Podcast

Episode 49 - How To Deal With Difficult Aging Parents

Diane Carbo

01 Oct 2024 — 22 min read

Welcome. Today's topic is on how to deal with difficult aging parents. It can be difficult dealing with elderly parents that struggle with making the best decisions for this situation. Especially if they refuse assistance or advice but it is possible to communicate with your aging parents effectively. As a primary caregiver, it is possible to help them take charge of ensuring healthy choices are made while still allowing autonomy and independence. Start by not falling into power struggles.

Pick your battles wisely when expressing your opinions. You are still their child, and adult children are often dismissed and discounted by aging parents. Family caregivers must learn to be persistent but sensitive. Not an easy thing to do. I'll tell you that right now.

Criticizing your elderly parents might put them on the defensive and encourage negative emotions and not allow you to provide assistance for them in the future. So how do you help your caregiving.

Dealing with elderly parents can be a very tricky situation, especially if they're prone to verbally or emotionally abusive behavior. Yelling, lying, accusing, and calling insulting names are some of the common forms of abuse experienced by caregivers from their parents. There are also more subtle tactics like manipulation and gaslighting that make caregiving even harder on those involved.

These are tactics that your aging parents may be using to feel in control at a time when their bodies and even their minds may be failing them. So take some deep breaths and acknowledge that you may not ever change your family dynamics. Accepting this will allow setting boundaries to preserve your own mental health and even your own physical health and well being.

Family caregivers find it difficult to set boundaries and have limits with an elderly parent or even with other family members. So is it normal to resent caring for elderly parents? Boy, do I get asked that question a lot. Caring for an elderly parent who exhibits abusive behavior can be a difficult journey.

How it's downright brutal. However, by understanding the root cause of their anger and anxiety, finding ways to practice self care for yourself and utilizing techniques like deep breathing that can help maintain calmness during tense moments, it is possible to establish positive relationships with parents while avoiding unhealthy ones from forming between yourself and other family members.

Don't let anyone take away your resolve in taking care of both you and those around you. Navigating the challenging situation of helping aging parents who refuse help can feel overwhelming and confusing, especially with 77% of adult children reporting their elderly parent is stubborn when it comes to taking advice or getting assistance.

I'm sorry, I shouldn't laugh, but you know what? I'm surprised it's as low as 77%. I come across this with my family caregivers every single day. Let me tell you something, older adults hate change. It's important to take a step back and consider why they may be resisting support. Is it out of habit? Or is there an underlying mental health issue like anxiety or fear that needs addressing?

Are they scared about losing independence? Or are they confused due to dementia related symptoms? Compassionately address these feelings around maintaining independence as well as facing reality in terms of age then decide which battles you really want or need your elderly parents or anyone accepting care on.

Safety should always come first, but don't overwhelm them trying too hard at once. The last little bit of a wisdom, accept what cannot be changed and understand everyone has the right to make decisions, even bad ones. Then prepare to manage by crisis because that will happen and it is only a matter of time.

And you'll find on my website, Caregiver Relief, an article, a lot of information on management by crisis. Because I have a lot of caregivers that end up doing that. How to deal with elderly parents as they go through the aging process. Are you dealing with an aging loved one that is angry, hostile, and has verbal outbursts?

Dealing with aging parents can be incredibly challenging. As they age, their behavior may become more hostile or angry, which makes conversations difficult. And often puts family members in a defensive position. I am sure you feel this is emotional abuse and you would be correct in that assumption. It is important to try not to take it personally.

And remember that the source of this aggression could stem from various factors associated with aging. Such as feeling overwhelmed by life's changes. Or seeking control when there isn't any left to have. Some older adults may experience personality changes, have difficulty with performing daily tasks and maybe experiencing mild cognitive impairment.

If you have not taken the Elder Care Communication course on caregiver relief, I suggest you look into that course. We help you learn how to listen and to talk to your loved one. Communicating in a kind, compassionate way can make a big difference and help you to plan ahead for your parent's future care needs.

