Caregiver's Tips on Communications

The central decision in caring for an older person must be acceptance of his/her right to make personal choices. There may be situations where the elder may not be capable of choice making, such as in advanced Alzheimer's disease, but such a situation should not be easily assumed. Hence, the first priority must be to understand the desires of the older person.

First, spend time talking with, and listening to, the elder. It is essential that you communicate respect for the autonomy of the individual. In crisis situations, you may not have much time to understand his/her perspectives, so it will be important that you ensure his/her understanding of the situation and the choices possible by using follow-up questions, and repeating your understanding of what has been said. Encourage your older relative to ask questions and to be assertive. Many times elders get the message from adult children and professionals that acceptance of instructions or advice is the only response desired. Remember that a "difficult" elder may be in much better emotions and mental health than a passive or apathetic elder.

Since many older people have a hearing loss, sit or stand facing the older person so he/she can see your lips and your expression. Shut off the radio, television, or other sources of noise, that could interfere with your conversation. Use short, clear statements, and avoid long explanations. The best distance from which to speak is probably three to six feet, not from the other side of the room. Speak in an even tone at a steady pace. Do not shout in an effort to be understood. Often shouting sends the voice to a higher register, making it even more difficult for the elder to understand.

Anyone in a health care crisis is likely to be nervous and to feel panicky. So it may be important to touch the individual by holding hands or giving a little hug. Remember that active listening includes nods, murmurs of understanding, and other nonverbal responses.

If the person is confound or disoriented, keep the routine as simple as possible and give very brief, one-step instructions. Be prepared to repeat yourself frequently without expressing annoyance, and give sufficient time so that your message can be understood.

Your elder relative may much appreciate your presence during visits to the doctor. Ask if you might go along, or perhaps ask if you can phone the doctor after the visit to discuss findings.

Dealing with Guilt

When people become dependent on others, they may learn to control the behavior of others through manipulation and particularly through the use of guilt. It is important that you assess the abilities of the older person and expect responsible behavior based on those abilities. Allowing yourself to be intimidated or otherwise pushed into doing what your relative wants, will be bad for you and in the long run very unhealthy for the manipulative elder.

Dependent elders may also use one family member against another and may praise one adult child for a very token contribution to care while complaining about the behavior of another who provides a great deal of support.

Visiting an Older Relative

Older people look forward to visits from family and friends. They may also particularly enjoy the chance to leave their house and visit a friend or relative. However, it is important to remember that energy levels may decrease a lot with age. Hence, visits by well-loved children, accompanied by grandchildren, pets, etc. can be an exhausting experience for grandmother and grandfather. This is particularly true if they feel that they must play the host and get food ready, clean the house, and entertain the children. It is better if such visits are planned and discussed beforehand, and kept to a limited time.

When visiting a parent or other older person, be as observant as possible regarding the environment and make sure that basic fittings are secure. You may also want to make some environmental changes to enhance the supportiveness of the home. Discreetly check the medicine cabinet to make sure that all medicines are up to date. On the occasion of such visits, it may be important to touch base with the elder's physician and leave your phone number for emergencies. You may also wish to say hello to a neighbor and perhaps obtain a phone number here as well. Get in touch with the Area Agency on Aging, and obtain a copy of the directory of local services for the elderly.

If your parent is frail and receiving help from a spouse, adult child, or other relative, an offer to take over for a few hours, a day, or longer, may be in order. Respite care can be a blessing. Oftentimes, the primary gets no break from care duties, and your greatest gift to them may be a little time off. If you cannot provide this service personally, you might arrange for respite care from an agency such as the Visiting Nurse Association, Upjohn, Kelly Assisted Living, or some other resource.

Family Meetings

The family is by far the greatest source of care for older adults. However, in many families the burden of care is placed on the shoulders of one person such as the spouse or the nearest child. In order for the family to become an effective care resource for the older person, a family meeting is often recommended. The elder and spouse, all adult children and spouses, grandchildren who are close with the grandparent, and siblings of the elder should be invited to come together to plan the care. One family member should act as meeting coordinator, making sure that all are heard, especially the elderly relative.

A written plan of care can be drawn up, clearly stating what each person can contribute to the care needs of the elder. Remember, no one should volunteer to do what he/she cannot reasonably accomplish, nor should anyone take on a task he/she does not intend to carry out. It will be the role of the convener to assist this process. The plan of care may change over time as the needs of the elder change and as other family obligations change. It is important, therefore, to regard the plan as a short-term arrangement, subject to review in six months or less. Family members should agree on a date for review of the family plan, so that no one need feel permanently trapped in a particular arrangement.

If your older relative is living with you, or such a decision seems best, make sure that he/she has privacy and autonomy. Make any re-organizations necessary before your older relative arrives, and involve your relative in arrangements for their space, for redecoration, and in the placement of any pieces of furniture or personal articles that may be brought from the old residence. At this time, many adjustments are required of everyone in the household. Candid and courteous family discussion can help everyone to adjust successfully. Remember that the elderly person is making the greatest change, which usually involves loss of many lifetime aspirations, prized possessions, and loss of contact with friends. Be prepared for grief and perhaps depression, and provide tolerance and gentle understanding. Teenagers may need to be briefed on the emotional trauma of such a move, and often understanding can lead to very supportive relationships.

Friends

Surveys show that many women are more likely to confide in a close friend than in a spouse. Friendship is important throughout life, and it can be especially important in later years when the "busy," schedule of work is no longer there. Most friendships are between persons of the same general age group, so there is a high likelihood that close friends will die or lose their ability to visit just when they are needed the most. However, intergenerational friendships are possible through shared interests such as church, sports, hobbies, and neighborhood activities. Also, new friendships can be developed through senior centers, group travel, elder hostel, and other programs.

Seniors particularly enjoy contact with young children; tutoring programs through the local school are one example of successful intergenerational sharing. Today, there are hundreds of "intergenerational care centers" where young children and elders can share a sheltered environment and planned social activities. Apart from the intimacy that friends can share, they can also be helpful in getting depressed or withdrawn elders to move back into contact with others.

After a fall or dizzy spell, it is only natural that elders avoid going out in public. Many shrink their social environment dramatically after such occurrences. You may need to invite your older relative to separately engage in social activities outside the home. Gain the assistance of old friends of the elder. When they issue invitations, they may get through in a very powerful way to someone who is afraid to go out. It may take some time to get to know your parent's circle of friends, but it is time well spent, and a friend of the elder can be your greatest support, and source of respite, as you cope with caring.

Source

Source: U.S. Department of Defense (DoD). (n.d.). Tips on communications. In Caregiver's guide. Retrieved June 23, 2008, from http://dde.carlisle.army.mil

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