The stubborn streak among the aging: Safety issues abound

There is an underlying general truism to the art and science of eldercare: watch for the stubborn streak and learn how to deal with it, or else…!

In my personal journey of eldercare with my aging parents, it took me way too long to learn this rather simple truism, and it cost all of us dearly.

Generally speaking, our aging loved ones really do know they are aging, regressing on a number of levels at different speeds. And deep inside, they aren’t happy about that; some are even afraid of the consequences and the uncertainties of an unknown future.

Aging and the loss of independence

Essentially, the process of aging inevitably leads to loss of independence and control. It happens in many ways on many fronts. Having to stop driving is a defining moment. Discovering that navigating the stairs is becoming more a chore is another example, as is hearing loss.

The fact is that while aging really is a study in the personal regression of life of any elderly person, it’s something many aging individuals find difficult to accept, let alone cope with.

And as a result, more often than not, they push back the only way they can that still exerts a modicum of control: through stubbornness.  Sometimes that stubbornness has no impact or consequence, but there are times when stubbornness creates problems, tension, confrontation, and in the extreme, issues of safety.

I know I had many needless and senseless confrontations with my aging parents over the course of a decade of steady decline. It took me a long time to really understand what was happening cognitively with them; how their own expectations and fears were driving what they said and what they did.

Putting an aging person in hospital

Now place those aging loved ones in a hospital setting. Suddenly, they are in a foreign environment, and seldom is it by choice. They are in a safe setting, but many don’t believe that because it is not ‘home’. It’s pretty ‘cold’, not that comfortable, with lots of new sounds and sights and feelings to try to absorb and understand.

Plus, they are among many strangers who may be dedicated, knowledgeable, and caring health care professionals, but are busy: focused on fact gathering, assessing, treating, succinctly explaining, and moving on.

Add to all that being around yet other strangers in the form of other patients with whom they are sharing a room, plus the many visitors who come and go.

And then there are the meals, the tests to be taken to and to endure, and all the other aspects of being in a hospital.

Visits to family physicians and the often many specialists who come into play for an older person are as a rule less stressful, yet they too take some level of emotional toll.

So what can we learn from caring for elderly people in their homes? I believe there are four factors that can guide the important considerations to keep in mind.

1.    Time. Everything takes longer, because often the elderly are not as mobile and flexible. They need longer to get out of the wheelchair, to walk across the hall, to drink a glass of water.

2.    Processing. Most older minds take longer to process what is happening or what is being said, and the more complex the activity, the instruction, or the conversation, the more it takes to process and then act on it.

3.    Respect. They all want to be respected. They need to know they are not just another body on what for many seems like the conveyor belt of healthcare.

4.    Fear. There will be an element of fear in more aging patients. Whether caused by the setting, language issues, the nature of illness and treatment, or whatever: most will have anxieties and fears that, while often unexpressed, will cause them to either withdraw or become even more assertive.

Stubborn older patients and health care professionals

Given the dynamics and factors outlined so far, here are three recommended approaches to interacting with older patients:

1.    Slow it down; keep it simple. Everything. The speed of your speaking. Your own movements. What you tell them and how, and give information in smaller chunks with a bit of time to absorb it all. Ensure they hear you properly. As possible, clarify and confirm that they understand what you have told them.

2.    Show respect and caring. Ask their names, ask a couple of questions about their lives. Explain you can imagine how they feel, and you are here to be helpful in the process of making them comfortable and well. Every step of the way, ask if they understand, how they feel, if they have any concerns. If there are cultural, religious, or linguistic challenges, get help and support early on to reduce possible issues later.

3.    Engage the family. With the elderly, it is a good strategy to involve family members and even friends who they trust. Those people can help repeat information, underscore what the health professionals have to say, re-explain any procedures that have to be conducted, and in general be helpful in the overall process of communicating information and offering support.

Each one of these approaches, though, means more time, and time always is at such a premium for healthcare professionals. However, consider that investing a little more time could well save even more time later on, and that those elderly patients likely will feel much better about their experience and you.

Dealing with agitated, stubborn aging patients can be a real challenge for any healthcare professional. By reducing the possible flash points, you can minimize the negative interactions for both those patients and yourself.

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