So let's talk about one caregiver's experience. As a primary caregiver, try responding with empathy rather than attacking back. I had a family caregiver, Linda, that lived 40 minutes from her parents. Her dad had been diagnosed with Alzheimer's disease. Her mother had a bad back and lives with chronic pain.

Linda's mom, like many older adults, has a troubled relationship with her four daughters. All four daughters have families with young children, and all four daughters have full time employment obligations. Linda was the oldest daughter, and was the designated healthcare proxy for her father. Her mother insists that Linda go to every doctor's appointment, and expects all four daughters to provide support for her and their father.

The problem is, Linda's mother has been non compliant with any recommendations that the doctors made. Linda's mother dismissed everything the doctor recommended. Her behavior became a source of contention with the daughters. Linda's mother was recently ordered in home care for physical therapy.

Of course, she refused in home care, she's refusing outside help of any kind. Instead, Linda's mother insists that her husband's cognitive decline is not affecting his driving abilities and that he should be able to take her to her appointments. Linda's mother became very irrational and she began having inappropriate behavior that caused Linda fear and guilt.

Interacting with her mother became very challenging. Linda's mother refused to talk to her. She became angry and refused to talk to any member of the family that she perceived was not on her side and supported her thoughts on her husband's memory loss. Time for a family meeting. Linda decided to call a family meeting and discuss how to maintain the quality of life of her parents.

At the family meeting, it was discussed that Linda's mom, like many seniors, wants to make her own decisions. The family discussed about how much each should visit and help with daily tasks. One sister discussed the parents moving in with Linda. And I explained to the family that a demanding parent will not become less demanding just because you have given in on a particular issue.

And that's an important fact to remember. Let me say it again, a demanding parent will not become less demanding just because you have been given in on a particular issue. Each family member had to discuss what they will and will not do when providing care and support to ensure a quality of life for their parents.

When it comes to assisting elderly parents who refuse help, remember this, above all, the goal is to help your parents receive the best care possible.

Above all, the goal is to help your parents receive the best possible care.

This list was created and each family member decided they would each pitch in funds to help pay for outside help to transport their parents to doctors because the doctor's hours are during their work time. And they also decided that they would help provide care to Linda's dad as his needs will increase.

They wanted to help support paying for outside care to come into the home. There was a discussion that in the future, the dad may need to be placed in an assisted living facility, in a memory care unit. The youngest daughter was assigned to explore the assisted living facilities in the area and come back with her findings at the next family meeting.

The family members decided they think having their dad placed in the facility they choose for respite care to get a real feel for the facility and their caregivers. Of course, Linda's mom refused the help that was offered. This is a time when you need to set boundaries and set limits on what is expected of you.

Do the things you are willing to do and draw the line over the things you won't do. Don't argue. Don't fight. Just stick to your decision, and it's challenging I know. Remember, family caregivers experience tremendous amount of guilt on an ongoing basis. Caregiving is the most guilt producing role you will ever take.

Get rid of it. It's a negative emotion that negates all the good you do in your life. Know when to seek outside help. There are times when aging parents are uncooperative and cause the family caregivers feelings of guilt. Oh, yeah. Linda decided to hire a geriatric care manager to support her through her caregiving journey.

Linda's relationship with her mom still caused Linda anxiety and frustration. The care manager took a lot of stress off Linda as she was able to continue to work and be employed. Because of the animosity and the verbal abuse of her mother, Linda decided to give the POA of her father's health care over to another sister.

As hard as it is to accept, any care recipient has the right to make their own decisions and have a say on their own lives. Even if those choices and decisions are not the right choices for them. And Linda was having a hard time accepting. Her mom couldn't see that she needed help and support. So why are your aging parents making risky decisions?

Because aging can be scary. Seniors often fear the unknown, including the loss of independence and the potential long term effects of serious medical conditions. This fear may be why many seniors are resistant to seeking help and are sometimes even secretive about any new symptoms they experience.

