Alzheimer's Disease – Part 3

If you have a loved one or a parent that you are having difficulty with, forget about everything, and ask your parent if they wish to name you in their medical power of attorney. If they wish to name another sibling or a friend, don't get upset, but ask questions. Maybe the friend lives closer or communicates with your parent every day. Just maybe they trust a sibling more than you and the sibling lives closer. In this case, contact the sibling and inform them of the situation if they are not aware. If they have the medical power of attorney, then step back and let them act.

Yes, you may have good reason to be concerned about a parent, but unless the parent feels they have control, you may not get anywhere. Having a medical power of attorney is an important document and should be obtained while the parent can understand what the medical power of attorney means. Waiting until something happens, and your parent is unable to act on legal matters, may leave the door open to other siblings that may not have your parent's interest and wellbeing in mind, but their own interests.

This is my own opinion and I do not like it when other writers omit this from the discussion or leave it as the last item for discussion. This writer omits this entirely and focuses on other issues. Concern for older parents or aging relatives is a valid concern for a geriatrician as is their safety.

For better health and wellbeing in older adults or parents, it is not enough identifying the underlying health and life problems, although it is a key place to begin. It is understood that a difficult parent or older relative can cause immeasurable frustration and stress.

Dr. Leslie Kernisan lays out four actions that families can take when older parents or relatives are actively resisting help. To this I would add – are the proper legal documents in place and understood by everyone concerned. Here is her list:

#1. Consider the possibility of cognitive impairment. Do not assume that this is the cause, as the parent or older relative may be making health and safety decisions that you don't agree with or feel is wrong.

#2. Make sure you’ve heard and validated your parents’ emotions. This surprised me, but I realized that it is true. Logical arguments can often fail to convince people that we have emotional relationships with, such as parents or older relatives. All people care about having their emotions validated. People also want to feel connection, love, and self-worth.
Whether or not your parent or older relative might be cognitively impaired, it is crucial to remember this. If there is potential Alzheimer’s, it can be even more important to help a parent feel heard and validated because this will reduce stress and help the brain function better. If you can afford it, consider investing in a few sessions with a relationship therapist or another person trained to facilitate family conversations. It can be especially productive to work with someone experienced in helping families address aging issues, like a geriatric care manager

#3. Review your parents’ goals and what trade-offs they might be willing to make. Doctors want to prevent falls, injuries, illnesses, and new medical problems.

People with older parents or relatives generally want what their parents want – to live as long as possible. But, there can be real problems with this as they age. The older adults in our lives want autonomy and independence and this is when the conflicts happen and can cause real dilemmas.

There is usually no easy answer to this conflict. Once an older person becomes more vulnerable in body or mind, you cannot have perfect safety as well as perfect independence. When the trade-offs are identified and goals discussed, it’s usually possible to help everyone feel better.

Common goals of older adults include:

• Living in their own home for as long as possible
• Dictating the terms of their daily life
• Living their usual life for as long as possible
• Minimizing pain, illness and suffering
• Spending quality time with family and loved ones
• A good quality of life, which generally means more enjoyable activities and fewer stressful or burdensome activities.
  
  Safety is important, but don’t fall into the trap of assuming it should always be your family’s No. 1 priority. Because when faced with a trade-off between safety and autonomy, most older adults choose autonomy. This is especially true of people with dementia. An approach called “positive risk-taking” is now being advocated as a way to make communities more dementia-friendly.
  
  

#4. Distinguish what you need from what your parents or older relatives need. This is probably the most difficult part for the younger generation because they refuse to recognize what fear is driving them.

Some common underlying issues include:

• A need to minimize guilt
• A fear of conflict with other siblings
• A fear that a parent is going to decline further and require more help
• A desire to know that a parent is happy and comfortable
• A desire for control and for knowing what will happen next
• A fear that what is happening to our parents might eventually happen to us.
  
  People being people, we all have a tendency to try to address our needs by wanting other people to do something differently, or by trying to keep things from changing. But as the relationship experts have been telling us for decades, the best approach is to accept that things change and to focus on what we can do differently. We shouldn't try to meet our own needs by controlling what others do.
  
  Even when you become informed, are thoughtful in your approach, and obtain the right kind of assistance, helping older parents through this stage of life will be a challenge. Of course, you will worry about them. And they will probably never be entirely free of reluctance to make changes and accept help.
  
  Some families get stuck in a rut of conflict and frustration, whereas others find ways to move forward more constructively. It might feel like an extra effort to do these things. But by investing in your ability to better navigate these difficult situations with your parents, your family will get closer to what we all want: less stress for ourselves and better quality of life for our parents.