Elderly parents...

[Jennifer]

Hi all,
Just wanted to take a poll and maybe some free advice from you all. My mother is back at home after a long almost 3 weeks in rehab for her knees. I call her every morning but I find my calls are usually peppered with unwanted advice in response to her many aches, pains and concerns. Smarter folk than I need to tell me how would you respond to her in a way that would make our conversations at the very least, more peaceful? I can just listen. Really I can but it's hard not to say "Talk to your doctor! He can help!" or some such unsolicited solution. Does anyone have any tips? I want to be the best long-distance daughter I can be!
Best regards,
Jennifer

[Pat Floyd]

Speaking as an 82-year-old who has had knee replacement surgery and knows that knees heal slowly and probably won't ever be completely pain-free all the time--also from experience in talking with people in constant and often severe pain, I make the following suggestions:

Of course, you call to see how she is, but as much as possible stay away from her physical health. Ask, "What did you do yesterday?" "Who did you talk with on the phone?" "What TV programs did you watch?" "What did you read?" "What's happening on the local scene?" "Have you heard from _____ lately? Why don't you call her?" Tell her about something you or your family have done and things for which you are grateful or something beautiful you have seen or heard. And most important of all try to find some things to laugh about.

If it's appropriate for your relationship with her, tell her about a scripture passage you find meaningful. Psalms 23, 27, 46, 121, 130; Isaiah 40:27-31 and 43:1-3a; Luke 11:1-13, 12:22-34, 15:1-32 are a few that might be helpful. I have found peace in this prayer from Baha'u'llah:
"Thy name is my healing, O my God, and remembrance of Thee is my remedy. Nearness to Thee is my hope, and love for Thee is my companion. Thy mercy to me is my healing and my succor in both this world and the world to come."

At any age, and especially in old age, we find health and joy by living in gratitude for life with all its flaws. Focusing on aches and pains makes them worse. Your mother may not respond immediately to a change of focus, but thinking about ourselves all the time is deadly. You can offer her--not remedies--but companionship and new interests.

[Jennifer]

Pat,
Those are some really good suggestions. I tried hard today to keep things on the up-side. I didn't ask her how she slept. That's a black hole! She's going out for lunch today which is always a thrill. She didn't want to talk much which I think means that she's not any more interested in dreary self-focused conversations than I am. We just need to learn (seems like we both want to learn) how to be upbeat when we talk. I can certainly tell when she wants to change the subject. And I know in the past I haven't been very subtle either. Maybe we should talk about that, just a bit so we both understand that neither of us wants to be discouraging. Can not share scripture with her. She truly believes that she is on the outs with God, that he has visited so much adversity on her that she either can not be a good person or that he doesn't care about her.
Jennifer

[annie]

Jennifer, I celebrate Pat's wisdom, and share your frustration. I am not as calm & philosophical as Pat. The practical nurse in me also wants to say "do something about it, or don't moan!"
I would also say that some people (Pat is obviously not one!) do get in the habit of detailing their ailments to sympathetic listeners, and it can sometimes get in they way of doing something practical about it.
I think there is a time to moan and a time to do something about the problem.

You know your mum, and were there when she had her surgery, so you probably have a good instinctive feel for when sympathy is needed and when it is actually unhelpful & delaying recovery.
As well as Pat's idea of talking about other things, I suggest you have a bit of a plan in your mind: whilst it feels helpful simply to listen to the moans, do so; when you think the time is right for action, then pick your moment, and say what needs saying very clearly.
The next day, if the moaning starts again, say "how did you find that exercise / what did your physio say about....." and only enter into a discussion if it feels helpful.
This does not always work in terms of moving things forward, but it does put a boundary on wallowing!

I'm sorry to say that I did, on occasion, tell my mother I would not discuss her knees any more until she acted on advice, and if it didn't work, stated clearly what the problem was. I could not cope any more myself. Later when I had to deal with her dementia (something I hope you are spared), I was glad that I had reserves of energy for coping with something she had no control over at all.

[Strawberry Curls]

Some very good advice here already, so I can only add that my mother used me as her connection to the world in those last years when her mobility was limited. When I called her or visited each day she wanted to hear about my life, about my job, my son and his wife, my friends, my husband. She wanted to know what I had done that day and I gave her a commentary trying to punch up silly or funny events to give her a laugh.

