To be clear, many “disconnected” adult children don’t step back in. For them, there is no going back. The outside world may judge them harshly, but it matters not. I have a friend who walked away from his family at an early age, and refused the urgent call in his fifties to reconcile with his dying mother.

Cold hearted? Depends on whose reality you choose to inhabit. In an unusual moment of transparency, he shared with me his childhood trauma. It was raw and left me distressed. He broke away in his mid-teens and never went back. Understandably, he spent many non-linear years trying to outrun his demons and scars, but finally, with help, righted his thinking and his life into a stable success story. Then he got the call.

His mother was dying. She wanted to see him. He refused. “I barely survive her once,” he told me. “I can’t take a second round.” And he didn’t. Her deathbed request went unanswered. His family condemned him. He has no apparent regrets.

But others change their minds. Unlike my friend, they see an opening that allows them to return and lend a hand. Some find their ability to forgive is big enough for both parties. Some find an all too familiar disappointment they recognize from their childhood. I think all of them hope for some form of a better ending for their story about their earthly parents. And that, I think, is the key to those who return and those who won’t.

At some point in the parent-child disconnect, you decide its time to let it be. It’s over and probably for the better. That point may be death, but for many, it comes much earlier in the saga. These early adopters resign their affiliation and call it a day. It’s not a case of good or bad, but what is necessary given the players and the circumstances of the family drama. Those who leave but don’t disinherit their family keep the door open for some form of reconsideration. What is important for adult children is to recognize that both choices get the job done. Bad connections are one of life’s nasty dilemmas, leaving all parties unsure of what to say, do, or expect. In the end, we all wind up doing our best, as we understand it. Nothing more. Nothing less. Accepting that, proves to be another matter…

In most cases, our aging parents passed on when we well on our way in middle age. With each loss, our world became more sober as the reality of being “next” in line collided with the world of sixty-something. But a new emotional tipping point in the drama of being older occurred with the unexpected death of the first cousin.

It’s not that we hadn’t experienced the loss of peers in childhood or as young adults. And then after fifty, the news of friends, friends of friends, and people we simply knew about being suddenly gone began occurring with a prophetic regularity. While it was disorienting and disturbing, it initially spared our family network of adult children. But when the first cousin of the surviving herd died at sixty-something, all that changed.

While it was a single loss, we knew it was a cautionary tale about our generational position and predicament. Despite the density of our modern lives, we could no longer afford to ignore this new vulnerability, a realization that haunted our awareness. We knew we were never going to reclaim the frequency or closeness of childhood. That was another life that had served us well, but was gone. We also know that the meaning and import of our early years now took on legacy proportions with the threatened loss of its primary players. We felt compelled to undertake a “cousin audit” of the history that defined so much of our early family life.

We spoke out loud about what meant the most to us and why. We disagreed about chronology but respected personal importance. We confessed our bias, preferences, blind spots, selective memory and the out and out rewriting of history. But most of all we saw, from the end of middle age, how complicated life was for our parents, like it or not. We didn’t gloss over the unsavory and pathological events we would have gladly avoided, but the easy assessments of “they could have done better” lost its steam. Life turned out to be hard for everyone, including us.

New support services to enhance their “aging in place” environment
New lifestyle changes to protect and improve their health
New living accommodations to put more fun back to their lives as well as reduce isolation and loneliness
New long-term care options to better prepare them for major setbacks

But many times our attempts to discuss these and other “change topics” are met with extreme push back that includes indifference, rejection, and hostility. Despite the constant media prompting to have “the talk” with our aging parents and despite our best intentions, we wind up sending out the wrong signals that are show stoppers instead of conversation starters. Why is this happening and what can make it better?

An extremely valuable book written for healthcare professionals may hold the part of the answer. It is called Motivational Interviewing in Health Care: Helping Patients Change Behavior. The authors offer new insights and strategies for discussing change topics in a clinical medicine setting. It appears that their approach could be equally useful to adult children of aging parents. Here are some highlights from the book that seem especially relevant for all caregivers.

