How do we validate concerns and keep our sanity?
I have been reading a bit about the importance of validating concerns. I know I am terribly guilty of ignoring and minimizing my mother's concerns. I know I'm not really to blame, because I've been hearing the same type things every day for many years now. I've gotten immune. But I started to wonder if all the complaints may be a search for validation and knowing that somebody cares. And I wondered if ignoring and minimizing may be shortchanging her and keeping her reaching for validation. Maybe she needs to know that someone cares.
But then I wonder if she needs so much validation that it would drive me crazy, since there is no one else to help. She has two friends, but she avoids them for some reason. Strange, because when she is with them she really enjoys herself. It picks her up for a short while.
I thought that I really do need to be more validating to her concerns. She is old and facing death within the next few years. But then I also know that she is a deep well of need and is a bit of a drama queen. I might get totally engulfed if I become too validating.
How do we keep a balance when someone is such a deep well of need and there's no one else around?
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"Oh Mom, it certainly must be very annoying to you to repeatedly find problems with the floor. I certainly wish we could fix it once an for all so you could relax a little. You deserve some peace in your retirement."
"I can understand why you'd like to be waited on more. You worked hard all your life, you have health issues, and you deserve some pampering. I want you to be able to continue walking on your own, and the doctor says getting up to get your own drinks and magazines and such will help you do that."
Good luck!
horselady and babalou, I've been on the group so long I have a bad habit of assuming that everyone knows my mother by now. I forget that I am just one of many. My mother is sick with something abstract almost every day. She wants to go to the doctor a lot. For two years I was going crazy, taking her to doctors 2 or 3 times a week sometimes. I stopped doing that, but at the same time I started ignoring and minimizing her concerns about her maladies. I know that neither extreme is good.
Then there is the house on stilts/floor issue that Jeanne talked about. And there is the moss growing in the yard problem in her mind. She's called our yardman to destroy it again this week. She zeros in on something, obsesses on it, and can't let it go. I've not been very effective in handling her concerns, since she doesn't pay any attention to things I say.
But maybe if I could find a way to validate her concerns in a way that doesn't drive me crazy. I could validate by taking her to the doctor every couple of days and getting out and chopping that poor moss to pieces. That sounds like I would just end up in an early grave. We've tried a couple of antidepressants because of some other issues. The one that had an effect put her into hypomania and extreme obsessive behavior. That scared me away from further testing of antidepressants. It was like it uncovered a hidden bipolar side of her.
I was interested in learning how other people validated their parents' concerns without running themselves ragged. I think Jeanne had some very good words if I rearrange them and make them sound more like me. My mother would faint if I ever sounded as nice as Jeanne. :)
Okay, so, is it possible that your mom actually IS bipolar? That would explain the drama queen stuff. Are you working with a geriatric psychiatrist? Your mom's obsessions are very real to her, but I've never found validation made them go away. The only thing that laid my mom's obsessive worries to (sort of)rest was a combo of antianxiety and antidepressant meds.
You may want to do some online research about validation therapy which was developed for communicating with people with dementia.
Do you think your mother just wants attention, sympathy or does she really believe that specific maladies exist? Have you ever tried playing her game, such as asking her every hour how she feels, where she hurts? She might get annoyed if you turn the tables on her and emphasize the issues she raises, but beat her to it. She might even stop the drama.
I think her needs turn on why she does the things she does, i.e., whether she's manipulative and wants attention, or whether she really believes they're real.
Perhaps there's a way to validate her concerns without following up with action, but I'm not really sure how you'd do it. For the moss, maybe you could just agree with her, make plans to do it after checking the weather forecast for rain, getting ready to go outside on the appointed day, then pretending sympathy when thunder and drizzling rain begin. Then reset the next time for another rainy day.
I'm thinking that if you can neutralize the issue by agreeing to take care of it for her, but creating a built-in reason to avoid having to do it, then you're validating her concerns but not really implementing remedies.
One of the things I had to learn to do was not to challenge the ability to do things that are dangerous. It most certainly wasn't easy. But eventually just discussing the plans worked, and the event never happened. I sleep a lot easier now....generally.
