Wednesday, August 27, 2014

Interdependence with aging parents

Family dynamics can really be challenged as aging parents 
need more help from their adult children.

The relationship dynamics of family drastically shift over time.  Children, once dependent on their parents, grow and mature to adults.  Parents grow too and eventually reach an age where they need to depend more upon their adult children. This tends to cause a considerable amount of stress and anxiety for all involved.  On average more than half of elderly over 85 need help with their daily life.  It would seem natural that family would provide much of the care their elderly loved ones need. Yet many elderly and their adult children have difficulties finding a working balance between independence and providing care. 

Independence is a deeply ingrained part of the American psyche.  It is revered just as dependency is looked down upon.  Many older Americans refuse to accept help, even from their adult children for fear of being dependent and a burden. Yet this deprives the elderly of needed assistance that promotes longevity and health as well as the opportunity for grown children to care for the ones who once cared and provided for them. 

Most societies across the globe care for their aged within the family and only turn to outside caregivers in cases where medical issues demand it.  In other cultures, generations of families co-exist, often in the same home, providing support and care for each family member as needed.

The multi-generational American family could greatly benefit from becoming more interdependent.   But to achieve interdependence in a healthy way, families must rise above some common hindrances.

Filial maturity 
Adult children need to accept their parents as individuals, recognizing their personal needs and goals and accept their imperfections as well as positive qualities.  Filial maturity means relating to and supporting aging parents in an adult way and requires understanding, patience and respect of their stage in life.

Parental maturity
Elderly parents need to accept their adult children as adults.  They need to rise above deep-rooted attitudes of being in control and graciously accept help from the younger generation.

Acknowledge loss
Both elderly parents and adult children need to come to terms with the loss that is part of aging. The elderly experience many losses. The loss of status, health, financial security, spouse and friends can cause despair and needs to be recognized by the family. The children of an elder experience a sense of loss too, as the parents they once knew and depended upon progresses through the aging process.  Recognizing that loss as part of the circle of life instead of battling against it can help ease the transitions as relationships with in the family continue to change.

Mixed expectations
The elderly and their adult children often have different agendas of what is important and requires assistance. The adult children worry about practical cares and safety issues.  They see help with bathing, food preparation and the prevention of falls as important.  Where the elderly are more interested in getting help with bureaucratic issues like managing health care or financial paperwork and can take offence at being offered help with daily needs.  Having different agendas causes stress and can result in misunderstandings, anger and hurt feelings.  When the elder parents and the adult children openly communicate their concerns and expectations there is a much better chance at a smooth relationships.

Avoid role reversal
Assisting a parent with bathing and dressing or taking over their decision making roles can be uncomfortable for both generations.  Elderly often resent and resist being treated as a child and adult children miss having their parents be parents.  A role reversal is not easy or healthy for either generation.  There are times when the adult children will have to make difficult decisions on behalf of their parents, but in general it is best to keep family roles intact. The elderly, no matter how frail, should maintain control of their own decisions as long as possible and the adult children need to respect their parent’s desires.

Bring in help 
Hire a home health Caregiver to provide services for your elderly parents at home. An extra pair of helping hands will take care of the daily tasks and intimate cares that often cause conflict between the generations. Getting help inside the home works to maintain healthy boundaries and relationships in the family and can make a world of difference in having healthy interdependence with aging parents.

Kate McCarthy is Director of Operations for HomeAid Health Care which provides services for the elderly who wish to remain safe and independent at home.  HomeAid is sister company to Prairie Home Assisted Living which has served the physical, spiritual, mental and health needs of their residents since 1999.  Together the two companies provide comprehensive care for the elderly in the Fox Valley of Wisconsin.

“As Parents Age, Family Will Have Role Reversal” by Dr. David Lipschitz. Retrieved from, 10/15/12.
“Building Positive Relationships”, Texas A&M Agrilife Extensions Service. Retrieved from, 10/15/12.
 “’Parenting” Your Elderly Parents’ by Family Caregiver Alliance. Retrieved from, 10/15/12.

Wednesday, August 20, 2014

Working Through Grief With Dementia

A person with dementia may not remember the name 
of their missing loved one but still deeply feel that loss in their lives.

