Although demanding and stressful, the problems of aging can be contained or eliminated. Lost prescriptions can be refilled. Unsafe staircases can be modified. Transportation for an unscheduled medical testing can be arranged. Solving problems means eliminating uncertainty and most caregivers are well versed in how to do this.
In sharp contrast, the dilemmas of aging defy containment or elimination. They demand sustained engagements with uncertainty, a challenge most caregivers are ill equipped to handle. Consider the following example:
An 84-year-old woman is scheduled to seen by her doctor at her family’s request over her unwillingness to use a walker. She has an unsteady gait, a history of falls and significant bone loss. She lives alone with the assistance of home care services. Her family has tried a number of approaches to get her to use the walker, but she has rejected all of them because she feels it makes her look old and frail.
This situation typifies the nature of the dilemmas, which present as:
• Complex and messy
• Threatening
• Unsolvable
• No-win options
• Decisions must be made
Given the stress and complexity of dilemma management within family systems, what are some strategies caregivers can adopt to successfully navigate them? Here are some suggestions:
• Reorient the big picture—Caring for aging parents involves sustained engagement with uncertainty on an unstable playing field. The rules and expectations of stable, problem dominated environments do not apply. This means success needs to be redefined to allow for messy outcomes and wobbly consensus.
• More dancing, less wrestling—The metaphor for engaging dilemmas in family systems is dancing instead of wrestling. Attempts to impose solutions or outthink the structure are doomed and only accelerate and intensify decision fatigue. Honoring the nature of dilemmas by acknowledging that imperfect choices have to be made reduces the endless recrimination over outcomes that are beyond anyone’s control. Honoring the nature of family systems by acknowledging that all caregiving decisions are vulnerable to emotional crosscurrents reduces exhaustive attempts to craft perfect and lasting consensus.
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• Shrinking the horizon—In the non-linear world of dilemmas and family systems, recalibrating the horizon can reset expectations that may have become distorted and emotionally punitive. The reality is that caring for aging parents occurs one day at a time. Recasting the horizon to a daily dance based on “doing the best I can do with what I’ve got” honors our best intentions while restoring a sane estimation of our capacity and limits.
• Reorient self-care—Sustained engagement with dilemmas in family systems is not possible without a recovery ritual. Without one, caregiver morbidity and mortality rapidly and tragically declines. While recovery rituals vary in style and content, they all share a common theme. Rest, nurturing relationships, and enjoyable activities. The noble call to do the right thing for aging parents should always include the preservation of the physical health and sanity of the caregiver.
• Partner Up—Sustained engagement with dilemmas in family systems is always better with the non-judgmental support of those who have walked the same path. Caring for aging parents is a long game full of dark vignettes, dramatic reversals and thankless service. It is not designed for solo heroics or the faint of heart. Partnering up one on one or in a small group setting is a personal breakthrough for both caregivers and aging parents.