Asking "how do you feel" every time you talk just isn't useful between parent and child. If you mom starts off with a list of woes, let her vent, then change the subject to something else, a story you read in the newspaper, a local event, or a tale of something the kids are doing. Letting her vent is great, but don't get sucked into a cycle of her complaining and you trying to offer suggestions of how to fix it. She really doesn't want your advice, you are her child. Anyway, FWIT that is how it always seems to me.

[Jennifer]

Jennifer, I celebrate Pat's wisdom, and share your frustration. I am not as calm & philosophical as Pat. The practical nurse in me also wants to say "do something about it, or don't moan!"

Annie,
I am so glad you said you were a nurse (I guess I had forgotten) because I wondered if you could confirm something for me. My mother must be from the "Old School" because she doesn't seem to have a very good hold on when to take her pain medication. When it's something like knees, I was told she should take the pain medication before the pain starts and not in response to it. My mom takes Ibuprophen before bed and then wakes up in the night to take pain pills as the pain wakes her up. I feel like Alice in Wonderland when I tell her to start the serious pain meds before bed. She doesn't seem to understand. I am worried about her cognitive function. She's been alone without my dad for so long, almost 20 years and she's used to doing things according to her lights, so when I made that suggestion, she dismissed it....I won't run to her with your answer, I just want to be clear in my mind whether I am right or wrong...

And Sheri, I don't live very close to any of my parents or in-laws so I have built-in boundaries. I would have a very hard time being as clear as you have been if I were closer. You give a lot to think about....
Jennifer

[annie]

Jennifer - I am very wary of giving advice when I don't know the individual situation (and will your mum give consent for you to ask her doctor?)
However, as a very general rule, yes, it is a good idea to take medication BEFORE the pain gets bad - to nip it in the bud - so to speak.
What worries patients is - how will they know when to reduce medication, if they are always taking it before the pain gets bad?
The answer - as anyone who has dealt with pain, especially post-op pain knows - you are always aware of the level of pain, even when managed by medication. So when the time for medication is due, you are aware that the pain is less than it was previously, and you can leave it a little later, or reduce the amount (depending on the medication)
Do familiarise yourself with the types & doses of medication so you can advise, as some, such as some anti-inflammatories, need the full dose to be taken, but maybe less frequently, and some others can be reduced.

Looking at the other replies, I think it is clear that we all need to set boundaries; where we set them is very individual, but we do need to set them.

[Jennifer]

Jennifer - I am very wary of giving advice when I don't know the individual situation (and will your mum give consent for you to ask her doctor?)
You are a good clinician. I understand how dangerous it is to give advice by long distance, when you don't know all the details, all that can be quite dicey...But okay, what worries me is that no professional that has dealt with her has given her any indication of timing. She seems to make up the rules as she goes. And if I talked with her doctor, at this point, I think she'd consider that officious interference. The mule-headed factor is great in this case....
Jennifer

[KarenB]

All very good advice given and I have little to add that wouldn't be repetitive. The one thing that we do in my family - between mom and me and between dh and me - is sometimes we just need to vent. And we use a phrase, "just let me dump my bucket" which means please just listen to my complaints and don't offer advice because I just need to tell someone about my woes. It excuses the listener from needing to offer advice, and it allows the teller to get it off his/her chest and then move on. We don't use it all that often, but it's helpful for clear communication.

[Jennifer]

Karen,
I like that idea too. I think it's a good way to create a boundary of a sort. I would appreciate not feeling like I need to help all the time. And I am sure she'd appreciate not feeling talked down to all the time! Don't you think at the base of all this is loneliness? I mean for so many people? The problem/advice patter seems to be just a method of engagement. And in order to keep the conversation going, which is what the original person wants, they somehow feel that the problem/advice mode is their best shot. It seems to go along with the thought that negative attention is better than no attention...
Jennifer

[112233]

A discussion interesting to someone "celebrating" her 88th birthday today.:D

[Jennifer]

Now I do not know what to call you, 112233! I feel like that time when Prince was no longer Prince but some sort of design! But lest you feel that I am groaning about my aged (10 years your jr.) mother, do not feel so. I know it's not easy when your health isn't great but I have learned an important lesson from my mother's situation. Growing older is a huge challenge and not all of us can meet that challenge with peace and equanimity. The difficulties of life leave me with no desire to bust anyone, but just a prayer that I will be able to be "alive" as long as I am living...
Jennifer

[annie]

I remembered something that may be helpful to explain to your mother:
we know that mobilisation aids recovery - by not allowing muscles to stiffen & by increasing circulation to the wound, encourages healing. We mobilise better when pain is reduced. Analgesia is not just about comfort but about healing.

