Monday, March 11, 2013

Dealing with the Difficult Elderly

There are bound to be some challenges when providing care for an elderly loved one.

Personal Experience

When my husband’s grandmother moved in I knew there were bound to be some challenges.  She spoke no English and communicating with her in my elementary level Greek was difficult.  Yet I was determined to show compassion, include her in the family and provide whatever care she needed.  Everyone said she had always had a difficult personality, but I was not at all prepared for the ordeal which I had just signed up for.  At 94 she proved to be as wilful, manipulative and mean tempered as a child going through the “terrible twos”.   I had often wished I could give her a time-out or send her to her room. Not knowing why she was acting out or how to handle her caused troubles throughout the household and was devastating to me as her caregiver.  
 
There are times when caring for a difficult elder feels impossible.  Elderly loved ones may feel embarrassed, frustrated and depressed when their physical limitations force them to rely on a grown child or family member for care. Their dependence and sense of helplessness can lead to a feelings of despair and resentment which expresses itself in negative behaviour.  Knowing what can be done to help the situation and what will have to be endured with lots of loving patience, can make a difference in the caregiver’s ability to provide care long term.  

Looking for the cause

When dealing with a grumpy grandma or grandpa it is important to find if there is an underlying reason for their complaints and crankiness.  If anger and negativity are relatively new personality traits there may be external causes which need to be addressed.

·         Medications Certain medications can cause personality changes.  Antidepressants, anti-seizure medications, blood pressure and anti-inflammatory medications can all cause behavior issues if not matched and adjusted correctly to the individual.  Also a combination of different types of medications can play a role in behavioral problems.  Always have a pharmacist check for interaction problems when dealing with your loved one’s medications.
·         InfectionsBladder infections (UTI) are common among the elderly and can cause trouble physically and behaviorally.  An onset of out of character behavior can often be traced back to a physical infection and should be treated medically.

·         PainChronic pain makes everyone feel a bit cranky and often an elder will try to bear the pain and forego seeing a doctor.  Being stoic about pain isn’t always the same as suffering in silence and often the elder doesn’t see the connection between his pain and a general crabby attitude.  Getting proper medical help for pain management will go a long way in helping with behavioral issues.

·         DementiaMemory loss is frustrating to those suffering with dementia and can cause unusual behavior.  People with dementia are often unable to mask negative aspect of their personality and will say and do socially unacceptable things. In addition, there are many types of dementia, such as Alzheimer’s disease, Sundowners Syndrome and Pick’s disease, which are marked by dramatic personality changes and rather aggressive behavior.   
 
In some cases, such as with my husband’s grandmother, a life-long habit of being difficult means behavior becomes increasingly impossible as aging issues come into play.  Ingrained difficult behavior that was somewhat kept in check for years, with age cannot be hidden or masked.  Add into the mix a bit of dementia and behavior can become unreasonable, irrational and aggressive.

It is important to recognize that ingrained negative behavior is not likely to change at an advanced age.  According to Jacqueline Marcell, author of “Elder Rage”, in cases where dysfunctional behavior is compounded by age, the best thing a family caregiver can do is to develop an “emotional shield”.   By letting hurtful words and irrational deeds bounce off, caregivers protects themselves from the stress of caring for loved ones who are not behaving in a loving manner.  She also advises getting help from support groups.  Having support from those who going through similar situations can help a caregiver cope and knowing you are not alone can be a source of comfort.

Getting help

Equally important is getting respite.  Caregivers, especially those with difficult elders, need to take break to rest and relax.  There are many community services and home health agencies available to help with providing occasional, temporary or even round the clock respite care.  Often having a professional caregiver come into a difficult situation can break a pattern of negative behavior and is beneficial to everyone involved. 

Providing loving kindness to our elders is the right thing to do, even when behavior issues make it difficult.  Knowing what can be done to help the situation and what, unfortunately, must be tolerated helps caregivers keep things in perspective. 
  

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Sources:
“How to Deal with an Elder Who Complains Too Much” by Carol Bradley Bursack, www.agincare.com. Retrieved 7/9/12.
 “I love My Mother, But I don’t Like Her” by Jacqueline Marcell, www.agingcare.com. Retrieved 7/9/12.
“5 Success Tips with Difficult Aging Parents” by Carolyn Rosenblatt, www.forbes.com. Retrieved 7/9/12.