By JUDD MATSUNAGA, Esq.
In Japan, the culture dictates that children grow to care for their elderly parents. More than 65% of the elderly population in Japan lives with their children. Typical three-generation households exact a commitment from each co-resident adult child (or grandchild) even before the need arises, establishing who will do what when elderly parents become frail, bedridden or otherwise acutely needy.
In Japan, children are expected to care for parents. Until recent times, it used to be completely unheard of for the Japanese elderly to be placed in a nursing home. In fact, Japanese culture dictates that placing your parents in a nursing home is equal to neglect. (Source: University of Pittsburgh, “Aging and the Family,” Akiko Hashimoto)
Not so in America. After meeting with thousands of Japanese American families, my experience is that Nisei parents don’t want to be a “burden on their children.” Although some elderly parents will move in with a child (especially after being widowed), most elderly Nisei parents would rather hire in-home care, or move into a retirement or assisted living facility. That’s the good news.
Unfortunately, the older they get, the more health and memory issues will slow them down. Many elderly Nisei refuse to accept that they are having difficulties — that’s the bad news. Take driving for example, “Dad can’t tell if the light is green or red, but he won’t stop driving.” It’s scary when it happens…. noticing changes in your parent and becoming increasingly worried about their health and safety.
Despite issues that feel glaringly obvious (and concerning) to the rest of the family, many Nisei parents don’t welcome much help from their adult children. They may see it as interference, or an invasion of privacy. Some aging parents with memory issues simply begin to seem more withdrawn. Others start acting paranoid, e.g., claiming someone took or moved something, or leveling accusations at others.
Whatever it is, you know something’s wrong. You wonder about Alzheimer’s disease. You want to help and you want your aging parent to accept help. Although helping an older parent can be gratifying, it can be especially hard if they’re resisting your efforts, refusing to make changes, or otherwise ignore and dismiss your concerns.
It’s a transition no one looks forward to, and most haven’t prepared for: the time when you might have to start helping your aging parent. Maybe you’re starting to see problems with memory, such as forgetfulness or asking the same questions repeatedly. Or maybe you’ve noticed trouble with driving, keeping up the house, managing stairs, or paying bills.
When my 94-year-old dad started to ask me the same question repeatedly, I would respond, “You just asked me that 5 minutes ago.” Although I knew Dad had been diagnosed with beginning Alzheimer’s, I didn’t realize that Dad interpreted my response as “I’m not interested in hearing about what you have to say.” Yikes! Not at all what I intended to communicate. So it was time to get help.
Fortunately, Leslie Kernisan, MD MPH, is a board-certified geriatrician, offered an online course called “Helping Older Parents with Early Memory Loss.” Dr. Kernisan has a special interest in empowering older adults and their families. She believes with a little knowledge, it should be easier for older adults to have the best possible health and quality of life as they age.
According to Dr. Kernisan, helping a parent with memory loss is not easy. But it gets a lot easier when you learn better ways to talk to your parent and handle safety concerns. In fact, teaching families specific communication and care strategies is more effective than FDA-approved medications when it comes to independence, safety, and well-being in memory loss.
Dr. Kernisan refers to an empathetic connecting approach, i.e., empathy instead of explanation. If we focus on trying to get them to understand by explanation and reasoning, you may be stuck in battles, frustration, and relationship stress. All aging parents benefit from an empathetic, connecting approach and it’s even more important when a parent has memory loss or other cognitive issues.
The following information in this article is taken in part from Dr. Kernisan’s course. This article addresses how to help older parents with early memory loss make safety changes that they are resisting.
MISTAKE #1: The first mistake many (if not most) adult children make is trying to reason with the aging parent. But explanations and reasoning don’t work when there’s memory loss (even if you repeat them over and over). The brain function is damaged and isn’t able to understand your explanations. With most forms of memory loss, insight and judgment are impaired, but emotional responses are not.
Therefore, adult children worried about their parent’s health and safety will try to help by giving information and explanation. But all the reasoning and explanations (however brilliant) are not understood, i.e., there’s a lack of understanding. However, what does happen is negative feelings, e.g., embarrassment, resentment, afraid, ashamed, angry, threatened. The result is a lack of cooperation, conflict and relationship stress.
But you can avoid this cycle when YOU (the adult child) get better at understanding THEM (the aging parent). “But how?” The key is to focus on empathy rather than explanations.
You explore your parent’s perspective, feelings, priorities and fears. Try to understand how the parent sees the situation, e.g., what matters most to them. Then, you validate them and help them feel understood. This connection will improve the relationship and give a better chance to implement a safety change (later).
MISTAKE #2: The second mistake adult children make is expecting your parent’s doctor to address the safety issues with your parent. Since our parent’s memory loss is a health issue, we think their doctors (their health experts) will tell them (or us) what to do to keep them safe and well. Perhaps doctors SHOULD be doing this. But most won’t.
Doctors usually focus on their usual well-paved route, e.g., medical tests, medications, familiar medical conditions, referrals to medical specialists, and things the patient asks for help with. This is easy, fast, and profitable. But memory loss is a less traveled road for them. They have to address mental capacity issues, get information from others, e.g., family, discuss “sensitive” topics with the patient, coordinate with non-medical experts. This is time-consuming, messy, and not reimbursed.
You DO need the doctor’s help for most safety issues, e.g., driving. But your parent’s doctor doesn’t have the training, experience, or support that they need to identify and address safety issues in people with memory loss without your help. Since we love and respect our parents we want them to remain in charge of decisions that affect their life. And so we wait for them to agree to making needed changes. Because we don’t think we could or should make changes unless they’re on board. Even though the current situation is putting your parent at risk (and maybe others as well).
Let’s say that your parent has gotten lost while driving and had an accident. And their doctor has recommended they stop driving. You’re hoping your parent will understand and agree to stop driving. However, despite everyone’s explanations and trying to get them to understand, your parent hasn’t yet agreed.
But here’s the truth: many parents with memory loss never agree to stop driving. So what happens if you keep waiting for agreement? Their driving gets worse, and their insight and judgment get worse. The risk to your parent goes up as the chance they’ll agree to stop driving goes down. This leads to a serious accident. Adult children have to choose: (1) serious accident; or (2) step in without their agreement?
You’re trying to do the ethical thing, by respecting your parent’s wishes, their autonomy. But it’s actually unethical to leave a person in danger when they lack the mental capacity to understand the danger they are putting themselves (or others) in. If there’s a serious safety issue, don’t wait too long for your parent’s agreement. Especially if their decision-making capacity is in question.
In conclusion, an empathetic connecting approach means you: (1) LISTEN before you make suggestions; (2) FOCUS on understanding how they see things; (3) VALIDATE their feelings; (4) REMEMBER that it’s their life and they may have different priorities than you do; and (5) APPRECIATE how important dignity and autonomy is to them.
And once you learn those better responses, your parent will feel better about you (and about them). You’ll also better understand what matters to your parent and you’ll be building relationship capital and valuable intel for later. As a bonus: Their brains will work better when they experience less conflict!
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Judd Matsunaga, Esq., is the founding partner of the Law Offices of Matsunaga & Associates, specializing in estate/Medi-Cal planning, probate, personal injury and real estate law. With offices in Torrance, Hollywood, Sherman Oaks, Pasadena and Fountain Valley, he can be reached at (800) 411-0546. Opinions expressed in this column are not necessarily those of The Rafu Shimpo.