Besides moving the beds, which you know is a huge task, we would have to buy new mattresses for the old, old single bed. They must be 50 years old and look even worse. She said that would be okay. So I asked her if she wanted to spend a few hundred dollars and do a lot of work just to use some sheets. She said yes and went into how unhappy she was with all the things of the big bed. (Sigh) Everything culminated somehow with it being my fault and this being her house to do what she wanted.
I talked to her about assisted living and how she could set things up like she wanted there and that she could sell the house.The house is supposed to go to me in the will, but I'm willing to let it go if she is willing to move. She may have to go into a NH.
So Validation Day 1 was a bust. I don't think there is anything that can make her happy unless she finds it inside herself someway. That's not likely to happen.
Wish I could offer some helpful suggestions, other than just getting out for some fresh air.
Sometimes I wonder where older folks get these ideas from.
It's my sig other who constantly wants validation and he doesn't need caring, he's a grown adult who works full time and can do things for himself. In the past I was interested in his health until I saw how he related to my major health issues... he wasn't caring, he was angry... so now I tune him out whenever he says his back hurts, etc. He had a doctor's appointment today and heaven forbid if I don't ask him how it went... he will whine and get in a snit.
JessieBelle, the only other strategy is to make attention non-contigent on health complaints to whatever degree you can - in other words, provide as much inquiry about how are you feeling, what's going well today, etc. as you can without her having to mention being ill or having symptoms. Really reinforce anything positive she might say. Do NOT go to the doctor every few days, but if you can get some reasonable frequency of pre-scheduled visits (again, non-contingent on having complaints) going it may help (most providers don't want to do these kind of reassurance visits that often though). This approach is tricky and the easy problems have been solved already. And, you are NOT obligated to expend all your time and energy pursuing resolution of fruitless and pointless and endless concerns.
You are a caring, compassionate, sensible, no-nonsense person (at least by what you present here.) You can do a lot to help mom deal with her cognitive losses, but you cannot cure her dementia. You cannot restore her to reasonableness. This is (repeat with me) Not Your Fault.
So, do what you can. Kudos to you for looking up other approaches. Don't give up on validation but don't expect it to work miracles, and do know you'll have to adapt it to your situation. You are a good person and a good caregiver. The situation is Not Your Fault.
I like vstefans idea of pre-scheduled clinic visits. Coy's geriatrician wanted to see him every three months. (He had a number of health issues in addition to dementia.) Between visits I could call with concerns and she would generally prescribe or give advice without my bringing him in. This was really a useful arrangement. I could validate Coy's concern without taking him to a doctor. "Yes, dear, I understand that ankle hurts and I'm very sorry it does. The last time Dr. April looked at it she said it was arthritis and the best thing you could do for it was pain meds when it flared up. I'll start you back on the pills today. Then we see Dr. April in 2 weeks and she can look at it again. Would a root beer float help take your mind off your pain?" (Acknowledge the complaint. Sympathize. Suggest a solution and sympathize that there isn't a better one. Distract.)
While you are in a mood to look into different approaches, I'm going to suggest a book you've probably seen me recommend often. "Loving Someone Who Has Dementia" by Pauline Boss, PhD. I heard her speak and immediately bought this book. One of her chapters is devoted to "Good-Enough." We strive for perfection, and in its absence at least a continual improvement. But with dementia it is unrealistic to expect improvement. The disease itself is getting worse, so if we can just hold our own or not slip back too far that is a huge accomplishment in itself. You will never achieve a perfect relationship with your mother, even a "very good" relationship may be unrealistic. So go for "good enough." If you read the book, I'd like to hear your thoughts on it.
(And this whole mess is Not Your Fault.)
My mother sees a geriatric specialist every 4 months. We set up the next appointment when we leave. The doctor orders blood and urine tests each time, and everything looks good. The only thing really wrong is that her back is bent with arthritis and she has the unusual dementia. I don't think it's Alz or LBD. I don't really know what it is. Sometimes I just think it's craziness with some memory loss. This is quite possible.
Anyway, I do think some of her insights would apply whatever degree of love is present. The book is easy to read. English was not her first language and she claims she has to express things simply because of that. I doubt it, but I appreciate the straight-forward writing without a lot of technical jargon.
