How To Communicate Tough Choices To Aging Parents

At some point in the lives of our aging parents things slip out of control. It may be a subtle change over time that finally becomes unmanageable or the sudden arrival of a medical setback. As much as we want them to remain independent, events take them off course and tough decisions need to be made about the quality of their lives. It could be unsafe driving, near accidents at home, poor compliance with medical treatment, financial negligence, or the inability to recover from the loss of a spouse. Regardless of the circumstances, it becomes clear to those who care about them and to those who care for them that something needs to change. The question is how to communicate this urgent and unavoidable need for change? What is the right approach to navigate these delicate and many times volatile interventions with our aging parents that will minimize the trauma of the tough choice while at the same time give them hope about the future? While there are no easy answers, there are three communication strategies that can improve the chances of our aging parents eventually participating in and successfully surviving these tough choices.

1. Use their developmental agenda to reframe their choices.

Our aging parents are navigating two powerful developmental currents that influence every aspect of the final phase of their life: the need for control and the need to discover their life’s legacy.

This is the developmental agenda of the last stage of life. Tough choices pose yet another threat to them as they struggle to maintain control in a world where control is already compromised or being lost. Simply stepping in and trying to take away more control will only make the situation worse. However, the extreme sensitivity our aging parents have about control issues offer us an opportunity to reframe unavoidable tough choices as “control preservation strategies” in the face of a threat to their independence.

The most effective way to reframe the tough choice is to recast the unmanageable situation as undermining their control. The format for the reframing conversation should begin with a clear acknowledgement that you understand that control is critical to their well being and you fully support their need to have control. The goal is to signal you get it.

  1. Mom and dad, I know you and both are proud of your independence and have always made your own decisions. I want to do everything possible to support your independence.
  2. Dad, you know what’s best for you. My job is to help you figure out your choices and then let you decide what you want to do.
  3. Mom, no one wanted this to happen. But it did. The important thing is determine how you want to handle it. This isn’t something you have to do alone. All of us will help with whatever you choose.

The conversation should then move on to describe the behavior or circumstances that present a “clear and present danger” to their control. The goal is to signal you are concerned about a specific area of their life that is threatened by a loss of control.

  1. Dad, mom’s forgetting to take her medication has caused her diabetes to get out of control. According to the doctor, it has reached a point that it could take away both your independence if she has a stroke or heart attack.
  2. While I am glad the fall wasn’t more serious, it looks like you are going to need to have surgery on your right hand. For six weeks after surgery you are not going to be able to use your right hand for even the basic things like eating, bathing, and general chores. Given that you live alone and are very protective of your privacy, this is going to challenge your ability to live independently.
  3. I know it started out as fun, a chance to be with your friends and get out the house. But the trips to the local casino have cost you nearly half of your savings. At this rate, you won’t have any savings in six months and will have to get by on social security sending things further out of control.

And finally, it should layout how the tough choice is a “control preservation strategy” to prevent this from happening. The goal is to signal there’s a way to regain control and you are dedicated to helping them accomplish it.

  1. You both have a chance to bring this situation under better control. Let’s talk about the three options that will insure that mom takes her diabetic medication and you tell me which one sounds the best to you.
  2. Let’s talk about some ways that you can stay in your home as you recover from surgery. While you may need to be flexible about your privacy, it can offer you the chance to control where and how you recover from this operation.
  3. The most important thing right now is to determine what you need to do to regain control of the situation. There are some tough choices, but if you allow me to work with you, we can develop a financial plan to preserve your remaining assets and manage your monthly bills.

This is not to suggest that tough choices can be managed in such a brief exchange. Rather it lays out a reframing sequence and signaling strategy that is crafted to resonate with the developmental needs of the older adult. Control is essential to quality of life for aging adults and unfortunately it is being lost. What steps need to be taken to make the situation better? As the conversation progresses with questions and concerns about what has to change, this reframing provides a way to bring the focus of the dialogue back to the most pressing issue: preserving control as long as possible.

