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Finding a balance between physical safety and mental health for older adults

"Minding Our Elders" columnist Carol Bradley Bursack says even with dementia, people need to be allowed as much autonomy as they can possibly have without undue risk.

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Carol Bradley Bursack, "Minding Our Elders" columnist.
Contributed / Carol Bradley Bursack
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Dear Carol: After suffering a stroke, my dad, 83, was left with one weak side. So far, he is independent and wants to do things for himself including minor maintenance and planting flowers around his condominium. When we tell him he should leave these jobs to others, he says that he enjoys “puttering” and he needs a reason to get out of bed. I worry about him, but he’s shown he’s capable of making good decisions so he wouldn’t take on projects that he should not attempt. My sister, on the other hand, says that we should insist he give up all the maintenance and gardening because he could fall and get hurt. Who is right? — GK.

Dear GK: You’re both right in your own way, which is often the case in caregiving. Longtime readers will notice that this is a frequently asked question and that’s because there’s no concrete answer.

Your dad sounds as if he’s doing well for now so unless he’s climbing ladders or attempting obviously ill-advised projects, you and your sister should continue to restrain your need to protect him. He has a right to his dignity and part of dignity is making our own decisions to the degree we are capable.

An example from my past: When my neighbor, Joe, for whom I was the primary caregiver, would want to “walk downtown” on nice days, even with ice and snow on the ground. I’d offer to drive him, but he’d refuse, saying that he enjoyed getting out. I came to understand that to Joe, his independence was a priority, so I’d hold my breath and let it go. A few hours later, I’d see a cab pull up outside his home dropping him off. He was content.

These decisions can get trickier with dementia, but even then, other than forcing an older adult to deteriorate while they sit in a chair wrapped in bubble wrap, there will be some risk in simply living.

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Carol Bradley Bursack is a veteran family caregiver and a nationally-recognized presence in caregiver support. She's the author of “Minding Our Elders: Caregivers Share Their Personal Stories,” a longtime newspaper columnist and host of her blog at mindingoureldersblogs.com. Carol's an introverted book nerd, so you won't see her mugging in viral videos, but you can easily reach her using the contact form at mindingourelders.com.

I mentioned dignity above and I’ll emphasize here that even with dementia, people need to be allowed as much autonomy as they can possibly have without undue risk. My family had to wrestle with this concept on many occasions after Dad developed dementia following surgery. Balancing physical safety and emotional/mental health was an ever-changing challenge so it required flexibility depending on the day.

Your dad sounds quite capable right now, GK, and he presents a good case. Like Joe, his independence and basic dignity are vital to him and he’s still capable of making rational decisions. Could he fall while gardening? Of course, but he could fall while doing his laundry. Give him a big hug and tell him how happy you are that he can continue to do things that provide satisfaction.

Do continue to offer help without pushing too hard or referring to his age or his stroke. If help is offered without implying that he’s no longer capable, he’s more apt to accept your offer when he has a more critical need.

Carol Bradley Bursack is a veteran caregiver and an established columnist. She is also a blogger, and the author of “Minding Our Elders: Caregivers Share Their Personal Stories.” Bradley Bursack hosts a website supporting caregivers and elders at www.mindingourelders.com. She can be reached through the contact form on her website.

Related Topics: FAMILYWELLNESS
Carol Bradley Bursack is a veteran family caregiver and a nationally-recognized presence in caregiver support. She's the author of “Minding Our Elders: Caregivers Share Their Personal Stories,” a longtime newspaper columnist and host of her blog at mindingoureldersblogs.com. Carol's an introverted book nerd, so you won't see her mugging in viral videos, but you can easily reach her using the contact form at mindingourelders.com.
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