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Posted July 18, 2006

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Elderly Behavior: How to Motivate the Unmotivated

Q. My grandfather is 89 and fell in February, damaging his neck and requiring surgery. He has been in a nursing facility since the surgery. He is not very cooperative with physical therapy and lacks motivation to do things for himself. He is healthy and strong but his mental state is in question as he seems uncooperative to therapy, won't try to stay sitting up straight, or won’t let us help move him from bed to chair, etc. During therapy, there are many times when he just refuses to do anything asked.

He has three months more before the neck brace can come off, according to his doctor in the facility. The family has tried everything to give him incentive to work to get stronger so he can come home. He verbally agrees, but his actions and moods show us differently. We are looking for ways to motivate him or give him more hope. Otherwise, he will spend all his funds to stay in a home, lying in a bed day-in and day-out -- and he is leading us to believe that is okay with him. He is on meds for his depression, but we have not seen any results.

How can we motivate him to try harder?

Linda G., Evart, Michigan

A. First, I commend you for wanting to keep trying. Too many people just shrug their shoulders and say, "What do you expect? He's 89 years old."

At some level, that may be just what your grandfather is saying to himself: "I'm 89 years old, and I'm tired, I'm uncomfortable, I'm fed up, and I just don't want to work this hard any more."

Antidepressants alone don't always do the trick. An antidepressant along with the opportunity to talk about what he's feeling and thinking might be the combination he needs. If he's on traditional Medicare, he can receive psychotherapy in the facility where he's currently being treated with just an order from his physician. If he's on a Medicare + Choice plan (Medicare HMO), he will have to have prior authorization and a doctor's order.

Perhaps the family is pushing too hard? Try backing off and making your visits simply pleasurable. Offer to play cards or dominoes (or whatever he used to enjoy). Give him a backrub. Bring milkshakes to share if he's not on a restricted diet. If you can, try to visit just before therapy time. Help him get ready and walk with him to the therapy room. Don't be surprised if you get nowhere the first few times. This is a pattern of behavior he's grown accustomed to, and it might take some time before you see results.

Ask for a meeting with the social worker, the director of nurses, the physical therapist and the activities director of his facility and get their impressions and advice. They have seen this kind of behavior before, and they may have some ideas.

In the end, though, it's your grandfather's choice. It's our job to try to keep him from backing himself into a corner. That's why we keep coming at him from different directions and try to find rewards that he can enjoy while he's rehabbing, rather than just when he's done and can go home. That may be much too long for him to wait for a reward, especially if he's not sure any more whether he can really do it.

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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