In March 2013 I released my new book Caregiver Mind Maps: New Tools for Aging Parents. I elected a PDF format because the book’s mind maps are designed to be used on the front lines of caregiving, a kinetic space filled with continual explaining, bringing up to speed, and handing off. From personal experience, I knew the book’s mind maps would be marked up, revised, and passed around. All of this tactile interaction required a format that could be easily printed and PDF proved ideal (Download the introduction along with The Healthcare Team Mind Map).

Here is a recent review of the book:

We”ve all heard, “A picture is worth a thousand words.” In his book, Caregiver Mind Maps: New Tools for Eldercare, David Solie illustrates (literally!) the process towards meaningful, results-oriented communication between older adults, their family members, and other stakeholders. David Solie reduces the anxiety around these all-important conversations with step-by-step guidance to ensure a successful outcome. David truly understands the challenges associated with making key, later-life decisions, and provides his own innovative tools to enhance the experience for everyone involved.

Caregiver Mind Maps could revolutionize the way we engage in caregiving in the future. Fortunately for all of us, it’s here now!

Mary Kay Buysse, MS
Executive Director, National Association of Senior Move Managers
(NASSM)

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“It sounds like you have reached a tipping point in terms of what you can offer your aging parents. Despite heroic efforts, their needs exceed your capacity. It a simple fact of the complexity of aging. We do the best we can do until we are not enough. Hopefully we don’t self-destruct before we figure that out. But once we do, it becomes clear things need to change. This insight may not be shared by your parents who would like things to continue as they are or your siblings who would prefer a hands off position. Trying to convince them you are drowning under the weight of “keeping everything together” is pointless. This is your epiphany and your responsibility to act to protect your sanity and your family. The pleading phase is over. The informing phase has begun.

Inform your parents and your siblings you have gone as far you can go. Your home is no longer an option. Your parents need to find a living environment that is designed and staffed to address their health issues now and in the future. You are willing to help the family select a senior living location and with the transition. If your siblings feel this is excessive and your parents don’t need this level of care, they are free to offer their home as an alternative.

This is not to suggest that the informing will be easy or without pushback coming in ample doses of guilt and anger. Hold a firm reign, stay calm and rational and things will shift away from you carrying the entire load. Don’t expect anyone to thank you or be thrilled with the new configuration. But as your stress level recedes, you can take comfort in the fact your parents needed more and you had the courage to insist on it.”

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The directive is a contextual document where the marching orders of the past may no longer apply or need clarification with changing health. In good health, where disease and death seem to be distant rumors, the advanced directive can be brisk and definitive: Don’t let me suffer; pull the plug. Fair enough.

But once our aging parents slip into chronic illness, the “prior” directives may be mismatched for the new burden. The reality of illness that won’t go away transforms the brisk and definitive to more complex algorithms of “if this, then that” along with caveats that offer compassionate wiggle room. At this point, it is not unusual for older couples to diverge in what they do and don’t want from medicine and the family’s good intentions.

The beginning of the end of life creates the third contextual mandate to revisit the directives. In this sacred space, all previous bets may be off the table. No one knows what they really want until they stand face to face with their final act. What we do know is that the final marching orders should be our best efforts to find the right blend of compassion, comfort, and courage, a middle ground between suffering and release, between just enough and not too much…

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Jean de La Fontaine

The inclusion of genetics into a life management strategy may appear at first to be mistake. Life management implies choices and genetics is seen by most people as more luck of the draw rather than something that can be changed or upgraded. “Why bother” is typical response. Genetics, however, proves to be an ideal reframing tool for middle age adults. It provides an essential global view of a person’s family history that is beneficial in two areas:

1. It provides information for schematic overview of a person’s family medical history that we have entitled The Pedigree Road Map™.

2. It offers and emotional connection to specific risk factors and their outcomes, an essential step in the reframing process.

The Pedigree Road Map™ is unique portrayal of an individual’s family health history. While genetic history is one of the most valuable tools in preventative medicine, it is also the most underused. Part of the reason for its obscurity lies in its limited emphasis in clinical medicine.

While physicians will enquire about the family members and close relatives, alive and dead, the information is rarely developed or transferred into a usable form that allows patients to benefit from a global view of their risks, possible outcomes, and options. In the baby boomer world of increased volatility, stability begins with accurately knowing and managing risk.