There are a lot of factors at play when your parents make the decisions they do. Often, the way you approach them when giving your opinion can make a world of difference. Pay attention. I'm going to repeat that. The way you approach your parents when giving your opinion can make a world of difference.

The following tips can help you manage conflict as you navigate what to do with your aging parents in a way that is supportive rather than pushy. That's always been a hard one for me because I just want to be pushy. I'm the oldest sister I'm the bossy sister they tell me. And I had to learn how to bite my tongue and support my dad as he was going through his pancreatic cancer.

Behaviors such as anger, stubbornness, and lack of insight may turn into pattern of abusive behaviors. Those behaviors do occur in older adults at times. These behaviors may stem from the mental health issue that your loved one has had lived with for years, or it may be due to personality changes due to a type of dementia.

You got to learn, don't take abuse personally. In this case, if you've had a person who's had lifelong issues, you may already have some coping skills that can help you navigate the situation. However, if abusive behavior is new, this can indicate a change in mental health or cognitive abilities. As difficult as it is, you should never take any attacks personally.

I know that's hard, but you've got to learn to take a deep breath in and just slowly let it out. To get yourself centered, give yourself time to calm down. If the abusive behavior is new, consider the possibility that your loved one has a urinary tract infection. It is the first thing a family caregiver should consider when they see unusual behaviors.

Infections in the elderly do not always have symptoms we may see when we're younger. They may not have a fever or even pain. Caregivers can get a urine sample and have it tested. I recently had a client call me and tell me the assisted living facility his mom was in was threatening to kick her out of the facility because of her challenging behaviors.

First, this man had his mother in a very upscale assisted living. He was paying over 7, 000 a month for her to be in memory care. Because she had dementia, she was on a memory care unit. So he was upset because he felt panicked there was not going to be a place to put her in. I asked him if they tested her for a urinary tract infection.

He said he didn't think so. The caregivers at the facility did not think to check on that. I recommended that he take her to the emergency and ask her to be tested for a UTI. Now I want you to know, I don't normally recommend going to the ER to be tested for a urinary tract infection. But the facility was demanding that she be removed.

So I suggested the ER because her challenging behaviors were not due to an infection, then I suggested that she should be admitted to a senior behavioral health unit to see if her dementia had advanced. Then she would have medication management to help her with her challenging behaviors.

As it turns out, his mother had to be admitted to the hospital for IV antibiotic therapy. Her UTI, or urinary tract infection, was so bad, oral antibiotics would not be effective. Of course, if you have a loved one in assisted living, be aware. You still must monitor the care of your parent. Don't think that those that work in those facilities have any kind of medical knowledge or experience taking care of the elderly.

Because the majority of them don't. Keeping the lines of communication open. So let's get back to communicating with an aging parent you are providing caregiving for to help them age in place. Try explaining how their behavior makes you feel. I know they're not gonna listen. I know you're rolling.

Your eyes going, oh, is she crazy? They're not gonna care. You're right. They might not, but you need to let them know how their behavior makes you feel sad. It makes you feel frustrated. Remember, you can also leave the situation as long as your loved one is safe before you go. The difficult issue that many adult children face is the constant battle of the child parent relationship.

It is hard not to fall back into that child role. Many older adults, especially the women, have provided care to a loved one. Many that have been caregivers before believe they are entitled to the same level of attention and care they provided their aging parents.

When the aging parent feels as if their family members should be giving up their life, their career, and taking care of them. You have a problem, and this is a problem that's rampant through the country. Anxiety and fear starts to creep into the aging parent's behavior. Unrealistic expectations of the elderly parent is the cause of many untoward behaviors, accept you cannot control everything. No matter your very best efforts, it's important to understand, you cannot control everything when it comes to dealing with stubborn aging parents, persistence and patience are key. Don't expect to resolve everything in one go. It may take several conversations to get through. Also, try not to overwhelm your parent with too much information at once, especially if they have cognitive impairment.

