Essential Conversations with Dr. Amy: What to do when your aging parent won’t accept help

I’d like to start off by providing you with a situation that one of my clients is experiencing with her aging parent.

Diane* walked in to her mother’s house and saw that her mother, Elaine,* had several large bruises. Elaine explained she had fallen getting out of the bathtub. Diane immediately got upset and told her mother that she needed grab bars installed in her bathroom and really should have someone there to assist her when she showered. Elaine replied that she had been fine living alone for most of her adult life and she didn’t need any help now. Diane brought up other times her mother had fallen or slipped, and other ways she thought her mother needed help to be safe in her home. By the end of the discussion, both Diane and Elaine were very agitated and nothing had been resolved.

Diane experienced what many adult children feel when talking to their parents about safety issues: frustration about why their parent doesn’t understand how unsafe they are and how important it is that they make a change to be safer. Conversely, Elaine experienced what many parents feel when their adult children talk to them about their living situation: that their son or daughter treats them like a child and doesn’t really understand things from their perspective.

It's important to understand some of the reasons a parent might reject help, even when there is an immediate safety issue. For some older adults experiencing declines in functioning, those declines have been very gradual and they may not realize they now need some help. It is as if they are still viewing themselves through the lens of their earlier years. For other older adults, they may be trying very hard to maintain their independence, using a definition of independence that may not fit their current needs and situation. Others may be afraid that if they admit they need help, other people will start making decisions for them and they will lose control over their lives. Some people also fear that if they accept help, it will become a slippery slope in which things will just continue to unravel in their lives.

It can be useful to understand some of the reasons behind your parent’s hesitation to talk about their need for help. It’s often easier to be emphatic when you can appreciate what is behind behaviour that may not feel logical to you or may feel unnecessarily stubborn or difficult. Viewed from your parent’s perspective, things can look very different.

The next step is to have a conversation in a manner that allows both of you to feel heard and understood, and that facilitates you getting to solutions you both can live with. It’s important to approach that conversation remembering that most older adults are very focused on maintaining their independence, sometimes despite safety issues you might be identifying. Here is one way that you could open up a conversation with a parent, beginning with acknowledging what is important to them:

“Mom, I’d like to chat with you about something I’ve been thinking about a lot lately. First, I want you to know that my goal is to help you maintain your independence and your quality of life. And I want to talk about how I can support that. I’ve noticed a few things that have me a little concerned. And I feel like if we talk about these, and come up with solutions together, it will make your life easier and better.”

This approach often reduces defensiveness because you are starting with what is important to them. Not everyone will respond to this approach, or any other approach, but you increase the likelihood of a productive conversation with an opener such as this. As the conversation progresses, it is important to stay calm, listen to what your parent is telling you is important to them, and also to listen to what may be behind their words. It’s ok to guess at what might be motivating their words or behaviours in a way that opens up the conversation. For example, you can say:

“Mom, I can’t imagine what it must feel like to have changes in your balance. I know you want to stay independent and I’m guessing it’s scary to feel like you may be at risk of falling. How about if we figure out ways that you can stay safe when you are showering so you don’t have to worry about this?”

It is a natural human tendency to want to prove that our perspective is the correct one. It may take some practice to have conversations with your parent that steer away from proving each other right or wrong and focus on the mutual goals of safety, independence and maintaining their dignity—but that practice is well worth the benefits!

*Names have been changed to protect privacy