There is a cycle to the life process. We start our lives dependent on others for care, nurturing, and safety, and we often conclude our lives in the same fashion. In the middle years though, we are full of ourselves, our independence, our power to make choices and effect change.

As those qualities and activities that we take for granted begin to diminish — our vision, our hearing, the stamina to shop or clean house, the reflexes to allow for safe driving — we run out of ways to show our power. Often, all that’s left is the power of “no”. This can manifest in refusing care, non-compliance with medical and medication regimens, and increased anger, depression, isolation or anxiety.

If you are encountering a frustrating situation with an Elder where the answer always seems to be “No”, if you are wanting to just “step in and and decide”, let me offer some alternatives.

1.  Examine the idea that this person’s behavior represents the only way they know right now to exert power in their lives at this moment.  For someone who has lost the ability to easily say “yes” — or who has had so many others tell them “no” … you can’t drive anymore, you can’t afford that, you can’t live by yourself, you can’t stay in your home, you can’t have ice cream, etc., being able to refuse is the last bastion of their independence. Can you look at “no” from their point of view?

2.  Help clarify values — both yours and theirs. There is nothing like fighting with someone to keep them safe and medically compliant if their first concern is how will they afford to feed the cat if they incur a budget busting medical expense or “what will the neighbors think?”  One example of this from my life involved my own mother’s refusal to use a Life Alert system.  My 87 year old mother lived alone in her home, about 2 miles from me.  Yes, we could (and did) check on her by phone and in person daily.  As a nurse, though, I understood the reality of both her night time bathroom trips, health issues that caused her to bleed rapidly when injured, as well as the life-changing impact even witnessed fall could bring.  But I couldn’t convince her to get a Life Alert button.  It turned out to be a vanity issue (as the cost was about $35.00 a month).  She didn’t want to wear “the button”, because it made her feel old.  It finally took another professional’s intervention to point out that she was torturing her children by not wearing it.  That she could understand — the power of saying “no” to this communication device was causing us emotional pain, and she didn’t want that either.  It gave her power, in that instance, to say “yes” because she was doing something proactive to nurture her children.  (She would sacrifice vanity to reduce our stress, but not for her own safety.  Hey. Whatever it takes.)

3.  Seek concensus. On what points can you agree? Build your strategies from there.  “I know you feel like you take too many medicines.  Let’s look at them together and remember what they are for.”  Review with your Elder the root condition being treated, and why that’s important.  For example, “The blue pill keeps your blood pressure down.  If your blood pressure goes up, it increases your risk for a stroke.  Taking the medication is the most sure way right now to keep your blood pressure controlled and reduce your risk of stroke.  Can we make an appointment together to talk to your doctor about what other things you can do to reduce your blood pressure, and what physical markers would make them feel safe in reducing your dosage or discontinuing the medication?” (Look for more on polypharmacy and seniors in a later post).

Together, make a plan that empowers the Elder to say “yes”.

Physical changes in taste, sight, hearing, smell can also lead to refusals, especially around institutionalized food.  If you have an Elder that is suffering from Failure to Thrive because of lost appetite or missed meals, look for environmental changes that can be made (sometimes using a bright colored plate to make the food more visible makes it more appealing).  Is the food tasteless?  Try adding fresh herbs (avoiding excessive salt), like basil, lemon or garlic to give it some zest and wake up the taste buds.  Do their teeth hurt or are dentures ill-fitting making chewing difficult? Often there is a physical cause underlying refusals that we (or caregivers) don’t take the time to tease out, and make refusals a power struggle instead of a cue about discomfort.

When we are pressed for time, it is easy to discount someone exerting their power and authority through the use of “No” as just being obstinate or difficult.  Seek to find that underlying cause, without judgement or patronizing.  This aged individual has probably forgotten more than you currently know and has seen life through many transitions.  A gentle, understanding and cooperative spirit often gives such an entrenched person a sense of significance and value, and helps bring them around to more positive decision making.  It’s certainly easier on the heart than frustration and annoyance, and lifts the Love vibe to a shining level.

Remember always that this person has seen more, dreamed more, lost more and had to be stronger than you may ever face. Don’t demand. Don’t demean. Offer dignity, respect and the time to really hear what’s on their heart. This gives us all the power to get to “Yes!”.

Blessings to you and your family this day!

Katherine