Communication and Relationships

Learning Objectives
After completing this module you will be able to:

• Define relationship and communication needs of older adults
• Identify effective communication strategies
• Examine the complex roles of family members
• Use techniques to build more effective communication and partnerships between family members
• Examine challenging behaviors and effective responses


Index/Content of this Module  

In this module you will learn to recognize relationship and communication needs of older adults, ways to utilize effective communication responses and strategies. You`ll also gain knowledge of the complex roles of family members, use methods to engage family members and and respond to more effectively to resolve conflicts & recognize and respond to challenging behaviors of older adults.

Click on a topic below to go to that area of the page:

1. Relating to Older Adults
2. Practical Steps for Relating to Older Adults
3. Reminiscence
4. Essentials of Good Communication
5. Dealing with Difficult Behavior
6. Impact on Relationships and Family
7. Sibling Relationships
8. Family Conference
9. Resources for Caregivers
10.Sources

Relating to Older Adults

We must be cautious about treating all people who are older as if they are all ill or cannot understand us well. Most older adults are independent and have their own ideas and opinions worthy of our respect. Treat older adults as you would treat anyone from a generation different from your own. Respond to their experience and language and do not expect them to adjust to your own.

Jeanie Crane, author of Let`s Visit, is a Fort Worth, Texas advocate and community volunteer. Drawing on her experiences as a family caregiver and a volunteer she offers some insights into how to interact with older adults.

Knowing grandparents seems to be a key in relating well to older adults. People who were around grandparents seem to be more comfortable and communicate more easily with older people.
Older adults do not consider themselves older; they see themselves without age. Although their appearance may be that of someone who is older on the inside they feel the way that they have felt throughout their lives.

Older adults may experience `time stress.` The world is moving too fast for them. Although many people experience this time stress it can be challenging for older adults as they have to make constant adjustments to changes not only in the outside world but in their own health and lives.

Everyone needs to be needed and to “live the best quality of life whatever the circumstances.”

Everyone needs to feel as independent as possible and have choices and control.


Practical Steps for Relating to Older Adults

• Listening is probably not only the greatest gift that we can give to older adults but is one of the most important skills in understanding their life and needs. An older adult said “I stopped talking when people stopped listening.”

• Recognize their view of their age
• Relate to older adults as a 2-way communication bridge
• Treat older adults  as individuals not as part of a larger group labeled ‘seniors’ or ‘the elderly’
• Health care providers:  “Put down your clipboard and look at me”

“There is a reason that we have one mouth and two ears”

Reminiscence

Many older adults will reminisce about significant events and people in their lives.  Reminiscence is a way of reliving and re-experiencing or savoring their history.

Caution
: Some gerontologists believe that lay persons should not encourage reminiscence since it can cause unpleasant memories to surface and a professional should address these memories

The caregiver or listener can use reminiscence to build a better relationship and build a bridge between the past and the present. In addition, reminiscence can help the older adult in a number of ways:addition, reminiscence can help the older adult in a number of ways:

• Maintains self-esteem and reinforces a sense of identity
• Feels a sense of achievement and pleasure
• Copes with stresses related to aging
• Gains status or acceptance by revealing life history
• Places aspects of the past in perspective
• Deals with emotions such as grief
• Establishes a common ground for communication

If someone begins to be upset or angry, redirect the conversation into another area. Perhaps find a key word or experience in the story that is a more current experience for either of you. Steer the conversation in a different direction while not ignoring that he/she may be upset. Listen, reassure and be supportive.

Reminiscence brings value to the listener in a number of ways:

• Gains knowledge and understanding of the period in which the person lived
• Builds a bridge between the past and present
• Establishes a relationship through sharing information and experiences
• Provides a context for gaining insight about the person’s behavior in the past

Can be used as a therapeutic tool in care planning or identifying assets, needs, and resources.

Essentials of Good Communication

“The difference between the right word and the almost right word is the difference between lightning and the lightning bug”             -Mark Twain

Watch your language!  Older adults want and need to be treated with dignity and respect.

Referring to people with a medical condition such as “handicapped,”  “diabetic,” or “arthritic” is defining someone by a medical diagnosis, not as an individual.  Avoid negative references and the use of words such as “suffers,”  “afflicted,” “victim,” “unfortunate,” “confined to,” or “bound to” a wheelchair.

Click here for the handout: Terminology When Referring to People with Disabilities or Older Adults.   

Here are some tips for communicating effectively with an older person:

• Call the person by name
• Assist the person’s orientation to time and place “Here it is Tuesday already”
• Really listen
• Pay attention
• Speak distinctly
• Talk directly at the person
• Take your time, one thought at a time
• Use body language/non-verbal cues
• Use tone of voice appropriate to the conversation
• Listen to silence
• Acknowledge feelings even if you don’t agree
• Look for hidden meanings
• Encourage and reassure

Additional approaches may be helpful when communicating with a person with Alzheimer’s Disease or dementia:

• Identify yourself and call the person by name
• Use active listening (check out what they hear)
• Keep sentences short and simple
• Use repetition
• Speak clearly
• Keep terminology simple, avoiding jargon and acronyms Use concrete statements.
• Speak in a clear, even, normal tone
• Wait for responses to questions
• Don’t attempt to finish the person’s sentences for him or her
• Use humor when appropriate

Click here for the handout: Communication with Persons with Alzheimer’s and Dementia.


