Dealing with querulous, anxious old people. Need tips.

In My Humble Opinion
1

I’ve been a hospice volunteer for about ten months. So far, all of my time is spent with very elderly people. Who are all in some way or another in the process of dying, which can clearly make people querulous and anxious and fearful and sad and all of those things. I do get that. And I know that very elderly people sometimes get anxious and fretful, generally. Also I understand that the people I see are very often frightened over losing control. But the obsessive worrying and fretting seems to be very common.

What I want to know is: how can I do better at allaying anxiety and obsessive thoughts? At least while I am there. I do practice active listening and reflecting back what I hear, ask for clarification, try my best (as a paraprofessional) to help my clients feel empowered and autonomous, given the circumstances. Sometimes using humor, or distracting them by asking questions about their lives, works. But not always.

To clarify, my main concern is a lady I spend 4-5 hours a week with, on a night when her caregivers are off doing hobbies. It’s almost like she needs to have something to fret about. Every week it’s a different thing. For the record, I adore this lady, she has so much to offer. But she can be difficult.

An example: she recently had a birthday, and one of her daughters gave her a pair of pajamas, but the legs are too long. She wanted to shorten them up. For my first hour there, she fretted and obsessed about why she could not find a needle and thread in the house, and why her caregivers did not have such an item in the house. Finally I ran to the corner drug store and bought her a little sewing kit. We spent the next few hours hemming her PJs. But she could not stop obsessing about why there were no sewing supplies in the house, frequent requests for me to go through everyone’s drawers for sewing supplies (I declined to do this), endless ruminations on whether her caregivers had hidden needles and thread from her, repeated concerns about where to put the sewing kit I’d bought so it wouldn’t get lost or stolen…

Honestly, I see why some caregivers are exhausted and frustrated. As a volunteer, my “job” is “caregiver relief.” But I would love to learn better skills at allaying, or derailing, obsessive worrying. The organization I volunteer with is basically crap for giving volunteer support - so far I’m staying because of my clients. But I do want to be able to do the best I can for the folks I visit with.

2

I don’t have much advice for you, but I will be keeping track of this thread. My mother recently started a job doing something like what you describe, taking care of daily tasks for the elderly, spending time with them, etc. I will be interested to read what other people have to say on the matter and may pass it on to her.

3

Hm, with respect to your little old lady and the sewing supplies - many people now tend to toss stuff instead of repairing them - I don’t know anybody else my age or younger that actually has a darning egg and actually can darn socks [I am 51]. Why do you think women go nuts looking for safety pins to do quick repairs at work instead of grabbing the tiny repair kit that used to be common in secretaries drawers and nipping into the ladies room to do a quick fix on a zipper, button or hem? You know how many times I have seen a woman I worked with repairing a hem with a strip of tape or staples?

4

The idea it sounds like you’re describing is perseverate. That is to focus on one idea, desire, thought over and over again. My dad would do this. He’d get an idea in his head (He wants ice cream, are the bagels going to be stale if we buy them too early, can we leave before dark), and no matter how many times we answer he frets on it.

This link has some helpful tips: http://ezinearticles.com/?The-Perseveration-(Getting-Stuck)-That-Comes-With-Memory-Disease&id=391287

5

Distractions may be helpful. Brush up on card games. Lots of older folks like to play cards. If her eyesight is still good, she might enjoy working on a jigsaw puzzle together with you.

She may also simply need someone to hear her voice and respond to her - and it seems you’re doing a fine job of that.

Bless you for the time you share and for wanting to alleviate her worries.

6

I have a couple of darning eggs and I know how to use them! I’m 55. I also know how to patch clothes and match the pattern, if I have the fabric available to me. A lot of commercially made items just aren’t worth darning or mending, though.

To address the OP’s problem, I’d suggest either crafts or cards. Or possibly Classic Movie Night, complete with popcorn (if the old woman can eat popcorn) and other movie type snacks and drinks. Depending on the time of day when the caregiving begins, possibly a special (but not expensive) dinner. And discuss the movie afterwards.

7

I hear you! My 93-yo grandmother is like this.

Whenever it gets annoying or unreasonable, I just think to myself that her world is so tiny and compressed and her mind is just searching for something to occupy itself with.

