Posts Tagged ‘How To Say It To Seniors’
Last Updated on Saturday, 16 March 2013 12:59 Written by David Solie Saturday, 16 March 2013 12:48
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.
Last Updated on Monday, 11 February 2013 12:37 Written by David Solie Sunday, 6 January 2013 06:28
A lead caregiver of aging parents was going to extraordinary lengths to keep everything together only to find herself drowning in transactional quicksand. As her parents drifted into the land of “more and more care,” her uninvolved siblings either refused to acknowledge the burden (it’s not that bad) or preferred to keep their distance from the fray (I’m not comfortable having them move in with me). Even when the lead caregiver’s own family faltered with a sick husband and dysfunctional teens, it drew essentially zero empathy from the siblings. As a last resort, the caregiver attempted to plead her case. It fell flat, and that’s when she asked me for advice. Here is what I said:
“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.”
Tags: aging parents, caregiver, caregiver stress, Caring for aging parents, communication conflicts with aging parents, conflict with siblings over aging parents, David Solie, eldercare, How To Say It To Seniors, sandwich generation, sibling conflict, sibling problems, the stress of caring for aging parents | Posted under Aging Parents, Siblings | No Comments
Last Updated on Monday, 11 February 2013 12:39 Written by David Solie Tuesday, 1 January 2013 07:05
Conversations with adult children about their aging parents eventually include the dilemma of declining health. Embedded in this emotional topic is the volatile issue of “advanced directives.” Everyone knows that you need one, but having just one version turns out not to be enough.
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…
Last Updated on Monday, 11 February 2013 12:50 Written by David Solie Wednesday, 5 September 2012 12:12
The best way to predict the future is to invent it.
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
Tags: aging, aging parents, Boomers, Booming On, caregiver, centenarians, Communication, David Solie, David Solie's blog, depression, diet, disability, exercise, Health Coach Advantage, healthy aging, How To Say It To Seniors, Janet Solie, middle age | Posted under Boomers, Health, Quality Of Life | No Comments
David Solie Updates
David’s New Book
David Solie’s new book Caregiver Mind Maps is being acclaimed as “tangible breakthrough” in communicating with aging parents...
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Aging Parents Insights, hosted by David Solie, is a blog radio show that provide listeners with "new ideas and strategies” for understanding and communicating with aging parents.
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