Remember to avoid power struggles and respect their opinion. By empowering them to be part of the decision making process, you'll build a stronger relationship free of yelling and disputes. So here's some communication tips. Here are some tips for talking to your parents about their well being. Be sensitive as criticism and judgment can make them defensive.

Instead, use I statements like I'm feeling concerned to express your thoughts. Timing is key. Don't pick a day when everybody else is already stressed out. Choose a day when your parents are relaxed and open to having discussions. Stay calm, even if your parents are resistant to acknowledging the challenges they face.

Speak with love and tenderness to reassure them that everything will be okay. Taking care of stubborn aging parents can be a challenge, especially if you're feeling frightened, helpless, and frustrated. The emotional abuse is negatively impacting on your health. If that's the case, it's important, and I always recommend this no matter what, it's important to take care of yourself, too.

Join a meditation group, visit a counselor, or find a support group, ask for help from a caregiver coach or a care manager. It is important to know for every problem there is a solution. There is a solution that will be right for everyone. You just need to take time to find that solution for you and your parents.

As you continue to support your parents, spend some extra time with them if you can or if the relationship isn't a source of conflict, which is challenging for some of you that have a narcissistic parent. Asking open ended questions and proposing solutions will help your interactions become more harmonious.

Together, you can address your parents concerns and cultivate trust to support each other. Again, Caregiver Relief has an Elder Care Communications course which addresses many different topics and offers tips and strategies to use when you talk with your aging parents. Again, for every problem, there is a solution.

To make your solution irresistible, focus on the benefits. For example, with assisted living, your loved one won't just get the care they need, they'll enjoy a range of social and recreational activities. I recommend that family caregivers not try to tackle caregiving all on your own. Keep your siblings in the loop.

Call for a family meeting or encourage them to speak with your parents. Get everyone on the same page and striving for the same goal. In the elder care communication course, I have a section on how to run a family meeting. I recommend taking a team approach to caregiving. Yep, a team approach to caregiving.

Support your parents by enlisting the help of friends or neighbors. Oftentimes it's easier to accept hard truths from somebody outside the family circle. If you're still not getting through, try to reach out to your parents doctors. In the end, they may be the one person your parent listens to the most.

Now, I want to say here that if you have not had a HIPAA form signed that allows your family member's doctor to release information to you, you have to not talk about the conditions, but you can talk to the doctor about your concerns and ask him to try to support you in some way.

Sometimes it can be tricky convincing our aging loved ones to modify their behaviors, even when it's for their safety. It's important to approach them calmly and remind them that their decisions can affect more than just themselves. Try to be understanding and listen to their concerns, even if they're hesitant to open up.

At the end of the day, if your parent is unwilling to change, it's important to respect their wishes and honor their independence. It's tough when our parents resist making key decisions about their living arrangements or driving habits. If you've tried gentle persuasion to no avail, it may be time to have a heart to heart.

Here are some things to keep in mind. It's helpful to remind them that their choices affect not just the family, but others as well. No need to talk down to them like they're kids.

Just be gracious and honest about your concerns. A few gentle reminders that their independence shouldn't come at the cost to others may help. Parents are adults and we cannot force them to change. As a family caregiver, we have to realize that our parents are adults and we can't force them to change.

Still, it's worth the effort to express ourselves respectfully. And let them know how we feel. Lastly, it's important to listen to their perspective too. Their stubbornness may be coming from a place of fear or worry. Perhaps they're anxious about making friends in a new place, or they're scared to hear what their doctor may say about their condition.

Whatever the case may be, we must try to understand where they're coming from. Through empathy and compassion, we can have a better chance of helping them make the right decision. Now let's talk about some specific examples you may be dealing with. Refusing personal care. Does your loved one stubbornly refuse to shower or bathe?

