My mother had a complicated relationship with her walker. She grudgingly admitted that its hand grips and sturdy frame helped her walk more steadily. But using it clashed with her self-identity as still youthful and vibrant. She frequently “forgot” it as she moved around her apartment as if she were willing to lose her balance rather than lose her sense of self.
She fell once or twice a month. I caught her several times as she was reeling backwards. One day, I used my key to let myself into her apartment and found her sprawled on the living room carpet, unable to get up. Her walker was in the kitchen. She tried making a joke of it, but I was upset that she could have landed hard and been seriously hurt. I pleaded with her to use the walker. She complained I was hassling her.
Thus, a line between us was drawn: I wanted to keep her safe; she wanted to maintain her dignity. I thought I was responsible for protecting her from harm. She thought her life was her responsibility. I said worrying about her affected my life. She frowned and stayed silent.
Many caregivers struggle to find the right balance between preserving their loved one's safety and dignity. Some err on the side of safety, taking over finances and chores for a parent who may not need such help. They mean well but sometimes cross boundaries of good sense and even respect. Others err on the side of dignity, offering a parent no assistance for fear of offending her. As pleasing as this approach may be to a proudly independent parent, the kids will later kick themselves if she trips down a flight of steps or has a serious car accident.
These are difficult determinations made in the face of a parent's changing condition and needs. What was once safe — for instance, operating a lawn mower or cleaning out rain gutters — may become dangerous. How can caregivers find the right balance between safety and dignity that's timely and appropriate? Here are some ideas.
Talk about change
No older adult enjoys talking about changes they may be undergoing. But change happens anyway, from diminishing senses to slowing reflexes to decreasing concentration. We adapt by getting glasses and hearing aids, driving more slowly, and double-checking that we've balanced the checkbook correctly. Adult children should talk with their parents about these changes ("Do you really want to continue living in a multilevel house where you have to climb stairs?") and offer their help as one more adaptation for their parents to accept to live as well as possible.
Put safety first
There are everyday activities which, if mishandled, could be a risk to our parents’ or others’ safety — for instance, driving, using the stove, and taking multiple medications. If there are concerns about how well those are being managed, then caregivers should never hold back on taking what steps they can to ensure greater safety. When in doubt or in conflict with the parent ("How dare you question my driving!"), resort to asking her doctors for objective clinical assessments. This isn't about trying to take over; it's demonstrating love.
Never sacrifice dignity
Any activity for which safety is not at risk should be left to the parent's discretion. If she can climb the stairs, then leave her be in her cherished three-story home. If she can drive at night, then don't press her to accept a ride. Keeping parents safe is not always the same as keeping them well. The latter includes encouraging them to be as active, engaged and in control of their lives as possible. Increasing self-esteem fosters health and happiness, too.
A new normal
Ideally, a parent doesn't try to preserve her dignity through rejecting safety precautions and her children's pleas. She decides that taking the lead on being safe is the best way to live with as much independence and dignity as she can.
That's what happened with my mom and her walker. She never liked its clunky look or awkward maneuvering in tight spaces. She also hated when she thought younger people regarded her as a little old lady whenever she used it. But after many falls, lots of black-and-blue marks and a broken tailbone, she decided it was right for her. Between its aluminum handle bars, my mother learned to stand tall with head high — a different image of herself than she once held, but dignified, nonetheless.
Barry J. Jacobs, a clinical psychologist, family therapist and healthcare consultant, is the co-author of Love and Meaning After 50: The 10 Challenges to Great Relationships — and How to Overcome Them and AARP Meditations for Caregivers (Da Capo, 2016). Follow him on Twitter and Facebook.