Pride Goes Before the Fall!

It is no secret that as we age, our bodies are less sturdy, our gait can be less balanced. Too often, pride is the greatest obstacle to making changes to reduce the risk of falls or injury.

PRIDE: keeps us from removing throw rugs (the single greatest tripping hazard in any home).

PRIDE: keeps us from asking for help to do things we used to do with confidence. (I remember the alarm I felt when I discovered my 88 year old mother was changing her own ceiling lightbulbs – standing on a stool, reaching up over her head).

PRIDE: keeps us from using assistive devices (especially canes and walkers) when our doctor or family has asked us to.

PRIDE: leads us to believe we are unbreakable if we do fall.

PRIDE…will get you in trouble!

http://cdn.phys.org/newman/gfx/news/hires/emergencydet.jpg
Photo credit to phys.org, article on Emergency detection systems.

A fall with a fracture can be a sentinel event. 30% of people over the age of 80 who suffer a fractured hip die within the year, because it is that taxing on one’s health and stamina. Risk of injury is increased if one is taking blood thinners. A fall with a bonk to the head can be an inconvenience for some, but a deadly experience for those on anticoagulants. Blood pressure medications can cause dizziness – rise slowly, don’t walk off until you feel steady.

Clearly, the best thing to do is NOT FALL!

Look for tripping hazards in your home, and consider ways to remove them.

  • Throw rugs can be secured with double sided carpet tape, but are still a significant hazard. Can you remove them altogether? Uneven flooring can also be hazardous.
  • Mind your pets and their toys. They can be small enough to not notice, large enough to cause tripping.
  • Make sure your walkways are free from clutter, especially at the end of the day.
  • Provide good lighting to those paths you walk, especially at night.
  • Ask for help when you need it, and if you have to do something risky (changing light bulbs, getting into a high cupboard), make sure someone knows what you are up to.
  • Wear comfortable, non-slip foot wear that give you good support.
  • If you live alone, please consider a Life Alert type call system. They are well worth the cost. Find a Call Buddy – someone you agree to check in with at the same time every day.  Make a back up plan for what to do if you call and they don’t answer when you expect them to!

Balance and strength come from our core muscles. Find an exercise class or home program that gently helps strengthen muscles and improves balance. Elastic muscles are strong muscles, older adults who exercise daily are less likely to have a fall, and less likely to suffer severe injury if they do. It is never too late to begin toning and strengthening! Swimming, yoga, walking, tai chi, are good forms of exercises that are easy on the joints.

As always, if you want more information on any topic I write about, or information on something you haven’t seen here, please email me at info@artofparentcare.com

 

Elder & Family Care: A Call to Churches

Our global population is “graying” and multiple generations of family are often separated by great distance. Churches will be increasingly relied upon as a resource for Elders and their families. Now is the time to call ministry teams and develop Elder-adult outreach programs. Older adults need to remain visible to church membership, their families need to remain on the radar for spiritual care. Churches can set the standard for how we care for and with each other across the lifespan.

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To better understand the urgent nature of the “flood” of aging persons and their coming needs,  consider the impact of the following two facts on the family, the church, the community, and the individuals who need care and support.

  • Currently, for every person receiving Social Security and Medicare benefits, there are 4 contributing individuals in the workforce. By 2030, (only 14 years away), there will be approximately 2.2. (Reference available upon request).

Nurses, social workers, doctors, care givers, etc, will be in shorter supply by half. Greater pressure will be placed on Medicare dollars. Supports for aging in place over a longer life span must be strengthened. Churches should be part of the solution.

  • Assisted Livings are marketed as vibrant communities filled with fun and social activities, but it is very easy for older adults to become isolated and discouraged. 13% of institutionalized adults suffer from depression.  Spiritual care is sparse.

Facilities rely on volunteer programs from the community to engage with residents, and church members hunger for support and visits from their “church family”.

I feel an urgency in the call to develop ministries that serve Elders and their families. Whether your church’s focus is evangelism or social justice, the trumpet is sounding and the time to act is now.