Personal care is often a sticking point for older adults, especially those with Alzheimer's or dementia. There may be multiple reasons for this, such as vulnerability or fear of falling in the shower, poor eyesight or cognitive decline.

Modesty can also play a part, and there are many easy ways to maintain privacy. You can also try using like waterless shampoo and soap to keep your loved one feeling fresh. Finally, if a loved one refuses care, it can be difficult and even heartbreaking. Remember, they may be feeling embarrassed or afraid of being a burden.

For whatever reason, there are several things you can do to work with elderly parents. The first thing you have to consider is changing your view. Yep, changing your view, your perspective on bathing and dressing. Aging skin does not need bathing every day. The aging skin is often dry and it needs moisture.

Moisturizing soap dries it out. Instead, use the times when they use the bathroom to toilet, to wash the intimate parts of the body, you have to do things in bits and pieces sometimes it's a compromise, but it can work. Take time to use warm washcloths that are scented with lavender to calm them or lemon scented to awaken them as they, and use it on their face and hands before they eat and before bed. Create a foot bath and while they are sitting and watching TV, allow them to soak their feet in warm, wonderful, soapy water, and if possible, do nail care.

If you have home visiting podiatrists in the area, ask them to visit to provide the foot care, nail care. I also am going to recommend that soaking the hands in soapy water is also comforting and nice for them, and it's a great way to get them started on a good day to doing nail care, because nail care can be so challenging.

Again, you have to choose your battles and you have to make the decisions that are right for the moment. Do you have a senior with inappropriate language? Another common issue with seniors is using inappropriate language or making offensive remarks.

And I can tell you, I've heard some pretty hair, they burn your scalp, like they burn your ears when they say the things and they cause so many embarrassing moments. It's painful sometimes. I get it. I've seen it, in my decades of nursing, while cognitive decline is often the culprit, it can still be challenging for caregivers to deal with.

And like I said before, I've heard comments from seniors that would make your hair curl. If your loved one starts using offensive language or making inappropriate or improper comments, don't panic. Ignoring the behavior is sometimes the best answer, or you might try calmly calling it out and expressing your dislike of the language.

But remember, Dementia can make it difficult for someone to remember instructions or even consequences. I recommend to my family caregivers to get business cards made and put on it. Please excuse my dad's behavior or my mom's behavior. He has dementia and is unable to control what he is saying.

It works. Family caregivers, when they go out, they are at a restaurant or whatever, they give that card to the waitress or they give that card to a passerby that dad may or mom had made a rude remark to so that people understand and, as long as people understand they're kind and they don't take offense to something.

A terrible comment. So do you have a family member with delusions and paranoia? When a loved one starts experiencing delusions or paranoia, it can be startling experience. What could be causing this behavior? Medication side effects dementia and infections like urinary tract infections or pneumonia can all lead to these behaviors.

The key is to work with your loved one's medical team to pinpoint the underlying cause so you can make informed decisions about treatment. Oh, hoarding. Now let's talk about hoarding. Hoarding may not always look like the dramatic cases you've seen on TV, but even small scale clutter can pose a hazard. It's important to understand that hoarding can stem from a need for control, a desire to save memories, anxiety, or cognitive decline. If your loved one hoards food, It's important to check the fridge and cabinets for sanitation issues.

For those with dementia, creating a rummage drawer can help curb the urge to hoard. I want to tell you, I have had several experiences in my career of nursing where I have gone into a one was in a very upscale assisted living. I was the director of nursing and I was new, so I was visiting all the rooms in this 350 room bed facility, and I walked into a room that had clutter from top to ceiling, and I couldn't believe it. It was such a safety hazard, and we had to instruct the family to get rid of this stuff. And I will tell you, I have personally known family members move out of a house, take their family member that hoards out of their home, put them in a new home and get rid of everything and clean it.