I think the 3 times a year doctor schedule is excellent. I would not run her to the doctor between those scheduled visits unless it was clearly warranted. (A broken wrist? Yes. Arthritic pain you've already discussed with a doctor? No.) Validating her emotional feelings is not the same as allowing someone with dementia to dictate your activities.
Frequent Flyer what you said about your hubby reminds me of mine. I've been sick and it seems like as soon as I get sick he comes down with something ten times worse. Then sick as I am I'm running to the kitchen to get him a cold compress for that fever he doesn't have. If it weren't so comical it would be sad.
I would not be able to do day to day care for someone like your mom. I think the distractions that are provided in an AL would be at least as therapeutic as meds.
Babalou, it is not always so bad. Most of the time she is quite content to watch the Waltons on TV and I just do my work or what I need to do. I've been looking at some local geri psychs to see if I think she would be able to relate to any of them. Most I've found so far don't seem quite right for her. Maybe we can find one that she can relate to more than the last, which was not her fault.
The first geripsych my mom saw (while she was in the hospital having a 3 day eeg, and started having paranoid delusions), she truly disliked. He came to her room and talked to her, in our presence for maybe 10 minutes.
At that point, my mom had been in the hospital for nearly a week, and he was the first doctor who actually "saw" the whole person, her frailties, her fears and her poor reasoning. We met with him and he told us EXACTLY what she needed (better antianxiety meds, a more supportive environment and a geriatrics doctor).
When we returned to her room after we'd talked to him, she "well, I REALLY disliked HIM. I'm not seeing HIM again! I smiled to myself and thought fine, mom, he's already given you the best advice you'll ever get.
So, I guess my point is that your mom may only need to see this person, briefly, a time or two and then meds can be managed by her regular pcp or a NP who is nearby.
You were lucky with your mother, because the doctor realized what she needed right away and it worked. We weren't so lucky this spring when starting my mother on mertazapine on top of the citralopram she was already taking. We went through three months of upping the dose on the first, while going down, then up on the dose for the second. The mirtazapine did make her feel better, because she became hypomanic and very obsessive. I am a bit more gun shy now after that experience. After three months the pscyh nurse asked me if we had any bipolar in the family.
The billing for the facility has been a bit comic. They didn't file the insurance and sent us the total bill, which was shocking. I had to call in the information. Then they didn't file the insurance for two months and lost my mother's file. The psych nurse had to ask me what she was taking. Back to billing -- finally they filed the insurance and sent a bill for the copay. I have sent them the credit card information twice now, but they still haven't charged it. We'll get another bill in a few days, I know, so I'll call them and straighten it out on the phone. (I talked to the rep the last time I sent payment and it is what she told me to do if we ended up paying twice. What a way to run a business!)
So yes, it will be better if she can get a good geri psych she can relate to and who will talk to her to evaluate.
But there are cold doctors who are so impersonal that I think it would be hard to relate to them in any manner except on a strictly business level. We have one who's very competent and thorough but very, very impersonal. I think sometimes the younger doctors can be like this until they find their comfort level in communicating with patients.
I'd suggest a physical and if she will do it, a psychological workup, but I'd also suggest that you try validation. See where it gets you. It shouldn't hurt and it may help at least a little.
By the way, I'd suggest the physical first as just something we all need to do and I'd write the doctor a note ahead of time saying that you'd like him/her to watch for a reason to refer her to a neurologist or psychologist. In your letter, list specific reasons for your thinking. Often people will follow up with these issues when a doctor refers them when they wouldn't listen to family.
Good luck and take care of yourself!
Carol
I've never heard of "working with the drugs" Does that mean that you have to want the meds to work? Never heard that said, but I'd be interested to read about it.
Justa, I know what you're talking about. I feel better about me if I stay kind. I feel bad about me when I get irritable. Sometimes I catch myself being pissy and know that it's me, not her, when that happens.
Today's Sunday and she is happy about going to church. It's raining, so me, I'm not so happy. She has a fellow that she is interested in there, though, so it's kind of endearing. So off in the weather we go. And no, I don't mind. "Elder love" is a wonderful antidepressant.