Listen Between the Lines
The last human developmental stage compels elderly adults to work hard at maintaining control over their lives in the face of almost daily losses. A big part of the losses they experience involve their health and functioning, and the ways different patients cope with loss and the perceived stresses of healthcare have been analyzed and categorized.2-5
But in addition to loss of control, the elderly also face the daunting task of discovering what their legacy will be—what will live on after they die. “The way our elders communicate contains clues to the urgency they feel in trying to resolve these items on their agendas,” writes Solie. “In almost every conversation with older adults, control and legacy issues rise to the surface.”
Ask open-ended core questions to connect with what they might be thinking and feeling. Examples are those that may be related to healthcare issues or that will help elicit relatedness, which will then facilitate decision-making:1
- What was the world like when you grew up?
- In what ways are you like your mother?
- In what ways are you like your father?
- What was the most significant event of your childhood?
- What were your family’s greatest strengths?
- In what ways do [did] you and your spouse complement each other?
- What has been the happiest time of your life?
- What are you most thankful for?
Begin statements with “Tell me about … .”Remember that the loss of health can change everything, and the move from being young-old to old-old gives a new urgency to the life review. Listen for statements that reflect this, such as:
- “I guess that’s the last time I’ll be able to make that trip to the lake.”
You could respond: When did you make your first trip to the lake? Who were you with?
- “I am not sure how many more birthdays I’ll be around to celebrate.”
You could respond: What was your best birthday ever? Why?
- “I don’t want to be a burden on my son when I die.”
You could respond: My grandmother said the same thing to my mother. She was never a burden to my mother.
- “I hope you will remember our talks.”
You could respond: How would you like me to remember you?
All of these attempts to connect with a patient can pay off in huge personal and professional rewards. “My big thing when elderly patients are in the hospital,” says Dr. Green, “is really paying attention to some of the nonmedical things and using [them] as an opportunity to explore [their personal and home issues] or provide them with the help they need to be able to stay in their homes. It’s huge to be able to send someone home if you can.”—AS
A Matter of Loss
By the time a person is old (over 70) or old-old (over 85) their losses may have manifested in many areas: They’ve lost:
- Parents;
- Other relatives—perhaps including children;
- Friends;
- Places of residence (both homes and the familiarity of cities or towns);
- Possessions;
- Other relationships (sometimes other healthcare providers);
- Careers;
- Consultative authority (“ours is not a culture that values the wisdom of our elders,” writes Solie);
- Identity;
- Financial independence;
- Habits and pleasures;
- Physical space (the room at their son or daughter’s or in assisted living or the nursing home can’t compare to the homes, gardens, and expanses of view they may have had as younger people), and, of course; and
- Physical and mental capacities.
