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Dealing with Difficult Family Situations

Published by Chapster on 2001/11/27 (2559 reads)
This interview about dealing with difficult family situations was taped with Dr. James Griffin November 27, 2001.

Q: So what are we talking about today, Mike?

A: Today we're talking about some of the demands of caregiving an elderly loved one. One of the hardest aspects of caregiving is that of seeing unexpected changes in our loved one. Sometimes, this is a parent who has formerly been very loving and affectionate, and for some reason, is now harsh and inflicts enormous emotional pain. This is a devastating change for the family to encounter. It's so unexpected and out of character for the elder. The doting father who never forgot to bring home his daughter a little treat after his workday now screams at his daughter, telling her that he hates her. Or, a very sweet and gentle mom, yells at her son to get out of her house, that she's never trusted him. These changes are so out of character and so painful that they create a deep sense of self-doubt and sadness on the part of the caregiver.

Q: What causes these changes?

A: Really, it can be any number of factors. It can be caused by physical factors such as some forms of dementia or specific “events” that happen in the brain. It may be caused by a of biochemical imbalance. It can also be brought about by emotional changes, such as a feeling of fear on the part of the elder. They may realize that they are going to have to give up the car keys. For many elderly folks, this is the last symbolic bastion of independence. Nothing evokes a sense of fear like feeling your future or your independence are at risk. And, even though you may legitimately be trying to help, it can be perceived as a threat. They may not want any part of it.

Q: How can caregivers cope with these changes?

A: Well, regardless of what we choose to do, it will still be painful. We can help the pain a little bit, but regardless of what we do, continued assaults will be hurtful. Nonetheless, one important step is to pay attention to this signal that something is wrong and to address it. It should not be ignored. It is essential to try to discover what is going on. Certainly, these kinds of changes can be scary, and raise the fears that something is very wrong. Often, we allow these fears to paralyze us. While this is natural, it may prevent treatment that could really help from being started.

When they go to the doctor, the caregiver should try to insure that they AND their loved one are heard thoroughly. It may help to go to a clinic that specializes in gerontology, the care of the elderly. For example, UT Southwestern, here in Dallas, has some very specialized treatment facilities for the elderly and are frequently doing studies relating to dementia that offer free resources for the elderly and caregivers. Our listeners today should especially seek out these teaching hospitals, as they are called. They are often on the cutting edge of treating geriatric disease.

Also, when speaking with a physician, make sure that your concerns as a caregiver are heard. The newest and best studies in dementia care focus on the caregiver as well as the patient.

In the case of dementia or some other disease processes, it may help caregivers to keep in mind that, “It is the illness speaking.” This is not the person as they knew, talking. It is the disease process or pain (pain's a biggy!). The person they knew would not talk to them like this unless they were ill or in pain.

Q: Is there anything else they can do?

A: A couple of other pointers may help: Caregivers who are firmer and more direct tend to have more success with patients when this behavior is due to dementia. Caregivers should also protect themselves and give themselves space from the situation. Of course, when we say protect themselves, we don't just mean physically, we mean emotionally as well. Caregivers who maintain an interest in some of their own activities will gain additional resources for support, and will generally do better in the caregiving experience. Also, in our experience, those who are able to find some sort of meaning or purpose in their heartache will also fare better. Victor Frankl, the famous psychiatrist was imprisoned in the Nazi concentration camps. After his imprisonment he wrote: "In some way, suffering ceases to be suffering at the moment it finds a meaning..."
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