Bringing up the topic of senior care with a loved one can difficult, but the situation is even more fraught when that person suffers from a mental illness. Many family caregivers are left wondering how to approach the subject, worried about upsetting their elderly parent, or even fearful of an irrational or violent reaction.
Unfortunately, this is by no means an unusual situation. According to a report by the Institute of Medicine of the National Academies, between 14-20% of the nation’s senior population have one or more mental health issues, including bipolar disorders, depressive issues, dementia-related symptoms and substance abuse problems.
In combination with the natural physical and cognitive impairments that occur with aging, psychological issues can endanger a senior’s health and place stress on family members.
So how should caregivers bring up the need for senior care?
Mental Illness Treatment
Some people who need help do not seek treatment because they dismiss their mental changes as a natural part of aging, or they are ashamed of talking about it. While it is normal to experience some forgetfulness as we age, the American Psychiatric Association advises families to seek professional advice if an older adult shows obvious changes in behavior or mood.
One potential roadblock is that your loved one might be resistant to the idea of treatment. Heather Adams, psychology professor at University of Phoenix in Modesto, California, says:
“If the elderly parent is unwilling to acknowledge their disorder it may help to focus on symptoms rather than the disorder itself. This also works well for encouraging an elderly parent to schedule a doctor’s visit.” Then, if a diagnosis is reached, “medication can help to soften symptoms which could otherwise hinder lucid communication.” This can pave the way for a calm and effective conversation about senior care.
Professor Adams also strongly advises adult children of seniors with a mental illness to seek out resources and support for themselves. “Managing an elderly parent with a mental disorder is emotionally taxing,” she says. “Sometimes speaking with a therapist can help adult children create a plan for addressing issues with an elderly parent.” Also, support groups can help you connect with others in the same situation.
Having the Tough Conversation: Mental Illness in Seniors
If your parent’s mental illness is beyond your capacity to provide home care, then how should you let them know they need additional senior care? Here are some tips that can help you start a difficult discussion:
1. Make sure they are taking their medication.
“Facing a mental disorder can be very stressful for an elderly parent and so every effort to lower anxiety should be considered,” says Professor Adams.
2. Choose a time when both of you are calm.
According to the Mayo Clinic, “This will make it easier for you and your loved one to listen to each other and speak your minds.” Then, explain your needs, stress the benefits of care — and be prepared to compromise.
3. Take resistance in stride.
“When it occurs,” Professor Adams says, “shift the conversation to less inflammatory aspects of your concerns. Threats or emotional outbursts will only add anxiety and shut down communication. Remember not to take outbursts personally and know that they often stem from fear of the unknown.”
4. “If at first you don’t succeed, try again.”
Your loved one may not want to discuss the topic when you first bring it up, the Mayo Clinic advises trying again later. The same goes for conversations that go wrong. “If you feel yourself becoming emotional, the best advice is to take a break from the conversation and choose another time to discuss the topic,” says Professor Adams.
5. Get the paperwork you need to properly care for your loved one.
“In cases where an elderly parent is a danger to themselves or others, adult children may want to acquire a medical power of attorney for their elderly parent so they can make medical decisions on their behalf.”
Many specific disorders pose unique challenges. “For Anxiety (OCD) or Depressive (Depression, Bipolar Disorder) disorders, it is beneficial to delay discussion until the elderly parent has come out of an episode,” Professor Adams says. “Manic or depressive episodes create a difficult environment for discussing sensitive topics.”
The Importance of Treating Mental Illness in Seniors
Bringing up care for seniors with mental illness is a scary prospect, but the risks of leaving our loved ones without proper treatment are far more severe than any potential conversational blowups.
According to the Institute of Medicine report, untreated mental health conditions lead to poorer physical health outcomes, higher costs and longer hospital stays. Seniors with untreated depression, for example, are less likely to properly take medications for other problems like diabetes or hypertension.
To mom or dad, accepting care may seem like giving up their independence, but getting professional help may in fact increase their ability to live a normal life. Even if they do lose some independence, says the Mayo Clinic, “loss of independence isn’t a personal failing. Help your loved one to stay active, maintain relationships with caring friends and family and develop new physically appropriate interests.”
In the end, your ability to keep them involved in their own care decisions may help them feel more comfortable about taking a new step in the right direction.