I was at home one afternoon doing nothing in particular when an unrelenting voice in my head kept repeating: “Call Dad NOW!” Ordinarily when I thought about him, I’d smile and remind myself to call. “Gee, it’d be nice to speak to Dad. I must remember to phone him later, when I get the chance.” But this time something about it seemed urgent.
I obeyed.
Florence, our caregiver, picked up the phone and formally announced: “Wolf residence.”
“Hi, Florence. I’m looking for my Dad. Is he okay? Will you go tell him I’m calling, please?” I sounded cool, but my heart was beating loudly in my chest. I was focused and uninterested in chatting with Florence, as I ordinarily would have done to gain her view on the current situation with my folks. Now I just wanted to feel the relief of hearing my dear daddy’s voice. I had a very cold feeling crawling up my back and chest.
Florence got back on the line to tell me she couldn’t find him.
Now my heart was jumping out of my chest. “No! Go find him!” Florence disappeared again. It was not a very big place, so he couldn’t be lost! They only had a two-bedroom apartment! What the . . . !
Florence returned breathless. It turned out that Dad had quietly slipped into my former bedroom, aka his music business office, and locked himself inside. Responding to my demands, Florence burst in on him and found that he had placed a plastic bag over his sad bald head. He’d been trying to end his life!
I grasped the enormous importance of my being alert to my own internal voice and willingness to respond by calling. What if I had not been alert to my internal voice? What if I had dismissed that relentless urging? What if I had not phoned? What if Florence had not been there?
I am so grateful that I heeded my nagging voice on that otherwise “do-nothing” afternoon. Somehow, I’d felt it, that instinctive signal parents describe getting when their kids are in danger. Perhaps my close POP attachment to Dad had in a similar way alerted me that something was very wrong, even thousands of miles away.
I was already having serious doubts about the long-distance POP I was trying to do. Maybe it wasn’t my finest idea. In fact, the afternoon’s events seemed not only a blessing in having saved Jack but perhaps also a wake-up call: I would need to be watching more carefully than before, more than I could even imagine. And since my parents didn’t want to leave New York, my greater oversight would have to come from a distance.
Dad’s behavior had truly shaken me up. I’d been totally unprepared for him to become so beaten down by life’s stressors that he would contemplate suicide as his last life statement. He’d been “the rock” for everyone else since his childhood, helping his kid brothers, buying up my uncle’s cleaning business. “Dependable Jack,” they’d called him. “Mr. Moderation,” as Jack sometimes called himself, wasn’t the kind of guy to take his own life. But somehow over the prior several months, when I’d expected Jack and Lillian to settle into their more protected life, my ever-stable father had been acting in dangerously uncharacteristic ways.
Even with the abiding humility he cultivated, Jack had always seemed bigger than life to me. Maybe most girls feel that way about their daddies. Looking back at the time, I remembered how his being ever curious about everyone and everything had meant I couldn’t pull my dates away from talking with him. When had he stopped being curious? He had always seemed so comfortable being the strong, invincible one. Had he tired of the role? Only once in my whole life had I ever seen him cry. Dad had become totally frustrated over something rather small, but it had gotten to him and he just sat and wept. It was eerie to watch as a child, but the incident also humanized him for me. I’d never seen a serious break in him before. Nor had I foreseen that of my two parents it would be Dad whom I would need to rescue from a suicide attempt.
I was shocked and profoundly saddened that he’d felt so desperate that he wanted to end his life. Of course, I jumped on the next plane to New York. I had no idea what I would do when I got there or what I’d actually say to him. I’d figure those things out in the moment. Now I just wanted to hold his hand, take him on a walk in Central Park, and offer him the peacefulness he used to give me when I needed rescuing as a child.
Maybe Dad would share his burdens or disappointments with me. I also felt badly for not having been more aware. I’d not seen his unhappiness, and he’d never confided it to me. I was shocked that he’d think suicide could be a solution. I wondered if he’d been thinking at all or just reacting. Maybe he was just feeling forlorn and overwhelmed. I feared that even when I was by his side, Dad—like so many men of his generation—wouldn’t communicate very much about his emotions. I also wondered how much, if at all, I could help him.
By the time I got into Manhattan from the airport, Dad had been calmed down from his suicide attempt. He was grateful to have me there and told me he appreciated my answering his “call for help.” I’d naively hoped that some of the fatigue, withdrawal from life, and absence of joy I’d seen at Christmastime would clear up after his daughter and the caregivers improved his life. However, this depression had not abated much at all.