She’s also obsessed with British History so, if there are a few moments of silence, she’ll stare into nothingness and then start, “Now, Thomas Cromwell was a fascinating man…”

8

Distraction is good. Sometimes moving to another room will break the cycle. Sometimes agreeing with them will help because they finally feel “heard” (but sometimes it will increase their anxiety, so you’ve got to be careful with that one.) Sometimes you can ask them about something related but different and get them to tell you stories instead (“Did you ever have a favorite sewing kit? What did you like to sew? Who did you make things for?”). Sometimes a wordless smile and touch on the arm will help reorient them to the here and now and break the cycle.

If it’s simply repetitive without getting increasingly upset, sometimes your best bet is to just let it repeat until it runs down on its own. Sometimes the best thing to do is nothing, and just remember that this isn’t actually about communicating with you, but processing their own stuff. Sometimes what they’re processing has little or nothing to do with the words coming out of their mouth.

9

Ah! Another lovely word: perseverate. Indeed. My grandma used to do this as well. It makes sense that it’s related to memory disorders.

You know, that is not a bad idea at all…I think I will try this idea out. Not sure if she can track well enough to complete a jigsaw puzzle but this is definitely worth a go!

LOL.
And yeah, I’ve figured at least part of this behaviour in elderly people is associated with (among other things) simply having less to do after a lifetime of being useful, effective and active. Which has got to be quite distressing.

Yes - actually this is one of the things I try. Sometimes it works, sometimes not.

It occurs to me that this behaviour might bother me more than it does her; after all if it is serving a purpose I should just go with it? Except it doesn’t seem to make her happy, she often gets quite upset and agitated and I feel like I ought to “fix” it.

I am 54, do not own a darning egg but definitely learned to darn socks. :slight_smile: Back in the day when people actually fixed holes in socks instead of tossing them out and buying another 3-pack from WalMart.

10

You sound like an enlightened, patient caregiver. Hang in there; the world needs you.

I agree with the posters saying they probably don’t have enough interesting stuff going on in their lives and can become too self-involved. Could you slowly “train” these ones to expect that when you are there, the time is going to be spent doing such-and-such?

Also, they might just need a safe chance to vent (not pissing off their regular caretakers.)

In our area we have a group called Stitch 'n Bitch. It covers both.

11

Stitch n bitch! I love it! There should be one in every town!

I too am a caregiver for elderly people. All I can say is yes, I see this all the time too; and once I have done my best to allay any fears with rational responses or suggestions for action, I tend to ignore the obsessing and go about my business.

What’s been eating me lately is what I’m almost sure are attempts to “bait” me. My clients are in good shape with respect to cognition, so maybe it doesn’t happen to every caregiver. But one guy in particular – he will bring up controversial viewpoints that he knows are going to piss me off, and insists on debating them.

One time it was, **“Good looks are a positive indicator of intelligence.” ** Now, I acknowledge that intelligence may = ability to provide, and so = ability to choose a goodlooking mate which then can result in smart, goodlooking kids. But he insisted that there is a direct correlation between being pretty (somehow, it wasn’t about men, but only women) and being smart; and if you weren’t pretty, you weren’t smart.

I had a hard time keeping my temper on that one, even with all the good counter-examples at my disposal, because he had this attitude of smug certainty. And of course, I’m not a raving beauty, but you can’t tell me I’m stupid.

I said okay, maybe if you’re pretty there’s a good chance that you are also smart, but not being pretty does not preclude you from being smart; but he wouldn’t hear it. I am still kinda resentful about that one.

Then last week it was, **“Illegal Mexican immigrants are screwing up life for California natives.” ** I said, well first of all, this WAS Mexico until relatively recently; on top of that, I just don’t feel that illegal immigrants are taking anything away from me personally. Finally I asked him what percentage of Californians he thought were here illegally, and he said, “Twenty percent.” Well, no wonder he’s freaked out. I said, three or four percent. Turns out that it’s estimated at six percent.

He actually did apologize to me over that one.

But I think that somehow the old folks get a sort of energy boost from getting me riled up. I should make it clear that I am very warm, supportive, self-effacing and usually meek. I try to always defer to their judgement and remember that in their home, each person is king or queen. But I will not phlegmatically just agree with bullshit if they press me.

12

I love Stitch 'n Bitch! LOL!

brujaja, I think you are correct. And thanks for the reality check on it being OK to ignore the obsessing at times. That’s that part I have a hard time with.