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“I Don’t Need To Check My Sugars.”

A surprised adult child told me that her Mother was recently hospitalized because her blood sugars were too high to even test. When the senior was asked, she replied that she didn’t see the need. She added that she was drinking extra orange juice. (The logic of that escapes me) The doctor hospitalized her and would not release her back to her independent-living home. Let’s unpack this situation.

First, seemingly-sudden changes like these are common in seniors. The issues range from blood sugar levels to refusal to use an appliance, or a refusal to follow dietary guidelines. These refusals usually involve the management of chronic conditions. Chronic conditions cannot be cured and continue the rest of their lives. The management of a new condition adds to the management of previous condition(s). These tasks become a full-time job! A former client lamented that she had not had time to clean her refrigerator. I pointed out that she was now doing in-home dialysis. I asked her to view this as a new full-time job (and give herself a break). Ask yourself if your senior has a full-time management job. Is this incident your senior’s way of saying they are feeling overwhelmed?

Second, the situation may seem sudden to you; it isn’t. Think about the last 2-4 weeks. There were probably some early warning signs you didn’t realize were signals of change. Did the senior make a comment such as I don’t need my walker any more, or did they complain about all the bathroom trips due to the water pills?   These may have been their way of showing you that their tolerance for these life-style effects was sinking fast. Some indicators take the form of behavioral changes. The senior referenced earlier had forgotten an appointment three weeks prior; she never did that before. Ask yourself is this change a sign of deeper issues?

What could you do with the change? The immediate response may involve a move to a more supportive facility or bringing help into the home. Beyond those plans, there are deeper issues such involving the senior’s will to go on. Have they just lost their driving privileges? Did their best friend pass away? Are they having more problems getting out of the house?

One of my former clients was down cast because her recent health issues required her to give away her beloved dog. She could not keep up with its care. My conversations with her did not center on what had happened but around what it meant to her life. At the same time, the grocery store had a sign, “Take a bird to lunch”. I asked her if she would like to investigate the idea together. She purchased a bird feeder and some seed and had it put up outside her window. From that moment on she was involved with her birds. Ask yourself, what do all these management changes mean for my senior’s quality of life? Is there any way to give something back?

Sometimes there is no way to compensate for all the changes. It’s time to shift to a different paradigm. Our society has no cultural tradition for leaving life by decision. Elderly Eskimos decide when it is time for them to go. They leave the igloo in the spring and get on the melting ice to float away. Our society allows similar decisions such as electing to remove life support under a DPOA. Those measures only apply in extraordinary situations. We allow cancer patients to decide if they want to discontinue treatment. There are other reasons why an elder may decide to leave that are not cancer-related. Ask yourself, is there a deeper agenda operating here? If so, how can I come to terms with that agenda within myself?

I have seen more than one elder decide it is their time to go. Their decision contrasts with medicine’s orientation to preserving life. Preservation of life is a laudable goal but should not remove an elder’s personal decision.   Preserving the senior’s decision may be the more important form of preservation at their point in life. Some seniors find it hard to discuss their decisions with their adult children.

The roommate of one of my former clients related the events leading up to the Mother’s death. She told the daughter and me that they had discussed her Mother’s decision to go and prayed together. The Mother told her roommate that she did not think she could have this talk with her daughter. The roommate said she was instructed by the Mother to explain this to us after the Mother’s passing. It came as a surprise to the daughter. She and I discussed its impact. I offered that it may have been her Mother’s last form of parenting; to spare her such a difficult discussion. Actually, I thought the daughter, who had health issues of her own, would have been overwhelmed by a direct discussion. (Perhaps Mother knew best) Ask yourself, how would I handle such a time-to-go discussion?

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