Predictable Dilemmas Faced by Older People

David Solie, MS, PA
February 11, 2005

These extracts from David Solie's book "How to Say It to Seniors" describe some predictable dilemmas that older people face, and what we can do to help. The extracts are reproduced here with the author's permission.
Robert Griffith, Editor.

Becoming a Legacy Coach

We've already taken a big step by understanding the communication habits of the elderly that can signal the conflict they feel between their need for control and their need to let go; the rest of this book offers practical suggestions and skills that can facilitate resolution of this conflict and lead to life review. These skills are easy to learn and effective with any elderly person with whom we come into contact - relative, patient, client, friend, or acquaintance. Briefly, the primary job of legacy coaches is to help senior adults discover the ways they wish to be remembered.

Predictable Dilemma No. 1: Where Will I Live?

Mom and Dad, now in their 70s, are no longer able to maintain the home in which they raised their family. But when we broach the subject of moving to a retirement home or assisted living facility, our parents refuse to discuss the topic. On the subject of where they will live, the elderly frequently dig in their heels.

Their Predictable Reaction: "Here is just fine."
Our Predictable Response: "You're not serious?"

Given the developmental agenda driving us, we argue, cajole, and try to persuade our elders that moving is "for their own good." There are safety issues, or practical financial considerations. After all, who is going to put up those storm windows, re-grout the bathtub, or shop for groceries when they are no longer able to drive? On a fixed income, how will they be able to pay for unexpected major repairs that houses need from time to time - replacing the roof or repaving the driveway - we want to know. An assisted living facility makes so much sense: Someone else does building maintenance; provides 'round-the-clock' medical assistance; cooks a hot meal every day. There is usually a social director to supervise activities. They'll be with their peer group. We've researched the subject and the advantages are attractive and undeniable. How can they not see the wisdom of selling the house to a growing young family that needs the space and can enjoy it in ways that have become a burden to our elders and to us?

The Legacy Coach's Approach
Be aware of the role the family home plays as the memory repository necessary for many senior adults' life review. We need to respect their decision and refocus our energies.

Step up to the plate. If their health permits, consider getting them the support services they need in order to remain in their home. If we are going to get pushy, let's push for better home care services. If they need help with house maintenance, we must find someone to do the work. Call Meals on Wheels to make sure they have a hot meal every day. Make it clear by our actions that they can stay in their home as long as they want.

Use the plant-and-wait technique. When we sense resistance to the idea of moving, drop the subject entirely and instead bring the house to life. Reconstruct stories, events, passages, and themes from their life in the house. We need to allow them to repeat stories we may have heard many times, but now listen with our legacy coach ears and respond, not with boredom but with renewed interest.

Don't mention moving until they bring up the subject again. And they will, because once they have done the psychic sorting they need to do and the home's meaning to their legacy is clear, their need for connection with the physical space will disappear. They'll begin to ask subtle questions such as "Is that new block of apartments completed?"

How to Say It:

The answer to the question "Where will I live?" is "Here is fine. Take all the time you need to think about what this home has meant to you. Let me know when you're ready to move on."

Predictable Dilemma No. 2: How Can I Best Manage My Health?

Arguing with our parents about following the doctor's advice doesn't seem to work. Trying to figure out what the doctor is saying is tough enough at any age. Add to that the presence of multiple medical problems, and simply taking all prescribed medications at the right time can be a daunting task. Unless we accompany them to each appointment, it is hard to get the details we need to understand their medical issues. Concerning the question "How can I best manage my health?" older adults may simply be saying "Help me wage this war for control."

Their Predictable Reaction: "I don't know what to do."
Our Predictable Response: "Why are you making this so difficult?"

Legacy Coach's Approach
We must intervene in our elders' attempts to manage their medical concerns.

Insist on clarification. Remind the doctor that jargon makes medical conditions and treatment choices difficult to understand. "Would you explain what you just said in plain English?" "Is it possible to draw a little picture of what you are talking about?"

Research more information on the illness or treatment. As legacy coaches, we must intercede and find out as much information about what the doctor said as we can. The Internet is a useful tool.

Ask for support. Don't hesitate to ask the doctor or someone on his staff to recommend support or affinity groups that will explain procedures to elderly patients in a way they can understand.

Be your loved one's advocate. As legacy facilitators, we must demystify the jargon for our elders. ("Don't worry about the term 'edema.' It refers to that swelling you were mentioning on your kneecap." "A CBC means he's going to draw a little blood, look at it under a microscope, and see if the medicine is working.")

When news is dire, be prepared to accelerate the agenda. More serious medical conditions can open a door that invites the elderly to focus on the legacy work they must do to fulfill their developmental mission. Very often there's a softening of the heart, a changed perspective on life, an enhanced opportunity to speak frankly, that as legacy coaches we must facilitate.

How to Say It:

The answer to the question "How can I best manage my health?" is "Let's get more information, clarify exactly what the procedure is, talk to others who have encountered this bump in the road - and don't worry, I'll be with you every step of the way."

Predictable Dilemma No. 3: How Will I Cope All by Myself?

