How To Cope With Older Parents Who Resist Help Or Advice
Kim Sylvester was worried about her 80-year-old mother, Harriet Burkel, who was becoming increasingly frail and isolated. Sylvester would ask her mother, who also had emphysema and peripheral artery disease if she needed help. Sylvester said her mother would respond, “No, I can do this myself. I don’t need anything. I can handle it.”
One day, Burkel fell in her Raleigh, North Carolina home and fractured her pelvis only days after the death of her 82-year-old husband, who had been living in a memory care facility. With her mother in rehab, Sylvester went to her mother’s home to find out more information and review all the paperwork she could find.
“It was a shambles—completely disorganized, bills everywhere. It was clear things were out of control,” Sylvester told KFF Health News.
Sylvester took steps to help her mother, such as canceling her mother’s two-car warranty insurance policies (since her mother was no longer driving) and ending a year-long contract with a chiropractor for knee injections. When Sylvester’s mother found out what she did, she was furious.
“I was trying to save my mother, but I became someone she couldn’t trust—the enemy,” Sylvester said. “I really messed up.”
Many adult children can relate to Sylvester’s experience of making their aging parents angry for interfering in their lives when they didn’t ask for help.
“It’s hard when you see an older person making poor choices and decisions,” Anne Sansevero told KFF Health News. “But if that person is cognitively intact, you can’t force them to do what you think they should do. They have a right to make choices for themselves. Sansevero is president of the board of directors of the Aging Life Care Association, a national organization of care managers who work with older adults and their families.
Barry Jacobs, a clinical psychologist and family therapist, told KFF Health News about a psychiatrist in his late 70s who resisted help and advice. For example, the psychiatrist had diabetes and he prescribed medicine for himself instead of going to a doctor. He also had several strokes which affected his vision, yet he continued to drive.
“You don’t want to go toe-to-toe with someone like this, because you will lose,” Jacobs said. “They’re almost daring you to tell them what to do so they can show you they won’t follow your advice.”
So, why are some seniors reluctant to ask for help or advice? Dr. Lee A. Lindquist, a geriatrician and chief of the Division of Geriatrics at Northwestern University Feinberg School of Medicine, set out to answer this question. Dr. Lindquist conducted focus groups with nearly 70 residents who were 65 and older and lived in rural, suburban, and urban areas of Fort Wayne, Indiana, and Chicago, Illinois.
The residents provided some reasons why they are resistant to accept help:
- Fear of losing independence.
- They do not want to be a burden to others, even if help is readily available.
- Lack of trust. Whether it’s a family member or a caregiver, seniors were not sure who they could trust.
- Fear of losing control or giving control to others.
Strategies To Use With Older Adults
Rather than throwing up their hands and walking away, healthcare professionals recommend adult children and friends of the elderly learn new communication skills and strategies to counteract the resistance.
For example, Dr. Lindquist recommends reframing the concept of independence and focus on “interdependence” to show how everyone relies on someone else of help. Also, people can show seniors how receiving help is giving a gift to the person providing help.
In the older psychiatrist’s case, Jacobs said he would use “empathy and appeal to his pride as a basis for handling adversity or change.”
“I might say something along the lines of, ‘I know you don’t want to stop driving and that this will be very painful for you. But I know you have faced difficult, painful changes before and you’ll find your way through this.”
This response appeals to the “ideal self” of older adults “rather than treating them as if they don’t have the right to make their own decisions anymore,” Jacobs explained. The psychiatrist had ongoing conflict with his four children, but Jacobs said he eventually stopped driving.
Cheryl Woodson, a retired physician based in the Chicago area, told KFF Health News that her mother was once a “very powerful woman,” but later developed mild cognitive impairment. She would get lost while driving and would buy things she didn’t need, and then give them away. Woodson, however, learned that chastising her mother for doing this was not working.
So, when her mother got upset, Woodson learned to “appeal to her mother’s pride in being the family matriarch.” For example, Woodson would ask something like how to make macaroni and cheese. “And she’d forget what she was worked up about, and we’d just go on from there,” Woodson, author of To Survive Caregiving: A Daughter’s Experience, a Doctor’s Advice, said.
Dr. Leslie Kernisan, a practicing geriatrician and the founder of the Better Health While Aging website and podcast, suggests that adult children who believe that their parent has a cognitive impairment should try to get the parent medically evaluated rather than trying to get the parent to accept more help.
According to Dr. Kernisan, author of When Your Aging Parent Needs Help: A Geriatrician’s Step-by-Step Guide to Memory Loss, Resistance, Safety Worries, and More, it’s important to give parents with mild cognitive impairment or early dementia a chance to express their concerns and feelings and talk about what’s important to them.
“If you frame your suggestions as a way of helping your parent achieve a goal they’ve said was important, they tend to be much more receptive to it,” Dr. Kernisan told KFF Health News.
Sylvester said she attended Dr. Kernisan’s family caregiver group from 2019 and 2021 and found value in the lesson about “therapeutic fibbing,” which is lying to people with dementia or other cognitive impairment if it gives them comfort. For example, Sylvester said her mother developed dementia and went to a nursing home at the end of 2021. She was furious about having to move. So, Sylvester waited two months before visiting.
When Sylvester finally went to visit her mother, she brought a Valentine’s Day wreath. Sylvester said her mother hugged her and said, “I’m so glad to see you,” before pulling away. “But I’m so mad at my other daughter.” Sylvester, who doesn’t have a sister, told her, “I know, Mom. She meant well, but she didn’t handle things properly.”
The mother-daughter relationship improved and Sylvester said she saw her mother often up until her death. “If something was upsetting my mother, I would just go, ‘Interesting,’ or ‘That’s a thought.’ You have to give yourself time to remember this is not the person you used to know and create the person you need to be your parent, who’s changed so much.”