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Posted July 9, 2008

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Elderly Behavior: When Loved One Sabotages Their Own Care

Q. My father is 78 years old and he has a host of health issues. He's been diabetic for almost 40 years, and the disease is really taking a toll. A few years ago, he was diagnosed with cancer, had treatments and for the most part is "fine." 

Here's the issue: He is very angry now. My mom tries to care for him, but he takes it out on her -- and this also is taking a toll. There are many issues here: he won't medicate himself and unless mom puts his meds in front of him at the appropriate time, he won't take them on his own. He's skipping his blood sugar readings, etc. He is self-sabotaging. He said it best: He's sick of being sick.

Mom won't hear of assisted living but she's at the brink. I live local and help the best I can. My youngest daughter (2 1/2 years old) seems to be everyone's best medicine. My two siblings are in different states. I want to propose some solutions and need a professional to step in and guide us -- this is Greek to me. Please advise. 

Mary Anne B., Oswego, Illinois.

A. I can hear the worry about both of your parents in your words, and I sympathize with your frustration. It is so difficult to watch someone you love do this.

You don't say whether your father is mentally competent to make decisions about his medications and other health needs. I am going to make the assumption here that he is.

If he is competent, there is only so much you or your mother can do to influence how he takes care of himself.

Have you sat quietly with him when no one else is around (not even your mother or your daughter) and talked with him about his hopes and desires for the future? Sometimes a loving talk that focuses on him, rather than his illnesses and his "self-sabotage," as you put it, can give you ideas about how to better help him. Perhaps there is something in the future that would bring him great pleasure, such as seeing your daughter go to kindergarten on the first day. You won't know unless he tells you. 

If there is something he would like to live for, ask him directly how you and your mother can help him get there. He may surprise you with an answer.

It certainly sounds like he is depressed. If he is unwilling to see anything in the future worth sticking around for and working toward, it would be a very good idea to push hard for a psychiatric evaluation. If you feel he would not receive this suggestion well from you, see if you can enlist his doctor to make the push. Unfortunately, most psychiatrists no longer do much talk therapy, which could be very beneficial for your father. However, most psychiatrists work closely with therapists who do provide this kind of therapy and who accept Medicare.

You and your mother would clearly benefit from some support through this, as well. Most caregiver support groups seem to focus on the dementias, which is probably not what you need. If you can't find a general support group that offers both emotional and practical support, I strongly suggest that the two of you consult a family therapist for a few sessions. A good family therapist can help you and your mother to clarify your limits and your options, and therapy will give your mother the opportunity to do some healthy venting.

While moving your father to assisted living might seem like a possible alternative, if he is competent, he can refuse to go. He can also refuse his medications and sabotage himself there, just as well as he does at home. If he is abusive to their staff, he might well be asked to leave.

So, getting a handle on his thinking and trying to help him find his own reason to live is where I would begin, if this were my father. I certainly hope this helps with your very difficult situation.

This answer is provided by Molly Shomer, MSSW, LMSW, a family caregiving specialist and licensed geriatric care manager. Molly, a nationally recognized expert on eldercare issues, is the author of The Insider's Guide to Assisted Living. Her website is www.eldercareteam.com, and she can be reached at molly@eldercareteam.com.

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