The Pedigree Road Map™ plots out the magnitude and nature of the dangers that lie ahead. What was a curiosity in the first half of life, now becomes an essential piece of information for preserving quality of life. The effectiveness of The Pedigree Road Map™ to provide this level of risk management lies in the emotional context it creates for health issues.

Middle age adults are encouraged to exercise, watch their weight, eat a balanced diet, quit smoking, and reduce the stress in their lives. While this is all good advice to reduce the risk of heart disease, diabetes, and cancer, they are essentially perceived as facts. Facts, as previously discussed, are usually not enough to change concepts and behavior. Good advice needs to be presented from a different vantage point, repackaged with an emotional context in order to be effective in reframing. The emotionally charged world of families is an ideal platform to accomplish this.

Families are charged with emotions, both positive and negative. One thing they are not is neutral. Setting out to build The Pedigree Road Map™ may appear at first to be a clinical endeavor. It is not. The contextual diagramming of parents, siblings, grandparents, etc. initiates an emotional experience between real people and the person who stands on the base of the genetic tree. Each life, for better or worse, has dimensions, a story, and lessons. These insights are not lost on middle age adults who are wondering who they are, what the future will bring, and where their vulnerabilities lie.

The simple building of The Pedigree Road Map™ seems to ask as many questions as it answers. It sends the builder back to the family drawing board to find out more about the people who are directly linked to their lives. The obvious disease patterns are one thing, hyperlipidemia, hypertension, diabetes, heart disease, and cancer. But it is the unplanned discoveries within the family system that make The Pedigree Road Map™ such a potent sector in The Quality of Life Portfolio™.

Not surprisingly, so much of what individuals know about their family is comprised of second hand information and in many cases myth. Facts have a way of changing over time with details being lost or changed from one telling to another. The Pedigree Road Map™ offers a forum to reexamine what really happened to family members. It becomes a vehicle to fill in the blanks on subjects or people that had been vague or misunderstood for years.

Unknown or unappreciated patterns begin to emerge, themes that have a significant bearing on the quality of life for middle age adults. The search for heart disease not only turns up heart disease but also a strong and undeniable pattern of depression in each successive generation. This discovery raises a red flag regarding mental health issues for all close family members. Like untreated hypertension, untreated depression can be devastating to quality of life. But a warning regarding depression in itself is simply a health alert.

The Pedigree Road Map™ gives it an emotional context inside of the family. Its expression and consequences become personal, linked to real people and real lives. It resonates as both a warning and forecast unless further action is taken. Because of this, it is ideally packaged for the reframing process, able to make a cognitive impression that can potentially alter behavior. In a world of long standing lifestyle habits, this turns out to be no small feat.

Finally, The Pedigree Road Map™ brings into focus an overlooked element in discussions regarding quality of life. All lives, upon close inspection, are deeply unique and require customized management plans. Clinical medicine does a good job of offering general guidelines for health screening, but the final and most important choices reside with the individual.

This has become more apparent as the financial burden of health care is being steadily shifted to consumer. In a similar fashion, the outcome burden is also being transferred as physicians readily admit they cannot know or implement every diagnostic or treatment option. Individuals must take a bigger role in their health care including wellness management. Middle age adults have enough mileage to realize that illness is not an abstract concept that only happens to others. They know risk factors pose a real danger to both personal stability and the ability to pursue their goals. What good are new dreams if your body can’t make the journey or you spend all of your time and resources on being sick?

The Pedigree Road Map™ gives the abstract world of risk factors and poor outcomes substance by adding an emotional dimension to what works and what proves to be disastrous. It personalizes the why and how of spending health care dollars and in doing so, offers middle age adults a new level of confidence in their ability to read the danger signs and chose a better outcome.

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1. Death resolves nothing
2. All words return to haunt you

In moments of irony and pathos, I find a poem is worth pages of empathy. So here is the one I wrote for him:

Funeral Song

By David Solie

Even when things are going your way,
Words don’t come easy on funeral day.
Mourners turn up with guarded belief,
Awaiting your words of pain and grief.

But others arrive with their heart amiss,
Suffering and grudges topping their list.
Things in the room are not what they seem,
As secrets are leaked in darker themes.

Most of us wander with both lives in tow,
A brain full of stuff that others don’t know.
For better or worse it will all be replayed,
Whatever the version, whatever you say.

