Posts

Cognitive Dysfunction or Emotional Dysfunction?

There is a difference between “emotional dysfunction” and “cognitive dysfunction.” For those caring for an old-old, it’s helpful to understand the difference. My mother suffered from emotional dysfunction. And though it hurt my ego, it’s a pattern I was familiar with, and it was not going to change—she was more of who she had always been. It was her emotional dysfunction, not her cognitive dysfunction, that pushed my buttons. I could help her cope with the cognitive dysfunction, but that she didn’t seem to appreciate my efforts was her emotional dysfunction. And I couldn’t change that.

A post from the front line during my caregiving days.

I’ve been feeling that I’m living crown-over-slippers in the Cinderella syndrome. My mother doesn’t seem to understand or appreciate my contribution to her living. Why is that?

Well, I’ve had an epiphany. Living close to an old-old has heightened my awareness of my own immortality. The day will come when I can no longer do what I can do now, and that’s a bit of a freak out; like being the ghost of Christmas future. But what of my mother? She has my youth in her face day in and day out, reminding her of what she can no longer do; the ghost of Christmas past.

I watch my own children in the prime of their lives—raising children, boundless energy for friends and activities, and home improvement without fear of back injury and knee pain; a whole future ahead of them—and I understand a bit what my mother sees. But, unlike me, she has nothing ahead.

I ran across some information online about “emotional dysfunction” and “cognitive dysfunction.” For those of us caring for an old-old, it’s helpful to understand the difference.

My mother suffers from emotional dysfunction. And though it hurts my ego, it’s a pattern I’m familiar with, and it’s not going to change. As our parents age, it’s likely their emotional functioning will become more of what it has always been.

Cognitive dysfunction is another rabbit, and is new to all of us. It demands a new kind of response, and it’s not going to be perfected overnight. The only way to deal with it is to take it as it comes. And just when I figure it out, it changes again. How do I deal with that? Imperfectly. I make mistakes, which pushes her familiar emotional dysfunction buttons and my childhood outrage buttons and we go into battle mode. And then we forgive each other and ourselves and move on.

My mother’s frustration with old age doesn’t manifest in anger often—she is not a person given to emotions, remember? But she is angry, she must be. Her body is failing her. She can’t see, or hear, or depend on “normal” bowel function. She can’t dig in the dirt or change a light bulb or cook her own dinner. It’s outrageous! And here I am: young, active, capable. And in her face day in and day out, reminding her of days long gone, never to return. Reminding her of all she can’t do. Maybe even doing it better than she ever did it. Is she proud of me? Damn straight she is. Will she tell me? Never. Why? Lifelong emotional dysfunction. I’m beginning to see how this works.

It’s her emotional dysfunction, not her cognitive dysfunction, that pushes my buttons. I can, and am, helping her cope with the cognitive dysfunction. That she doesn’t seem to appreciate my efforts is her emotional dysfunction. And I can’t change that.

Like a child who acts out at home, but not at daycare, or an adolescent who holds it all together at school, but is alternately sullen and outraged at home, the frustrated and fearful elder lashes out at caregivers. They feel safe to let down their guard with the person closest to them. Is it appropriate? No. Is it okay? No. Is about the caregiver? No. Is it crazy-making? Yes. Is there anything to be done about it? Was there anything to be done about the toddler or the teen? It ended when they outgrew it. My mother’s will end when she dies. But I can learn to cope with it.

▪️  Time away. I realized before I started this gig that my life still needed to be about me. I’ve been here three and a half years now, and I have clung steadfastly to that resolve. My mother has occasionally challenged it, thinking I’m not earning my room and board. I take trips (but not guilt trips), I have a regular day away each week, I have coffee with friends, I spend time with my grandson (and miss the far away ones). And I have been known to assure my mother that I am earning my keep; and much, much more.

▪️ Get help. A few months after my arrival, when I realized this was not going to be the one year commitment I made, but that it would be until, well, the end of time—her time, hopefully not mine—we hired help. We are lucky she has the resources for that, my sisters and I certainly do not; but there are also volunteers and seniors’ programs, one only need look. And the parent doesn’t have to like it. I didn’t agree to “do it all,” and I’m not going to. I’m just not.

▪️  Engage in and take time for interests. Whatever they might be. Stay relevant to yourself. Follow your curiosities. You won’t get this time back.

▪️ Let go of expectations. I came here thinking there would be emotional recovery. Maybe it happens for some parents and adult children, but I think it’s most unlikely, and then only if the parent is deeply sunk into dementia. We don’t change our spots; certainly not in old age. Lose the glass slippers and pull out the hip waders, there is deep shit ahead. And put blinders on that tiara.

My mother depends on me now, like I used to depend on her. It’s a radical change. And I do just about everything wrong. It’s how it is. And, of course, it’s not how it is. It’s her circumstances that are wrong, not me; it’s her circumstances she is angry at, not me. We are doing well enough, my friends. And even Cinderella got her paradise in the end.

Taking Care of Business . . . and Yourself

A reader’s story reminds us of the importance of getting legal and medical powers of attorney (along with end-of-life wishes) in place while your loved one is mentally able to consider and sign the orders. And, when things change, to take care of yourself.

FINANCIAL MANAGEMENT. By the time I decided that Dad could not live on his own, it was too late to put Medical and Financial Powers of Attorney in place. I had to go through the process of becoming my dad’s court-appointed guardian. Families should look at the financial and medical powers of attorney as much as a will, living will, or trust account. Dad would have been willing to let his children have those powers but we just were too slow in getting something in place. I had a full-time job, lived over two hours away, and visited two weekends a month until I realized dad needed more care. By then, he clearly would not have been able to sign the legal documents needed (in good conscience on my part).  Take care of the finances, discuss them openly, and be prepared for push back. My siblings were very willing to let me take charge and live with dad as long as their inheritance was not touched. It became clear it was an important factor as I asked them about paid care for dad. None of them were willing (or able) to bear those costs, but didn’t want to give up their “stake” in the estate.

SELF CARE.  I could not cope with the stress of taking care of dad, managing his affairs, managing my own affairs, and working part-time to keep myself sane. I ended up going to my own primary care physician and getting a prescription for an antidepressant. Then a stronger one, then a stronger one. I stopped eating, went to town only for groceries or doctor appointments, and was isolated. I wouldn’t answer calls or texts from friends; I barely communicated with my children. I needed help with dad and, even though I am a reasonably intelligent woman, I could not dig myself out. Dad’s death was my release. I tried to find resources to help with Dad, but there just isn’t much in my county. What there is takes forever to book an appointment. Families need to build a good support network and not be afraid to ask for help and have back-up care regularly scheduled as well as for emergencies. I didn’t have those resources and they are essential.

Sonja S.