elaborate sweaters she once did, doesn't mean she can't do some beautiful needlework. Because dad's eyesight is poor doesn't mean the world of books should be shut off to him.

Strive to make each encounter a fresh one.

Even though a suggestion was ignored in the past doesn't mean the person will never be open to it. One older adult didn't respond for years to the three notes a week she received from her sister. But after a long illness, she wrote her sister a letter and at age 90 began writing to the family and friends she had neglected for years.

Acknowledge to the elder that meaningful change is hard, but worth the effort.

Consider that you may be shortchanging an older person by not asking the elder to take on challenges.

Don't attach your ego to the end goal.

Much of living is in the process. Even if a goal is not met, the process of reaching for it can be satisfying and pleasurable. Our relationships and encounters with older family members are laden with emotion. When we find ourselves or an elder unable to get free of old problems and patterns, the input and insight of a skilled professional may be valuable in redefining the situation and offering a fresh perspective.

Hope is an essential ingredient in all long-term, healthy relationships. Some of us are late bloomers. Just as we relish the beauty of the autumn bush and the winterberry, with patience we can find our elders blooming, even late in their season.

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Learning to Give and Receive

For many of us, the holiday season focuses on giving. It is also a time to consider whether or not we are receptive to receiving from others. Being a “giver” and a “receiver” in relationships with others and the world helps each of us shape the meaning in our lives.

Of the value of giving and receiving is especially important in responding to older adults. One of the challenges that older adults face is learning to receive with grace. That requires an acknowledgement of needs and vulnerabilities. Being able to receive with grace nurtures a sense of mutuality, an essential ingredient in all healthy relationships.

Adult children and relatives are at times frustrated by an elder's rejection of the help they want to give. Reflections on why giving is often easier than receiving can offer insights on why an elder may find it difficult to accept assistance.

An unspoken expression of power is inherent in gestures of giving and receiving. An inclination to give may be as much a statement of one's stature, accomplishments and capabilities as it is an expression of generosity. Even when offered with love and concern, help may be resisted because the older adult isn't ready to acknowledge the losses in ability that make help necessary. An understanding of the exchange of power in giving and receiving can help provide a sensitive environment in which the power is shared.

You can help an elder accept help by first acknowledging the loss that the needed assistance represents. Allow time for denial and grief before coming to the “rescue” with a ready answer.

Communicate, through an open discussion of concerns, the intent to do things “with” rather than “for” the individual. Explore and offer choices – rarely is there only one “right” choice. Don't expect the recipient to feel good about making the choice. A person can learn to accept help, and at the same time be sad about the need for it.

While it is important to help an elder accept help with grace, it is equally important to provide ample opportunities and challenges for an older adult to give to others. The capacity to offer and share something with others gives a person a sense of well-being and potency – a “reason to rise in the morning.”

Many older adults are afraid of being a burden on others. That fear can be eased when reciprocity is realized. An elder can offer invaluable perspective and insight. You can encourage mutuality with gentle encouragement, such as, “I miss hearing from you” or “what do you think about it…”

When we nurture giving and receiving in the older adults we love, we gain a richer understanding of our own capacities and our needs to give and receive.

Credit: ElderCare Solutions newsletter, Fall/Winter 2002

Give the Gift of Time

The holiday season is upon us and once again the stores and catalogues are brimming with gift items. The impulse to buy things for an elderly person is well prompted. Yet, often the most meaningful, desirable gift is not something you buy, but is one of time and attention.

Most older people live in homes brimming with “stuff.” They truly don't need another thing. Health conditions may preclude giving candy or food treats. What many elderly desire more than anything else is pleasant company, the opportunity to talk to, laugh with and be touched lovingly by another. Simply visiting and sharing a cup of tea may be what an elder person wants most.

ElderCare Solutions suggests you consider sharing with an elder activities that elicit a joyful reminiscence, revisit hobbies abandoned or fill a void. Considering such a gift is likely to remind you of an elder's neglected or forgotten talents. It may rekindle, perhaps only for a brief joyful interaction, those skills in an elder. In short, sharing activities will bring you back in touch with the person your elder is.

Think of a gift that stimulates neglected senses. Arthritic hands or poor vision may interfere with an elder's ability to fully participate in an activity, but activating the senses may recall wonderful memories. An elder who is unable to accomplish many things alone may be able to do so with the support of another.

To assist and encourage you, ElderCare Solutions offers the following ideas to incorporate in a visit:

• Repot plants or create a small indoor garden.
• Make an album with old photos.
• With an easy-to-use camera, take photos of the wintry outdoors.
• Bring a tape of holiday music and sing a few songs together.
• Look at family movies or slides.
• Prepare a lunch together or bake bread for neighbors.
• Give a manicure, or a hand or foot massage.
• Watch a video together.
• Read a poem or short story.

Adapt the suggestions for older persons who are able to easily leave home. Take an elder who relishes plants to the botanical gardens. Go to a movie with a film buff. Take photos on a walk through the neighborhood. Go out to an ethnic restaurant of choice.

This year, give the gift of time. During a time of life when loss looms large, you may give life to a new, rich, holiday tradition. Who knows, you may decide that people of all ages relish this gift.