  1. Hire a Parish Nurse, part or full time. Look for grants to support the position. RNs can:
    1. Create a program for home visits, medication review, wellness teaching, patient advocacy, and communication with families and medical providers.
    2. Be a medical case manager who can also address spiritual and wellness needs.
    3. Work with Eldercare Advocates to write policies governing the church’s supportive programs for aging adults and their families.
    4. Encourage discussion of Advance Directives, end-of-life care wishes, and emergency contacts. Develop a way to secure that information in the church in the unfortunate event that it is needed.
    5. Discern how to provide spiritual support for individuals facing the end of life. (Hospice chaplains are often the sole spiritual providers at end of life).
    6. Coordinate church staff annual CPR and AED training.
    7. Assures volunteers working with Elders (and children) have criminal back ground checks completed.
  2. Develop a ministry of Eldercare Advocates. EA’s can:
    1.  Host family/caregiver support groups open to the community.
    2. Identify safety and accessibility for older or fragile church members and work with the appropriate leadership to make changes.
    3. Introduce weekly visits Assisted Living Facilities/ Memory Care Units where members or family members reside. Share Bible Study, music, prayer, and monthly worship and communion.  Never assume “someone else is taking care of their spiritual needs now.”
    4. Teach other volunteers, expanding the scope and reach of the ministry.
  3. Scrutinize your buildings and programs for accessibility and safety.

    1. Is there a handicapped accessible bathroom, complete with a cupboard of protective undergarments, disposable gloves and cleansing wipes?
    2. Can mobility-impaired persons get around the building safely in a wheelchair, scooter or using walker, canes or crutches?
    3. Is there a protected “drop off” area for inclement weather? Is there a greeter to help those with mobility needs?
    4. Adapt your “cry room” for families with a potentially disruptive Elder, and include some appropriate interactive items.
    5. Consider hosting an “IT” room for those who don’t have home computers. Computer literate members can teach others to use Skype, email, and social media to connect with distant loved ones. Get them talking!
    6. Create an emergency response plan to contact members who are home bound or have special needs.
  4. Bold congregations can also consider developing:
    1. Adult day care programs to provide respite care and social opportunities. Not unlike a church preschool model, it can include Bible Study, teaching and respite for family members.  For adults with dementia, a routine can includes chapel, music, scripture and creative projects. (This same ministry can be offered in facilities.)
    2. Manage a church run “board and care home” to serve the congregation and others. One efficient, but small scale model is the Green House Project thegreenhouseproject.org/ . Social policies generally support “aging in place”. Some Elders need fulltime assistance when they are no longer safe to live independently.
  5. Communicate and collaborate with local social service agencies to understand the needs of seniors in your particular area. There are likely Foster Grandparents, spouse/caregivers, or seniors living in poverty that would benefit from “adoption” by a congregation. Are there special needs in your area? In 2001, the Faith Based Initiative partnered churches and social service agencies. In the case of Eldercare, it could be revived to promote protection, support, and spiritual nurture of the aging population.

There are other ways to support an aging congregation and its local neighborhoods.  From community gardens to home repair ministries, the opportunities are endless. The first step is to understand the needs that are closing in upon us. May your ministry teams prayerfully prioritize and begin to address these needs within your local congregation.

 

 

Mission Outreach to Aging Adults & Families

IMG_0744.JPGPart 2/4 in a series about how churches develop mission outreach to aging family and elder church members

As Jesus’ hands in the world, guided by the Holy Spirit to demonstrate His love through our actions, church mission must include seeking out those who are isolated due to age or health and support and encourage their families.

gusJohn 4:35 “Do you not say, ‘There are yet four months, then comes the harvest’? Look, I tell you, lift up your eyes, and see that the fields are white for harvest.”

Churches need to recognize the need to reach out to children of aging parents in a multidimensional ways. What services they can be offered to adult children and spouses caring for loved ones? Perhaps Parentcare support groups, Bible study with respite care, regular adult day care, and at the very least, some form of regular and frequent home visitation for the older church member, to provide companionship and spiritual care. If we come to see Elder care as a mission and ministry, we will deliberately and actively seeking out isolated older members and the people who care for them. In isolation, our Elders suffer. We (the focus of the church as a whole) are neglecting the spiritual care of older adults and their adult children.

