Don’t let Life happen “unexpectedly”!

IMG_1487_2We have choices about the story we tell as our families age. When I was doing some research on the literature available to support the aging, multi-generational family, I found the material woefully (and I do mean W-O-E fully!) inadequate. I kept coming across first-person stories that in describing their synopses began with “suddenly, my aging mother who lived across the country, needed assistance” or “unexpectedly, Dad wasn’t able to take care of himself anymore”. REALLY?

As a culture we seem to have a peculiar denial that allows us to ignore the changes that are typical across the lifespan? For example, we know that new parents need support and time to adapt to the demands of their infants, that teenagers will go through particular behavioral changes as they assert their independence, that college freshmen often gain 10 pounds their first semester.

We have analyzed and quantified and reported on changes across the lifespan — until we reach a “certain” age. I guess after the “empty nest” the Golden Years are supposed to manifest and the rest is all an easy listening, waves-crashing-on-shore-at-sunset relaxing life to be enjoyed. You know, where your greatest challenge is Erectile Dysfunction (and they have several pills available for that now!)

Parents don’t “suddenly” or “unexpectedly” age anymore than babies grow “suddenly” into toddlers or school-aged children “unexpectedly” become teenagers, yet we ignore these changes until the need arises.

I strongly believe that “failing to plan” – especially in the case of our parents – “is planning to fail.” Unless you are a fan of crisis and drama, you really want to start thinking this through now – while your children are little, you are still talking to your siblings and your parents can start making “back up plans” for when one or the other becomes temporarily indisposed. These conversations are so much easier to have and are much more empowering all the way around when had before someone is in the hospital.

The first step to that planning process is to get through the fear that your parents are aging, and that this means you and your lover will eventually age too. Teach your children how to communicate with you later by modeling good communication with your family now. I pray that this New Year brings open hearts and health and safety for you all!

Happy Family-ing!

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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!

Holiday Jolly, 2007

Love to you and Blessed Family-ing!


Making Ends Meet

My mother was a strong woman, resiliant and fiercely independent. She lived on her own until 2 weeks before her death, and it’s not unthinkable that she waited at home until she knew her time was at hand, and then asked for help in getting her moved to a situation where she wouldn’t have to fret about us or the activities of her daily life. She reminded me of a woman in labor — knowing the birth is coming but backing away from that last transition even as she leans into the contractions. It was a tumultuous time.

In my mother’s case, we found her a wonderful adult foster home (a system of care in Oregon). I knew of the home because it was one I had some oversight in as a Community Health Nurse for the State Seniors and People with Disabilities Office. I loved the home, the caregivers, the ambiance. It was primarily a hospice home, though I really did not anticipate that was the service my mother needed. Even I, her RN daughter, thought that what she needed was time to rest, heal, let someone else take care of her. She was walking on her own with stand by assistance the day we arrived at the house, her bedroom already set up, furniture and pictures from her own bedroom adding familiarity and comfort. By the end of the week she could not stand without assistance, was irregularly communicating with us verbally, beginning to exhibit repetitive neurological motions referred to as “terminal agitation”, and sleeping frequently. (It was that weekend that I saw my father, deceased some 35 years before, standing by her bedside. It was a brief vision, but brought intense comfort to me).

On her 88th birthday, only days later, we were able to get her dressed and into a chair in the living room, where we shared an apple pie, her choice of birthday desert. Amanda her caregiver, my husband and I shared her birthday, untold friends called and sent cards.

It was clear this story was coming to an end.

My mother passed away very peacefully on a Sunday morning, with my sister, my husband, my brother in law all at her bedside. I was telling some silly story an uncle had told me the week before, about her father and a couple brothers and truck in a ditch. A “Golden Oldies” CD was playing, and I became aware simultaneously of her lack of respirations, and the words from one of her favorite songs, “Walk on the Sunny Side of the Street” — “like Rover, I crossed over….”. I asked Amanda, a tender hearted and very mature young woman, for a stethoscope, and I listened to her chest — her very silent chest. Stethoscopes are built to pick up sounds, and so are my ears, accustomed to focusing in on the earliest of fetal heart beats, the sometimes complicated extra sounds of the adult heart beat. I had never before heard just a hollow “nothing”.

The years leading up to my mother’s passing were busy, crazy busy with teenager activities, and her increasingly frequent medical trips or emergency room visits. For years I waited for “the other shoe to drop”, and after it did, after I bid her a tender and gracious goodbye, I did not grieve much. There was work to do, a memorial to attend to, a house to empty and sell, a marriage that dissolved rapidly after my mother’s demise and still… children to raise. My siblings and I went our own ways, I think each in our sorrow and orphan-ness to adapt.

I was unprepared for my first trip to visit my sister, some 18 months later, and in her guest room, find a chair. My mother’s chair.

The following is a description of the grief that finally found it’s expression. Grief comes in it’s own time, in it’s own way. There are no rules, except that there are no rules. I hope you don’t mind my sharing the rawness of that morning.

There was such a deep sadness… loss… confusion

curled up like a child in my mother’s chair, my head resting tiny against the wing of the back, where her head would loll as she’d fall asleep in front of the television.

There was a hug for me in the pillow she’d made, as I clutched it to my chest

and it became a depositor for my tears, my sobbing, my racking breath.


All the anger and love and resentment and loss, isolation and tenderness rolled all up in a ball in my chest —

fragile —

like a Christmas ornament dropped on a cold tile floor, shattered into a million shards of glass; prismatic, sharp, painful,

liquified me into brutal tears pouring forth, each sharp piece piercing my heart and the shell of detachment worn thin in spots

thin enough to be rent apart.

