When older parents resist getting help or advice, use these coping tips.

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KFF Health News
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It was a regrettable mistake. But Kim Sylvester thought he was doing the right thing at the time.

His 80-year-old mother, Harriet Burkel, had fallen at her home in Raleigh, North Carolina, breaking her pelvis and going to a rehab center to recover. It was just days after the death of Burkel’s husband, 82, who had moved into a memory care center three years earlier.

With increasing anguish, Sylvester had watched his mother, who had emphysema and peripheral arterial disease, become increasingly fragile and isolated. “I would say, ‘Can I help you?’ And my mother would say, ‘No, I can do it by myself. I don’t need anything. I can handle it,’” Sylvester told me.

Now, Sylvester had the chance to find out more. He went into his mother’s house and went through all the paperwork he could find. “It was a mess, completely disorganized, bills everywhere,” he said. “It was clear that things were out of control.”

Sylvester sprang into action, rescinding his mother’s orders for anti-aging supplements, canceling two car warranty insurance policies (Burkel was not driving at the time), rescinding a one-year contract for knee injections with a chiropractor, and turning down applications donation from dozens of organizations When her mother found out, she was furious.

“I was trying to save my mother, but I became someone I couldn’t trust: the enemy,” Sylvester said. “I really was wrong.”

Dealing with an older parent who stubbornly resists offers of help isn’t easy. But the solution is not to make an older person feel like you are crushing them and taking control of their affairs. What is needed instead is respect, empathy and appreciation of the autonomy of the older person.

“It’s hard when you see an older person making bad decisions. But if that person is cognitively intact, you can’t force them to do what you think they should do,” said Anne Sansevero, president of the board of directors of the Aging Life Care Association, a national organization of care managers who work with older adults and their families. families. “They have the right to make decisions for themselves.”

That doesn’t mean that adult children concerned about an older parent should step aside or go along with everything the parent proposes. Rather, it takes a different set of skills.

Cheryl Woodson, an author and retired Chicago-area physician, learned this firsthand when her mother, whom Woodson described as a “very powerful” woman, developed mild cognitive impairment. She started getting lost while she was driving and buying things she didn’t need and then giving them away.

Punishing her mother wasn’t going to work. “You can’t put pressure on people like my mother or try to take control,” Woodson said. “You don’t tell them, ‘No, you’re wrong,’ because they changed your diapers and it will always be your mom.”

Instead, Woodson learned to appeal to her mother’s pride in being the family matriarch. “Every time she got angry, she would ask, ‘Mother, what year did Aunt Terri get married?’ or ‘Mother, I don’t remember how to make macaroni. How much cheese do you put? And she’d forget why she was so worried, and we’d just carry on from there.”

Woodson, author of “Surviving care: a daughter’s experience, a doctor’s advice”, also learned to apply a “does it really matter for safety or health?” standard in her mother’s behavior. He helped Woodson let go of the sometimes unreasonable expectations of him.

She recounted an example: “My mother used to put hot sauce on pancakes. She would drive my brother crazy, but she was eating, and that was good.”

“You don’t want to rub their noses over their disability,” said Woodson, whose mother died in 2003.

Barry Jacobs, a clinical psychologist and family therapist, touched on similar themes when describing a psychiatrist in his 70s who didn’t like to bow to authority. After his wife died, the old man stopped shaving and changing his clothes regularly. Although he had diabetes, he did not want to see a doctor and instead prescribed medication. Even after several strokes compromised his vision, he insisted on driving.

Jacobs’ take: “You don’t want to go head-to-head with someone like that, because you’ll lose. They are almost daring you to tell them what to do so they can show you that they won’t take your advice.”

What is the alternative? “I would use empathy and appeal to this person’s pride as the basis for handling adversity or change,” Jacobs said. “You could say something like, ‘I know you don’t want to stop driving and this will be very painful for you. But I know you’ve faced difficult and painful changes before and you’ll find your way through it.’ “

“You are appealing to their ideal selves instead of treating them like they no longer have the right to make their own decisions,” he said. In the case of the older psychiatrist, the conflict with his four children was constant, but he finally stopped driving.

Another strategy that can help: “Introduce yourself, but do it in a face-saving way,” Jacobs said. Instead of asking your father if you can check on him, “Go to his house and tell him, ‘The kids really wanted to see you. I hope you don’t mind.’ Or ‘We made too much food.’ I hope you don’t mind me bringing it to you. Or ‘I wanted to stop by’. I hope you can give me some advice on this subject that I have in mind.’ “

This psychiatrist did not have any cognitive problems, although he was not as smart as he used to be. But pervasive cognitive decline often colors difficult family interactions.

If you think this might be a factor with your parents, instead of trying to persuade them to accept more help around the home, try to get them evaluated medically, said Leslie Kernisan, author of “When Your Aging Parent Needs Help: A Geriatrician’s Step-by-Step Guide to Memory Loss, Resilience, Safety Concerns, and More.”

“Decreased brain function can impair an older adult’s insight and judgment and ability to understand the risks of certain actions or situations, while also making people suspicious and defensive,” he noted.

However, this does not mean that you should stop talking to an older parent with mild cognitive impairment or early-stage dementia. “You always want to give the older adult a chance to weigh in and talk about what’s important to them and their feelings and concerns,” Kernisan said.

“If you frame your suggestions as a way to help your parents achieve a goal they’ve said is important, they tend to be much more receptive,” she said.

A turning point for Sylvester and his mother came when the older woman, who developed dementia, went to a nursing home in late 2021. His mother, who did not at first realize the move was permanent, was furious and Sylvester waited. two months before the visit. When she finally walked into Burkel’s room, wearing a Valentine’s Day wreath, Burkel hugged her and said, “I’m so glad to see you,” before walking away from her. “But I’m so mad at my other daughter.”

Sylvester, who doesn’t have a sister, replied: “I know, Mom. She meant well, but he didn’t handle things right.” He learned the value of what she calls a “therapeutic filetfrom Kernisan, who led a group of family caregivers that Sylvester attended from 2019-2021.

After that visit, Sylvester saw his mother frequently, and all was well between the two women until Burkel’s death. “If something bothered my mother, she would just say, ‘Interesting’ or ‘That’s a thought.’ You have to give yourself time to remember that this is not the person you used to know and create the person you need to be your parent, that she has changed so much.