Credit: ElderCare Solutions newsletter, Fall/Winter 1999

Making Difficult Decisions after a Diagnosis

"Sometimes the gentlest of breezes can topple us off the precipice." While we all know that death will come, its inevitability is difficult to accept. Often we search for answers through medical procedures and technology, when the true answers come from nature, the "gentle breeze theory." The world of technology and a "fix it" mentality are blessings, yet they can also be a curse. Instead of helping families experience death as a gentle breeze, they may create a stormy and troubled time.

How do individuals and families discern when enough - when testing to find the answers to the "why" of a decline or the "what" might be done - is enough? How do we recognize when less is more? How can we come to embrace death as an option, rather than view it as a defeat or a sign that we didn't do enough? That takes thoughtfulness and a measure of courage.

Clearly, such decisions are among the most difficult we'll ever make. Personal values, the meaning of life, and view of death are part of the decision making, and as important to consider as medical information. There is no right or wrong, and each individual family must come to peace with its own decisions. Some considerations, however, can help a family be more clear and comfortable with their decisions. As tests or procedures are proposed, it's important to ask:

• what information will be gained?
• how will that information guide care decisions - will it make a difference?
• how much discomfort will be involved?
• what are the risks of not doing tests?
• what are the alternatives to tests and/or procedures?

Most importantly, information needs to be evaluated in the context of an individual's life context. An individual who was very active and engaged in life may have the reasons and reserves to withstand difficult treatment and will have a different recovery than one who was bedridden and whose pre-illness physical and mental resources were near depletion. Ultimately, it's important to consider: "will the medical interventions merely forestall death or will they likely provide for a comfortable and meaningful life?"

Very often health care providers are foremost in helping the family with their decisions. It is important that those providers know the person, their history and values, their pre-illness life circumstances. While specialists brought in for consultation can give information about tests and procedures, they are often less able to fit the information into an individual's life context – that is for the regular care provider AND the family to do. Other supports to and for the family – valued friends, ministers or rabbis, hospital chaplains – can be an important source of guidance.

Choosing to forego tests and treatment is not the same as doing "nothing." Choosing to accept death and support the dying process is a real and valuable intervention. But doing so can seem foreign and out of sync with a culture that strives to keep aging and death at bay. The opportunity to accompany someone in the dying process can be life-giving and comforting. It is an opportunity lost if it is not actively considered as an alternative to treatment. Choosing death can be part of choosing and gracefully accepting all of life.

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Talking about Death

Marilyn died last week. I was stunned by her death, which I considered sudden. It didn't occur to me that the death of someone 84 years old might be seen as inevitable rather than unexpected. Marilyn and I had many conversations, but we never talked about death and I regret that.

It's no revelation to say that most of us have difficulty talking about death. We use euphemisms to disguise the reality and finality of death, someone "passed on," "passed away," "moved on." It's as if we think if we don't talk about death, it will happen effortlessly and even magically. Ironically, our aversion makes death and dying more difficult.

The quality of life during the later years and during the time close to death is often poor. The fear of death seems in large part a fear of being abandoned and dying alone. Conversations that are open offer reassurance that needed care will be provided and that love ones will be present.

In contemporary society, death is generally removed from day-to-day experience and people are on unfamiliar ground as death approaches. Families and the elderly are often robbed of active, informed involvement in end of life decisions. Rather they become subjected to a high tech, high intervention mode of care. If they are willing to look at the closeness of death as years advance and make thoughtful plans for care, they will be able to better maintain control over the dying process.

Many health care providers, who are expert at keeping people alive, are uncomfortable in allowing death to come. Commonly, professionals look at problems to "treat," leaving the family to consider "to what end."

We cannot be in full control of death and dying, but thoughtful discussion and realistic planning is more likely to help the family assert and maintain their values and desires in the process.

An openness to death leads the family to find resources that can help create a climate in which "unfinished business" is addressed, honest goodbyes are made, and healthy interaction is fostered. Unless willing to acknowledge that death is coming, families are unable to take advantage of resources, such as hospice, which provides valuable emotional and material support in the last months of life.

Talking about death, as social critic Studs Terkel says, is really talking about life. The late years are a time for reflection from which meaning and purpose are derived - a time for telling tales and passing on wisdom.

Willingness to talk about death opens up the possibility of rich, life-giving conversations that help create a sense of an elder's legacy - on a very personal level. Looking at death offers the opportunity to embrace some of the best of life. — Signe Gleeson

Credit: ElderCare Solutions newsletter

Taking Care of Yourself while Caring for an Elder

All of us want our elderly parents and relatives to be well cared for. Yet, despite the very best of intentions, we may be unable to do everything that is needed for our elders.

Meeting an elder's needs can be exhausting and lead to a sense of failure.

One critical element of effective care giving is to learn to set limits for yourself.

Determine what you can and cannot do for an elderly relative.

Doing so will help you establish and maintain a healthy relationship with your elder.

Caring for an elderly parent or relative is done best when it is a positive choice

– not when it feels like an obligation or imposition. Look at your motivation and ask yourself "why do I want to help?"

