Facing change together

Information for families talking together about changing needs.

Issues relating to the final stage of life are common to everyone, but talking about them is often avoided. We discuss ways to undertake these important discussions.

Whether you're an older person wanting to lead this discussion with your family, or a family member needing to raise issues, effective communication is the key.

It’s impossible to solve other people’s problems for them, but you can explore difficult areas and sort out their feelings, so that they are better able to make decisions that are right for them. 

Key issues

Some of the important issues of ageing that families need to talk about relate to:

• Housing – looking at options for smaller, more manageable accommodation, retirement village or residential care.
• Increasing dependency – becoming dependent on others for help with daily living; finding what services are available and the cost; clarifying expectations of/by family members for help; considering transport needs when driving is no longer possible; recognition of interdependence – we all need help at some time.
• Finances – planning how to best manage or dispose of property and assets; making a Will and an Enduring Power of Attorney to help avoid financial abuse; budgeting income.
• Illness and dying – recognising symptoms of depression and seeking help; thinking about who will provide assistance in the event of an illness, stroke or dementia; accepting the reality of death; deciding on funeral arrangements and respecting wishes.

Older people have the right to Independence, Participation, Care, Self-fulfilment and Dignity – United Nations Principles for Older Persons.

How to approach the issue

• Regard talking about the future as a normal process.
• Broach subjects before the time becomes critical – perhaps on several occasions.
• Decide what facts you will need to know.
• Consider how best to present them – there may need to be time for adjustment.
• Convey concern and care.
• Plan the follow-up action – allow for a 'change of heart'.

Why talk?

Talking with older family members:

• Helps them to identify what they need/want.
• Leads to a better understanding of the present, sorting out of the past and deciding on options for the future.
• Can decrease guilt and a sense of burden about obligations to older relatives.
• Means parents are treated as adults, even though they may require nurture, support and help to enable them to cope and adapt to losses.
• Helps decision-making through clarification.

Effective communication

An attitude of acceptance, respect, and a desire to help is essential. Equally important is how you respond to the words and feelings of the older person. Your understanding can enable them to work through their issues and help them make their decisions. Communication will only be effective if undertaken at the right time, in the right environment and in the right manner.

Feelings

Feelings are internal reactions. We can not always know what people are feeling by their actions or expressions. Everyone is entitled to their own feelings and it is important that they are respected. Sometimes feelings are not conveyed directly. If you are uncertain how the person you are talking to feels:

• Describe what you think the feelings are.
• Check with them whether that is accurate.
• Refrain from expressing approval/disapproval of their feelings.

Listening

Active listening can establish a good atmosphere for real sharing to take place where needs and fears can be expressed.

• Show you are willing to give time and be attentive.
• Be comfortable with silence.
• Encourage expression of feelings.
• Clarify anything you're not certain about.
• New ideas need thinking time, without pressure to respect immediately.

Non-verbal behaviours

We convey our attitudes in many ways. Nov-verbal behaviours include dress, posture, facial expression, eye contact or avoidance, tone of voice, rate of speech, distance from the other person, touch, tension. Our unspoken messages may reinforce or contradict the words we use.

• Make verbal and non-verbal messages consistent.
• Be aware of changes in your voice.
• Maintain a reasonable amount of eye contact, especially when the other person is talking.
• Sometimes difficult things are easier to say if you're side by side looking at something else. You might want to make contact by sitting close, or by touching their hand.

Helpful hints

Even in late old age most people remain capable of knowing what is right for them and resist being told what to do. A positive and open attitude is helps when talking or trying to find solutions to problems.

Clearing the messages

• Be direct and build on the other's comments.
• Own your own messages. Make "I" statements not "you" statements.
• Make messages complete and specific, in simple stages.
• Check whether you're saying what you want to say.
• Get feedback about how messages are received.
• Make verbal and non-verbal messages consistent.
• Repeat messages more than once in different ways.
• Check whether you're hearing what is really being said.

Keeping it cool

• Involve your older relative in discussions – don't take over.
• Describe your reactions as they occur.
• Avoid arguments and being on the defensive – be prepared to listen.
• Describe the other person's behaviour without judging it.
• Offer reassurance where appropriate.
• Share feelings.
• Be aware of the power of non-verbal messages, e.g. facial expressions, posture, voice tone, eye contact, silence, touch.
• Allow time to work through each issue or schedule another date for a particular subject.

Talking openly and honestly about the realities of the future means that everyone's needs can be taken into account and the outcome is more likely to be successful.

These conversations are often important ones to have and you may need to think about timing – try to choose a time when you are both relaxed. If you find the conversation upsetting, there is a good chance the other person may be feeling the same way. It's okay for both of you to feel emotional and it's also reasonable to expect you may find it hard to talk about a loved one's ageing or dying. Acknowledging that to each other can make the rest of your conversation easier.

Cultural differences

Many families today are made up of people from different ethnic backgrounds and religious beliefs. Discussing and respecting different customs, views and beliefs is important as it can help overcome problems, promote understanding and lead to positive and enriching experiences for all family members.

Useful suggestions

Ensure older family members have an opportunity to share aspects of their culture and life experiences
Ensure all family members talk about the features of differing cultures
Encourage family members to learn the language and customs of their cultural backgrounds

Rights of older people

Older people have the right to self-determination and self-fulfilment.

Older people have the right:

• to be treated fairly, live in dignity and security and be valued for themselves.
• to make decisions about their care and quality of life.
• to refuse assistance.

They need access to information about:

• Health care – to maintain physical, mental and emotional well-being.
• Social, financial and legal services – to remain autonomous and independent.
• Home support services, retirement villages, residential care – to be able to make appropriate accommodation choices.

Remember

• Try to talk through the issues together for the best outcome
• Not all situations can be resolved – be aware your solution may not be their solution
• Families sometimes find it difficult to work through issues – an outsider may be able to help.

Resources

Age Concern New Zealand thanks the Ministry of Health for supporting this project.