REDIRECTING RESISTANCE

 

There is an art and a science to understanding resistance in senior age adults and what strategies will be helpful for changing behaviors, according to Joseph M. Casciani, PhD in his article in Aging Well, Fall 08.

 

The art of understanding resistance requires taking into account an individual’s perceptions and interpretations of what he or she is facing, the motivation to comply with the recommendation, and what age-related barriers take center stage.  The science of understanding resistance requires recognition that there are stages we all go through to embrace new behaviors  ---stages that are predictable and require unique approaches. 

For older adults who are resistant to complying with healthcare prescriptions, one challenge lies in involving them in their own care.  This involvement is effective for reducing resistance because it allows the behavior change to be internally rather than externally directed.  In a sense, this strategy requires the elder to become responsible for his own decision- making and behavior change.  Alternately, by not moving toward increased self-management, or patient-driven care, we continue to rely on the power relationship between the advisor and the patient and face the inherent risks and pitfalls of this power struggle.

 

For other elders there may be embarrassment causing the resistance to care.  This is sometimes seen with respiratory ailments.  A specific aspect of resistance is evidenced by non-compliance with prescriptions.  Research cites the quality of the doctor-patient communication and the information the patient receives as additional factors affecting compliance with treatment recommendations.

 

The final factor of resistance in older adults is that of control over one’s environment.  Failing health, limited choices over one’s life, and considerable personal losses take away an older adult’s sense of control. 

The more an older adult is involved in his or her own care, the more likely it is to have a lasting effect.  The following elements can be helpful in achieving compliance and cooperation on the part of the older adult: 

• Empathy, understanding ,and two-way communication
• Give the elder permission, thus, enhancing their sense of empowerment
• Good listening skills, without passing judgment
• Point our discrepancies between the goal and the behavior
• Value self-directed behavior over externally directed behavior
• Resist pushing the older adult until they are ready
• Focus on solutions

Even when a loved one (spouse, child) employs the aforementioned communication elements, the party in question may still tend to be resistant, perhaps due to the inherent relationship with the loved one.  When such occurs, the use of an outside professional, i.e., geriatric care manager may prove helpful.