I probably make a thousand choices in a day. Most of them are insignificant and don’t even hit my radar. Which of my flavoured coffees will I have this morning? What will I wear? Will I have a salad or a sandwich for lunch? After dinner, will I read a book, watch a movie or knit? What time will I go to bed?
Sometimes, life brings more significant choices. What kind of car will I buy? How will I solve the problem of the needed renovations in my basement? Where will I go for vacation?
For our elders, the ability to make choices shrinks significantly. Physical frailty, and sometimes cognitive decline often mean that others are making choices for them. Some can’t manage their own care or find the process of making decisions overwhelming. Choices, and the ability to make them become more important.
“Autonomy is a domain that is challenged early, and often severely, as a result of societal stigmas surrounding dementia. Loss of autonomy is also a common source of anger and resistance. We tend to think of autonomy in terms of big decisions, but autonomy can be created on many levels, and most people have the ability to make choices, with proper communication and support.”1
The problem comes when care partners, professional or family, come to believe that because an elder has challenges, all the decisions need to be made for them. The result is an elder who feels helpless. Sometimes “learned helplessness” results when a task is completed for an elder when they could do it themselves, given time and support. After a few attempts, they give up and soon can no longer complete the task. This leads to another of the plagues–boredom.
Here are some examples:
An elder likes to set the table. It’s imperfect, and some of the utensils are missing. Do we go back and complete the job, or make a suggestion like, “Thanks so much for your help, Jane. Here are some more spoons to put in these places.”
Buttoning a shirt is possible, albeit slow for an elder, and sometimes the wrong button gets in the wrong hole. Do we fix it, or, knowing this is an issue, sit with them and suggest which button goes where?
I am guilty of this one: an elder hesitates with their speech, and sometimes has difficulty finding the words. Do I supply what I think might be the words, even if I’m usually wrong, or wait?
Joan always drinks tea with lunch. Do I automatically pour her tea, or do I say, “Joan, would you like your usual tea today, or would you like a cold drink?”
Joe’s family know he was always interested in trains, so they are surprised and disappointed when they bring in his train magazines and he shows little interest. He’s fascinated, though, by a visiting dog.
The basis of choice is respecting the personhood of the elder. Respecting the time it takes to make the choice. Giving opportunities to choose when the choice seems obvious. Realizing that choices change.
Choice. Make it as person-centred as possible.
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1. http://www.edenalt.org/ondemandwebinar/understanding-the-many-levels-of-autonomy/