Posts Tagged ‘How To Say It To Seniors’
Last Updated on Friday, 25 November 2011 03:20 Written by David Solie Saturday, 30 July 2011 10:59
How do we help our aging parents consider making positive changes in their lives? We want to help, and feel we have good ideas that could improve their quality of life. For example, we would like for them to consider:
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.
Tags: Aging in place, aging parents, behavior change, Boomers, caregiver, communication conflicts with aging parents, communication problems with aging parents, communication struggles, coping, David Solie's blog, death of a spouse, disability, home health care, How To Say It To Seniors, loneliness, long distance caregiving, long term care giving, Motivational Interviewing in Health Care, moving into assisted living, old age, on aging, the elderly, Unlocking the communication code | Posted under Aging Parents | 1 Comment
Last Updated on Friday, 25 November 2011 03:23 Written by David Solie Wednesday, 25 May 2011 05:27
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)
Tags: aging parents, caregiver, caregiver depression, caregiver stress, caregiver support, caregivers, Caregiving Websites, communicating with aging parents, communicating with elders, communicating with seniors, David Solie, How To Say It To Seniors, long term care, mindful meditation, mindfulness, Nursing homes, old age, on aging, sandwich generation, the elderly | Posted under Aging Parents | No Comments
Last Updated on Tuesday, 21 December 2010 08:04 Written by David Solie Tuesday, 21 December 2010 07:59
One sees great things from the valley, only small things from the peak.
—Chesterton
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.
Tags: aging, aging parents, attitude, baby boomers, Boomers, caregiver, Communication, David Solie, depression, How To Say It To Seniors, middle age, Navigational Thinking, Riptide | Posted under Aging Parents | 3 Comments
Last Updated on Monday, 1 November 2010 07:00 Written by David Solie Sunday, 31 October 2010 09:45
As boomers approach the outskirts of being old, a new aging dilemma is beginning to emerge: simultaneous developmental phases with their aging parents. It is one thing to be fifty-something and have aging parents in their mid to late seventies. Both parties are clearly situated in separate developmental phases. The fifty-something adult is navigating the tasks of middle age, preserving stability while at the same time orchestrating a new purpose and direction for the second half of life. Their aging parents, on the other hand, have different marching orders, preserving control in a world where all control is being lost while at the same time creating a legacy before time runs out. The challenge is to find an effective middle ground so both parties can successfully complete their developmental tasks. But what happens when adult children enter their late sixties and their aging parents are still alive, where both parties wind up in the last phase of life?
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.
Tags: aging parents, Boomers, David Solie, How To Say It To Seniors, Longevity | Posted under Aging Parents, Boomers, Middle Age Caregivers | No Comments
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