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It’s 2026. The future is here, 14 year later. We are taking a sneak peak into the lives of two baby boomer couples that are now well into their late seventies. Both couples live in Southern California. Both couples have worked hard and saved diligently for retirement. Despite the similarities of location and financial dedication, decisions each couple made in their mid- 50s have created very different futures they are now living 20 years later.

Couple number one, Linda and Ted, live in a retirement community north of Los Angeles that offers many levels of care. They have lived their lives using the “coping” approach, which meant adjusting to health problems as they arise but not venturing far from a lifestyle they chose 20 years ago. Linda and Ted stuck to what they knew and how they wanted to live their lives.

Ted has been in the assisted living unit for a couple years and would like to see Linda more frequently. Sometimes he gets depressed and cries. Ted has been overweight for over 30 years; 20 years ago he developed diabetes. Now he’s suffering from multiple complications of diabetes including advanced heart disease, poor circulation in his feet and lower legs, and poor vision. He is being transported to the hospital today for amputation of his left foot below the knee due to gangrene of three toes. Although the staff did their best to monitor his health, his lack of feeling in his feet due to his diabetes and limited ambulation due to his sedentary lifestyle allowed the gangrene to take hold of him. His vision problems caused by his poorly controlled diabetes resulted in him losing his drivers license many years ago. The demands of his poor health take almost 100% of his coping mode just to get through each day. Each day is a struggle for him depending on others for the most basic daily living activities. It takes almost 2 and half home care providers 7 days a week to assist him with his daily activities of living (ambulation, bathing, food preparation and eating, and visits to the doctor). His prognosis is poor and he is unlikely to survive another year.

In another part of the same retirement community, Linda and their kids are sorting through the couple’s belongings as they prepare for Linda to join Ted in the high level assisted living center. Linda had been a smoker all her life and after the development of emphysema stopped smoking 10 years ago. Unfortunately 80 pack years of smoking (40 years of smoking 2 packs a day) took its toll on her lungs. She has a constant hacking cough and audible wheezes with each respiration. Her face is covered in deep wrinkles especially surrounding her mouth accompanied by her raspy voice as she gasps for air in her tiny apartment. Her emphysema necessitates both a portable oxygen unit for day trips with her kids and a larger unit at her bedside. Between the emphysema and heart problems, she has to sleep with her oxygen on in a sitting up position or she experiences a worsening cough and heart palpitations. She curses those “damn cigarettes” daily. Her daily regimen includes taking seven medications and frequents visits to her cardiologist, pulmologist, and internist. She can no longer cook or take a bath unassisted. She is just too tired and out of breath all the time. Sally will follow Ted within 12 months of his death. Although good savers all their life, their health problems bankrupted both their quality of life and bank accounts.

Couple number two, Heather and Jack, live in the same house they have called home for over 40 years. They have lived their lives using the “upgraded” approach, which meant in their mid-50s they added good health as a goal for the rest of their lives. To reach that goal, they had to change their lifestyle, acquire a new set of habits.

Jack just celebrated his 79th birthday. Jack loves life. He is a deacon at their church, leads a men’s group on Wednesday mornings at the local coffee shop and walks three miles daily with his wife Heather. Heather and Jack cherish their 50 plus years together. Each morning as they walk, they catch up on their plans for the day, discuss the grandchildren and talk about various projects they are working on. Heather reminds Jack they need to decide if they are returning to the same small village in Mexico for their volunteer vacation next year. Heather has already talked to their granddaughter about house and pet sitting while out of the country. After their walk, Heather, who just turned 75 years old takes care of the dog, two cats and the household parrot. Later today, they are scheduled for visiting pet nursing home rounds at a retirement home with Winston the parrot and Carmella, their fat orange tabby cat. The staff and residents look forward to their biweekly visits. Jack and Heather bring a sparkly presence and a new story or two about the animal mischief in their household each visit.

Jack has a little arthritis in his back and hips but otherwise is in good health for an “old guy”. He continues his annual birthday health screening visits with his physician. Together the couple enjoys a high vegetable, fruit, and whole grain diet with small servings of animal protein. Both Jack and Heather maintain normal weights and blood pressures.

When Heather was age 60 during her annual health screening an early breast cancer tumor was found in her right breast without lymph node involvement. A lumpectomy and short round of chemotherapy put her into remission now in its 15th year. Heather’s biggest current health problem is her diminishing hearing. She just visited the audiologist as part of her annual check up and is excited about a new hearing aid that is almost invisible but will provide near normal hearing.

