But, is it really Denial? … or Something Else?
When we see our elderly parents having difficulty dressing, cooking, laundry, housekeeping, etc. — or bills are piling up unpaid — or other unsettling warning signs — we assume they need help. But, when we ask, they’re quick to reply that they don’t. Everything is okay. It just takes a little longer to do things now. Naturally, we suspect they’re in denial — denial that worsens as time passes and their difficulties increase.
As often happens, there are underlying causes for what appears to be denial. But, we won’t make any progress toward helping them unless we understand those reasons.
So, what are the possible reasons?
Pride — Fiercely independent, they simply don’t want to admit they can no longer do many of the things needed to live independently. They live by the “Suck It Up” philosophy. That is, don’t complain despite pain or hardship. Be strong. (For men, this is often referred to as “Male Ego.”)
Embarrassment — They are uncomfortably self-conscious because they can’t do things they used to do with ease. They may be embarrassed because they need help using the toilet or taking a shower — activities that are very personal and private. Perhaps they’re embarrassed because they’re in trouble financially — they can’t afford the food or medications they need — they can’t afford to buy new clothes or have their house repaired.
Ashamed — They are afraid of disappointing friends, family members and other people they admire and love because they are no longer capable of living independently. Perhaps they’re ashamed because they haven’t done things they know they should have done — like visiting their doctor when they should have, or having their prescriptions filled — instead of waiting until a major medical crisis occurred.
Fearful — They are afraid of losing their independence and/or their ability to function independently. Examples: Getting Alzheimer’s — giving up driving — being put into a nursing home, etc. Perhaps they’re afraid of dying or of the suffering that can accompany death.
Depressed — They look sad, talk less, never smile, are joyless, believe they are a burden, shouldn’t take up the time of the caregivers, and may say such things as: “You’d be better off without me” or “I wish I were dead.” And they may be delusional, saying their life is worthless or useless and they are draining family resources, when they aren’t, convinced further struggle or effort is futile. In other words, pessimistic resignation.
Powerless — They feel helpless — like they no longer have the power or ability to act to change their circumstances. They withdraw, become socially isolated, and wait for whatever life sends their way.
Core Identity — There’s nothing that leaves you feeling more powerless than losing your core identity.
Your memories — your spouse, your friends, your home, your family, your sense of purpose — make you who you are. If you lose them, you lose part of yourself. Each thing you and your spouse accumulated over the years also carries with it uniquely cherished memories.
When one member of a long-married couple passes away, the surviving spouse usually feels or has a sense of deep personal loss, not only for the spouse who has passed away, but also for the loss of a part of the surviving spouse’s personal identity. This is especially true when the couple has been married for a long time.
Similarly, when someone moves from the home in which they have resided, perhaps for decades, there is another loss of personal identity. After all, it is the place where one has raised their family and cared for their loved ones.
So when it comes time to move into a care facility or into an adult child’s home, things that trigger those cherished memories often times have to be left behind, again making one feel incomplete because those memory triggers are no longer available.
“Oh, she’ll make a lot of new friends here.” Wrong. Stop and consider for a moment: How long did it take you to make genuinely meaningful friendships when you moved into your present home?
So, when you ask your mother to move, please consider just how much of the meaning in her life you are asking her to give up.
Changes to these “set-in-concrete” attitudes
won’t occur overnight. Instead, expect to work with your parents over a period of time.
More Signs and Symptoms
In addition to the signs and symptoms of denial I’ve already described, men are more likely to display their frustrations by becoming increasingly irritable or angry — often at themselves, sometimes at their spouses, even at no one in particular — because of their inability to do things they used to do with ease.
“So, What Do I Do?”
- Once again, take a deep breath. Remember to pause from time to time and collect your thoughts. Clear your mind and relax. It may be difficult, but it will help sustain your spirits and prevent you from sinking under the weight of caregiving burdens.
- Be totally mindful — don’t think about the past or the future — concentrate on the here and now. Mindfulness is “paying attention on purpose, in the present moment, fully and without judgment,” with no interruptions by outside distractions such as smart phones, blaring TVs and young children. And absolutely no multi-tasking. Be totally present for your parent, not just physically, but mentally and emotionally as well.
- When you need to create an opportunity to talk, don’t ambush your parent. At least begin with something like: “Do you mind if I asked you about ____________?” It gives your parent a moment to think and to plan emotionally for what might be a touchy conversation.
- Be an active listener. That is:
1. Actively listen to your parent. Focus your attention on and maintain good eye contact with your parent to convey engagement with the intent of understanding and conveying empathy.
2. Using your own words, summarize what your parent said and repeat it back to them to be sure you understood them correctly. If you did, respond to their statement.
3. If you didn’t understand your parent, ask them to repeat their statement, then summarize and validate it to be sure of your understanding.
- Gently remind your parent(s) that it’s OK to ask for help. No one (who matters) is going to think less of them. If they do, they’re not a true friend. “If you’re absent during my struggle, don’t expect to be my friend any longer.” paraphrase of quote by Will Smith.
- People are afraid of nursing homes because “people go there to die.” But, the most recent statistics show only 26% of deaths of people age 65 or older occur in a nursing home. Most people – 35% – die in or on the way to hospitals. Only 28% die at home.