The Change Dilemma

It doesn’t matter how obvious it seems that change would make things markedly better for our aging parents; it is hard for everyone, period. There is a deep inertia to change that anchors all of us to what we have always done. With aging parents, there is the added inertia to change that comes from their developmental need to maintain control in a world where all control is being lost. Change is a threat to control and is viewed with suspicion. So it is unrealistic and impractical to assume our aging parents will suddenly be “change friendly” just because they are older and have glaring issues that could benefit from something new. But as Motivational Interviewing in Health Care so effectively points out, the real six-hundred-pound-gorilla in all of these conversations is the quagmire of ambivalence.

Ambivalence

The insights and practical advice on ambivalence alone is worth the price of Motivational Interviewing in Health Care. It turns out that ambivalence lurks behind all change conversations and can be provoked by our attempts to argue away our parents objections to change. These are those unsolicited lectures we give our aging parents to inform or direct them to do something different. I call this all to common habit of adult children the “better answer” syndrome. This is code for “I know what’s best, please pay attention.”

But instead of consensus, it only provokes the dreaded righting-reflex that entrenches our aging parents into arguing against the suggested change, moving the conversation from uncomfortable to communication gridlock. Thankfully, the authors offer an effective, non-intuitive approach to work around this all too common dilemma.

Change Rapport

Motivational Interviewing in Health Care makes it clear that our goal is to avoid triggering the righting reflex and make an honest effort to understand our aging parent’s point of view. This involves finding out what they are actually experiencing and then signal that we are listening and get it. Within this non-triggering conversation environment, we can begin to test open-ended questions about issues where change might be useful to increase long-term control. Here are some simple examples:

How are you doing?
What’s worrying you most today?
What do you think would make this better?
How have you been feeling?
Tell me more…
What’s new with your friends?
What do you feel like doing?

Open-ended question invite our aging parents to choose the direction of the conversation. Once they pick the direction, we simply reflect back their thoughts and comments to indicate we are listening and understand their point of view. Although tempting, we need to resist the temptation to interrupt. Interruptions only make matters worse. We need to hear the whole story on a topic. But as the authors point out, we are listening for more than the story. We are listening for “change talk.”

This may be the most important benefit caregivers receive from reading Motivational Interviewing in Health Care. Change talk is where aging parents begin to voice some interest in change. It is a soft signal, more a preliminary musing about what if, wouldn’t be nice, I really need to, it would be better if, and I am sure I can, all examples of change talk phrasing. The most important thing about change talk is that our aging parents are exploring the other side of their ambivalence to change, speculating on how or why it might be worth considering. How we respond to these pre-change-exchanges will have an enormous impact on whether or not change actually occurs.

Motivational Interviewing in Health Care offers a detailed explanation and ample examples of how to develop these moments of change talk into positive changes. Despite its focus on clinical encounters for healthcare providers, it offers adult children a compassionate and effective strategy to explore change topics in a non-threatening, parent-centric style. It is an approach could be a game changer for adult children searching for a new way to help their aging parents make positive changes.

I have read and reread this tale of estrangement, bitterness, regret, and the search for “repair” because I heard endless versions of it from friends, colleagues, clients, and audience members. I also lived it.

Below is the “comment” I posted to article’s website when I first read it in 2008. In the three years since I wote this, my opinion of my father has “expanded.” Much to my surprise, I have found a window into his suffering. This has given me new empathy for the gap between his dreams and where life finally took him.

