Mom was all about the holidays. She always started her extensive planning on the first day under 50 degrees. Now, this was back in the day before Thanksgiving hit the stores before the Fourth of July. She was all about festivity, menu, getting the family together. The more, the merrier. The goal wasn't a Hallmark holiday special. It was authentic comfort, enjoyment, and lots of love.
This year, it's different.
We could say that Mom's enthusiasm has been taking a gentle slide; we all thought holiday planning would perk her up. It hasn't happened. Taking inventory, we looked at what the past year held. It was mostly ordinary except that her cousin passed, but she seemed to be coping well with the loss. Physically, she seems in as good or even better health than last year. We couldn't' really "tag" any one thing that might be the cause of her slump. But it seems to be progressing. What can we do?
Something has changed.
You've identified a significant change in response to something that Mom loves. Something that she has always been engaged in, motivated by, and that has been very satisfying to her. The "reason" isn't obvious.
How concerned should you be? What to do?
Start with her primary care physician (PCP). Many changes in affect and personality have a root cause in physical health. The approach might be a thorough physical exam, blood work, other diagnostic testing that the practitioner orders, and careful consideration of a change that the family is concerned about. The outcome of this work-up may yield results that have treatment options.
If you see symptoms that cause you to want a consultation with a specialist, follow up with her PCP. Mom may indeed have a physical reason for her slump. There may be simple treatment options for her. Is she anemic, a vitamin deficiency, low blood pressure, or a medication dose that needs to be reduced, changed, or eliminated? Is there something more complex to diagnose? Be empowered; you are her advocate.
Dig deeper.
If the physical exam rules out obvious reasons for the changes, the root cause may be emotional. Initiate a gentle and caring conversation, ask questions, and listen carefully. Maybe Mom shares her feelings easily, but maybe not. Customize your approach to whatever allows her maximum comfort in discussing what she may find difficult to express. If she reveals that she feels "down much of the time," "can't get over giving up my license," "still feels so deeply sad about my cousin's death last winter," she is describing loss, grief, and perhaps, depression.
Mental health, in general, and particularly for elders, has long been stigmatized, under-acknowledged, and undertreated. Why would it evade them? It doesn't. Why would it be hard for them to discuss their feelings? Well… they are the role models, the matriarchs, and patriarchs. They don't want to disappoint; they are proud and may not have the language to describe their experience. They also come from a "snap out of it" generation. Who had time or luxury for feelings?
If Mom isn't able to open up easily or discuss this very personal situation, there may be someone in her physician's office (a medical social worker, a clergy member, or a professional therapist) that she could connect with. Maybe an old friend, who is tipped off that there is an issue, can do a gentle check-in. Skilled mental health professionals are masters of being able to "peel the onion" gently, and in a non-threatening way, providing a safe environment for difficult things to be revealed and discussed.
Mom's slump may be just that, and it may be more.
We don't need to accept Mom's feeling so blue as permanent or untreatable. She deserves to have this situation embraced, whatever the cause, and may need advocacy to get the help she needs. Once you start asking, you may find that this is more prevalent than you first thought. Talk to others in similar situations, seek out experts. Our local Councils on Aging are great resources and a perfect place to begin.
Let's hope Mom can get the help she needs and be ready to "deck the halls."
Joanne MacInnis, RN, is the founder and president of Aberdeen Home Care, Inc., of Danvers, a concierge private duty home care agency in business since 2001. With 35 years of nursing practice, management and administration experience focused on home care and hospice, Joanne and her team specialize in advising and supporting families addressing the elders in their lives retain dignity and quality of life.