[Jennifer]

Annie,
Someone else, someone who went to med. school told me the very same thing! But I am flummoxed as to why her doctor (or any of the many medical personnel she's come into contact with) has not told her this! Sadly, I can quote this to her but somehow if her doctor doesn't tell her, it's not pertinent...I guess you can see we have communication problems...I am just another gadfly buzzing around trying to make her feel inadequate and stupid (really I am not! But perception is everything...)
Thanks for the confirmation though. I was beginning to think nothing I said had any merit...
Jennifer

[Pat Floyd]

Karen,
I like that idea too. I think it's a good way to create a boundary of a sort. I would appreciate not feeling like I need to help all the time. And I am sure she'd appreciate not feeling talked down to all the time! Don't you think at the base of all this is loneliness? I mean for so many people? The problem/advice patter seems to be just a method of engagement. And in order to keep the conversation going, which is what the original person wants, they somehow feel that the problem/advice mode is their best shot. It seems to go along with the thought that negative attention is better than no attention...
Jennifer

Jennifer, I think you are right on target about the effort at engagement as is Karen about the need to vent at times. My cousin Emma lived to be 107 years and 9 months old, living in her own home. I was visiting her when she was 96 and heard her end of a telephone conversation. She listened for at least 5 minutes without saying anything, then she said, "Now Marriott, it's time to think about some good things," and proceeded to change the direction of the conversation. I didn't know Marriott, but her daughter who was my age was always a whiney child so she may have gotten it from her mother. Emma's life was rich with the literally hundreds of people she knew and cared about and did things for and all the interests she maintained, including ACC college basketball. At 96 she did not yet have someone spending the night with her. She told me, "I could fall and lie a long time before anyone found me, but there are worse things than that." She preferred to rub her painful knees rather than take medication that made her "feel funny." On a later visit she said, "You know, I really hadn't expected to stay this long," but because of her interest in people of all ages, she was still surrounded with friends.

[Pat Floyd]

A discussion interesting to someone "celebrating" her 88th birthday today.:D

Congratulations! And many happy returns of the day. I celebrated by 82nd on September 13.

[Jennifer]

Pat,
I am seeing so many of the home truths you spoke of with your 107 year old relative. To say it's "attitude" really can be irksome to people who feel that they have legitimate complaints and hurts but it's so true, even with all those terrible things that happen to us all. I am borrowing this quotation from a writer who's quoting St. Augustine:

Bad times, hard times—this is what people keep saying; but let us live well, and times shall be good. We are the times: such as we are, such are the times.

(This is the link if you'd like to see the whole article)
Read more: http://www.ncregister.com/blog/mark-shea/#ixzz1YUayaccn

And the people who seem to live their whole lives know this.
Jennifer

[AmyLizzie]

I'm sorry to say that I did, on occasion, tell my mother I would not discuss her knees any more until she acted on advice, and if it didn't work, stated clearly what the problem was. I could not cope any more myself.

Annie, I think that's a very British way of dealing with things! I'm the same with my dad, he has terrible back pain but wont do anything about it, but because we are so similar, I know the best way to deal with him is to just tell him to shut up and get on with it! My mum on the other hand knows what to do, she's been dealing with her breathing problem since she was 18! So in that way I'm blessed..in the other I wish she didn't have the condition at all but that's the way the cookie crumbles...

Jennifer, I think you just have to take it day by day, as much as you love her and she you I think sometimes people just need to moan, need to vent that frustration and have a real person just listen without actualy wanting any advice. I think when she's ready she'll come to you for chats and sort herself out. I think you've just got to wait it out! I hope everything works out :D

[Jennifer]

That listening thing is the hardest to do! I want to by sympathetic and allow her a safe place to vent but at some point it tears you up to hear the problems esp. the ones that can be addressed. It makes me look at my own "insurmountable" problems and wonder what obvious solution I am not seeing. Like last night. Monday nights is Scouts at this house. Has been for a while. But seems I am the engine driving this pursuit sometimes. After son puts up a fuss when I ask for some extra help so we can get out the door, I realized that the obvious solution is: If he doesn't want to get there on time, why am I busting my tukas to do this and making enemies in the process? So I went to the parlor, sat on the nice sofa and prepared to relax. If he wants to go, I thought, he'll figure it all out. He did, and even though we were about 15 minutes late, it felt pretty good not to be playing the same dumb roles. Turning the tables made for a nice change. Now, if only me mum were so easy...
Jennifer

[MaryL]

I do a fair amount of Geriatrics, and this discussion is one that happens all too frequently. There seem to be several issues:1. Your mother is not living in the same community as you. 2. She has a somewhat serious problem with pain and mobility issues. 3. The Mother-Daughter relationship is in flux, with a reversal of some roles, uncomfortable for both of you.

