Aging Matters:Dealing with a difficult elderly person: to intervene or not to intervene?

This month’s column arises from a friend’s troubles dealing with her mother, who lives in California, has mounting challenges, and is very resistant to any help. The trouble recently became clear when the mother (I’ll call her Fran) reported, about a week after the fact, that she’d had a black-out incident that led to finding herself in an unknown neighborhood with her car dented.

Fran’s daughter went to offer help but Fran refused all support. Fran later got a diagnosis via MRI that her brain is experiencing deterioration that would explain lapses of memory and judgment. Fran is isolating herself from friends and family that have constituted her support system and is in denial about her condition.

You may have seen this problem first-hand or heard similar stories. Some guidelines for decision-making are clearly laid out by Grace Lebow and Barbara Kane in “Coping with Your Difficult Older Parent.”

First, you have to evaluate the level of risk to your parent and to others.

Second, if the level of risk is unacceptable, you must try to get the cooperation of friends, family, and outsiders.

Finally, if all else fails, you can enlist the help of Adult Protective Services.

Lebow and Kane emphasize that protective services staff do not strong-arm older adults into institutions. Their general principles include:

The client’s right to self-determination. Competent adults are entitled to decide where and how they live.

The use of the least restrictive alternative in treatment and placement.

The use of community-based services rather than institutionalization, wherever possible.

My friend is aware that in both California and Washington, asking a physician to contact the Department of Motor Vehicles is an option. The physician can initiate a licensing exam directly. For Fran’s sake and the safety of others, that could be the most urgently needed step.

More subtle steps are helpfully suggested by Lebow and Kane, involving showing empathy rather than anger in conversations with the older person. These patterns are hard to re-establish but can make a difference, whether the difficult behaviors are new or longstanding. But if risk to self and others is likely, protective services can be engaged by calling the national Eldercare Locator line at (800) 677-1116.