Does this example sound too extreme? Are we overstating the poor outcome of Linda and Ted? We wish that were the case. The fact is that these stories reflect what really happens in the journey from 50-something to 70-something. They portray the uncomfortable and painful truth about quality of life: you either define it or it defines you. That’s what happened to these two couples. Over 20 years ago they set off on very different paths as they invented their future in their mid-50s. Linda and Ted opted for the coping approach to embrace their senior years because they did not want to change the way they lived. Although they worked hard and planned for retirement, long term planning to preserve health and minimize disease was, in most cases, left to chance. Jack and Heather chose the upgraded approach as part of their planning for the second 50 years of life. It required change. It required dedication to a new direction in the utilization of health care, diet, physical activity and exercise, community activities, their spiritual life, and their attitude towards the stress of everyday life. These changes did not happen overnight. They were the end product of a series of “baby steps,” small but ultimately profound changes in key areas of their lives that paid huge dividends in the quality of their life today. Nor was it all smooth sailing. Despite a few detours along the way, it is clear they are experiencing a better quality of life than 20 years ago. And that is payoff, the key to even considering upgrading or reinventing our futures.

Both couples had satisfactory lives in their mid-50s. They had success and hope for the future. But their future was actually in the midst of a profound transition, one in which there would be little room for error, few if any second chances. It is hard to believe in our mid-50s that such an intense and unforgiving storm is just around the bend. But it is. Linda and Ted saw it one way. Heather and Jack saw it another. Both couples made choices and set out to live their choices. 20 years later those choices point out two crucial elements about quality of life beyond 50-something:

1. The individual has immense power to reinvent their future.
2. Modern medicine is has limited power to reinvent a poorly structured future.

Quality of life is not based on cosmetic surgery, new drugs or the latest medical procedures. The clinic cannot save us from bad choices or poor game plans. It all starts with us, but we need a plan. That is where many of us get stuck. When we look for a plan, the choices are overwhelming. Do I eat organic food and meditate? Should I sign up for a marathon? What are the good “carbs?” Should I take St. John’s Wort to handle stress? Did I need a body scan? Just finding a plan more proves more complicated than just doing what we have always done. Surely not all of the thing we have been told to do for our health, our quality of life, can be right? How do we know what is right? What’s the plan?

We have asked ourselves this question for many years, both for ourselves, for family member, for friends and for patients. What plan is simple, easy to work with, offers realistic baby steps and, most importantly, actually works? By works, we mean, a plan that has been around long enough to validate its effectiveness, meaning real people have used it with great success. For a long time we used a variety of approaches, a mix and match approach to our own health and the advice we gave others. And then by chance we discovered a plan by the most successful group of people to ever use them. We discovered the centenarians. The centenarians are people who have lived to 100 and beyond. Who better than those who have actually lived the journey with good health and great engagement to provide us with insights and strategies to obtain both quality of life and the potential for longevity? We were intrigued, but we wanted to know more. Here is what we found.

Currently in the US, we have 58,000 individuals who are at least 100 years old, a number that will increase to 1,000,000 by 2050. Some of the centenarians are fortunate enough to have longevity genes (usually evidenced by a family history among family members of long lives), but many have achieved long lives by a healthy lifestyle, even in the face of major medical problems. How did they do this?

The how is what this book is about. Not about the “how” to live to 100, but rather the “how” of their game plan that took them through the passage from their mid-50s through their 70s and 80s. This is the most likely passage for the majority of baby boomers. Some of us will get to 100, but most will get to between 70 and 90. This is our focus. How we can get to 70-something with the best quality of life.

Our research on the centenarians demonstrated that as a group they share common traits that impact the quality and length of their lives. Despite their diverse backgrounds and experiences, their lifestyles follow a common path, a common set of habits that offer a plan, a road map that is both profound and yet surprising simple in design. We call their common traits the “centenarian markers,” the unique building blocks that account for their impressive quality of life. Taken as a group the centenarian markers offer up a game plan that is both an assessment tool and a coaching tool. It can tell you what’s working and what can benefit from an upgrade. It offers the global view we need to see the big picture as well as the practical coaching tips we need to make changes. It addresses life, as we know it.

It is easy to forget with the avalanche of health messages we get from the popular media that we are more than blood pressure readings or cholesterol levels. Our lives are embedded into a complex landscape that has children, grandchildren, older parents, challenging jobs, marriages, and uneven health. Any road map that does not give us the tools to manage the whole process, life as we really live it, can’t help us. We don’t need a diet as much as we need a clear view of how the physical and psychological issues of our lives either work for us or against us. This is the value of what the centenarians have to teach us.