In preceding years, churches grew from the younger ages on up. Young families were embraced, children grew up learning about Saving Grace, play groups formed, families met in fellowship and worship and community was built. 25 years ago, that was what drew me in the doors. As the mother of two preschool aged children, I became hungry for a foundational faith we could grow as a family. I was initially attracted to the church because mothers in my La Leche League group were members. I found a wellspring of children’s activities, and became immersed in the church/child/parenting culture. It was vibrant and fun and alive, full of music and song.

My current church home is a rapidly aging congregation who span 50-101 years across a few dozen members. Most no longer participate in outreach activities. There is little engagement between this church body and adult children, our youth are a small handful of great-grandchildren of longtime members.

Previously, I shared the story of Mae and the encounter I had with her son. We have 4 such “Maes” in the last year. Physical decline, cognitive impairment or some other combination kept them from worship and activities. Their adult children don’t engage with the church much, perhaps because no one is left for them to connect with, perhaps because they feel overwhelmed trying to get Mom to church and, perhaps, because no one is reaching out to them. This would explain Mae’s son’s anger toward the congregation he grew up in.

Allow me to unpack that just a bit:

First, these activities need to fall to someone other than the Pastor. Pastors already have a full-time calling, and what I propose requires a called and gently trained team for this mission outreach, not unlike Stephen’s Ministries of recent years.

Small group outreach: Eldercare Advocates can be trained to run small groups for spouses or adult children caring for parents. A ministry opportunity exists people come together to share stories, build support networks, learn about local resources from each other and receive spiritual care. By understanding the needs of these families and their challenges in co-generational care, an environment can be developed to support study and worship participation for all generations.

Respite care: Developing a respite care program -perhaps a lunchtime activity – on a regular basis allows time for self care for other family members.  Through regular, scheduled activities trusting relationships are built.

Home visitation More than monthly prayer and sacraments, we can bring time, companionship and respite to the home. Loneliness experienced by homebound or institutionalized Elders causes suffering, which none but family and care providers hear. Home visitation, especially when coordinated with the family offer respite and time for Spiritual care as well.

My calling is to help churches and families find creative ways to meet the needs of a rapidly growing population of Elders. They way we have cared for the aged and fragile in the past will no longer be sustainable. We need a new model that begins in the family, in the community and addresses not only the physical, but the spiritual needs of Elders and their families.  Time is of the essence.

Church Congregations and Aging Adults

Part 1 of 4:  The Invisible Aging Person

The church needs renewed consideration of the Eldest members. People too often become invisible once they are no longer able to get out, when they are too fragile to “contribute” to the growth or life of the church. I have witnessed a sad trend played out in congregations I have participated in and the work I have done with Elders both in the community and in Assisted Living Facilities.  Once a person becomes absent – through relocation to an institution, becoming home bound due to infirmity or because the church is not set up to accommodate special needs –  they become invisible.  Deacons may send a card on special days.  A church visitor may pop in for an hour once a month, but the Older member becomes exiled, wandering alone in the spiritual desert of their last years.

I belong to a small, aging congregation in a rural community. There has been discussion of late that if we don’t bring in younger families, the church may not have sufficient members to keep the doors open.  That’s a reality shared by many small churches, and the focus of revitalization strategies taught by leaders like Thom Rainer and Ken Priddy. It makes sense: We must find ways to invite people to come in – and stay – to keep the church alive.  The Great Commission calls us to make disciples and certainly we can’t do that if the doors are closed.

Historically, churches grew from the younger demographic upwards, not unlike societal institutions. Historically speaking (pre Baby Boomer cohort) the majority of our population were in their middle years, with a large base of youth and children at the base of the population pyramid, and retirees and Elders comprising the narrowing tip. Nursery care, preschool programs and Vacation Bible School drew families by attracting  children and their parents. That was an effective paradigm for growth as the Boomer Generation was created, well into the 90’s as they then had their own children. (This format worked for me. I was “unchurched” until a program drew my children in and then I followed. Nothing softens the heart of a parent more thoroughly than seeing their children glowing with joy and a sense of purpose; the innocence of “letting their light shine”).

