The Complex Issue of Control
The desire for control is a something we can all relate to. We can see this displayed in little kiddos who struggle to find independence in a world run by adults. Given the patronizing label of a “temper tantrum,” kids can become overwhelmed with distress when things don’t go as hoped. They may cry, throw their toys, or run off to hide in their closets. For my generation, our need for control may not be as apparent because we usually have it, we know it, and we use it. (But when I don’t have control I am also prone to cry, throw my toys and run off to hide in my closet). For an elder, control takes on greater importance. Not only do they want to maintain independence and the ability to direct their lives, it is also a biproduct of loss. At this stage of life, loss is a constant presence that can come at any time, both in subtle and life-altering ways. The stakes are high so the natural tendency is to try to control whatever possible. If the connection between control, independence, and loss is unclear, people can unfortunately label the elder as difficult, bull-headed, and unreasonable, yet if time is taken to understand the factors/priorities at play, their responses may make a whole lot of sense.
Loss
I can honestly say that when I think of what elders face each day, it can take my breath away. There are so many losses younger generations rarely have to consider let alone navigate. Here are just a few:
- Physical strength and energy. I love this quote from Bob Hope, “I don’t feel old. I don’t feel anything until noon. Then it’s time for my nap.”
- Time spent on medical issues: think of how much time is spent sitting on the phone to get assistance, talking to insurance companies, and driving to and from appointments. I’ve heard some elders talk about managing their health being as demanding as a full-time job
- The capacity to heal. “You don’t know what it is like to wake up each morning and realize today I will be the healthiest I will ever before the rest of my life.” The man who spoke these words said his days are spent preserving what he has, not looking forward to some new, inspiring achievement.
- Relevance. There are all kinds of messages that say the world has moved on- elder’s music is no longer playing on the radio, advertisements are geared towards working families, with the exceptions being prescription or other physical needs.
- Moving from having a voice to being unheard. A form of agism, this can be particularly scary when providers ignore the words of the very people they are trying to help.
- The death of peers, siblings, and parents. One person told me, “I look in my address book and there are pages upon pages of people who are no longer here.” An author mentioned that older people, as their parents die, become orphans. What must it be like to when the only person(s) who have known you for your whole life are gone?
- Touch. So many people go days without this form of caring and connection.
- Mental capacities. Memory challenges, infections that impact cognitions, slower brain processing, all impact the ability to navigate the world and make wise decisions. not understanding the unfamiliar, and the impacts of help can complicate making informed decisions. George Burns playfully remarked, “By the time you’re 80 years old you’ve learned everything. You only have to remember it.”
- General safety. Small things we usually do not think about can have major impacts. An uneven sidewalk , stairs, climbing onto a chair to get something off a high shelf…. There is no way to address them all.
- Their nest. A home is tied to the familiar, is part of a larger community, and holds memories like a living scrapbook. All that changes when a higher level of care requires a move.
- Privacy.
- Financial independence.
- Dignity.
I urge you to close your eyes and picture what it might be like to live with these kinds of realities! What does this show you? Imagine how you might respond to in these conditions.
What We Can Do
Here are some strategies to help you and the elder person navigate challenges that come up. These are basic skills to use in any relationship- we are just being extra intentional with our elders.
Respect– their values, beliefs, and opinions are important. Remove any ideas of “less than.” For example, I have heard adult children talk about become parents to their aging parents. Cohen and Eisendorfer emphatically stated, “You are not and can never be a parent to your aging parents!” You may be their advocate, confidant, nurse, housekeeper, etc., but you will never be their parent.
Honor Self-Determination– Becoming less independent does not remove the right to make decisions for oneself as much as possible. “So long as we still possess it, the power to carry out simple intentions is one of the many unnoticed pleasures of life.” Wendy Lustbader, Counting on Kindness. Action may be necessary in times of immediate threat to life or safety, but control should be returned to the elderly person as soon as possible.
Maintain Your Boundaries – Just like an elder has a right to take care of themselves, we have a right to to determine our priorities, preserve our health and sanity, and follow our own values. Please speak up and advocate for yourself.
Listen– If you want to try to understand the reasons behind their decisions, don’t be afraid to ask questions about what they want, what is at stake, and what values are at play. You may discover some choices are wise, even admirable. That said, you may not see eye-to-eye. In those cases, times, go get a massage. The situation may not have changed, but you’ll feel better.
Adapt a New Vocabulary– We want to begin speaking the language that will resonate with them. Consider words that recognize that they hold control: choose, direct, elect, determine, etc. Ex: A primary care doctor saw that after heart surgery, her patient’s chart was empty. When the elder came in for her appointment, the doctor reflected, “It’s a bit mysterious why you stopped seeing your cardiologist.” The patient shared that she takes her blood pressure regularly, has no symptoms, and didn’t want to go to the doctor to get meds that made her sick. Instead of chastising or dismissing, the doctor acknowledged her decisions. “My only question would be: since you are in such great control of these conditions, is it possible there are some other factors you may not be aware of and thus may be out of your control?” When she asked what she should do the doctor said, “I’m not sure, but you might choose…”
Interacting with elders often requires new skills and perspectives to ensure we can operate from a place of compassion. I hope that through this concerted effort, we not only have more satisfying relationships, we also learn lessons about how to approach this chapter in our own lives. Here’s to opportunities for both elders and those who love them to practice empathy, gain wisdom, and appreciate what these relationships have to offer.