An elderly friend of mine had some severe health concerns a few years ago.She admitted to me that she recognized she was in trouble, but she was concerned that if she admitted this to her children, she might end up losing her independence.
She expressed her anger at her situation, because she had always taken good
care of herself. I asked her if she felt
like she was starting down a “slippery slope.” “Yes, very much,” she replied.

How can you tell when your parent or friend needs help? As we age, our physical capabilities, body functioning abilities and mental abilities change. Many people compensate for these changes by developing coping strategies that help them to continue to feel in control. For example, many older people, due to deteriorating eyesight, don’t drive their cars after dusk. However, a parent who shows signs of lessening confidence can indicate that they are starting on a slippery slope. For instance, when your parent is refusing to go to activities she once enjoyed or she isn’t taking care of herself, it may be time for you to get concerned. If your parent seems more confused or forgetful, be attentive to what may be happening.

Sometimes, we see changes happen very quickly. Perhaps the last time you saw your parent, she was managing quite well. This week, you discover she seems quite confused, or she remarks that she got lost going to a place that she has been many times. She may also seem to be having a great deal of difficulty remembering people she has known for a long time. (I remember my father-in-law not recognizing the daughter of an old friend whom he hadn’t seen for a year but whom he had known very well.) If you notice a sudden change, follow up; it may be reversible if treated immediately. A change can be caused by such things as depression, medication interactions, changes in sleep patterns, eating leftover food that has been in the fridge for weeks, or increased isolation after a spouse dies or goes to a long-term-care facility.

Why is your elder reluctant to share health news or information with you? We live in a society that values independence and choice. Just because we are aging doesn’t mean that the value we place on these two things changes. As long as we are mentally competent, we have the right to make our own decisions—whether those decisions are good, bad or indifferent.

Most people are used to having and want to have control of their own lives. Having control makes us feel strong and independent and gives us a sense of mastery that is important to our self-esteem and emotional wellness. Our sense of pride, which comes from caring for ourselves, can diminish severely when we have to turn to others for assistance.

It is a very human response for aging adults to fear both the increased loss of their independence and the interference by their children. We expect this behaviour in teens who believe that they have the answers and who don’t want their parents to interfere. Our aging parent has felt that he has had the answers for many years. Why should he want someone else—especially his younger children—to interfere? Because dad feels as if he is losing control of his own life, he is far more likely to perceive others to be taking control.

Remember, relationships with family members are loaded with biases, emotional history and ways of managing relationships. As a result, it can be difficult for your parent to allow you to help or even let you see that part of him. It can also be very uncomfortable for you as an adult child to experience your parent’s vulnerabilities and to respond as an adult rather than as a child.
Sixty-seven per cent of those making changes believe they’ll be able to stay in their homes 10 years longer because of the changes.
Source: AARP
When should you intervene? Often, when elderly adults start to get into trouble, a family will notice increased trips to the hospital or receive calls about falls that their parent has had. They may also receive phone calls from a neighbour or friend indicating their own concerns. Either of these situations can be the first signs that things are not going well.

A family member needs to intervene when she or he sees a parent acting in a way that is not normal, when a parent doesn’t seem to be coping as usual, or when behaviours don’t fit with the required action.

Getting a parent to open up depends on how fearful she is of the consequences and how able she is to recognize the implications of her behaviour. It is vital to show your parent that you are not there to take away her rights. You simply want to support her to remain in her own home with a good quality of life. It may take several conversations over a long period of time before you and your parent understand that you are both on the same page. It has taken time for your caregiving situation to develop; it will take as long or longer to resolve it.

When should you let a parent live at risk? I believe that every individual lives at risk at times. We all make decisions that other people question or even suggest that we do differently. As long as any individual is competent, we need to allow that person to make her own decisions. We may help by providing our parents with resources such as information or telephone contacts, but we really can’t change what they choose to do with these resources. If we examine the implications of a risk, we may see things differently. For instance, a parent who moves to a long-term care facility may still fall. Living in her own home may mean she is alone when she falls; however, if she has a device such as Life Line on her wrist or around her neck, she can quickly get help. As well, she will continue to enjoy living in her own home with all its memories and familiarity.

If an individual can make his own decisions and chooses to live at risk in the last years of his life, why should you intervene? Whose peace of mind are you really worrying about? Is it yours or is it your elderly parent’s? Why not encourage your parent to use the resources that can support him in his own home. Also, a gift of your time given on a regular basis can both support your parent in his own home and give you the opportunity to assess just how well he is managing.

Betty Macpherson-Veitch, BSW, RSW, is the President of Aging at Home. Visit www.aging-at-home.ca.

As an occupational therapist, I recognize that a cane improves my mom’s mobility. She is able to walk faster and is more stable. My dad thinks that people are more considerate around her when she uses it. Yet we have an ongoing “conversation” about the use of the cane. (“I don’t need to take it. Your father will be with me,” she often says.) This article is a window on our discussions and provides a perspective on why our parents use and abandon assistive technologies.
Assistive devices—canes, walkers, reachers, bath benches, and so on—are usually prescribed for a reason, yet approximately 30 per cent of these devices are completely abandoned and not used by the person who “needs” the device. The Canadian Occupational Therapy Association compiled a list of why people abandon equipment. Many items on that list mirror the conversations my mother and I have had about the need to use her cane.

Self-image. One of the main reasons why people abandon equipment is that it does not fit with their self-image or that it draws unwanted attention to the user. The therapist may perceive the device as something that will improve the client’s independence, while the client sees it as a symbol of disability or growing old. This may be why there are so many options in “decorated canes,” which can be seen more as a “fashion accessory” rather than an assistive device.

Disappointment with the type or extent of the assistance. If the equipment does not do everything a client wants or makes other tasks more difficult, a client is less likely to use the device. The therapist may know that a device will improve a client’s safety or enable him to complete a task independently; however, if a client finds the device awkward or difficult to use, he may opt not to use it, even if this results in an increased dependence on others. For instance, canes may help balance and improve walking, but they can also make shopping for clothes more difficult. One common complaint is where to put the cane when it is not being used. A cane strap or holder that will attach to a table is helpful in some situations. Ultimately, the device needs to be “user-friendly.”

Perceived need. To the therapist or family member, the need for assistive devices, such as a cane, may seem obvious. The family can see that the balance and ability to walk improves; however, the client may not recognize that the device is needed, particularly if he can do the task on his own—even if it is difficult. For example, the client may not notice that his balance is decreasing, and that he is not able to walk as easily or may be at risk of a fall. Ultimately, if the client does not recognize the need for the device, he will not use it.

Fit with the environment. Assistive devices such as wheelchairs, commodes, bath benches, and so on may meet the client’s needs but not fit into the environment. The device may be too big or look too “institutional.” Some devices may be appropriate to use during the summer but are less functional during the winter. For example, a cane may need to be adapted with ice picks to improve its stability on the ice and snow. Ensuring that the device will fit into the client’s environment, and that the client has been shown how to use the device in his own environment may encourage use.

Respecting clients’ opinions. If a client does not feel as though his perspectives have been heard or considered, he’ll be reluctant to accept the therapist’s recommendations. The client may believe that the recommended device does not meet his needs. For some clients, the colour and “look” of the device may be important. If these are not considered, the client will unlikely use the device. For my mom and I, the cane will continue to sit on the floor of the front seat of the car so it is “handy” when my mom sees a need to use it. And we’ll probably continue to have “conversations” about the use of the cane, because as her daughter, I only want what is best.

Linda Norton, BSc OT, OT Reg (Ont), is the Rehabilitation Co-ordinator with Shoppers Home Health Care in Toronto, ON.