Thank you for giving a voice to the bitter outcome many adult children experience with their aging parents before they pass away. We wish it were different but history and personalities bring the drama to its only logical conclusion. But was you pointed out, the death of the parent hardly ends the trauma of such a “poor outcome.” My father and I parted on similar terms, incommunicado and mutually sorry about our biological connection. As Joyce reminds us in The Dead, the departed usually prove more formidable after their gone. My father was not exception. I have danced for years with the guilt, anger, and loneliness of the events surrounding his death. The fact that our relationship was never right from the beginning is no comfort. Even his blatant failings, alcoholism, violence, and a perverse perfectionism are not enough for me to bid him a final and much needed adieu. Instead, my post-death relationship with has all the qualities of emotional quicksand. I scheme, struggle, and sink deeper into complexity. Like you, I find myself circling the issue of forgiveness but never getting it to stick. I think having a life with next to zero nurturing from him, it’s proving next to impossible to find the emotional release I need. This is why your story struck such a deep chord. Lastly, I don’t think it is either smarmy (wonderful word) or too late in the game to want relief. But I also think that these bitter ending are essentially Greek in nature, tragedies of accommodation not assimilation. They are familial dramas that leaves us with the task of orchestrating a “survivor’s compromise” that allows them to be who they need to be and finally gone.

Thinking won’t help. The brain buzz of dilemmas is a closed loop swamp of internal dialogues, an emotional rabbit hole of endless backward (repair the past) and forward (control the future) conversations. Caregivers wind up thinking themselves into stress filled knots that make navigation worse.

Putting thinking in its proper place does help. Finding a respite from the brain buzz, a space between the riptides of competing conversations, offers caregivers reprieve, repair, and rejuvenation. Fortunately, the technique for creating this healing space is being used in healthcare to manage other dilemma-riddled life events including chronic illness, depression, substance abuse, and heart disease. This clinically proven approach is called mindfulness-based stress reduction (MBSR), a secular form of meditation (see this link for a quick summary of the technique Mindfulness Meditation)

The approach is straightforward and accessible to anyone at any time. All it requires is that the caregiver learn how to pay attention “on purpose” to moment-to-moment events in the present. The practice (operative word “practice”) of staying focused on the present creates a space from never-ending brain buzz. This elegant form of compassionate detachment from thoughts and emotions offers caregivers a new perspective from which to observe their dilemmas as well as their habitual patterns of behavior of managing them. All of this is done within the context of kindness, compassion, non-judgment, patience, acceptance, and trust.

Like other healthy habits, regular use of MBSR can have a positive impact on the caregiver well being. It can reduce the stress, anxiety, and depression. For caregivers who want to learn more about MBSR, Jon Kabat-Zinn’s book entitled Full Catastrophe Living is an excellent resource. He is the founder of the Stress Reduction Clinic at the University of Massachusetts Medical Center, is perhaps the best-known proponent of using meditation to help patients deal with illness. His book is a terrific introduction for anyone who has considered meditating but was afraid it would be too difficult or would include religious practices they found foreign. Kabat-Zinn focuses on “mindfulness,” a concept that involves living in the moment, paying attention, and simply “being” rather than “doing (see this link to find more about the book Full Catastrophe Living)

While aging is inevitable, arriving at a healthy perspective about its meaning and potential is not. In our youth-oriented culture, middle age more often than not is portrayed as embarrassing stage of life that is in desperate need of enhancements to stave off the signs of being older. But Botox® and hair transplants can not hold the line forever and at some point thoughts and feelings about aging have to be sorted out at a deeper level, a realty check on what it really means to be older. The outcome of this “aging moment of truth” will have a profound influence on the quality of life for middle age adults. It will either reframe the journey as a continuation of growth and learning filled with unique potential, or see a darker landscape riddled with loss, regret, and limitations. This vantage point from which baby boomers will judge the aging process is called perspective.

Perspective provides a “filter” through which life experiences are assessed, organized, and ultimately judged. Youth has its own filter typified by an optimism found in the first half of life that keeps the metaphoric glass half full. It is a perspective that always sees another opportunity, another deal, or a fresh start that is not limited by health, family, or time. The first half perspective quickly converts setbacks into opportunities based on an unshakeable faith in the magnitude of possibilities that lie ahead. Middle age changes the filter.

