Early in my career working with older adults, it was my strong belief that if a person needed help, and we were able to offer it, it should be provided.
However, several times our efforts were not met with acceptance. There was the senior who refused home delivered meals even though, after his hospitalization, he was unable to shop and cook for himself. And the single woman with a recent dementia diagnosis who did not want to share it with anyone. And the gentleman who had fallen many times and had been hospitalized for his injuries, refusing to use a walker.
Discussing the benefits of our suggestions did not convince them.
We asked probing questions to understand their reluctance to accept help. Each of them expressed deeply held worries.
The gentleman who refused home delivered meals was adamant he would not accept charity. The woman with the dementia diagnosis insisted she did not want to be a burden to her friends. And the gentleman who was constantly falling felt he could not get over the stigma of using a walker.
I asked myself, what happens if we don’t help? The concept of self-determination turned out to be a huge learning experience for me – the understanding that we need to acknowledge their decisions and not force our choice on them.
I discovered that there is a principle called the dignity of risk. Society has created structures and supports that in some cases can lead to the overprotection of older adults. Though well meaning, these supports can sometimes have the result of infringing upon the independence and dignity of an individual.
Dignity of risk states that it is a person’s right to make their own choices and decisions, even when those decisions could put them in harm’s way. It is another way of saying you have the right to live the life you choose, even if your choices involve some risk.
In each case, while honoring their choices, we attempted to develop an alternate plan that helped address their dilemmas.
For the homebound gentleman, we set up a profile on a grocery shopping app where he could order ready to eat meals.
For the woman with dementia, our care manager, for the time being, offered to be a resource for the woman that she could call upon when she had questions or concerns. When dementia is involved, it does not automatically mean the individual cannot make decisions, but we want to put in place a safety net to help when the time does come that she is unable to care for herself.
And for the gentleman with the balance issues, we provided grab bars and other home modifications to make it safer for him to get around in his own home. We encouraged him to use a shopping cart in the parking lot and stores whenever he went out. Lastly, we suggested a Life Alert® system, so that if he did fall, he could easily call for help.
In each case, those were acceptable solutions for the individuals that honored their personal choices and independence.
I recently went to visit my now 89-year-old mom, who is generally doing well.
During our outings, I watched her struggle with her heavy purse trying to place it around her neck and shoulder. I asked her a couple of times if I could go through her purse with her to see if there were things that she could leave in the car or at home to ease her burden.
I could tell she was reluctant. When she insisted on paying for dinner one night, I bargained with her that if she let me go through her purse, she could pay.
The next day, I realized that just was not the right approach and that I needed to allow her the freedom to carry around a heavy purse if she wanted to. Even seasoned senior providers need a reminder every now and again.
In interactions with older adults, put yourself in their shoes. Our loved ones with aging needs deserve resolutions to their challenges that honor their personal choices, dignity, and independence.
