How to Have Hard Conversations with Seniors

Follow these 5 tips when tough decisions have to be made about the  health, safety, or well-being of an older loved one.

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How to Have Hard Conversations with Seniors

Are you worried about a conversation you need to have with an older relative? The conversations may cover many issues, but they are all daunting. Maybe Mom hasn’t been taking her medications. Perhaps Dad has been advised to stop driving. The stairs at home might be getting too much for Grandpa. Grandma might have recently received a life-changing medical diagnosis. Decisions need to be made, and Mom, Dad, Grandma, and Grandpa might not be ready to make them.

Every adult child dreads these conversations. But they can be healthy, solution-oriented, and empowering for all involved if approached with respect and patience, according to David Solie, a Calabasas, California-based clinician and author of “How to Say It to Seniors: Closing the Communication Gap with Our Elders” (Prentice Hall Press, 2004). 

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Choose the Right Time, Place, and Posture
Avoid stressful, noisy places for difficult conversations, Solie advises. Regardless of where your conversation takes place, your body language matters immensely. If you are sitting, relax your body and maintain friendly eye contact. Keep your hands folded in your lap; crossing your arms can indicate a lack of openness. Breathe deeply to slow the pace of your conversation and relax your mind and body.

Don’t: Sit stiffly face-to-face, arms crossed, staring at the person.

Do: Consider walking together or driving in a car rather than sitting face-to-face. In a car or on a stroll, being side-by-side “might make the older adult more comfortable testing out a new idea, or thoughts about making some changes,” Solie says.

Be Ready to Listen
Seniors want to speak and, more importantly, be heard, says Solie. Storytelling can be a powerful way for seniors to remember ways other family members handled similar life moments, and those recollections can inform their own decisions. Stories can also connect seniors to a time before their present concerns were a reality, which can lower their overall stress and open their thinking.

Don’t: Shut down storytelling because you feel it won’t get you to a decisive moment.

Do: Ask open-ended questions that invite the older adult to think back on people and experiences that are germane to the topic you’re discussing. For example, ask, “How do you remember Grandma reacting to her transition to using a walker?”

Choose Your Words Carefully
The words you choose can determine whether your aging parent feels empowered and invested in a difficult conversation, or feels marginalized and tempted to shut down. Solie lists “linguistic land mines” like infantilizing elders, offering unsolicited advice, asking rhetorical questions (with implied right answers), and entrapping seniors by pressing them to agree to vague truths that can be used later to push for a particular outcome. Instead, ask open-ended questions, listen to whatever answers come, and respond with concrete options parents have in both the short and long term. 

Don’t: Use overly simplistic language, give ultimatums or unrequested direction, or use verbal tricks to later “prove” the person was open to your idea.

Do: Use the language of choice, focusing on the options the senior has, and ask open-ended questions that invite collaboration and honesty. If, for example, a parent is resistant to giving up driving, you could say something like, “I realize how important driving is to you and your sense of independence. Despite what the doctor told you, you still continue to drive. While that choice gives you short-term control over driving, it unfortunately sets you up to lose a major part of your independence in the event of an accident. What is your plan from here?”

Manage Your Own Feelings
Grown children naturally experience a range of emotions about the decisions their parents are facing, Solie says—worry, anxiety, and frustration are common. While these feelings are valid and important for adult children to explore, it’s not helpful to put emotional pressure on elderly parents. Solie urges grown children to be realistic about how much control they actually have. “We love somebody and get a distorted point of view about how we can keep them safe. It’s done with a kind heart, but there’s only so much we can do—and we have to have some peace with that.”

Don’t: Use emotionally-loaded statements like, “I can’t sleep at night because I’m so worried you are going to fall down the stairs if you stay in the house.”

Do: Be honest with yourself about your emotional experience of the situation, and seek the advice of a counselor or therapist to process your feelings.

Be Patient
Difficult conversations are not one-and-done scenarios. Most involve decisions that, while urgent, do not needed to be reached immediately. Solie recommends viewing conversations as a progressive series of interactions and developing insights. When one session takes a stressful turn, adult children can say something like, “I realize this is a lot to think about, and I appreciate you sharing your thoughts about it. I’m sure there will be other opportunities to revisit the topic in the future, but for now let’s table it for another day.” 

Don’t: Expect to arrive at a major life decision after a single conversation. This sets you up for frustration, and makes your elderly parent more likely to feel pressured and dismissed.

Do: Enter each conversation with a goal to learn something new about your elder’s perspective on an issue, and to contribute your own thinking in a healthy, supportive way. Know when to end each session and return to the topic another day

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Tags: Aging,Family
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