Ushering in an era of external and internal upheavals, middle age introduces a different reality that undermines the sustainability of earlier optimism. What appeared unlimited now has restrictions and complications. The unspoken and yet pervasive cultural shame that sees aging as pathology leaves middle age adults holding a glass that is suddenly half empty. In this new environment, the first half perspective can undergo a rapid deterioration leading baby boomers to buy into a more cynical future. Without reframing, this is the anticipatory reality they are stuck with to manage being older. Ironically, this cultural anxiety about aging has no basis in biology or psychology. Growth and learning do not wane in middle age, and creative capacity is at an all time high. But the media’s slight of hand trick that obsesses over youth as the ultimate consumer class delivers a convincing message about the downhill trajectory of the second half of life. This dysfunctional perspective is a trap for middle age adults pointing them developmentally backwards to a phase that is over while distracting and devaluing the rich and immediate next phase on which so much is riding. Avoiding this unhealthy entrapment requires a different type of inquiry into being older. We call this inquiry The Perspective Inventory™.

As a reframing tool, The Perspective Inventory™ allows middle age adults to “test” the critical questions that ask themselves and others about the aging process. As Dr. Marilee Adams succinctly argues in her book Change Your Questions, Change Your Life, questions are the raw material of how individuals size up themselves and their world. They are the building blocks of perspective, the framing tools that either discover hope and opportunity or perpetuate endless cycles of conflict and despair. From a developmental perspective, questions are an ideal vehicle to examine and change concepts. They have the right linguistic packaging to emotionally override long-standing beliefs. They are receptive to the right brain, which has proven to be the informational gatekeeper for middle age and beyond. They are also emotionally generative and as such quickly alter cognition and change behavior. But the benefit of The Perspective Inventory™ is not simply to arrive at a better set of questions about being older, as valuable as they may be. The Perspective Inventory™ offers baby boomers a way to build a new filtering ritual so they can habitually reframe the experiences of aging to facilitate their developmental journey.

First and foremost The Perspective Inventory™ is an inquiry tool. It is allows middle age adults to organize and evaluate the quality of the questions they ask about the aging. It is based Dr. Adams’ premise that most people simply adopt a “questions style” without giving much thought to the impact it has on quality of their lives. Once internalized, these core questions become the ingrained filter for looking at people and experiences. With middle age, the impact question style intensifies in either a positive or negative way. Negative questions such as “Who’s to blame?” and “How can I prove I am right?” extract a heavy price on individuals and family systems. They negate prior success, shut down communication, and close off avenues of collaboration and growth. Even more concerning, they have the lethal potential to undermine confidence at a time in life where confidence is already in jeopardy. In contrast, aging friendly questions such as “What’s useful about this?” and “What’s possible?” lighten the emotional load on everyone. Not only do they facilitate communication but open up new channels of creativity, possibility, and growth. They help restore confidence and optimism to individuals and family systems.

The Perspective Inventory™ is also valuable resource for baby boomers as they engage the predictable dilemmas of their aging parents, experiences and situations that can leave both parties feeling frustrated, guilty, and anxious. Reframing questions surrounding the monumental family tasks of determining the right health care, sorting out living options, coping with the death of a spouse, untangling financial decisions, and coming to grips with the final goodbye can create a more effective and nurturing perspective. Developmentally tuned questions such as “what are the control issues here?” and “what other ways to look at this situation?” can help middle age adults keep their bearings in the midst of an emotional family landscape.

Finally, The Perspective Inventory™ reminds middle age adults that they can make positive alterations in the second half of life; they can opt for a radically different approach from the one they used in the first half. Moving into the upheaval of middle age asks two primary developmental questions:

1. How am I going to manage all this?
2. What is it I really want?

Successfully addressing these questions requires a perspective that is both personal and collective, is about self-fulfillment that is wrapped in a nurturing community of meaningful relationships. This is the heart of the need for authenticity. It is about finding personal clarity and not simply searching for another twenty years of approval or more of the same. For baby boomers that understand this potential, it comes as a welcome relief and an extraordinary opportunity to leverage their experience and education into an unlimited universe of choices and possibilities.

Seniority appears to be the rule of thumb. While adult child in their late sixties are beginning the battle for control and the search for legacy, these developmental needs are usually “put on hold” for the sake of the aging parent. Practicality dictates that both parties cannot be insisting on control as well as the airtime for life review, but the seniority accommodation is not as simple as it sounds.