So: Mother is frightened and furious -her body is betraying her, she can't do what she wants, it hurts. She is able to tell you about the pain, but isn't able to talk about the rest. It comes across as exactly what it is: whining. As you are not in the next street over, the best you can do is encourage her to TRY the exercises and other modalities prescribed. Remind her that unused, tight muscles will hurt as they stretch out, but that it is something to work through, not to give up on the whole process because the muscle is acting as it should. Tell her a little pain is a sign the muscle is improving. (A lot of pain is different.)

The Medical Community may actually be saying all this to her, there was a study that said patients only hear something like 10% of what you tell them. I personally write it all down for my older folks, but then they lose the paper...I also encourage another person to come with them-neighbor/friend if a family member isn't available. 2 pairs of ears are better. Frequent follow up helps, eventually the patient hears what I'm saying. There is also a new program asking the patient to repeat back what was said, and explain what it means, but some of my elderly think I'm beign condescending or implying dementia, so it sometimes backfires...

Finally, for yourself: Your mother may not know what else to talk about, as others have commented. Let her whine, pick one small thing, ask her how she's going to deal with it, then talk about something else. Keep the calls short, but often,(NOT several times a day-every other day maybe?) and if something changes for the worse you'll pick up on it. Ask her how she feels compared to the beginning of the problem, not yesterday, and point out the improvement over time. Remember you might be the safe person to whine at because, after all, you love her.

Good luck getting through this, keep your head up, we're here for you!
Mary Lou

[Jennifer]

Thank you Mary Lou. That was as good a comprehensive look and analysis of my whole mess as anyone has ever been able to put in a reasonable-sized package....I will tell her about movement, just as Annie also said, and I will tell her that she'll get better results with taking pain meds before pain starts. I thank you for reminding me that just because she can not tell me what the doctor said, doesn't mean he or she didn't give her this information. That was the worrisome thing and now it places the worry in context. I am going to go back over it all and read carefully try to have a script of sorts so that I can be ready to say something different and hopefully helpful but not over-bearing. Thanks again. I forgot all the wonderful resources we have here at the VBC....
Jennifer

[Pat Floyd]

Jennifer, thanks for the quote and the link.

I would add to MaryL's excellent advice: Before you go to the doctor write out a list of questions and symptoms you want to ask about. In the course of a visit it's easy to forget some concerns.

I've gone with a number of people to provide a second pair of ears. Mostly it's just a detail or two that's forgotten, but in one sad case a very kind and clear oncologist told my friend that her brain tumor had reached an advanced stage, but one or two courses of treatment might be helpful. My friend understood her cancer was at the least advanced stage. I took a gradual approach to informing her otherwise. I think hearing she had cancer of any kind was all the shock she could absorb at the moment.

[Lenore]

Is it feasible (economically and otherwise) to have someone come to the house a couple of times a week to take your mother through her exercises (and make sure she's doing them properly and assure her that the pain and stiffness will be transitory of she does the exercises, etc.)? I occurs to me that this would have three benefits: 1) She would actually do the exercises, properly, at least while the physical therapist (or trainer or whatever) were there. 2) If something really is not right when she does the exercises, that person can spot it and the appropriate experts can be consulted. 3) The extra stimulation -- a new person to talk to -- would do your Mom worlds of good.

Just a thought -- for what it's worth.

[Jennifer]

Lenore,
She will be having physical therapy in the home for about 3 weeks. The problem is that she is in a rural area and it's difficult to find someone to come out after that ends. She has someone who comes in to help her with housekeeping but this saint of a woman is too busy to come any additional time. It's maddening.
But your ideas are solid and we'll be able to carry them out to some degree. I imagine after those 3 weeks, she'll be driving again and perhaps the isolation and focus on aches and pains will lessen. It's her goal to start water aerobics again! She had to give that up when her knees became so painful.
Jennifer

[Donna]

Hi Jen,

Good question.