We all experience grief. Unfortunately, at one time or another everyone will suffer a loss of someone dear to them. Although people grieve in different ways depending on the nature of their relationships and their past experiences with loss, the grieving process is quite normal and necessary. Grieving helps an individual adapt and accept the reality of their loss, work through the pain and adjust to all the life changes caused by the death of their loved one.

Going through the grieving process is very difficult for people in general; but for people with dementia, the process can be far more complicated. People with dementia experience grief, but their reaction to their loss is largely affected by their own cognitive understanding of what has happened to their loved one, the connection they had with the person they are grieving for and how well they can express their sorrow.

It is wrong to assume that because a person cannot remember the name of their missing loved one they do not feel that loss in their lives. Those with dementia generally live with feelings that things are not right, or a constant state of “wrong-being,” but are usually unable to put their finger on what the problem is. Most individuals suffering with dementia are somewhat aware of their confusion and live with grief over lost abilities, memories and understanding. Add in the loss of someone dear to them and their confusion can be compounded. Grief and the mourning process can be experienced by those with even advanced dementia, regardless of their cognitive ability to resolve or make sense of their feelings. So in most cases it is better to share the news of a death than to try to pretend nothing has changed.

There are several considerations to keep in mind when helping a bereaved person with dementia work through grief.

Choose carefully when to share bad news
According to Melanie Bunn, RN and Alzheimer’s training consultant, consideration must be given to the bereaved person’s cognitive condition when choosing when to share the news of a loss. Select a time of day when the bereaved is rested and feels comfortable and safe. Many people suffering from “sundowners,” a type of dementia, find late afternoons and evenings especially challenging and would be better able to process difficult news in the morning hours.

Choose carefully how to share bad news
Have a familiar and trusted person talk to the bereaved in a clear, calm and simple manner. It is best to have only one person relay the news of a death. People with dementia can be deeply affected by the emotional climate of grieving family members and respond with increased agitation and restlessness. Experts advise avoiding abstract phrases like “passed away.” It is much more effective to plainly state that the person “died.” Keep sentences short and do not overwhelm the bereaved person with dementia with too much information at once. Be prepared to frequently repeat the information as they will need time and repetition to process it. Do not be surprised by a delayed reaction or lack of response.

Help the immediate grief process
Those suffering from dementia can benefit by participating in the rituals of death. According to the article, “Sharing Bad News,” by Melanie Bunn, it may be necessary to modify rituals to make them more workable for the person with dementia. She suggests private visitations rather than participating in public gatherings, attending the funeral but not the burial or hosting a local memorial ceremony rather than traveling great distances to attend a funeral.

After the funeral, it is helpful for the individual suffering from dementia to reminisce about their loved one. Talking about memories while looking at a photo of the deceased will aid in the grieving process. Often the person with dementia needs help expressing their grief and speaking to them using empathetic phrases will help them verbalize their mourning. According to Alzheimer Scotland’s article, “Loss and bereavement in people with dementia,” phrases like, “You sound like you really miss him. Tell me what you miss about him most.” aid those who have a hard time finding words to express the emotions they feel.

Help with long-term grief  
Constant assessment of the cognitive state of the bereaved is very important. Ignoring the mood of the day and trying to force a person with dementia to understand a death can be detrimental to the grieving process. Try to have all people in contact with the person diagnosed with dementia be consistent and patient as they work through their grief over time.

By focusing on the person with dementia and validating their emotions, even though the source of the emotions are lost to them, the grieving process will be made easier for the person suffering from dementia and the entire family.

Kate McCarthy is Director of Operations for HomeAid Health Care which provides non-medical home services for the elderly who wish to remain safe and independent at home. HomeAid is a sister company to Prairie Home Assisted Living which has served the physical, spiritual, mental and health needs of their residents since 1999. Together the two companies provide comprehensive care that meets the needs of the elderly in the Fox Valley.

“Sharing Bad News” by Melanie Bunn
“Loss & Bereavement in People with Dementia” by Alzheimer Scotland
“Grief and Dementia” by Kenneth J. Doka