Many of us don't encounter communication difficulties with our aging parents or clients until the person's spouse dies. Up to that time, the couple had each other to negotiate these predictable dilemmas of old age, and we may not have encountered any challenges to our ability to communicate. But once widowhood sets in, the picture changes. We realize that there has never been a more urgent need to establish and maintain rapport, yet we can hit unanticipated roadblocks. We may feel that our duty is to assume the day-to-day tasks once handled by the departed spouse at a time when the survivor resists our efforts to be helpful, yet can't seem to focus on anything but the past.

Allowing the elderly a time to grieve in the midst of devastating loss is essential. The thought uppermost in their minds is the one they may repeat again and again.

Their Predictable Reaction: "I don't know where to begin."
Our Predictable Response: "We need to take care of a million details."

Legacy Coach's Approach
This is one communication challenge to which saying nothing may be the most appropriate response. Grief always makes us feel out of control. It is as if a raging river flips us out of the boat and sinks us, at least for a while. But at some point, grief opens a legacy door and offers an opportunity to articulate how we will honor the memory of the deceased.

How to Say It:

The answer to the question "How will I cope all by myself?" is "You don't have to. I'm here to help you remember the person, draw strength from those memories, and use them to go forward with your life. Whatever your timetable, I will help you come to terms with this devastating loss."

Predictable Dilemma No. 4: What Should I Do about Money?

Questions regarding financial planning either open or close an important developmental door. These emotionally charged matters can be resolved by listening to the values - expressed in almost every conversation - that are most important to the elderly person. The question "What should I do about money?" offers us a window into that person's most deeply held beliefs about himself and the world, and how he wants to be remembered.

Their Predictable Reaction: "I need to think about it."
Our Predictable Response: "But the choices seem so obvious."

From our midlife perspective, we can be stymied by an elderly person's reluctance to deal with vital money matters. Our plans make sense and can save bundles, and we feel tremendous conflict when our elders are reluctant to see it our way. Our usual response is to step up the pressure and apply arbitrary time limits that produce further delay and deflection. We try to relieve them of the financial planning burden - of setting up a monthly budget or deciding how to divide family assets - without realizing it may not be something of paramount concern to them. In fact, our focus on the subject leaves them wondering if we're more interested in it than in them, or if we're trying to wrest control of all they've worked for. They start to get the uneasy feeling that everyone is just waiting for the money. Moreover, they see how discussing financial issues can bring out the worst character traits in family members. We perceive unburdening them of financial concerns as a worthy goal.

They react in predictable ways to our attempts to usurp the control they need to have: They hang on tight and refuse to make decisions. We become deferential and considerate; they become distant and noncommittal.

Legacy Coach's Approach
The goal of most families is to avoid conflict concerning money issues; that of financial planners is to preserve a client's wealth by minimizing the tax impact on an estate and maximizing the transfer of monies to the heirs. But planners' desires to protect wealth override and undervalue its creative potential at just that time in life when creativity about money is most needed, which is when we are on the journey to discover and understand our legacy. By repositioning money as a means to an end - the end, of course, is how that person will be remembered - we can get to the issues surrounding legacy that will resonate immediately and strongly in an individual.

How to Say It:

To the question "What should I do about money?" we might respond "Take all the time you need to arrive at the answer that best reflects you and the life you've lived."

Predictable Dilemma No. 5: What Is The Right Way to Say Goodbye?

When the end is near, legacy starts to emerge with more clarity and urgency, but we have to listen carefully for repeated words, phrases, and ideas to distill the values by which the person wants to be remembered. Many elderly people may either be uncomfortable or at a loss to explain their feelings.

Their Predictable Reaction: "Where did the time go?"
Our Predictable Response: "Don't worry, everything will be okay."

Contemplating final wishes is sometimes more than we can bear, because we don't want to face life without the person. We avoid bringing up the subject, because it makes us uncomfortable. If our elders bring it up, we try to minimize its magnitude. "You are going to live forever." "Let's not get all dark and gloomy."

Legacy Coach's Approach
Part of saying the right goodbye is giving the person control over the form that goodbye will take. After control is no longer an issue, we can help the elderly manage this predictable dilemma. Through our efforts they sense a kindred spirit and begin to trust that the departure legacy they have in mind will work and be meaningful.

How to Say It:

The answer to the question "What is the right way to say goodbye?" involves an attempt to mine the deepest levels of a person's legacy. At life's end, the meaningful answers we seek are prompted by profound questions legacy coaches find the courage to ask: "Mom, is there anyone else we need to reach? Is there anything more you want to say? Are we both clear about the way you want to be remembered?"

The world can be a dark and hostile place to our elderly. As physical strength ebbs, they can become prisoners of their psyches and withdraw deep into themselves. It's clear that control is a dominant and pervasive developmental need, but while old age demands control, it does not necessarily offer the elderly the ability to manage end-of-life tasks alone. Most of the depression we see in old people results from too little connection with an understanding, caring person. Left to fend for themselves (difficult for anyone under the best of circumstances), without anyone to ask the right questions and give the right support, our elders don't accomplish their legacy mandate. Our relationship with them is powerful stuff that redeems both generations and can mean the difference between a life that falls muted by the wayside and one that is remembered and cherished.

You can buy David Solie's book "How to Say It to Seniors" at Amazon.com; click here

Source

• David Solie, MS, PA. How to Say It to Seniors: Closing the Communications Gap with our Elders. (2004) Prentice Hall Press, New York.

Related Links
How to Talk With Your Elders
How To Talk With The Doctor About Alzheimer's
First Step on the Last Journey

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