The times, though, they are a’changing. The Boomers will be launching the last of their babies shortly.  The Generations X and Y and the Millennials will not likely reproduce in the numbers that the Boomers and their parents did. Church nurseries, I predict, will not host the numbers that were common 30 years ago.

I will close this installment with a story I was privy to. I began reflecting on this situation as our church discusses revitalization efforts and how we become more welcoming. It occurred to me to think through “to whom do we need to be welcoming?”  We need to not overlook our aged church members, who once disconnected from their Spiritual fellowship, can suffer in isolation.

Mae was a resident at an assisted living where I was employed as a nurse. She was in her early 80’s, and suffered short term memory loss.  Mae had been moved to the assisted living apartment because she could no longer safely care for herself at home, and her family thought the socialization of the community living facility would benefit her. Mae had a church visitor – once a month a young gentleman would “round” on about a half dozen residents who had once been church members. As far as I could see, that was her only church contact.  In chatting with her eldest child one day, I heard an intense anger towards the church and it’s members, as he felt that for the 40 years Mae had participated in all aspects of the life of her church, no one “saw” her anymore.  She had become invisible to the church family, save the dedicated volunteer who provided ministry in the local facilities for “former” church members. Mae was starving for conversation, for regular prayer, Bible Study, a friend, and the ritual of church services.  In the assisted living, she was spiritually starving. Her children also felt abandoned by the church family they had grown up with, and thought would continue to be a resource for them and their mother as her needs changed.

Our seniors become “the forgotten” and often decline visits because “they don’t want to be a bother”.  I’ll let you in on a secret.  They DO want to be a bother.  They want to be seen, noticed, cared about, included, even in their changing states.  They thirst for authentic connection, visits, prayer, hymns, gossip.

Questions to consider:

How many of your aged church members seem to have become invisible once they no longer attended services regularly? 

Is anyone designated in your church to notice an absence and follow up with a call to the parishioner or their family? 

Who in your church family is tasked with making sure members, unable to get out often, are visited frequently enough to nurture still growing relationships, rituals and spiritual succor?

* * * * * * *

I challenge church leaders to take an inventory of the people that have faded from view in the last year.

Where have they gone?

Who has reached out to them?

What training is offered for your volunteer visitors, if you have such a body, so that they are equipped to have meaningful visits to those who are home bound?

Does your church regularly engage with the families of their aging membership?

