Individuals who resist care and assistance are trying to communicate to you. If dementia, stroke, vision loss, hearing loss or other illness limits one's ability to speak and convey information effectively, body language and physical actions take on a greater role in communication. Refusal to accept care, physical contact or participation in an activity is the individual's way of telling you something.
When your loved one resists care, step back calmly and think:
Are there any environmental factors such as lighting, shadows, noise, commotion or other external influences that are causing the problem now? (Before you say something, think about what you are going to say. Check your emotions and frustration before you speak. Your increased frustration can contribute to your loved one's agitation. (Put yourself in her shoes. Use your knowledge of her personal background to pinpoint patterns and reasons for her reaction. (Is this confrontation worth escalating?
Choose your battles wisely. A head-to-toe bath is not necessary every day or even more than once each week. Similarly, clothes do not have to be changed every day if they are not soiled. (Refusal to accept care or engage in once-pleasurable activities is a sign that something is amiss. The caregiver can assess the situation for specific complicating factor and make adjustments if necessary: (Refusal to get out of bed: illness - Assess physical factors such as injury from a fall, bruises, temperature/fever, urinary tract infection, or oral infection.
Keep a thermometer handy and know how to use it. Make a point every day or so of inspecting skin for dryness, sores or bruises. Catching skin or mouth sores early on will limit long-term damage and illness. (Refusal to join family or participate in even small activities: environmental - Assess for too much noise, harsh lighting, or specific individuals who cause distress. Correct these distractions and integrate positive factors such as music, aroma, comfortable fabrics and warmer room temperatures.
Refusal to perform tasks and activities: depression - The inability to fully perform tasks for oneself can cause an individual to avoid those situations. Assist them as much as possible while encouraging them to do as much for themselves without embarrassment. This is time-consuming, but it is the best route for enhancing self-esteem and independence. (Refusal to take medication: physical side effects - Sometimes side effects result from medication that are unbearable to the recipient. Learn what possible side effects can occur from the drugs your loved one takes. Consult with the doctor to see if over-the-counter anti-nausea, anti-diarrhea, or anti-dizziness products can be taken with prescription medications.
Perhaps the medication can be taken at bedtime or mealtime to reduce side effects. When administering the medication, tell your loved one how it will help them and use distraction if side effects occur. (Refusal to bathe or change clothes: embarrassment - Limit other people's presence (even their voices), approach in a non-threatening way, undress/bathe one area at a time and keep the rest covered, speak calmly and tell your loved one what you are doing each step of the process. Talk about pleasant memories and stories as you are bathing/dressing. (Refusal to eat or clean teeth: illness, incapacity - Oral hygiene is essential for elderly persons since poor hygiene can make eating painful and compromise nutrition.
Don't let oral health get to a point where it is a problem. The sense of taste declines with age, so make efforts to improve the flavor of food, make it appear appetizing, and ensure that portions are of the right size and consistency. You may need to provide pre-cut portions or thickened liquids. See if better shaped utensils and plates help your loved one feed herself. (You may have to use your own creative ideas to get around resistance. One caregiver's mother often refused to settle down for dinner. So the caregiver helped her mother get dressed up a bit with a nice sweater, a brooch and her purse. The two dined out on the patio without incident.
If your loved one still resists care even after adjusting for other factors, remember that confronting your loved one at that time of heightened emotions may make both of you more agitated.
When your loved one resists care, step back calmly and think:
Are there any environmental factors such as lighting, shadows, noise, commotion or other external influences that are causing the problem now? (Before you say something, think about what you are going to say. Check your emotions and frustration before you speak. Your increased frustration can contribute to your loved one's agitation. (Put yourself in her shoes. Use your knowledge of her personal background to pinpoint patterns and reasons for her reaction. (Is this confrontation worth escalating?
Choose your battles wisely. A head-to-toe bath is not necessary every day or even more than once each week. Similarly, clothes do not have to be changed every day if they are not soiled. (Refusal to accept care or engage in once-pleasurable activities is a sign that something is amiss. The caregiver can assess the situation for specific complicating factor and make adjustments if necessary: (Refusal to get out of bed: illness - Assess physical factors such as injury from a fall, bruises, temperature/fever, urinary tract infection, or oral infection.
Keep a thermometer handy and know how to use it. Make a point every day or so of inspecting skin for dryness, sores or bruises. Catching skin or mouth sores early on will limit long-term damage and illness. (Refusal to join family or participate in even small activities: environmental - Assess for too much noise, harsh lighting, or specific individuals who cause distress. Correct these distractions and integrate positive factors such as music, aroma, comfortable fabrics and warmer room temperatures.
Refusal to perform tasks and activities: depression - The inability to fully perform tasks for oneself can cause an individual to avoid those situations. Assist them as much as possible while encouraging them to do as much for themselves without embarrassment. This is time-consuming, but it is the best route for enhancing self-esteem and independence. (Refusal to take medication: physical side effects - Sometimes side effects result from medication that are unbearable to the recipient. Learn what possible side effects can occur from the drugs your loved one takes. Consult with the doctor to see if over-the-counter anti-nausea, anti-diarrhea, or anti-dizziness products can be taken with prescription medications.
Perhaps the medication can be taken at bedtime or mealtime to reduce side effects. When administering the medication, tell your loved one how it will help them and use distraction if side effects occur. (Refusal to bathe or change clothes: embarrassment - Limit other people's presence (even their voices), approach in a non-threatening way, undress/bathe one area at a time and keep the rest covered, speak calmly and tell your loved one what you are doing each step of the process. Talk about pleasant memories and stories as you are bathing/dressing. (Refusal to eat or clean teeth: illness, incapacity - Oral hygiene is essential for elderly persons since poor hygiene can make eating painful and compromise nutrition.
Don't let oral health get to a point where it is a problem. The sense of taste declines with age, so make efforts to improve the flavor of food, make it appear appetizing, and ensure that portions are of the right size and consistency. You may need to provide pre-cut portions or thickened liquids. See if better shaped utensils and plates help your loved one feed herself. (You may have to use your own creative ideas to get around resistance. One caregiver's mother often refused to settle down for dinner. So the caregiver helped her mother get dressed up a bit with a nice sweater, a brooch and her purse. The two dined out on the patio without incident.
If your loved one still resists care even after adjusting for other factors, remember that confronting your loved one at that time of heightened emotions may make both of you more agitated.
Excellent advice. Another psychological impact of a senior refusing care is the stress and frustration it causes on the child. Children need to be careful to watch that their own families and mental health are not negatively impacted as mom and dad get older and near the end.
Keep up the good work!
Rick Bryan
New York, NY
Posted by: Rick Bryan | Wednesday, April 29, 2009 at 08:35 AM