The motivation for care giving, unfortunately, too often arises from a sense of guilt or desire to repay a parent for what they've given you. A parent's gifts of life and rearing are not debts to be paid back - there is no way to do that. Care giving can be motivated also by a desire for parental recognition, approval or closeness. Acting from a sense of guilt or need for approval may endanger your care giving of a parent or lead to disappointment for you and your parent.

To determine what is best, begin by identifying your elder's needs:

the physical, social and emotional care giving that may be required. What does your elder need to remain well cared for in his or her current environment? How much is the elder capable of doing independently?

The input of a professional may help you to understand your elder's needs and to determine the best approach to take. Is dad's refusal to walk alone based on a bona fide physical limitation? Is it rooted in fear? Is it the result of desiring attention? You can learn how much help is needed and what private and public resources are available to assist.

Once you determine the types of assistance an elder requires, decide what you are able to provide. Consider how your time at care giving will affect other areas of your life, such as your relationship with a spouse and children or your career.

As you consider how to help an elder, do not underrate your own needs. As an airline attendant advises when we're starting on a journey, "the able person puts on their oxygen mask first." During a crisis, elder care concerns may lead to temporary disruption of your life. But don't allow long-term disruption. The health risks to you and to the elder and to the relationship between you outweighs the benefits of putting your life "on hold."

Don't over promise what you will do. Be conservative in deciding how much assistance you can provide and how available you will be. It is better to promise less and do more than to promise more and not fulfill your commitment.

If you elder wants you to do more than you can, be firm in your resolve. Focus on what you are doing and don't let the focus shift to what you are not doing. Acknowledge the elder's feeling with a simple, "I'm sorry you feel that way," rather than giving a lengthy explanation that will merely exhaust you without satisfying the elder.

When you think about what you can and want to do for an elder relative, consider these questions:

1. Am I acting to relieve my own anxiety?
2. Does the situation truly demand my involvement or can somebody else meet this need for my elder?
3. How will my involvement impact other parts of my life?
4. Am I trying to meet someone's standards other than my own?

Learning your limits and to say "no" are signs of strength. Make your care giving a positive choice, rather than a response to guilt or a sense of duty. Doing so will give you more patience and energy for the care you do provide. Contact ElderCare Solutions to help you and your family create and maintain healthy relationships.

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Alcohol Abuse in Older Adults

The use and abuse of alcohol by the elderly is a growing problem and a uniquely difficult one to handle because the elderly and their families often are reluctant to talk about alcohol use. A 1998 study by the National Institute on Alcohol Abuse and Alcoholism estimates that as many as 11 percent of all elders admitted to hospitals exhibit symptoms of alcoholism. Although elders abuse alcohol less frequently than those younger, the incidence of abuse is increasing among the elderly, a growing part of our population.

Older adults who develop problems from alcohol fall into two general categories: a) those who drank moderately in the past and b) those who begin drinking later in life. Lifelong alcoholics are less common in the older adult population because they generally have abbreviated life spans.

Elders are more vulnerable to the harmful effects of alcohol than those who are younger. They become intoxicated more easily. The liver, which breaks down alcohol, becomes less efficient as one ages. They also take more medications, many of which enhance the ill effects of alcohol.

Alcoholism in the elderly is often hidden from view. An elder who maintains the same drinking pattern as in younger years may develop a problem gradually without recognizing it. A moderate drinker who uses alcohol as an emotional outlet may grow dependent on alcohol when facing life changes. Having faced the loss of a spouse, siblings and friends, many elders live day to day without social contact or structure. An elder adult may turn to alcohol to cope with depression, loneliness and anxiety.

Traditional routes to diagnosis of alcohol abuse usually are not present with the elderly. Job-related issues usually don't occur to set off warning signs because most elders are retired. Marital conflicts are rarer as fewer elders have a living spouse. Also, physicians often misdiagnose physical ailments, especially neurological, heart and gastrointestinal problems, as signs of aging rather than alcohol abuse.

Despite well-known and serious health consequences, often alcohol abuse is only brought to light when the family no longer can ignore its effect on cognition and the resulting erratic, uncharacteristic behavior, mood changes, memory loss, or even brief blackouts.

Alcohol abuse in older adults, especially in one's parent, is a difficult condition to address. When the issue is raised, reactions may range from simple denial to angry accusations. Elders who haven't altered long-time drinking patterns often deny a problem. Many elders see alcoholism not as a disease but as a lack of will power and they attach a moral judgment or stigma. This misconception prevents some elders from dealing with alcohol abuse.

Family members who recognize an alcohol problem stand at a crossroads where neither path is easy. One choice avoids rocking the boat until an inevitable crisis occurs. The other is to confront the problem with resolve and compassion.

Treatment can be successful, if the family and professionals are willing to look at the problem. The elderly are more likely to complete treatment than those who are younger. However, intervention must be taken seriously, and handled with a structured and expert approach.

Ignoring the problem of abuse does not make it go away. Much can be gained by bringing the problem into the open. Contact ElderCare Solutions for more information about the use and abuse of alcohol by the elderly.

Credit: ElderCare Solutions newsletter