Hard Questions Article from AARP Modern Maturity, by Terry D. Hargrave

 

My Mother, My Child

 

Robin was so busy caregiving she got her roles reversed. How do you look after an ailing parent without falling into the trap of treating her like a baby?

 

by Terry Hargrave, Ph.D.

 

ROBIN'S STORY Imagine how it feels to have your mother throw a hairbrush in your face. I know my mother, Maggie, has early Alzheimer's, but does she have to throw things? I'm honestly at the end of my rope. I've tried to make her life better and more comfortable, but everything I do is met with resistance. It's as if she's trying not to cooperate.

 

After she was diagnosed, I brought Mom to my home from Arkansas, where she'd lived most of her life. I'm 60, the eldest in the family; my two younger brothers live far away, and my sister is still raising her children. My husband and 1 thought we were at the point where our lives would be slowing down. Our

 

children are grown and we have two grandchildren. But just about the time we started having more freedom, my mother needed me.

 

Here's the frustrating part: Much of the time my mother is reasonable and takes care of her basic needs. But when I get involved and try to help, she shuts down and doesn't do anything for herself. If I set her clothes out, I then have to tell her to get dressed. If I try to rein her in at dinner, she pays no attention at all to table manners. As for conversation, forget it. We have none. It feels like I'm raising another child, with none of the hope that the child will become independent.

 

I know that I am capable of handling the caregiving, but it would be nice to be appreciated. My mother is at the point of becoming violent, and I want to know if it is time to put her in a care facility. Right now I feel like the sooner I move her the better.

 

MAGGIE'S STORY My memory is terrible. That was my greatest fear in getting older. That my mind would go. I have this thing that makes your memory bad. I had to leave my home and my husband in Fayetteville. You know, the University of Arkansas is there. My husband worked there fixing things for years until he retired. [Later, she recalled that he had died a few years ago.]

 

Wonderful Robin moved me here to her house. She is so good about taking care of me, and she has a wonderful family. She gets mad at me a lot. She tells me what to do all the time. I know she is busy. I just wish she would not get so mad at me. I just want to do what I want to do. I'm 84. At my age I think you should be able to do what you want.

 

DR. HARGRAVE'S VIEW Robin and Maggie came to see me because Robin wanted to find out if it was time to move her mother. I felt it was important first to address how they could improve their relationship. Although Alzheimer's disease can cause severe changes in personality, including violent outbursts, often the anger results when the older person feels she is being emotion ally mistreated. I felt it was worth a try to consider this.

 

At the start, I reaffirmed Robin's caregiving efforts. "I see you are doing a good job of

caring for your mother, I said. "She not only looks good, she says you do a good job."

 

Robin said, "Thanks, but it feels like I am always running uphill. "

 

How did she come to be sole caregiver? "There wasn't any conversation among us children," she told me. "I was the eldest, I saw her most, so I got the job with no election."

 

Although Robin was clearly good at mothering, caring for a parent is very different from caring for a child, something I explained to her this way: "Although you may do many of the same things for your mother that you did for your children, your mother is an emotional adult. She is the one who taught you about growing up and how to think about the world. You may have to feed and clothe her physically, but emotionally she is still your mother."

 

Robin's response was to focus on her mother's erratic behavior. "She's so uncooperative. She threw a hairbrush at me. She acts like a child."

"Her behavior," I said, "may be inappropriate, but it may be because she is frustrated with your treating her as if she were a little child. You are very focused on what needs to be done, while your mother may want you to slow down and listen. "

 

I taught Robin a technique called reminiscing, a form of communication that helps people connect. Younger and middle‑aged people often focus on what needs to happen next while older people, especially those who have suffered a serious illness, tend to be more reflective. This frustrates both parties and can lead younger people to view older people as children. But no matter what the infirmities, treating him or her like a child is insulting. Reminiscing, rather than always being goaloriented, can help build connections around key events that both generations know about. Here's how it works.

 

Me: "You told me that you lived close to the University of Arkansas?"

 

Maggie: "Yes, my husband was a handyman there." ‑

 

Me: "I have lived in college towns before. It can be exciting with all those young people around."

 

Maggie (lighting up): "Yes, we all used to go see the football games. Nobody played football like those Hogs! "

 

Robin laughed out loud and added, "I remember some of our best and worst times were when the Razorbacks won or lost. Daddy was such a fan."

 

Maggie: "He loved that school, even though he never went there."

 

This simple looking back led Robin and Maggie into a conversation about "a good husband" and "a good father" and how they both missed him. At one point, Maggie slid her hand into her daughter's, saying, "Well, I guess you and I are what we have now."

 

Robin came to realize that the pressures of caregiving had caused her to press too hard to get things done in a hurry. In turn, this likely frustrated her mother at a level that she could not verbalize, and so she wound up expressing herself with a hairbrush.

 

Robin was eager to make changes. She sought ways to connect with her mother, like sharing old photos. Her siblings agreed to rotate weekend care, each coming to help four times a year. An adult daycare program gave her three mornings a week to herself. Finally, she took up some new interests in life.

 

Robin and Maggie continued to sharpen their reminiscing skills. Robin learned how to keep the storytelling from becoming repetitive, and picked out two personal events each week that helped bring back old times. Maggie had no more violent outbursts, but the disease continued to progress and 18 months later she moved into a facility that had an Alzheimer's unit. But in those months, Robin had learned to connect with her mother emotionally as an adult. "This year and a half has been so hard," says Robin. "But I can honestly say that my mother and I have had some of the most tender times of our lives."

 

Terry Hargrave, Ph.D., is a family therapist in Amarillo, Texas. He specializes in intergenerational issues.

 

Connections

 

Caregiving can be an exhaust­ing job that can crowd out emotional intimacy with oth­ers. Here are some reminders to help you stay connected:

 

Don't forget who the person used to be

All adults react negatively when they are spoken to or treated like children. Always respect emotional adulthood even when mental deterioration is advanced.

 

Remember together

Look for topics of mutual interest. Don't avoid talking about events of the past, both good and bad.

 

Don't wear yourself out

Frustration and burnout of caregivers is a major contribu­tor to all sorts of family prob­lems, like elder abuse, divorce, and sibling cutoffs. Explore and get involved in things that restore your own energy.

 

Where to turn?

Your local Area Agency on Aging can link you with resources. Also, try the Alzheimer's Association at 800‑272‑3900, www.alz.org; and the Alzheimer's Disease Education and Referral Center (ADEAR) at 800‑438‑4380, www.alzheimers.org.