Developmental needs are first and foremost embedded marching orders, which are involuntary, unconscious, and consumptive. They are background software for life-long human developmental and exert a pressing influence on perception, cognition, and behavior. When two generations share the same developmental zone, a new type of power struggle emerges over whose needs deserve priority. As with all generational conflicts, a middle ground is hard to find and hold.

The best course for adult children caught in this developmental simulcast is to make a selective course correction while their aging parents are still alive. This involves mapping out “control sustaining” strategies for their personal life (i.e. where to live, how to pay for it, how to manage health, how to foster community, etc.) while supporting their aging parent’s need to control their own destiny. It can awkward, confusing, and unsatisfying, but it defuses the unwinnable argument of entitlement. While everyone is entitled to address their developmental needs, in the context of families, this may require delay, compromise, and compassion for those who are going ahead.

The stories of what can and does go wrong with these transitions are legendary, maddening, and in most cases preventable. The sad truth is that older adults many times wind up back home with defective marching orders regarding their medications, recovery plan, and follow up care. Given the frequency and severity of the problems surrounding transitional events, what can make this better?

The good news is that Dr. Eric Coleman from the University of Colorado Health Science Center has a compelling answer: The Care Transition Program. His program is based on what he calls the Four Pillars?, an integrated transition management system that prevents medication problems, insures information continuity between handoffs, clear, follow up orders, and a protocol that identifies red flags that could crash the process.

It is a practical, brilliant solution that is gaining a growing population of followers across the country.

One key element critical to the program’s success is a Transition Coach?. This is usually a geriatric nurse practitioner that provides in-hospital coaching to both patients and their caregivers to help both parties prepare for the transition. As important, the Transition Coach? does follow up visits to skilled nursing facilities or the patient’s home to insure continuity across the transition.

To learn more about Dr. Coleman’s remarkable program and download a copy of his “Transition Survival Skills,” click here: http://www.caretransitions.org/transitionskills.asp

But this is no ordinary article about a bad outcome involving aging parents. This is a seminal article about a new and quite sobering level of vigilance that attends our role with our aging parents. The rapidity of events and the ever present pressure of “medical necessity” in the last phase of life can push families into decisions they not only regret but, as Ms. Butler so eloquently and heroically portrays, resist our best efforts to unwind them. If there was ever an article on this subject to read in a quiet, non-distracted moment, this is surly the one…

Primary Current Number Two: Internal Forces

While the external currents of the middle age challenge the capacity of boomers to handle complex and unpredictable life events, internal currents usher in an existential house cleaning that questions the purpose and meaning of the second half of life. Ironically, this involuntary reconsideration of the future comes at a time when so much has already been accomplished. But while boomer successes are a testimony to the faithful completion of the first-half life mission, they inadvertently lead to a developmental dilemma about what is to follow.

The mission of the first half of life is the steady pursuit of accomplishments, a long and noble list of all consuming life goals that are intense, quick paced, and well defined. Entering the first half of life stadium, young adults hear the cultural cheer of the rest of society encouraging them to on to greater accomplishments that include:

Growing up and taking their role in adult society
Getting an education as a prelude to a meaningful career
Finding a life partner to create a new family unit
Finding the right career to become successful
Starting a family to usher in the next generation of children and grandchildren
Becoming successful as a means to a secure future

As young adults immerse themselves in the first half of life journey, these goals are repeated at every turn in the questions they hear from family members, colleagues, and society as a whole. Did you get that apartment? Are you going to graduate school? Are things getting serious between you and her? Did you get that promotion? Are you two thinking about starting a family? Are you going to buy that house? The litany of goal-crafted questions offers definition, structure and much needed encouragement. The purpose and direction of the mission is never in question. But surprisingly and with little fanfare, the mission begins to change just at the point when so much has been done.

