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By Amy Rosett, Ph.D.

Whenever I ask people in an audience if their family is complex, nearly everyone raises their hand and softly laughs. Families often are an important source of support and unconditional love, but frequently they are also a source of stress, guilt and angst. And they can be all of these at the same time. Despite the multitude of possible family structures, small or large, there are generally similar dynamics within families. These dynamics shift as parents age and their needs change.

As people are living longer, it is more common to know couples married 55, 65, and even more than 70 years. But they usually don’t age in a parallel way. Thus one may be fortunate to have good physical health and cognitive abilities, while the other is more frail and/or confused. Sometimes one person is physically healthier while the other has stronger cognitive skills. Whatever the specific pattern, there are inevitable changes in how they manage as a couple when they need to take more care of one another.

Sometimes the one giving the care tries to keep these changes from their adult children. There may be well-intentioned reasons to try to hide the worsening condition, such as protecting the dignity of their spouse, guilty about being a burden to their adult children, wanting to remain an independent couple, and assuming it is expected to shoulder this responsibility. However, by hiding the need for increased care, problems often develop in the family, such as poorer communication, emotional distance because of this lack of candor, and wearing down, both physically and emotionally, due to the pressures of being the sole caregiver.

Furthermore, if one spouse is developing Alzheimer’s disease or another form of dementia, the changes almost always involve more than memory loss. These include other cognitive difficulties, behavioral problems and personality changes. Thus, one’s loving spouse of 56 years might seem depressed, have anger outbursts, and even become verbally or physically abusive. Covering up such changes often is depressing, and could compromise the safety of either person. Informing the medical doctor may lead to medications and other interventions that can alter the progression of the disease. Talking with the family may lead to getting the emotional and physical support they need.

The family dynamics become more complex regarding the adult children. One of the most common examples of this change is a “role reversal.” The adult children start to make “parental” decisions about caring for their parents. The parents become more dependent on their children. Some families accommodate to this shift graciously. They still allow the parents to be as independent as possible and work together as a partnership.

Unfortunately this role reversal frequently creates stresses for both generations. From the parents’ perspective, there is a fear of being a burden to their children. But there is also a fear that their needs and wants will be ignored by their family. Older adults often express guilt because their children “have their own life to live.” Frequently it is true that the adult children are busier with raising their own children, their work, and economic pressures. Nonetheless I’ve observed that most adult child experience more stress when they do not know what is actually happening with their parents.

From the adult children’s perspective, sometimes there is resentment about the increased responsibilities of caring for their parents. Often they have anxiety about making the correct decisions, balancing various recommendations about a particular situation, and a general worry about their parents’ worsening health.

The complexities of the family dynamics multiply when there are several adult children. Some of the stresses might stem from unresolved sibling rivalries. At the time that their parents need more help, it is unlikely that such long-standing conflicts will be settled. However, if the adult children recognize this dynamic and agree to focus only on the current concerns, it helps them to work together.

Even in the most supportive families, it is usually difficult to sharing the responsibilities of helping the parents in a way that seems fair to everyone. This is complicated by the fact that usually the siblings have varied abilities to help, especially when only some live near the parents. Specifically, some siblings may have more money, time, proximity, energy, and emotional wellbeing to participate than others. It is very helpful if everyone accepts that the amount of direct care provided most likely will never be “even.”

It is important to have frequent communication among the siblings, and when appropriate to include the parents. Find ways that each person can contribute, even if it is from a distance. They should work toward their strengths. Those who live further might coordinate visits to let the siblings who live close to take a short vacation.

One common problem is that a visiting adult child has wonderful ideas of how to improve the situation, makes changes and then leaves. In fact, those who live closer and have more contact with the doctors and other professionals should have a greater voice, but also be open to listen to what others might have to contribute.

Overall, families function best when the parents and adult children have frequent and open communication, including via email, Skype and telephone conference calls. There needs to be a willingness to be flexible, especially as the needs of the parents change. The family will face numerous decisions. It helps to consider many opinions during the process, but agree upon one solution, even if everyone is not pleased.

When all this can be done with the older adults’ participation, the likelihood of family stresses, guilt and angst will be reduced. I’ve yet to meet the family which has eliminated such negative feelings, but reducing them is a realistic goal. Finally, it is important to recognize that positive aspects of family, the support and unconditional love, can increase even during the often difficult adjustment to the shifting needs of the older adults.

Labels: Family, Family Dynamics, Feature Articles, For the Mind, Rosett