2. Reinforce the reframing with stories.

Successfully reframing tough choices as an opportunity to preserve control is only half the battle. Change is daunting at any age, but especially distressing for older adults who are experiencing losses on so many fronts. Even when it is clear that a tough choice is in their best interest, they may feel overwhelmed by what it will take to actually do it. They need realistic encouragement instead of false reassurance that “things will all work out,” or “don’t worry.” But the encouragement needs to come from a believable source, one with which they can an immediate emotional connection. The most effective signaling vehicle to accomplish this is a well chosen story.

Identifying “parallel stories’ of older adults, perhaps family members, who have faced similar setbacks but persevered and regained a new form of control in their lives provides both comfort and inspiration.

  1. Do you two remember when aunt Ethel found out she had heart failure and was told she might have to go into a nursing home? Remember how she was determined to get better and even her doctors could not believe how much improvement she made? She found a way to stay in control of her medical problem and lived in her own home all those years before she passed away.
  2. Dad, remember when granddad had hip surgery? Remember how mad he was when a nurse came in to help him? As hard as that was, granddad made a great recovery and said that his nurse “kept him out of the nursing home.”
  3. I don’t think you know that Linda’s mom had the same gambling problem. She didn’t tell Linda until most of her money was gone. But together they figured out how to save what her mom had left and worked out a way for her mom to socialize that didn’t involve gambling. Linda was just glad she could help while there was still a chance to regain control of the situation for her mom.

Remembering that other older adults have faced a loss of control, made tough choices, and gone on to a better life is a critical to preserving their hope they can do the same thing. As Dr. Mary Pipher says in Writing to Change the World, “People attend, remember, and are transformed by stories…”

3. Look for “legacy moments” amid the upheaval.

Control is not the only developmental current that dominates the lives of aging parents. There is an equally powerful need to create a legacy in a world where time is running short. Simply put, our aging parents are trying to sort out once and for all the meaning of their life and how they will be remembered. To do this, they are actively engaged in constant life review, a reconsideration of the most important experiences of their lives. As they confront tough choices, the turmoil of the process provokes strong emotions about the last phase of their life and what it all means. Asking sensitive life review questions can provide a critical on-ramp for a life review conversation. Many times this naturally occurs as stories are being told.

  1. The story about Aunt Ethel who overcame congestive heart failure to live many productive and happy years before she passed away can also be an occasion for life review questions. What is your favorite memory of Ethel? Was she always so sure of herself as I remember her?
  2. The story about how granddad overcame hip surgery to regain his independence can be an ideal occasion for life review questions. Didn’t you say that granddad was a ranch hand at one point in his life? Where was that and how did he get that job?
  3. The story about Linda’s mother surviving her gambling problems to find a new way to stay socially connected can be an ideal occasion for life review questions. When I was growing up, you said Linda reminded you of your sister Beth. How is Linda like Aunt Beth?

Life review questions like these provide an emotional forum to gather important memories from childhood and reconsider what they mean now. Legacy is all about discovery and discovery begins with the right questions.

The tough choices our aging parents face at the end of their life do not get easier. At some point they will have to pass on. But their need to preserve control and to discover their legacy offers us a clear direction and an important role in this phase of their life’s journey. Protecting and preserving their sense of control reduces their anxiety while facilitating life review opens their hearts and ours to what matters the most. The tough choices remind all of us that there is a large inventory of events in life we do not control. What we can control is how they are framed and communicated, and this gives all of us the best opportunity to capture their meaning and purpose.


5.0 out of 5 stars. THIS IS A GREAT BOOK!
By Another working momon August 2, 2017 Format: Kindle Edition|Verified Purchase

I wish my parent’s doctors would read this book! Everyone who deals with those over 70 should read it. We teach early childhood education, but why is there no education in how to deal with those in the last part of their lives, so they feel respected. This guy is great.


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