How to Manage Difficult Conversations with Elders

Advice and Help : How to Manage Difficult Conversations with Elders

By Maureen Lopes
You have taken the first steps to become involved as a caregiver for an elderly family member or friend.  One of the first things on your To Do list is to have a conversation with the person to find out their concerns, plans and dreams for their final years. 

Surprise – the senior doesn’t want to talk.  Their immediate response is that “everything is fine” and that they are taking care of themselves and their spouse (if there is one).  Elderly men may be especially resistant to sharing decision-making for themselves and their spouse with children or other younger family members.  This period of their life is an entirely unfamiliar situation for someone who for 60 or 70 years has been the family leader.  Sharing responsibility and decision-making is emotionally difficult for both the senior and their family members.


When is the right time for family and friends to directly address the resistance?  First, is anyone’s safety in jeopardy?  Jack and Ann, a couple in their mid-80’s, have been living in the same home for 60 years.  Their two daughters and one son all live in other parts of the country.  The nearest daughter is a six hour drive away from them.  Jack is still driving and has a regular routine of playing cards with friends during the week.  This activity is his major social outing and very important to him. 

Ann’s cognitive functioning has been slowly slipping to where she needs help dressing in the morning as well as reminders to take regular baths and to eat.  Neither her physician nor her family have talked about a possible Alzheimer’s diagnosis.  Jack has been taking care of her but she is left alone for several hours when he is out.  One day she leaves a kettle on the stove that burns dry and sets off the fire alarm.  Her daughters and son hear about it and are worried for her safety. They also see the changes in her when they visit. But Jack is resistant to hearing that his care-giving is no longer enough.

How do Ann’s children help protect her safety while honoring their father’s role in the family?  It is not unusual that for some period of time the adult children continue to be reassured that the cognitively intact parent is handling things.  But then there comes a time when either they too clearly see the changes or there is a safety or health crisis.  The care-giving spouse may have health crisis, which results in the children having to take over direct care of the elder still in the home.  Rarely does the situation return exactly to the previous status.

Here are tips for managing difficult conversations.  If at all possible, hold a face-to-face conversation.  The quandary for many families is that visiting happens during holidays when everyone wants to keep a calm and happy face.  But, remember, that it is rarely a one-time conversation and it is better to open the dialogue face-to-face.

•    Have the conversation in private.  If this is difficult to do in the home, suggest going for a walk or having a cup of coffee somewhere.
•    Focus on one or two items per conversation.  Take a deep breath and remember that not everything can get resolved with one conversation.
•    Ask pointed and open ended questions (that don’t allow a “yes” or “no” answer).  For example, ask “how do you go shopping?” or “what does mother do when she is alone at home?”  It may be easier to start with questions about activities of daily living than decisions about money or legal issues.
•    Keep your voice tone neutral, without accusations.
•    Listen carefully and repeat back what you have heard.  This will be especially necessary if the elder is confused about what he/she is trying to say.
•    Listen between the lines – be alert to facial expression, tone of voice, level of attention.  In some situations it can be helpful to have a second person with you just to listen and look for these clues.
•    Be patient – it may take your relative some time to express a thought.
•    Be prepared for negativity – the changes of aging can be difficult for people to accept.  Watch out for your negative reactions to what is being said by your relative.  You will be carrying into the conversation all of the “baggage” from your relationship with the relative.
•    Talk about your own feelings.  Use “I” statements rather than telling the relative what he/she “should” do.
•    Be mindful that your relative may fear that admitting a need in one area will cause the family to over-react.  So agree upon whom you will share information from the conversation.

In some situations the parent-child/children relationship is burdened by past behaviors and conflicts.  Children, who nevertheless are committed to being involved in elder caregiving, would be wise to seek a deeper level of knowledge and support to help them through this process.  To find a caregiver support group in your area contact your local Agency on Aging (which are federally supported everywhere in the United States), United Way or religious organization.  The tips on managing difficult conversations are drawn from Avoiding An Eldercare Crisis from VNA Community Healthcare.  Another helpful book is Coping With Your Difficult Older Parent:  A Guide for Stressed-Out Children by Grace Lebow and Barbara Kane.  Remember, you can act responsibly and feel good about your efforts even if you are not doing it out of love.

For Further Reference
Listen in to a Good Morning America program - "Mom and Dad - We Need to Talk."

NPR Program on "How to Have the Conversation"

Maureen Lopes
VNA Community Healthcare, Guilford, CT
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