And the responses you've received are wonderfully wise... The VBC has such terrific members!

I'm presently working with a CarePartners group. We have several handouts from various groups we use fairly frequently. Here is the one from the Alzheimer's Association:

Tips for better communication
Let the person know you are listening and trying to understand what is being said.

Keep good eye contact. Show the person that you care about what is being said.

Let the person think about and describe whatever he or she wants to. Be careful not to interrupt.

Avoid criticizing, correcting and arguing.

If the person uses the wrong word or cannot find a word, try guessing the right one.

If you don't understand what is being said, ask the person to point or gesture.

Focus on the feelings, not the facts. Sometimes the emotions being expressed are more important than what is being said. Look for the feelings behind the words.

Always approach the person from the front. Tell the person who you are.

Call the person by name. It helps orient the person and gets his or her attention.

Use short, simple words and sentences. Talk slowly and clearly.

Ask one question at a time.

Patiently wait for a response. A person may need extra time to process your request.

Repeat information and questions. If the person doesn't respond, wait a moment. Then ask again.

Avoid quizzing. Reminiscing can be healthy, but avoid asking, "Do you remember when...?"

Give simple explanations. Avoid using logic and reason at great length. Give a complete response in a clear and concise way.

Hopefully some of these will prove helpful even though it doesn't sound as if your mother is dealing with some form of dementia.

We also refer to these websites:


http://www.myseniorsite.ca/eldercare-talking.htm
http://www.caring.com/articles/talking-to-elderly-parents
http://www.caring.com/articles/communicate-with-elderly-parents-effectively-6-tips
http://www.boomers-with-elderly-parents.com/elderly-parents-communication.html
http://ezinearticles.com/?Tips-For-Communicating-With-Elderly-Parents&id=872558


You can probably find others with a little research. The Department of Aging is a good resource.:D

Pat had excellent comments and suggestions on the consolation found in scripture. Elie Wiesel pointed out that we can have everything taken away from us except the ability to choose our attitude. Gratitude and thankfulness certainly are viable stress reducers, not to mention their ability to lead us to contentment. God deserves our whole hearts - He's proven His love for us in so many ways. I love Psalm 119 which, though lengthy, has marvelous statements about where real contentment is found. As Pat pointed out there are many chapters in Isaiah that speak of encouragement; I'd add chapter 55 to her list. Romans 5 and 8, Ephesians 1-3, all of Philippians... really must stop but there are so many passages which encourage us to live lives pleasing to God and with firm hope in His promises. A good concordance (there are excellent on-line ones) can help you do a word search if you like. Have fun and then share some of your finds with your mom. ;)

Glad you are able to see her as often as you do - those times are precious and will be even more so as you look back someday. Hang in there Jen, and remember a little prayer when the strain rises can help immensely with attitudes and actions... ***grin*** I should take that advice more often myself.

Remember: You might not be a 'model of a modern major general' (or 'criminal'; depending on which version you are singing)... (***laugh***) but you are the perfect daughter in this situation. (And a fine encouragement to the rest of us!)
:):D:)

[AmyLizzie]

Remember: You might not be a 'model of a modern major general' (or 'criminal'; depending on which version you are singing)... (***laugh***) but you are the perfect daughter in this situation. (And a fine encouragement to the rest of us!)
:):D:)

I totally agree, just the fact that you are seeking this advice proves what a loving daughter you are. It's always hard when you watch someone you love suffer and there seems nothing you can do about it. I believe it does help to talk to someone on the outside of your situation. Thankfully my parents aren't at that stage yet but I went through it with my grandparents and I know how exhausting, heartbreaking and sometimes soul destroying, it can be.

Problems have a way of working themselves out, and in spite of everything you have to believe that 'It'll all come out in the wash ' :) xx

[Jennifer]

You all have been too kind. Donna, can you give me any long distance tips? I only see my mom once a year, but we talk very frequently. I loved all the advice that said let her vent and then get her off the subject....

AmyLizzie, you are sweet to say I love my mum and I do but I am not doing such a good job of supporting her but you all are helping me with ideas...If you are near yours, (and I know you are!) thank your lucky stars in a way. Wasn't my choice to leave my hometown and wouldn't have done it but for the need of a job!
Thanks again everyone. You have all blessed me with all the good ideas and support...
Jennifer