Flashflood. The torrent of emotion burst from me unexpectedly, profoundly, leaving me spent and more contemplative. I had not anticipated such a powerful response, having been so accepting of her passing and my circumstances as they unfolded. I didn’t know I held such pain, or that the pain held so much power until it’s critical mass was unleashed by a familiar, winged back chair in the wrong house, sitting empty save for the throw pillow that would rest her head.


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!

Getting to “yes”

There is a cycle to the life process. We start our lives dependent on others for care, nurturing, and safety, and we often conclude our lives in the same fashion. In the middle years though, we are full of ourselves, our independence, our power to make choices and effect change.

As those qualities and activities that we take for granted begin to diminish — our vision, our hearing, the stamina to shop or clean house, the reflexes to allow for safe driving — we run out of ways to show our power. Often, all that’s left is the power of “no”. This can manifest in refusing care, non-compliance with medical and medication regimens, and increased anger, depression, isolation or anxiety.

If you are encountering a frustrating situation with an Elder where the answer always seems to be “No”, if you are wanting to just “step in and and decide”, let me offer some alternatives.

1.  Examine the idea that this person’s behavior represents the only way they know right now to exert power in their lives at this moment.  For someone who has lost the ability to easily say “yes” — or who has had so many others tell them “no” … you can’t drive anymore, you can’t afford that, you can’t live by yourself, you can’t stay in your home, you can’t have ice cream, etc., being able to refuse is the last bastion of their independence. Can you look at “no” from their point of view?

2.  Help clarify values — both yours and theirs. There is nothing like fighting with someone to keep them safe and medically compliant if their first concern is how will they afford to feed the cat if they incur a budget busting medical expense or “what will the neighbors think?”  One example of this from my life involved my own mother’s refusal to use a Life Alert system.  My 87 year old mother lived alone in her home, about 2 miles from me.  Yes, we could (and did) check on her by phone and in person daily.  As a nurse, though, I understood the reality of both her night time bathroom trips, health issues that caused her to bleed rapidly when injured, as well as the life-changing impact even witnessed fall could bring.  But I couldn’t convince her to get a Life Alert button.  It turned out to be a vanity issue (as the cost was about $35.00 a month).  She didn’t want to wear “the button”, because it made her feel old.  It finally took another professional’s intervention to point out that she was torturing her children by not wearing it.  That she could understand — the power of saying “no” to this communication device was causing us emotional pain, and she didn’t want that either.  It gave her power, in that instance, to say “yes” because she was doing something proactive to nurture her children.  (She would sacrifice vanity to reduce our stress, but not for her own safety.  Hey. Whatever it takes.)

3.  Seek concensus. On what points can you agree? Build your strategies from there.  “I know you feel like you take too many medicines.  Let’s look at them together and remember what they are for.”  Review with your Elder the root condition being treated, and why that’s important.  For example, “The blue pill keeps your blood pressure down.  If your blood pressure goes up, it increases your risk for a stroke.  Taking the medication is the most sure way right now to keep your blood pressure controlled and reduce your risk of stroke.  Can we make an appointment together to talk to your doctor about what other things you can do to reduce your blood pressure, and what physical markers would make them feel safe in reducing your dosage or discontinuing the medication?” (Look for more on polypharmacy and seniors in a later post).

Together, make a plan that empowers the Elder to say “yes”.

Physical changes in taste, sight, hearing, smell can also lead to refusals, especially around institutionalized food.  If you have an Elder that is suffering from Failure to Thrive because of lost appetite or missed meals, look for environmental changes that can be made (sometimes using a bright colored plate to make the food more visible makes it more appealing).  Is the food tasteless?  Try adding fresh herbs (avoiding excessive salt), like basil, lemon or garlic to give it some zest and wake up the taste buds.  Do their teeth hurt or are dentures ill-fitting making chewing difficult? Often there is a physical cause underlying refusals that we (or caregivers) don’t take the time to tease out, and make refusals a power struggle instead of a cue about discomfort.

When we are pressed for time, it is easy to discount someone exerting their power and authority through the use of “No” as just being obstinate or difficult.  Seek to find that underlying cause, without judgement or patronizing.  This aged individual has probably forgotten more than you currently know and has seen life through many transitions.  A gentle, understanding and cooperative spirit often gives such an entrenched person a sense of significance and value, and helps bring them around to more positive decision making.  It’s certainly easier on the heart than frustration and annoyance, and lifts the Love vibe to a shining level.

Remember always that this person has seen more, dreamed more, lost more and had to be stronger than you may ever face. Don’t demand. Don’t demean. Offer dignity, respect and the time to really hear what’s on their heart. This gives us all the power to get to “Yes!”.

Blessings to you and your family this day!


Welcome to Holding Hands, a map for the Journey of the Aging Family

My name is Katherine Davis.  I am a nurse, mom, retired midwife and passionate advocate for families.  In my younger years, this meant supporting attachment parenting and assisting families with preparing for the birth of their children.  In my current life, I have taken that philosophy of attachment in the family and applied it to the most fragile members, our Elders, as they transition from independence to interdependence in their aging.  Daily, I hear about the challenges the middle generation (my generation) faces trying to balance parenting their children and being advocates for their parents’ changing needs.
I know this struggle, this dance on a tightrope of needs, having raised my teenagers through the last 6 years of my mother’s life, much of that punctuated with medical visits, hospitalizations, unexpected behaviors, and generally a lack of planning and a lot of “crisis” reactivity.  In retrospect, I can see how I could have set us all up (3 generations) for success, but didn’t have the tools to anticipate the needs of my loved ones.  Now I take that knowledge and wish to share it with you, fellow travelers.


Thank you for taking the time to read my thoughts.  It is my fondest desire that you find support, hope and maybe a pearl or two of wisdom that is of use to you in your own journey with your aging family.
Many blessings,

Katherine Davis, RN, BSN, CCM