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Posted: January 12, 2004

Practical Caregiving

Motivating a Person Without Motivation

A caregiver's role is hard enough without a lack of cooperation from the elderly person they are caring for. But that lack of cooperation may not always be what it appears to be - a person's physical condition may be the overriding factor in determining whether a person is motivated (or physically able) to do things for themselves. Still, as caregivers, we all need every bit of help we can get, as this question from Dawn in Hudson, New York, indicates.

Dear Jean:

I like the helpful Practical Caregiving column you write. I hope you'll be able to help me. Here's my situation - I am the live-in caregiver for my step-mother who is in her mid-70s and suffers from pulmonary disease (COPD) and Crohn's disease and is on oxygen fulltime and gets around with a walker.

My Dad, her husband through remarriage, is in his 80s and tries his best to help her, but in truth it really falls to me. I moved my family onto the property more than a year ago when she came home from the hospital. My problem is that no one can motivate this woman to move around the house and be as active as she can be, for her own good. As a result, I do everything for her, from the toilet to bathing to food preparation.

It's just that she doesn't try, not that I mind helping because I wouldn't have moved here if that was the case. But how do I get her to do what she can for herself? To even get up out of her chair where she sits all day? The only time she get's up is to go to the bathroom or to go to her bed. She never even goes outside for fresh air or even to sit when the weather is good.

Her doctor, nurses, others in the family and I have tried everything we could to get her to move but she just sits there. She doesn't have any interests except my Dad and watching TV. It is impossible to motivate her even though the doctor says walking around the house will help her breathing, circulation, heart and whole body. Can you help? Dawn, Hudson, New York

Hi Dawn:

I happen to know a little about this subject because my ex-husband has been diagnosed with COPD. I have talked to my kids about how they can help him and his wife. It seems he has many of the same issues your step-mother is facing.

When a person is told that they have a serious disease that will end in death, they have various reactions including grief and depression. Your step-mother could be grieving because she is gradually losing her life, which can result in depression. Why don't you talk to your doctor about the possibility of her being depressed? The doctor may be able to give her a prescription to help her fight depression.

Both of the diseases your step-mother has can cause weakness. Crohn's disease can cause malnutrition and other complications like anemia. COPD can cause the oxygen levels in her blood to be low, and sometimes the carbon dioxide levels can be high. Breathing with the help of an oxygen tank can help stabilize her oxygen levels, but even with the additional oxygen, her levels can become unbalanced. This can leave your step-mother feeling weak and out of breath. Her oxygen levels should be monitored closely to maintain the proper balance. A person needs good nutrition and oxygen in order to feel strong enough to do something.

If your step-mother doesn't feel like walking around, it could be because she is weak or afraid of falling. Maybe she would be more comfortable using a wheelchair or scooter. My ex-husband was bedridden most of the time until he got a wheelchair. He immediately started "rolling" around the house and sat up several hours a day.

Have you gone to a different doctor for another opinion on her condition? That is always a good thing to do. Even if she is given the same diagnosis, a different doctor may be aware of an alternative form of treatment that could be beneficial. Doctors are human, and it is impossible for them to be aware of everything regarding a specific disease, especially if you are in a rural area.

Get someone from outside the family to help with motivating your step-mother. It's amazing how much more a person will do for someone else. The person coming in may have to be rather stern, but after a while the patient usually grows to like their help and encouragement.

There are a couple articles under the News & Info tab on this website that you might find helpful. Take a look at "Avoiding the 'Winter Blues:' How to Keep Active and Mentally Healthy in Winter's Dreary Months" and "Fear of Falling: Helping Elderly Overcome Fears and Falls." Your step-mother is confined indoors because of her health, and that can cause the same "cabin fever" symptoms as being confined indoors because of the weather - and that can afflict any of us.

I wish you all the luck in the world. There are so many things we don't know about diseases and how they affect a person. But please remember - everyone is different.

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