Dealing with Difficult Behavior

Sometimes older adults may behave in ways that are challenging to caregivers. They may be argumentative, angry, challenging, or resistant to any suggestion or help. These behaviors could include not wanting to take medications, refusing to see physicians, or denying any need for help.

Here are some tips when difficult behavior is an issue:

• Find out what is causing the behavior. Is it a recent behavior? If so, see if there is a medical cause.   Is there a treatment?

• If the behavior is caused by dementia or mental illness, don’t confront. Validate the feeling, if not the content. You do not have to agree with the person but accept that the person feels that way.

• Remember that it is difficult behavior – not difficult people.

• Redirect someone who is getting agitated. Give him/her something else to do or to discuss.

• Eliminate distractions, if possible.

• Don’t take the behavior personally if it is related to a disease process.  Often care receivers lash out most at those they trust the most  They know that certain caregivers will take abuse and still be there.

• Use “I” messages. 

Impact on Relationships in the Family

Relationships with family members will change as the needs of the aging family member change.   Our own feelings and reactions to the care receiver and others may change many times as we provide care for a family member.

Family roles may change. Relationships, feelings, and reactions to family members often depend on past history with these family members. Complex relationships can create confusion, stress, and guilt. Other family members including children and spouse may feel neglected or ignored.

Although a controversial concept, some people believe that a common experience is a `role reversal` whereby the caregiver experiences a feeling that the roles and relationships of a lifetime are reversed.

Adult children may feel that they not only take over the role of caregiver but also becomes the primary or sole decision maker. This change in responsibilities creates a completely new relationship. However, it is important to remember that the parent will always be the parent and the child will always be the child.

Role reversal can also happen between spouses. For example:

• The husband, who always managed the family finances, is now unable to balance the checkbook, pay bills, or make investments due to dementia or Alzheimer’s Disease.

• The wife assumes management of finances in addition to other household responsibilities and may have a full time job outside of the home.

• The wife becomes ill and can no longer manage household responsibilities such as cooking and cleaning.

• The husband must learn how to do laundry, shop, prepare meals and also work full time.

Sibling Relationships

Adult relationships with brothers and sisters are complex and range from love to detachment to hatred. These  relationships need to be re-evaluated. Your sibling is not the same person he or she was as a child, and you may still be using childhood images that are outdated.

Why are sibling relationships important? Because all the siblings are the children of the care receiver. Your relationship with one another will affect the care that the parent will receive.

Recognizing feelings and understanding how relationships with siblings developed in childhood and over time can help siblings to negotiate the roles and responsibilities with aging parents.

When relating with siblings and other family members:

• Evaluate the needs of the family member
• Take the initiative to be part of decision making and to engage other siblings and other family members
• Communicate honestly. Stay away from statements that typically begin with “you” and sound like you are accusing someone of doing something wrong
“You are not being responsible!”
“You obviously don’t care about me or our parents!”
• Use “I” messages that are your own thoughts, opinions, and emotions and communicate them calmly

Family Conference

A family conference is a very important part of effective caregiving and can help deal with sibling conflicts.

• The family conference should include spouse, children, grandchildren, friends, neighbors involved.    (Be sure to include out-of-town relatives)
• Talk about the future including fears, potential problems, wishes, individual roles and legal issues
• Determine best fit, matching the skills and resources of each sibling
• Share resources and partnerships
• Engage other family members or people outside the family

The family conference can be an effective way for the primary caregiver to ask for help.   Use “I” statements when asking for help.  Here are some examples of “I” statements:

• I cannot manage this alone”
• I feel overwhelmed”
• I am concerned that Mom’s care requires more than I can provide myself”
• I feel that the responsibility for Mom’s care has been left to me and I don’t think that’s fair to either one of us”
• I do not mean to complain or criticize, and I very much appreciate you listening to me”
• I would like to let you know what I have found out about what they need and what we can do about it so far?”
• “I need you to call (Mom), (Dad), (other family member) at least once a month to help me out”

Resources for Caregivers
Call
• 2-1-1 throughout Texas. Provides information and access to health and human service information for all ages
• 1-800-252-9240 to find local Texas Area Agency on Aging
• 1-800-677-1116 – Elder Care Locator to find help throughout the U.S.

Online

• Benefits Check-up for an online way to determine benefits for which someone qualifies.

Assistance available through the Area Agency on Aging for caregivers:
   • Information and referral
• Caregiver education and training
• Caregiver respite
• Caregiver support coordination
• Case management
• Transportation assistance

Assistance available through the Area Agency on Aging for persons age 60 and older:
   • Benefits counseling
• Ombudsman – advocacy for those who live in nursing homes and assisted living facilities
• Home delivered meals
• Congregate meals
• Light housekeeping

Note:  Not all services are available in all counties. Call the Area Agency on Aging for information about a specific community.

Sources

Written by:  Zanda Hilger, M Ed, LPC, Family Caregiver Education, Area Agency on Aging, Revised,  2006.

Includes other materials written or adapted from:

• As People Grow Olderrevised by Jane Oderberg and Sue Smith, 1995
• AARP
• National Family Caregivers Association
• Various web sites
• Resources as cited in the presentation

Permission is granted to duplicate any and all parts of this program to use in education programs supporting family members caring for elders. This program is one module of a comprehensive caregiver education program provided by the area agency on aging.