- Beware of the argument that whatever you are proposing “costs too much.” This is particularly true if you’re talking about giving up driving or moving into assisted living.
“How am I supposed to get where I need to go when I need to go there?” For example:
● To doctor appointments
● To other appointments
● To the grocery
● To shop for clothes and other things I need
● To visit friends, at home or in the hospital
● To the senior center
● To church, synagogue, mosque or temple
Some of the reluctance to stop driving may be because your parent has rarely or never used alternate means of transportation such as cabs, buses, volunteer drivers, etc. To overcome this, I suggest you ride along with your parent the first few times to show him or her just how easy it is to make the necessary arrangements.
But, the really tough question comes up when they say, “OK, but how do I pay for this?”
This may take some patience on your part, but you must convince them that, once they lose their ability to drive safely, they will never drive again. That’s tough to accept! You’ll find guidance in our article “How to Talk with Your Parent about Driving.”
Or, you may be lucky enough that your parent is in my situation. I’ve had two seizures over the past 6 years. Aside from being vaguely aware of erratic driving during my first seizure, I quickly blacked out as soon as I got home. But, I was fully aware of what was going on during the initial stages of my second seizure.
I was sitting and talking with my wife in my home office. All of a sudden, I couldn’t talk even though I knew precisely what I wanted to say. Then I realized I couldn’t make any of my muscles move — none whatsoever — I couldn’t even nod my head or write a note to my wife to say what was wrong. If my seizure had happened while I was driving, my car would have kept going in the same direction and speed it had been going before the seizure began — and I would have been powerless to stop it, even if it meant plowing into a group of children!
So, keep up to date with all of your parent’s medical conditions. Something may be going on that makes him or her an unsafe driver — just like me.
When someone becomes a permanent non-driver, and their spouse has passed away or is also a non-driver, a silver lining appears in this otherwise dark cloud: When the car is sold, you no longer have to pay for gasoline, oil changes, tires and other maintenance expenses, auto insurance and, in some states, personal property tax on the car. These savings may be more than enough to pay for the taxis, buses or other alternate forms of transportation your parent may need.
The good news is assisted living is not as expensive as it first seems. Instead, to an extent that varies from person to person, it simply involves a shift of expenses from one living arrangement to another.
After someone’s capabilities decline to the point where they need assistance, their move into a facility is usually permanent. When their former home is sold, most of the expenses associated with it can then be used to help pay facility-based expenses. And, the money from the sale of their home can be used, for example, to purchase a CD or annuity that pays monthly interest to boost income. Also, since a facility’s fees usually include all meals, no groceries are needed, thereby freeing up even more money.
To help you evaluate whether assisted living is appropriate for your parent, go to our article, “Assisted Living — How to Find the Right Facility.”
- To help overcome the social withdrawal that comes with the feeling of powerlessness, suggest they visit their local senior center a few times. But, once again, because depression is often associated with powerlessness, merely making the suggestion may not work. Instead, you should visit the center first to get a feel for what it’s like, then go along with your parent to help them meet people and become familiarized with what they offer. If you get the objection, “How do I get here after you leave?”, refer to my advice about Driving above. Some senior centers also have their own van service one can call for a ride.
- Depression is probably the most undiagnosed medical condition of the elderly. It’s often the result of one’s loss of capabilities, loss of memory, loneliness, social isolation, fear of their future, and feelings of powerlessness. It’s important that you accompany your parent when he or she next visits their doctor. Ask to be with them during their examination, or if that would be an unwelcome invasion of their privacy, ask to speak briefly and privately with their doctor either before or after their exam. Then, let your parent’s doctor know of your concern about the possibility of depression.
- “I don’t want strangers in my house.” Does this imply your parent:
- doesn’t trust strangers?
- feels another woman would be an intruder into her (your mother’s) private domain?
- is ashamed he or she has not been able to keep their house as clean as it should be?
- doesn’t want anyone to see any other unsettling warning signs that they probably can’t live independently any longer
- doesn’t have, or doesn’t want to spend, the money to pay for outside caregivers? If this is the case, neither you nor your brothers/sisters will be able to handle everything as your parent’s condition declines. It may become necessary for you and your siblings to chip in together to pay for any in-home caregivers your parent needs.
- When a loved one needs assistance with normal activities of daily living (such as bathing, dressing, managing medications, preparing meals, etc.), it is often difficult for family members to know what kind of care is most appropriate and where to find reliable caregivers, particularly if their loved one lives more than a few hours away. A geriatric care manager can help relieve family members of much of the burden.These professionals are trained to quickly assess the overall situation and make recommendations about needed services. They are also skilled in getting older adults to talk about problems they (the elderly parents) are reluctant to discuss with their adult children. Start with the Aging Life Care Association. That’s the major national association of health care professionals who oversee long-term care arrangements needed by older people. Their website includes a locator to find care managers near your loved one.For additional fees, local elder care managers can also screen, hire and supervise professional caregivers, coordinate community resources, coordinate medical care, pay bills; and act as a liaison with families. They can also screen, hire and supervise other qualified people to help with housekeeping, laundry, shopping, maintenance and repairs; review applicable financial and legal issues and offer referrals to geriatric specialists; and assist with a change of living arrangements.