Client Education

Care Giving and Caregivers

Understanding the Pleasures and Pains of Growing Older

By: Vivian Fransen, Special to AccentCare

"How are you feeling today?"

That's a question most caregivers ask their loved ones every day. While the responses we hear can range from "terrible" to "terrific," the most common answers seem to be the person's immediate assessment of their physical health: "I'm feeling better now" or "I'm a bit under the weather today" or "About the same."

Understanding the emotions of loved ones as they age, however, may take further probing below the surface. It requires moving beyond the checklist of physical ailments to find out the emotional state of a person on a given day or a specific moment. Developing a better understanding of what an aging parent is going through emotionally can have a tremendous effect on the many ways you care for your loved one. And keeping in touch with your own roller coaster of feelings when your parent becomes more dependent on you is one key to managing your own life.

Mixed Emotions Are Normal

For some people, life in the later years is a time of enjoyment, contentment and creativity. For others, age means poverty, sickness and loneliness. When active men and women at any age find themselves undergoing mental and physical changes, you can expect that a wide range of emotions may surface, including:

• Shock (especially when a person experiences a sudden physical or mental decline)
• Denial (which is more likely to occur when a person has a slow, downward slide)
• Anger
• Shame
• Fear
• Resentment
• Sadness

Note: These emotions apply to caregivers and care recipients alike.

Life's Losses

For many people, life seems to become a series of losses:

• The loss of friends and family members
• The death of a spouse
• The loss of work and workplace identity
• The loss of financial security
• The loss of good health and mobility
• Eventually the loss of one's own home.

The bottom line: These circumstances seem to snowball over time and can diminish a person's sense of control about life. Whenever people feel less in control, they are likely to feel increased anxiety or self-resignation that can spiral into feelings of depression and decreased self-worth.

"In addition to the infirmities and frailties brought on by old age, some people may also develop unpleasant personality traits that are hard for (those around them) to take," write Barbara Silverstone and Helen Kandel Hyman, co-authors of "You and Your Aging Parent: A Family Guide to Emotional, Physical, & Financial Problems" (Pantheon).

Not only do older people find themselves surrounded by loss and newfound fears that accompany loss, but their loved ones are also dealing with their own set of feelings. For some adults, it becomes unbearable to witness their parent's decline in health and functioning. In fact, many children find it difficult to visit, phone, write and sometimes keep in touch at all for a variety of reasons, including their own denial or discomfort with seeing their parent become more needy or embarrassment about their parent's behavior.

Identifying which feelings are the strongest at any time can help people work through the feelings they are experiencing. Anxiety, depression, fear, anger and guilt can sometimes be anticipated as normal emotions as people grow older. Such feelings can translate into mistrustful behavior, stubbornness and avoidance of change, worship of independence, overdoing it, and ritualistic behavior (which helps reinforce one's sense of security).

The Good News About Growing Older

However, it's not all doom and gloom for everyone. Studies show that the bright side of growing older includes the following findings:

• While memory may decline with age, judgment often significantly improves
• Cancer grows less rapidly in elderly bodies
• Cataract surgery followed by lens replacement can restore and prolong sight for thousands of people
• Some symptoms that are often mistaken for senility -- such as confusion, disorientation, stupor, delirium or hallucination -- may result from any one of a number of causes: malnutrition, anemia, congestive heart failure, medications or infection, among others.

"Your parent's ability to adapt to loss is perhaps the key that determines whether they experience a satisfying old age, an unhappy one, or a totally dependent one," Silverstone and Hyman say in their book. "If people have developed the capacity to deal successfully with change and difficulty at earlier stages of life, they will more easily face the insults and injuries of old age."

Dementia Makes Communication Even Harder

Understanding that dementia often makes difficult life circumstances even more challenging for caregivers is one of the first steps in making the necessary adjustments that will benefit everyone involved. We all know that little can be more painful than discovering that a parent no longer understands us, or even recognizes us.

By definition, dementia includes:

• The gradual loss of memory
• Usually the loss of problem-solving ability and abstract thinking
• Disorientation in time and space
• Personality changes
• Difficulty in communicating, word-finding and learning
• Decreased attention span
• Impaired judgment

Depression, paranoia and agitation are all part of the disease process. As a caregiver, taking care of yourself does come first. When the challenges of daily living seem to multiply over time, you can expect to feel overwhelmed by it all. That's when you need to take a time-out to reach out for help and give yourself a break.

See "CAREGIVING: IT CAN BE HAZARDOUS TO YOUR HEALTH"

Tips on Communicating Feelings

Helping a person identify and express their emotions can be hard work. Many people try to avoid feelings that may cause them discomfort, and so they would rather discuss the details of blood pressure readings and bowel functions than talk about their feelings. For them, it may seem much safer ground to simply discuss physical symptoms.

Be realistic. Some people are in touch with their feelings at all times and freely communicate their feelings as a way of life. However, most of us have been taught to keep our feelings to ourselves. It may take some effort and lots of practice to increase our awareness of our feelings, as well as patience and persistence to help our loved ones express their feelings.

For example, if your parents plead with you to quit your job and stay home to care for them, you need to honestly state your feelings. It's OK to respond: "I know things are hard for you now, but your idea just won't work. Let's try to figure out a different way that's better for all of us."

Know your limits. Feelings are often complex. That's why it takes many years of formal studies and clinical experience for skilled therapists to help people deal with the personal terrors and tragedies of their lives. Whenever your loved one expresses feelings that you feel unequipped to address, do not hesitate to say so. Communicate specific concerns to your family physician and other health-care professionals who can suggest ways to address unresolved emotional issues.

Example: One caregiver's father might say, "I wish everyone would leave me alone and just let me die in peace." While such a statement may prompt a stranger to assume this is a plea for the termination of life support, the translation for those who know this person may be: "I am annoyed with all the fuss being made over me." Any self-destructive behavior demands serious attention. Self-destructive statements require further discussion to determine what is really going on.

Explore the feelings behind the words. Sometimes the best way to deal with a person's distorted reality is to sidestep what is said and pick up on the feelings behind the words.

For example, your loved one may insist, "The delivery person pounded on my door and was mean to me." Instead of responding, "That's nonsense," try taking a deep breath and saying, "You're frightened, aren't you?"

Now See What Happens

Try these tips and see the difference it can make in your understanding of your own feelings and those of your loved one.

First ask, "How are you feeling today?" Then take the next step and follow up on the response. For example, "You say you're feeling about the same today. Tell me, how are your spirits?"

You may even want to make a note of how your feelings and those of others change over time. Setting an example by communicating your own feelings to your loved one may help open the door to a better appreciation of how our emotions affect our health.

Vivian E. Fransen is a communications specialist working with health-care organizations and educational institutions and writing for New Jersey-based newspapers and magazines.