The Rise Of Dilemmas

The landscape of old age is populated with dilemmas, which represent a new and confusing layer of complexity. Here’s why.

We are all raised to be accomplished problem solvers. It is a skill set that focuses on the elimination of uncertainty through a problem solving protocol:

Identify the cause
Analyze the cause
Weigh the options
Choose the best solution
Eliminate the uncertainty

Here are some examples:

Problem: An older adult is forgetting to pay his utility bills on time
Solution: Set up an automatic payment plan

Problem: An older adult needs a follow up echocardiogram
Solution: Schedule an echocardiogram

Problem: An older adult is periodically misplacing her car keys
Solution: Have a backup set of keys

With problems, there is a clear path to eliminating uncertainty. With dilemmas, the path is at best elusive.

When most people think of dilemmas, they think of them as complicated problems. That is a big mistake.

Dilemmas are not complicated problems. They are rightfully in a class by themselves.

Instead of eliminating uncertainty, dilemmas trigger an engagement with uncertainty. Unlike problems, they have a different structure, duration and burden.

In terms of structure, dilemmas are

Complex and messy
Famed as “no-win” situations
Enigmatic and confusing
Riddled with puzzling choices
Insistent that decisions must to be made

In terms of duration, dilemmas are sustained engagements with uncertainty that ebb and flow in intensity and complexity.

In terms of emotional burden, dilemmas are frustrating, confusing, high-maintenance and exhausting.

Here are some examples that highlight these features:

Dilemma: Despite a history of falls and severe osteoporosis, an older adult refuses to use her walker for ambulation

Dilemma: Despite a history of poor night vision and a spate of minor fender benders, an older adult refuses to modify his driving habits or consider other modes of transportation

Dilemma: Despite mounting responsibilities and exhaustion from caring for a spouse in declining health, an older adult refuses outside help from family members or professional services.

Dilemma: Despite the need for long-term planning, an older adult ignores repeated attempts by family members and professionals to discuss or complete the appropriate power of attorney and health directives.

It is important to remember that the world of seniors is embedded with overarching dilemmas that involve all aspects of their lives. Here are the five major ones:

Where will I live?
How can I best manage my health?
How will I cope all by myself?
What should I do about money?
What is the right way to say good-bye?

Dilemmas pose communication challenges. Here are some things to keep in mind when dealing with them.

Different expectations

Dilemmas are non-linear challenges that have a life of their own. Expect messy dialogues, frustrating responses and a prolonged engagement.

Things fall apart

Dilemmas are unstable, unpredictable, and continually undermine sustainable solutions. What appears a successful outcome one day can completely unwind the following day without any apparent rhyme or reason. Patience and composure are needed to be able to start over from any point in the process.

Different horizon

Dilemmas defy long-term solutions. It is more effective to recalibrate the engagement-horizon to a daily timeframe built around realistic goals with an eye towards sustainability.

Engagement fatigue

Dilemmas are a long game full of confusing vignettes, dramatic reversals and thankless efforts. Inserting effective recovery rituals into the engagement process will not only reduce fatigue, but it will help preserve much needed empathy, patience and optimism.