Some thoughts on Advance Directives

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Every emancipated adult should have an Advance Directive. Once a child is emancipated, parents can no longer make medical decisions for them by default, should the offspring become incapacitated. Often we limit our conversations about Advance Directives to Elders, thinking they are more likely to become cognitively impaired. However, the age cohort often overlooked are young adults between 18 and 30 who are at risk for devastating traumatic brain injury (TBI) — due to motor vehicle accidents, recreational accidents or substance abuse.
Preceding the Patient Self Determination Act (PSDA) was the tragic, 1970’s case of Karen Ann Quinlan, which attracted sensational media attention and brought the controversy between family desires, medical opinion, ethics and law into the cultural conversation. I have no doubt that her case, and those that followed, helped propel the PSDA into being. Shortly after the Quinlans lost their appeal to have their daughter’s life sustaining treatments revoked, I found myself working in a “convalescent hospital”. There I had the unforgettable experience of caring for a high school classmate, not even 21 at the time. Shortly after graduation, while walking on a lonely road late at night, he was struck by a car. Suffering spinal cord and traumatic brain injuries, his quality of life was undeniably impaired.
I don’t think revoking heroic measures was an option in California in 1978, and this encounter, so close to heated debates about terminating life-support, left an impression on me. In recent years, I have had conversations with young adults that include thoughts about accidents and injury. They are quite clear “I don’t want to be kept alive if there is nothing left of ‘me’”. Youth are as important to include in the conversation about Advance Directives as are their Elder relatives, and for similar reasons. Loved ones can’t act on your behalf if they don’t know what you want.
We don’t like to talk about death and dying, about end of life mystery or transition. Life seems brighter if we ignore the shadow side and go merrily on our way. For us, it might be. If we’ve become incapable of making decisions for ourselves, chances are we won’t care much. Some won’t talk about death because they don’t want to upset their families or those that they love by “making them think about it”. The irony is that by trying to protect those we love by ignoring this reality, we force them into making decisions about us which they are ill-prepared to make. Some people don’t understand what Advance Directives are or how they can help.
I have watched this process when families are unprepared. It is often grueling and painful. The second-guessing about what “mom wants”, the contention between those mature enough to let go and those clinging to hope or fearing death can devastate a family that needs to support each other and prepare to grieve.
Most departments in my hospital, which serves a large retirement age population, assertively broach the topic of Advance Directives, and in my specialty clinic new patients are educated and offered a copy of our state’s Advance Directives workbook.
AD pamphlets read very similar from state to state. They are dry and medically oriented. Recently, I was introduced to a stellar revision of the standard Advance Directives, entitled “5 Wishes”. It reads very similar to the more bland AD pamphlet with three notable exceptions – “How comfortable I want to be”, “How I want people to treat me”, and “What I want my loved ones to know”. Those tools could soften and gently personalize the conversation about end-of-life decision-making.
Those three wishes give the powerless – those who can only stand by while someone they love is dying – specific tasks to perform to enhance the quality of the last days and hours and instill a sacred dignity to the art of dying. I wish that they had been a part of my own mother’s AD process. At 88, however, she was not very open to talking about what she wanted (besides that she didn’t want her children to hurt). Baby Boomer Elders may be more forthcoming about what would make their final passage sacred and meaningful, (or even fun and joyful!) My Depression Era mother was not. We had to guess. How much gentler it would have been if we had known what was important to her, to enhance her comfort.
There are few reasons for any emancipated adult to not have the discussion about end of life wishes — from medical care choices to what music you want playing when you are unconscious or passing — and legally initiate appropriate Advance Directives. Perhaps more people would engage in them if they knew that:
1. They can be revoked at any time by the issuer.
2. They only go into effect if the issuer cannot make medical decisions for themselves due to inability to communicate their wishes.
3. It alters the responsibility for making life-to-death medical decisions to the issuer, having had a discussion about their values and desires with their appointed representative. It is an act of personal empowerment — one is less “victim” to the end-of-life passage, and more a participant.

4. The process of reviewing the choices one must make when completing their advance directives opens the door to conversation valuable in any relationship, “what to do when I am dying”.
5. It is kind for the family to have decisions articulated and communicated in advance.
Inadequate understanding is a barrier to completing Advance Directives. The concept that it is somehow a “death sentence” or supported by “death panels” can link Advance Directives to one of the most emotionally charged phrases to come from the detractors of the Affordable Care Act, though the PSDA precedes the ACA by more than a decade. For those wishing to engage in all means of life-sustaining treatment, it is still important to appoint a representative to direct medical care and long term care choices from home health, nursing home to hospice. The idea that Advance Directives are only for those wishing to halt life-sustaining treatment is a common misunderstanding of it’s purpose.
There is a risk of exploitation and that needs to be guarded against, and is, by the stipulation that the appointed representative cannot be a caregiver or employee of a facility where the issuer receives care. It is possible to appoint the wrong person for the wrong reasons. A representative should be someone the issuer is confident will follow their wishes, who has knowledge of the care they have been receiving and their medical history, as well as their values and desires.
Life is short, the time is now to think about what you would want and who would be your voice if you couldn’t make your desires known. Have the conversation with your children and your folks.

For more information on “5 Wishes” visit http://www.agingwithdignity.org/five-wishes.php

Full list: Is there a primary stroke center near you? – USATODAY.com

Full list: Is there a primary stroke center near you? – USATODAY.com.

I hadn’t heard of Stroke Care Units until very recently. The data on recovery, reducing long term disability and reduced recurrence of stroke is significant for people who receive care from an SCU rather than an ICU/CCU or medical/surgical floor. The exact mechanism is not clearly identified, but whatever the reason, the outcomes are better and the stays tend to be shorter.

Is there the Stroke Care Unit near you???

The Art of Parent Care: Help me know what you need.