The goal is to upgrade the quality of our lives. Knowing the whole plan makes upgrading the parts so much easier. Why? Because we see how they are connected together in way that makes sense to us. Because we see how even a small step in one area yields huge results in the other areas. Because we see that one part of the plan does not replace or overshadow the other. Because we finally see that no doctor, no diet book, no fitness program can provide us with the invaluable perspective from the end of the journey, the advantage of looking back at what worked and why. This is the centenarian’s gift to us, the one they lived and now pass on to us to help us invent our future.

We wrote this book to provide you with a clear understanding why the centenarian markers are so crucial to quality of life and how they provide a clear road map that anyone can adopt at any age to upgrade the quality of their life. Knowing the centenarian markers is one thing; putting them into practice is another. The value of the book lies in its common sense approach to incorporating, most of the time in baby steps, this wisdom into our lives. It is not the big decisions that influence our lives so much as it is the small, determined decisions that yield profound influence over what we become. We are big on baby steps.

So as millions of baby boomers navigate 50-something, they are traveling through a critical period of time that will determine their future, the last major 20-year segment they have to invent a different outcome to their health story. For a larger portion of baby boomer population, this is a wake up call, like it or not. Which brings us to another important aspect of this book. It offers a plan that allows anyone to upgrade the quality of their life, on their own time schedule, in the order that suits them best, and in the manner that reflects who they are. Like we said, we are big on baby steps. Just choosing one new habit, one new goal from the nine markers we outline in the book can have a dramatic impact on the individual and those around him or her. This is what happen to Alan.

Alan heard us give a presentation on the centenarian markers. He can up afterwards to discuss a number of issues. Alan was looking for an upgrade in many areas of his life. Where to begin? What is the one step you can take in the next 90 days we asked him? Maybe a health check up he suggested. He was 55 and was long overdue for a physical. He decided to take that baby step and get a check up, colonoscopy and all. To his relief, everything was normal. He was relived and inspired. He opted for another small step. He began to test ways to get better connected in his community. Baby steps, piece by piece, building an upgraded future, on his own terms, piggy backing off of one goal after another, using the centenarian road map for keeping on course, remembering how the whole game was meant to be played.

While this book incorporates the wisdom of those who have lived to a 100 and beyond, it is not about longevity. Life is not a contest to see who last the longest. This book is about quality, about a balanced life that is more meaningful and satisfying. We won’t promise you that following the wisdom of centenarian markers will get you to 100, but wouldn’t it be wonderful as you approach 80 years of age and older to be like Jack and Heather? That is the purpose of this book, to provide you with a set of tools and strategies to minimize the development of future disease and to preserve good health, to upgrade your life to the highest quality you can have, for yourself and for those who are connected to you.

David and Janet Solie

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The 15 Things You Should Never Say To The Bereaved

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“Assessment of loneliness is not routine in clinical practice and it may be viewed as beyond the scope of medical practice,” the authors conclude. “However, loneliness may be as an important of a predictor of adverse health outcomes as many traditional medical risk factors.”

Beyond the scope of medical practice? Really? Cure when possible, comfort always but too busy to assess loneliness in a high risk population? Here’s the risk:

“After controlling for confounding factors (including depression), loneliness was associated with a nearly 60-percent increased risk of functional decline (loss of ability to perform everyday tasks such as bathing and feeding themselves, climbing stairs, walking, lifting things with their arms, and so forth) during the six-year follow-up period than the folks who were not deemed lonely. Worse yet, loneliness was linked to a 45 percent higher risk of dying during the follow-up period.”

Worth an assessment in my book, but there’s more. Here is the second punch line:

“Those findings deliver an extra jolt when you consider that just 18 percent of the people surveyed lived alone – and nearly 75 percent were married.”

Loneliness plagues the married and unmarried alike, which harkens back to the pressing need to maintain “nourishing” social connections in the final phase of life. It also intensifies the dilemma of where to live when we get old. Aging in place may maximize personal control but may inadvertently worsen loneliness. Senior housing may do the opposite.

Bottom Line: Wherever our aging parents live, they are at risk for loneliness. The good news is that this is a risk we can mitigate with creativity, determination, and compassion.

Here is the link to the article…

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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.

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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.

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