How to have a difficult conversation with a confused older person

How to talk to old people

It’s never easy when we see a loved one is struggling to cope. When that person is a parent or an older relative, deciding what to do or say is all the more tricky.

What may seem like small problems in isolation – occasional forgetfulness, a decline in mobility – can accumulate to make normal daily activities more challenging, with loved ones feeling the need to step in, says Lesley Carter, senior health influencing manager at Age UK.

Advisors and the family of Joe Biden may be in this situation. Concerns over the US president’s age came to the fore on Friday after he gave a stuttering and confused performance in a presidential debate against Donald Trump on Thursday. It follows years of gaffes from Biden, who has suffered falls and name mix-ups repeatedly. The latest example has prompted some supporters to say he should stand down.

President Biden repeatedly lost his train of thought during Thursday's presidential debate - Gerald Herbert/AP

“All those sorts of very slight things we can get over, but all together, they then start to become a big problem. And that’s what’s happening to Joe Biden now, isn’t it?” says Carter.

The best approach is starting discussions as early as possible.

If they need support at work

“If you’re a good manager, you’ll know if one of the people who reports to you is not firing on all cylinders,” Carter says. “You would pick up on that immediately and not wait until it became a huge problem.”

Signs that a person may need support could be that they are struggling with tasks that they had no problem doing one or two years ago, such as finding it hard to pick things up or becoming more stressed, she explains. But it wouldn’t be a sudden or dramatic change, as age-related difficulties are insidious and progress slowly.

Carter says ageing can also affect speech, as “sometimes we can’t think as quickly and panic a bit”.

If a more senior colleague is acting differently, it can be “quite tricky” but colleagues should be able to approach HR or a senior manager and express their worry.

A company should have policies in place with how conditions, such as dementia, are dealt with so adaptations can be made to enable people to stay in their job.

Those working with the US president may not have such a streamlined approach to raising concerns. “It seems to me that most people’s working set-up is much more organised than the president of the United States,” says Carter. “If you think about it, if our Prime Minister had dementia, Parliament would know and they would do something.”

If they shouldn’t be driving

If an older person makes an unwise decision or has a slow reaction while behind the wheel, then it’s time to discuss their driving, Carter says.

“If they can’t turn their head due to arthritis in their neck, or bad knees leave them struggling to brake properly,” she notes, “these have nothing to do with their mental capabilities, but may mean they can’t brake as quickly as they need to.”

While persuading a loved one to give up driving will likely be met with resistance, who wants to give up their independence after all, you should raise the issue when you first notice a problem, rather than waiting until a crisis happens, she says.

“We have to remember that it’s not a confrontation. Carers, relatives, sons and daughters know a time will come when a loved one can’t drive, so they’re watching on and thinking: ‘Is it going to be today? Have I got to take their keys away? What’s that going to mean?’”

But actually, you should start a dialogue before you reach this point.

“Instead of: ‘You mustn’t drive’, the conversation should be: ‘I noticed that you didn’t see that cyclist, are you having a problem with your eyes?’” Carter says. “This is a much softer approach and can lead the older person to making the decision to stop driving themselves.”

It’s also worth considering who should have the conversation with them, she says. “It could be their best friend, who would be much more appropriate or get much further than you would yourself.”

If they’re digging their heels in and being stubborn, continue to discuss their driving, giving examples of why you’re concerned.

“You have to also give alternatives. Some people may think, for example, that they can’t go to the football if they don’t have their car. But you could say things like, ‘The money saved on the car means you can afford a taxi’. Otherwise an older person will just think, ‘I’m so old and nobody thinks I can do anything’ – and that’s very disabling.”

As a last resort, you could go to their GP or take away the keys, she notes.

If they need support at home

If an older person needs help around the house, it won’t happen “just like that”, Carter says.

“You might find that the house is getting a bit messy, a parent isn’t looking after themselves as much as they used to or isn’t cooking for themselves,” she says.

They might also be struggling to wash, as they’re finding it tricky to get in the bath or shower, or they may have incontinence, which can cause a smell, says Carter. “It’s a really hard thing to raise because it’s such a personal thing.”

“This business about not being able to care for yourself really affects older people quite a lot. They feel bad, because they feel they’re losing their independence. And of course, nobody wants to go to a care home and everybody panics.”

Broaching the subject early is a “really good idea”. Notice the problems that an older person is having and consider what you can do about it, she says.

For example, Carter suggests you could get their shopping delivered or order a meal subscription service so their food is easy to prepare. You may also need to persuade them to let someone in to do the cleaning and help with their personal care.

“But it’s not just diving in and saying, ‘Right, this is what we’re going to do – you’re either going to have this person come and help you, or you’re going to the care home’. That isn’t going to work,” she says.

One way to avoid reaching this stage is to make a plan early – have an open conversation about what your loved one wants to happen when they eventually need help in the home, she recommends. “Ask them to consider whether they’d be happy for someone to come in and help with personal care, go to sheltered accommodation or move in with a loved one.”

Speaking to them sooner, rather than later, helps people to be independent for longer and will gain their trust, she says.

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