Thank you for filling out my poll.  I hope to use this information to guide me in my blogging, so I am addressing the issues most pressing to my readers.  Remember, we’re all in this together!

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The Art of Parent Care: Help me know what you need.

Thank you for filling out my poll.  I hope to use this information to guide me in my blogging, so I am addressing the issues most pressing to my readers.  Remember, we’re all in this together!

[polldaddy poll=6801129]

Plan for some self care in 2013!

I am sitting this holiday morning in the house that I grew my children in.  Here we raised lambs and goats and chickens and colts and a couple steers; where any given Saturday or Sunday morning could find unexpected teenaged bodies flopped sound asleep across my living room, arms and legs dangling over the edge of the sofa or arms of chairs as though some explosion had thrown them there.

A lot of memories were made in this house. It was a place of activity, growth and creativity, laughter and teenaged angst.  Felt tip marker identifies where pictures were colored; a bent heater vent displays someone’s foot expressing impulsive anger.  Here is the wall I papered while my then husband took our children away for two weeks (that was what I thought a vacation was in those years – everyone gone from home except me).

My mother spent a lot of time at my house.  Often, it was spent cleaning up after us, as I was not a stay-at-home mom, I was a doing-everything-but! Mom.  Besides working full time, we had 4H, FFA and Equestrian Team and later High School Rodeo, which took us out on the road 10 weeks a year.  I was a “lets tidy the barn” mom, while the living room could rock on it’s own with co-mingled clean and dirty laundry, dogs, books and toys laying about, waiting for the Saturday morning fit of cleaning.

Less clutter of both stuff and time makes everything simpler, and in simplicity, planning is easier.  I know I brought some of my own issues to the organized chaos that was our lives – afraid to say “no” to work or activities, trying to prove I was worthy of love, trying to prove as an educated, middle income woman, I could do and have it all.  (Not!)

As a family we rarely planned our activities to include my mother – in part because she didn’t want us to arrange our lives to meet her needs – but that was exactly how life was arranged.  Without intention it was often chaotic, haphazard and crisis-oriented.  Planning things together would have enabled us to utilize her energy and outside resources better so our time together wasn’t just spent doing errands. We could have done more of what I’m remembering this morning: Skip Bo and Scrabble at this dining table, 8 years of Christmas mornings in this living room, her grandchildren in jammies tucked under her arm as presents were doled out; Sunday dinners that brought everyone together.

We had love, we had animals, we had stuff, we had fun.  We had each other.  What we lacked was a plan – a vision for serenity in the midst of the jumble of activities and overlapping needs of three generations.  A plan for abrupt change in needs.  A plan for my spouse and I to get some rest and respite from juggling all that we did.

As a New Year shines on the horizon, I pose this challenge to you:  in the midst of organizing around your family needs, make a plan for self care so that you can more ably care for those you love, more intentionally spend loving time (not just busy-ness) with them. Time misspent is time lost to us…

I will post more on planning schemes and those things that should be considered in the multi-generational family during the coming weeks.  Let’s make 2013 the year that brings organized harmony, identification of family resources and confidence to your maturing family!

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Holiday Jolly, 2007

Love to you and Blessed Family-ing!

Katherine

Perseveration

perseverate |pərˈsevəˌrāt|
verb [ intrans. ] Psychology
repeat or prolong an action, thought, or utterance after the stimulus that prompted it has ceased.

I would add to this definition: confusing to those subjected to it.

Perseveration is something we expect of young children. We’ve all seen a child hold on to an idea or thought long after the thing that triggered it is past. The idea is often often predicated by “I want…”. They can hold on tenaciously and be difficult to redirect. When this behavior occurs in public and the only right answer is “no”, it can lead to further escalation – sometimes hysterics — especially if one’s child is tired. We’ve all been there. It’s a challenge with our children. Small wonder when we stumble into aged parents exhibiting this same behavior, we don’t know what to do!

With perseveration, the repetitive phrase almost becomes a mantra, and perhaps this is where the brain becomes wired to separate “want” from “have”; power over our desires to relinquishing them. It is where we learn “wait”, “not now”, or “you are safe”. Rarely can a young child be reasoned with logically, distraction tends to be a parent’s best friend in this situation. With children, it may take us by surprise, but it isn’t frightening (frustrating maybe!), or dangerous (usually). As their ability to understand time, patience, limitations increases with maturation, perseverating happens less frequently.

