Coping With the Unprecedented Challenges of Taking Care of Aging Parents

As the population ages and develops disabilities, many of us will be challenged to assume some caregiving responsibilities. It’s estimated that by mid-century, approximately 73 million Americans, or 1 in 5 people, will be over the age of 65.

Most of us are born assuming that our parents will always be healthy, strong, and eternal. As we grow up and they age, their hearing wanes, their gait slows, their memory dims, and this may trigger feelings of anger, anxiety, fear, frustration, and grief in adult children.

“Many people struggle as they witness the age-related decline in their parents' mental and physical abilities”, says Laura Carstensen, professor of psychology at Stanford University. It's a stressful transition: we worry about how fast the decline will accelerate, how financially sound they are and what their future living situation will be. 

Role reversal can challenge family dynamics that are complicated by negative stereotypes about aging. The perception that aging must be resisted or denied can further strain parent/adult-child relationships, where parents deny any signs of physical or mental limitations. 

The challenges of supporting an aging parent

The deterioration of an aging parent's health status is often the result of a progressive and chronic worsening interspersed with acute episodes of decline that preclude any prospect of a return to previous levels of functioning. Typically, it is a benign incident, such as a fall due to reduced mobility or cognitive impairment, or an infectious episode, such as Covid, that triggers the downward spiral. My aging mother-in-law (age 90) is a good example of how complex things can quickly become.

After contracting Covid last summer, she lost her vivacity and mental acuity, giving way to increased cognitive impairment and short-term memory deficits. This episode also led to the onset of delusional thoughts, including allegations of theft by other residents of the nursing home. The imaginary thefts involved everything from toothbrush and toothpaste to the TV remote control and worn-out shoes. Now, every time she leaves her room, she takes all these items with her on her walker. Naturally, she loses some of them along the way and then claims that she has been robbed. She becomes very defensive, agitated, and angry when we try to convince her otherwise. It's hard to deal with role reversal when the roles aren't completely reversed. As adults, are we really on equal footing with our parents?

Meanwhile, the quality of the relationship deteriorates as the cognitive dysfunction worsens. We don't seek to correct her recollections, but in doing so, we create two different worlds – our world and hers – and so we have less of a relationship. 

Another tricky issue is compliance. We try to help her by offering ideas and advice. Most of the time she seems to listen but then just goes about things the same way as before… and shuts down. So, we let go of unrealistic expectations, which defuses the conflict.

These realities underscore the challenge of providing healthcare and support to the elderly. Part of the challenge is medical: it is sometimes difficult to know what is medically "right" in patients who are often polymedicated, where it can be difficult to find the right balance between efficacy and side-effects. Another part of the challenge is to help in a way that respects the wishes and preferences of the senior.

Competing demands for care and other time constraints

On top of the natural stress of caring for an elderly parent, come the simultaneous demands of family responsibilities and work obligations. According to the Pew Research Center, almost half of adults in their 40s and 50s have a parent aged 65 or older AND are either raising a young child or financially supporting a child aged 18 or older. About 1 in 7 adults are part of the "sandwich generation”: that is, people simultaneously caring for their children and aging parents. The relentless financial and emotional stress of this dual caregiving can be overwhelming.

Suggested courses of action

Taking care of elderly parents can be emotionally and financially challenging even under the best of circumstances, especially if relationships are stuck in unresolved parent-child dynamics.

· There is one golden rule for dealing with role reversal, according to caregiving experts: “Never do something for someone that he can do and should be doing for himself”. Many times, we step in out of a desire to help. But really a person remains stronger if we allow them to do as much as they can on their own. When they can’t, we may step in, or ask or pay others to help.

· Establish a partnership with the aging parent from the outset. Except for severe mental impairment, it is important to establish a peer or same-adult-level relationship. Adult children are not meant to be "parents", but to help parents cope with age-related challenges. Parents should not become dependent but rather take responsibility for themselves while knowing when to ask for help. 

· Set healthy boundaries and build a relationship based on mutual respect. Define early on the extent of your involvement and be willing to say "no" to preserve your priorities. Be clear about what you can and cannot deliver; this is especially important to avoid guilt once they are gone. Taking a step back helps to set boundaries and avoid engaging in an unhealthy stressful relationship with your aging parents.

· Honoring an older person’s autonomy and independence can be tricky, especially when health crises or declines develop. No matter of how tricky this is, this should always remain the default position.

· Helping plan ahead regarding care and preferences can be difficult. Whenever possible, options should be discussed ahead of time : what are their preferences if the situation deteriorates, …

· Finally, this is their final journey. As a caregiver, you will likely experience difficult emotions of loss and grief, as well as anxiety and sadness, but also love. This journey will be emotionally challenging, but it will also be an opportunity to resolve differences, forgive grudges and say goodbye while moving toward acceptance and healing.

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