Saturday, May 18, 2013

Posts Tagged ‘communicating with aging parents’

Communicating with Older Adults: An Update

I have been studying how to unlock the communication code of older adults for the last twenty-three years. My first breakthrough came early on with developmental psychology, a model based on age-specific tasks that are easy to understand, easy to use, and highly effective. As a result, the two tasks of the final phase of life, control and legacy, have earned their way into the vernacular of how to communicate with older adults.

However, in the last few years I have discovered two additional elements that combine with the developmental tasks of older adults to complicate rapport. Understanding what they are and how to engage them preserves effective communication in even the most trying circumstances.

One of these elements is the invasion of dilemmas in the second half of life. Dilemmas resist heroic attempts to keep everything together. Like an unruly Rubik’s Cube, alignment in one caregiver area seems to trigger chaos in another. Just when driving issues calm down, sibling conflict erupts over money. Just when housing accommodations get better, a parent falls and winds up in the hospital. In the face of this steady stream of dilemmas, the natural instinct is to work harder in search of the illusive mix that will stabilize this disruptive phenomenon. Ironically, upping the work ethic on dilemmas only seems to give birth to new ones, a sorcerer’s apprentice law of dilemma management that runs caregivers ragged. Now what?

The first rule of dilemma management is to reset expectations. There are no final, elegant solutions, just the dance with complexity. Unlike problems, win-win is not part of dilemma management, which is usually a messy process that requires patience and smaller bursts of sustainability. All of this argues for a different orientation, softer reins, and deeper acceptance. In the end, the predictable dilemmas of aging require a different skill set that is not intuitive but essential for everyone’s well being.

The other element is the deep-seated ambivalence older adults have to unwanted advice. This goes beyond the collision between developmental stages, though that is part of it. There are different psychological forces at work here, present at all ages, but markedly enhanced in the final phase of life. We are talking about ambivalence to change.

Choosing to engage ambivalence head, to tell older adults what and how to change, only intensifies and prolongs resistance. Like dilemmas, overcoming ambivalence to change requires a different set of skills. Instead of provoking resistance, we need to soften ambivalence and make room for the possibility of change. This is not an intuitive strategy or skill, but it can be learned with patience and practice.

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Navigating Caregiver Dilemmas

As the drama of aging parents unfolds, it reveals itself as layers of interconnected dilemmas that resist heroic attempts to keep everything together. Like an unruly Rubik’s Cube, alignment in one caregiver area seems to trigger chaos in another. Just when driving issues calm down, sibling conflict erupts over money. Just when housing accommodations get better, a parent falls and winds up in the hospital. In the face of this steady stream of dilemmas, the natural instinct is to work harder in search of the illusive strategic mix that will stabilize this disruptive phenomenon. Ironically, upping the work ethic on dilemmas only seems to give birth to new ones, a sorcerer’s apprentice law of dilemma management that runs caregivers ragged. What can make this reality of caregiving better?

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)

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David Solie’s new book Caregiver Mind Maps is being acclaimed as “tangible breakthrough” in communicating with aging parents...

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No Money: No Comment

I was recently asked what to do about aging parents who had little or no savings but refused to discuss any aspect of their “money issue.” It reminded me that our role as adult children is not necessarily about problem solving; it is about compassionate containment. So many of the issues we feel compelled to “fix” have no clear answers. The best we can do is sort out what to accept from what we can actually change. Here was the advice I offered:

The issue of money, like so many other issues in the last phase of life, is about control. The best way to approach it is to reframe money as means of maintaining control. Lack of money takes away control. This link will take you to an article I authored on “communicating touch choices” that offers a practical strategy for how to do this:http://www.aging.org/i4a/pages/index.cfm?pageid=2103&textonly=1

You may also want to consider three strategies that will help you “hedge” your parent’s financial risk:

1. Buy a long term care policy with a two years home care/two years nursing home benefit. This assumes they will cooperative with the process (i.e. signing the applications and answering questions).

2. Start funding a dedicated “side fund” for expenses that a long term care policy will not cover.

3. If you parents own their home, become familiar with how “reverse mortgages work and when they make sense.

Lastly, you need to began discussions with local area agencies on aging to determine what, if any, community resources can assist your parents if they run out of money.

This is a tough end-game, especially if you parents don’t want to talk about. The article will help you frame your conversations. Be patient but persistent in your discussions about control and your desire to help them maintain it.