It feels very different when Elders, perhaps due to subclinical dementia, demonstrate perseveration. I heard a story recently about an elderly father who showed up to a Memorial with an agenda. He wanted something. He had apparently wanted this item for some time, and felt entitled to it. He spoke about it to family for several days before the memorial, where he would see the people he needed to talk to about it. His immediate family didn’t know what to do about his pit bull like tenacity, and when he did engage with the family who owned the object – loudly, publicly and at the gathering after the memorial – they were mortified. He wanted what he wanted, and that was all. Perseveration. “I wish I could have been this big” (demonstrated his daughter, closing her index finger and thumb together). “I wish I could have become invisible. We didn’t know what to do.”

In the end, this daughter left her father at the gathering. He could still drive. He lived independently and could engage in intelligent conversation but his behavior around his object of desire baffled and deeply embarrassed his family. Listening to the story and empathizing with the adult child, I thought again about how a lack of understanding regarding behavioral changes left everyone powerless to help him. Arguments ensued (with the inheritor of the belonging denying anyone else had any rights to it), upsets happened. No one had insight to de-escalate or re-direct his behavior, in part, out of respect for his position as a family Elder. No one wanted to appear patronizing.

Bad behavior is bad behavior and it doesn’t matter what the age. With our children, we know it is lack of understanding, patience, experience. But when our parents exhibit that same behavior, we expect more. They have demonstrated (and taught us!) appropriate boundaries, social skills, understanding and higher functioning emotions like empathy.

Perseveration is different from bad behavior, though. It suggests that a pathway in the brain is not working correctly, a thought becomes a compulsion. In the extreme, it can be a symptom of serious mental illness or an abrupt cognitive decline, but can also just be a more benign indication of changed cognition in that one instance. The individual likely won’t recognize they are doing this; and they aren’t engaging that way on purpose. Some automated thought loop in their head has been triggered. The challenge is for family or caregivers to find a way through it.

As a mother, I used to say “distraction and bribery” were my two best friends. This can be just as true with Elders who are stuck in a thought loop like this. I offer the following as tools for coping:
1. Validate their experience, whether it be something they want, they lost, they fear losing. Validate it, let them know they are heard. NOTE: if an Elder seems to be perseverating on a bad caregiver, living situation or expresses the same story of exploitation, abuse or neglect, this MUST be investigated thoroughly. Just because they repeat the story doesn’t mean it isn’t real. In the case of abusive care, the abuser is counting on the fact that people discount the Elder’s story because they have dementia or a history of perseverating.
2. Examine how you can relieve the anxiety. What can be changed to make the Elder more comfortable? How can they feel more powerful in this situation?
3. How can you redirect the thought process? One option would be to tell Dad “I hear that this is very important to you. You know that everyone is going to be sad and upset at the Memorial. Let’s talk to Bill and ask him not to do anything with what you want until after you and he have had a chance to talk about it, and we’ll make a time to do that together.” This probably would have had to be restated in many ways, several times, right up to the point of seeing Bill. (“Remember Dad, we’re going to make a special time to talk to Bill about this later. Please be patient.”)
4. Follow through. Trust-building and integrity is as important with Elders as it is with children. When they perceive a lack of trust and integrity, anxiety escalates. Elders have little to depend on. Make sure that you can be counted on to watch their back.
5. Don’t quit. If your child was screaming an “I want” statement in the grocery, you wouldn’t stop trying to find a way to redirect or de-escalate the situation. Treat the Elders in your life the same — with calm, patience and understanding. Your anxiety will magnify theirs. Perseveration means that something is beyond their self-control, and Elder or no, they need a kind intervention to break the thought cycle loose and see beyond it’s immediacy.

We don’t want to “Parent our parents”, but we can use our parenting skills to be better children, better advocates and better friends to them as their ability to “roll with the tide” becomes less flexible. They need us, as we needed them when we were young. Breathe deeply. You can do this!