People spend hundreds of thousands of dollars getting rid of stuff and then only to find their caregiver or their family member is going to continue to hoard. I recently had a situation where I was doing an evaluation for a veteran for him to him and his wife are both veterans to have paid for care in the home, they wanted an evaluation. So I went into the home and I was shocked because the hoarding was just like you see on TV. It was horrendous. I couldn't even find a place to sit. They had two dogs. They had this lady who they've known for years, move in with them.

And I don't know how she lived in that situation. But my first question to them was, which one was the hoarder? And that didn't go over very well. They kept saying to me, no, we're just moving. We're just, no, there's no reason. They that, all that stuff was there. In fact, they asked me when I did the evaluation not to mention the clutter and the living situation, and I had to, and it's really hard because I'm a caregiver and I want to take care of everybody, I had to walk away and say, I, can't write this evaluation for you because I have to be honest and she would have to approve what I'd written to give to them give to the VA and I said I'm not the person to do that because it's morally and ethically wrong not to be truthful about your living situation, which was unhealthy and unsafe.

It's very frustrating. Courting is very challenging. Do you have a parent who's spending too much? Or are experiencing extreme frugality? Are you worried about your older loved one's spending habits? Many seniors are on a fixed income and living frugally can be a smart move. However, extreme frugality can often lead to dangerous behaviors, like refusing to turn on the air conditioning or skipping medications.

And I can tell you, Seniors don't feel the heat the way a young person does, and that's why many of them are sick and get the severely dehydrated, which leads to confusion. Some have been found dead in their homes because they didn't turn on the air or skipping medications. This has been happening for decades.

Seniors have hit their donut hole in their Medicare prescription coverage, which I find is disgusting and from October to January 1st when they start their new coverage, many seniors have to choose between eating, paying rent or mortgage or insurance or taxes and taking their medications and these sometimes are life giving medications and they skip them or they change the dosage because they're trying to get through that period when they can't afford it.

It's a situation you really have to be aware of why they're skipping medications or why they're doing what they do. On the other hand, overspending is equally possible and can drain finances. I'll tell you, I have had many people call me caregivers over the years, tell me, their family members watching the home shopping network or whatever.

Or they call and donate to several charities that want money all the time and it's overwhelming them. Many of them buy things online and then when they get it, they just put it in a room and don't even use it. So I understand that there are things you really have to be concerned about.

Luckily, there are several solutions. If you suspect that your loved one is making poor financial decisions due to dementia or other mental health condition, don't hesitate to consult with their physician or other experts. Are you a family caregiver dealing with an aging parent's spending habits?

It's a common issue that can leave you pulling your hair out. Some seniors overspend, while others refuse to spend it all on essential things like medication or long term care. Talking about money can be a tough topic, but ignoring the issue won't make it go away. It's directly connected to your loved one's ability to remain independent.

Plus, mismanaging finances can be an early sign of dementia. Don't wait until it's too late to address this. In my elder care communication course, I have several lessons and one of them is on financing, talking about finances. If your loved one insists everything is fine, even when it's not, don't get discouraged.

There are options. For overspenders, try presenting the total amount they've spent on shopping sprees. Seeing the impact in black and white can be a wake up call for some, and I'm going to tell you not if they have dementia. They're just not going to see it. For hoarders, it might be more about ingrained beliefs from the Green Depression, but showing them the out of pocket expenses you're paying for their care can help them see the bigger picture.

There are times when you must take some unpleasant actions. If you have or are a POA over finances, you may want to lower the credit card limit or cut up as many credit cards as you can if they are overspending. You can block incoming calls from charities that solicit money. Or if you have a family member that buys stuff on TV like the shopping networks, you may want to call them and tell them the situation and close their accounts.

This must be done by letter and accompanied by a copy of your POA letters.

You can also block outgoing calls to certain numbers too. You want what's best for your aging parents. It's tough to navigate, but bringing a third party advisor or spiritual leader or an old friend can help. If you haven't already considered setting up a Durable Power of Attorney for Finances document to prepare for the future, do it now.

This is brought to you by Caregiver Relief. I'm Diane Carbo.