The second half of life journey does not share the same sociological advantage or clarity as the first half. Entering the second half of life stadium, boomers are surprised at how small the crowd has become and that it is surprisingly silent. Even more concerning is that the laundry list of first half goals has not been replaced by an equally compelling list of second half goals. In fact, goals have been replaced by social encouragements such as “you look good,” “stay healthy,” and “find something you enjoy.”

This surprising and disturbing loss of sociological scaffolding provokes an existential moment where boomers realize they have permanently moved into the “self-service” zone in terms of discovering their second half mission. While it is obvious that one set of goals is not enough for a lifetime, the question becomes what is the second set? Forced into an involuntary, midlife reinvention, boomers are unprepared to easily define the purpose and direction of the rest of their lives. Despite the unprecedented frenzy of modern life, part of them that feels adrift, eerily disconnected from the social agenda that has kept them on course for most of their adult life. Trying to resolve this dilemma is made more difficult by the tangible and unavoidable shadow of a sobering future. The futures of the past for middle age adults have always been multilayered, ten or twenty year segments that cascaded forward and offered ample “staring over” opportunities. The future of today’s boomers is smaller and time constrained, in most cases being played out before them by their aging parents. It is also less forgiving, with little room for error and or starting over. This time compressed future coincides with boomer’s new appreciation of their mortality.

Life and death is nothing new for boomers. Their generation ushered in a revolutionary social commentary on life and death issues that was markedly different from the generations that preceded them. But all the talk of life and death during the boomer’s youth was at an arms length from the humbling reality of middle age, a difference between discussing an illness and actually being diagnosed with it. Boomers are now living their mortality where the loss of parents, siblings, partners, and peers has created a new and sobering awareness of their own vulnerability. It is an experience that replaces the occasional tragedy of past where people were “gone too soon” with the more common occurrence of friends and family members simply passing away. This changes the urgency of the search for a new set of goals. Second half goals turn out not only to be a necessity for crafting a productive and meaningful life; they represent that last opportunity for most boomers to fulfill life long dreams and ambitions. It is a nagging reality that whispers to boomers, “if not now, when?’

The unsettling disorientation of the internal currents defines the second primary developmental task of middle age, which is to “discover purpose and direction for the second half of life.” This was the second hidden current that Linda did not see coming. Not only did her world become unstable, but also her role in this volatile landscape became unclear. It wasn’t a question of shrinking from her responsibilities; it was trying to determine what really mattered at this turning point in her life for the journey ahead.

These two tasks make up the mission of middle age: preserve stability and orchestrate reinvention. To do this boomers have to discover effective strategies to manage the onslaught of external currents while at the same time find purpose and meaning in their lives.

How do boomers navigate these formidable and intimidating currents? Is it simply the luck of the draw, with some having better outcomes than others? Or are there steps that boomers can take prior or during the riptide that can improve the quality of their journey. This is what Linda wanted to know. What needs to change to make things better? Fortunately there are strategies that improve boomer’s chances for a successful crossing. This is what the remainder of Riptide is about. It is about which navigational tools will help boomers successfully complete the mission of middle age and arrive well-prepared and ready for old age.

Navigation tools are designed to keep travelers on course. This is the goal of Riptide: keeping boomers on course. Understanding the currents of middle age is a critical first step, but knowing the developmental risk of middle age is only half the battle. Learning how to successfully navigate them is what determines outcome. Riptide presents boomers with a small but powerful group of navigational tools that are designed to keep them on course in the face of adversity and setbacks. All travelers will have difficult periods and their needs will change with changes in circumstances. The tools presented in Riptide arm boomers with the resources they need to overcome the challenges of aging. There were selected primarily on their ability to increase stability and facilitate reinvention. It not necessary for boomers to use all of them, only the ones that address their current navigational needs. As important, the themes of tools are familiar, topics boomers have heard from other sources as being important to preserving quality of life. What is different about Riptide is these themes have been reframed in terms of developmental utility, a unique approach that makes them “task friendly” and, as important, offers boomers new motivation to integrate them into their lives. It is an emotional reframing that resonates deeply with boomers offering them encouragement and much needed hope for the difficult stretches ahead.