Looking at hostility with curious eyes

What are the thoughts you can't express?

My “girls” (Ok, they are grown women) brought home a “free horse” recently (Yep. They did. IYKYK). They had met an elder woman and got talking about horses. She described a beautiful mare she had that was languishing in a pasture, and she had neither time, confidence nor energy to work with her. Would the girls like to have her?

It seemed on the up and up and they collected Bess out of the lush pasture she lived in. Her feet recently trimmed, they weren’t alarmed when she was a little stiff loading into the trailer or when unloaded into the large dry lot with her new equine companions.

I found the mare to be gentle and soft eyed, and I fell in love with her, too. That first day, she let me rub all over her and she nuzzled me back in a friendly way. The second day, I was concerned as she hadn’t moved much from where I had left her the night before. She had the expected nicks when horses are getting to know each other, and ours had some evidence of nip-backs. She had hurt a foot in the trailer, and so we moved her to our round pen for ease of doctoring and to protect her from the overzealous new friends. That second day she was not comfortable with my rubbing her, pulled her face away, flinched when I rubbed down her back. A big change overnight. The third day she didn't want to move at all and made a show of her discontent.

She'd stand in the lot, bobbing her head up and down, swaying back and forth on her feet, pinning her ears and jutting her nose towards me to warn me off. The horse who presented sweet, gentle and passive has, in the course of a week, become defensive, protective of her body, reluctant to move her feet. Her posture and behavior tells us she is in pain and she wants to be perceived as a danger to us.

Hundreds of pounds overweight from life in a pasture with no work, her feet and joints hurt, and we know she will feel better as her conditioning improves. Right now she is hostile and unpredictable.

Strange story to relate to aging humans, but bear with me.

A friend was sharing concerns that their 80 year old mother had “changed”. Historically kind and mild mannered, hospitable and welcoming, she is rarely any of those things now. Sharp spoken, quick to anger, withdrawing and not wanting to participate in activities she used to enjoy, her change baffled her family.

Abrupt change in condition in an elder can have many underlying causes and they may not be able to articulate what they are. Such changes warrant a visit to their provider for diagnosis and maybe treatment. While medical conditions like urinary tract infections can cause an abrupt change in behavior or thinking, there are other causes of physical, emotional or spiritual pain. Arthritic joints, muscle cramps, back aches, even clothing or shoes that don’t fit well can cause a constant low-level sense of abrasion. Elders often lose tolerance for stimulation, especially if they don’t hear well. Barking dogs, whining motors, homes with television, music and conversation going simultaneously can irritate the senses and lead to irritability and anxiety. Navigating multiple provider appointments and changing medications or treatment plans can be overwhelming. Disrupted relationships, social isolation or a sense of spiritual angst cause pain and a resulting change in behavior can preclude more serious mood disorders.

Regular visits and communication with our Elder help us to recognize changes early. An intervention as simple as a conversation and can lead to movement away from untreated pain and the behavioral changes it can bring.

 “Mom, you look/sound uncomfortable, like you are having pain.” (This is an observational statement without judgement or pressure to answer, but sufficient pause time may bring forth information.)

“Yes, my back has been hurting for days and I’m not sleeping well at night because of it.”

“Tell me what you are doing to feel or sleep better.”

“Nothing is going to make me feel better. It’s just what happens when you get old.”

“Have you taken anything? Tylenol, ibuprofen or CBD?”

“No, I can’t take anything because of my (insert diagnosis here).

“Have you let your provider know?”

“No. What are they going to do for me?” (This response common, and providers have many modalities for pain and sleep intervention besides drugs. It is always beneficial to keep the provider current on patient conditions.)

“Well, we could find out. Maybe they have some ideas for you. Would you be ok with my making an appointment for you?” (Here we are asking permission to help, instead of insisting, or taking control away from the Elder. Continue to respect their self-knowledge and autonomy.)

“Would you be willing to try something tonight? Can I get you anything now?”

The door to a conversation has been respectfully opened, and hopefully your Elder will feel confident in genuinely sharing what they are experiencing.

Sometimes just unlocking that “stuck” feeling by seeking information can reduce pain and anxiety, which unchecked magnify each other - More pain > more anxiety > more pain. Bess the mare is resistant to moving forward even after she is medicated. She starts out with mincing steps but after a bit, her hips loosen up, and she moves with a little more freedom. Her ears might still pin back, but not with the same ferocity, and she lets us approach her with treats and a rub. We have had to build some trust with her to get to this point (and had to move out of the way of threatening teeth and hind legs!)

If the Elder you love becomes uncharacteristically angry and resistant, consider it a symptom of an underlying cause. Validate their experience and feelings, offer to help them identify what is triggering their response and loosen the grip of anger by leaning into action steps to bring relief.

Wishing you comfort, safety and dignity on this aging journey,

Katherine