An aging parent wants to keep the car keys, while his adult daughter thinks he is a hazard to himself and others on the road. Or a widow who has lived in her home for 55 years refuses to move out, although her children worry that she’s too frail to manage the stairs.
As more and more adult children face caring for their aging parents in the coming decades, an expert on the clinical psychology of aging says the key to dealing with these types of situations is to discuss them before they become a reality.
“Don’t procrastinate,” says Brian D. Carpenter, Ph.D., an assistant professor of psychology in Arts & Sciences at Washington University in St. Louis. “Start the process of talking to your aging parents early — before a crisis.”
By 2050, more than 20 percent of Americans will be over age 65 and living longer, healthier lives than ever before, according to Carpenter. And the inevitable assistance they will need in their advanced years will fall mostly on the shoulders of their adult children.
Advance planning and good family communications can help the “sandwich generation” work through the challenges of caring for aging parents while dealing with their own issues of child-rearing, housing, finances, work and middle-age health, says Carpenter.
The worldwide demographic change is a result of improvements in health care and medical care, increased understanding of disease, and better nutrition.
“So we’re getting better at postponing death, but the basic fact remains that as you get older, you’re more likely to experience a variety of diseases and disabilities,” Carpenter says.
With medical advances, people are now able to live longer with diseases that are hard to live with, such as arthritis and diabetes. As a result, people will need more assistance as they get older, and the helpers very often turn out to be family members.
“Family members are a very important part of the support network that older adults have,” says Carpenter, the principal investigator of a research project on “Patient-Valued Preferences: Examining Agreement Within Families.”
About 60 percent of older adults have daily or weekly contact with their children, down from about 70 percent in 1962, according to a 1990 study by Eileen M. Crimmons and Dominique G. Ingegneri.
“While contact between older adults and their kids has declined recently, it’s still pretty high,” Carpenter says. “So this notion that families are fracturing and splintering and not staying in close touch with one another really doesn’t seem to be the case. Families are still very supportive of one another, and somewhere around 85 percent of the assistance provided to older adults in the United States these days is provided by family members.”
Due to other demographic changes such as smaller families and geographic separation, a greater amount of responsibility for the parents’ care will fall on those fewer number of children, Carpenter says.
According to Social Gerontology, a textbook Carpenter uses in his course of the same name, “this is the first time in history that American couples have had more parents than children. In fact, today the average American woman can expect to spend 18 years caring for an older family member, compared to 17 for her children.”
An increase in life expectancy, with a gap between that of men and women, means that more women will still be around at age 77 or 78, while men are dying at younger ages.
“Because a larger proportion of people who make it to old age are women, aging is a significant women’s issue,” Carpenter says.
Likewise, from the caregiver’s point of view, “aging is also a women’s issue for the other generation because women are the ones providing the bulk of care and the bulk of support to older adults.”
A 2002 study by the Family Caregiver Alliance found that 28 percent of care to older adults is provided by daughters, 26 percent by other relatives, 24 percent by spouses and only 16 percent by sons.
Matching expectations
In Carpenter’s Clinical Geropsychology Lab at Washington University, the goal is to “try to help improve family relationships, so that families are in good shape before they start to get really old and before parents start to get more frail and more dependent,” he says.
“Our goal is to help families be prepared, so that when aging issues come up, family members have talked about issues, they’re aware of how each other feels about issues.”
The lab’s recent work has focused on adult children’s accuracy when they are asked to predict their parents’ preferences regarding a wide range of issues. The research suggests that adult children may be inaccurate surrogates when it comes to making decisions for their parents.
“We ask children to predict everyday preferences such as whether a parent prefers a bath or shower, what kind of music they like, some of their food preferences,” Carpenter says. “We also ask children to predict parents’ preferences for certain kinds of medical care, housing preferences, and even preferences related to their death and dying, such as whether they want to be cremated and whether they want any of their assets to go to charities.
“Across many studies, we’re finding children are not very accurate when making these predictions. This is important because down the road children may be asked to make decisions in these areas for their parents,” Carpenter explains.
“One of the things that we know is most important in terms of having families successfully navigate these issues is that it’s better in families where expectations match — when parents’ expectations for what they want their kids to do for them matches what kids’ expectations are for what they should do for their parents.”
How can families get these expectations to match? The obvious solution is to talk about it, but it’s very rare when families do that, Carpenter says. “When it happens, it usually happens when there’s some sort of crisis in the family. Somebody has a medical health crisis, and then all the family gets together and decides these things.
“Nobody takes the time to talk about these things ahead of time before there’s a crisis, when people can sit down and be rational and think things through. Instead, families usually find themselves thrown into the middle of some situation where they have to make a lot of decisions really fast, when they’re completely stressed out and over-emotional.”
The challenge is to get families talking about aging issues sooner, Carpenter says. He recommended starting with general conversations about broad values, such as balancing the quality of life versus the quantity of life.
“Maybe what is most important for families is not talking about specifics — what would happen in this specific situation — but instead have conversations that are more broad and global,” Carpenter suggests.
Have frank discussions
Carpenter’s advice to families about taking on the challenge of talking about aging and end-of-life issues includes:
• Don’t put off talking about caregiving issues.
• Take small bites — but not of each other. ‘You don’t have to sit down and have a whole weekend where you’ll map out every possible health care situation and preference,” Carpenter says. “Schedule a conversation and give yourself enough time to do it in small chunks over a long period of time.”
• Take responsibility. “Don’t assume that your parent, sister or child is going to bring it up. Everybody in the family needs to take some responsibility for having the conversations,” Carpenter says.
• Flex and forgive. Be flexible and “be willing to think about ways you can forgive one another for things that may have happened in the past that may be getting in the way of having good family relationships in the future,” Carpenter says.
Many families find it difficult to have frank discussions about what support is expected and what support can actually be given. “It may be a difficult conversation to have and people may get upset and people’s feelings may get hurt, but better that than people feeling angry, hostile and upset without ever airing their feelings,” Carpenter says.
Some families may find it helpful to bring in an objective mediator, such as a social worker, lawyer, physician or psychologist, to help sort out these issues. In fact, a new career of “certified family life educators” has emerged to help families deal with such topics.
“It’s a very difficult thing to talk about,” Carpenter says. “It’s rare for people to willingly give up their car keys or say, ‘OK, I’m ready to go to the nursing home now.'”
Carpenter’s team is seeking volunteers to participate in various research projects related to older adults and their families. Volunteers may contact the project office at aging@artsci.wustl.edu or (314) 935-6173.