None of it had truly lightened the internal burdens Jack had placed on himself, it seemed to me now. Trying unsuccessfully to be his wife’s caregiver, Dad had to face that his wife and life partner had been diagnosed with Alzheimer’s and there was little he could do about that but watch the decline and love her. This news had taken its toll on the resilient man he had always been.
Depression is often hard to detect for family members even if you’re living nearby, and it’s even harder from a distance. As I looked back, there had been clues that Dad’s stress and life changes could turn into a major depressive episode. And statistically, there is a remarkably high rate of suicides (and attempts) among men in their eighties. But even I, the thorough professional therapist, had wanted to believe things were getting better and had not been looking for signs of depression in my father, my strong parent. And of course, I wasn’t there to observe him. But even had I been physically closer, suicide attempts are complicated phenomena and not necessarily predictable, despite someone’s depressed mood.
At this point in life, Dad was entering his late eighties and still working at his background music publishing business. It was very detail-oriented work, involving foreign rights and domestic contracts. My folks had been a team in that business from the beginning. As Mom’s cognitive decline became more apparent, she was less able to keep up her end of the tasks. I could see how her condition might have distressed and challenged Dad, demanding additional unknown skills from him at an age when he was finding it harder to learn new things. A man half his age would have had problems carrying on their projects (without his partner) and persevering despite grieving.
When I began POP, so much of my attention had been focused on Mom and the impact of her dementia on her activities of daily living, her moods, and her functioning. Now I’d been forced to pull the camera lens farther back on the scene and see the effects of Mom’s conditions on our larger family dynamics. Jack too had aged over the past visits. Caring for his ailing, aging beloved wife had stressed him and made him more vulnerable, first to pneumonia and later to depression. Despite Florence’s continuing attention, it was mostly my father upon whom my mother relied for real support, and her long-term cognitive illness also seemed to be impacting his emotions.
It couldn’t have been easy for him. I tried to get my father to talk with me as we walked through Central Park. It was not his practice to “burden” his child. But after I’d so quickly returned to be with him in New York, Dad began to talk more, although in a limited way, acknowledging feelings of confusion, loss, resentment, and even shame. I listened, offered an occasional interjection, and listened more. I held his hand, kissed his bald head, and reminded him of my steadfast love and appreciation. There was only so much I could do for him, even as I wanted to do more.
During my mother’s long cognitive decline, Dad had needed to become her primary caregiver and, as a result, he had needed to give up a central part of their marital arrangement: their working partnership. Dad was beginning to learn that medication could slow Mom’s dementia for a while, but that as time went by, she would become less and less his wife. Florence’s calming demeanor was very helpful for both of them around their house. Her quiet consistency and the predictable patterns she created worked well for both my folks, in spite of their very different personalities and needs.
On this visit, more clearly than ever, I’d come to see that, since I couldn’t rely on my parents to be accurate reporters of their own conditions, and since as a POParent I had a pressing need to know, it was my job to develop more reliable and regular procedures to oversee them at a distance. Florence and I created a protocol in which I’d be quickly alerted to any observable changes in my parents’ behaviors or health. She prepared written reports weekly. I advised their building’s superintendent to have the staff on the lookout for anything “unusual” with my parents, especially on the weekends when they were “home alone.” I was battening down the hatches around the boat carrying my fragile folks.
Even though I held onto the hope that Dad would feel like his former self after his suicidal attempt, he clearly needed more help. I checked into some psychiatric referrals for him and set up an appointment a few days later. Then I went home. Flying back to New York to be with him had only provided a temporary fix, it seemed. I returned to California, enjoyed a good night’s sleep in my own bed, and then heard the phone ring the next morning, very early. It was Dad.
“If you don’t come back, I’m going to kill myself.”
What would I do now? What would the experts advise? But I was supposed to be the expert! This is why doctors don’t treat their own families, I reminded myself. I was hardly objective.
Nonetheless, I looked to see how I, the geriatric expert as well as the daughter who adored him, could best help. I recognized that I must take his threats seriously, especially after his recent episode, but somehow this didn’t feel like the time before. This time it felt like what parents get when their child needs more of their attention. Was Dad truly suicidal or was he making some desperate attempt to test me? If he were truly suicidal again, the day after I returned home, then I would need to have Florence get him to an institution. If, on the other hand, he just needed more of my attention, then I was in parent-child territory, and I had some good ideas of what to do next.
I went with my gut and my new role-reversing mantra: “You’re their parent now!” It didn’t really feel like Dad wanted to kill himself, despite his words. It really sounded like he wanted me around more. I asked myself how could I best respond to him lovingly but also with appropriate limits, like a practiced POParent. I wanted him to know I was there for him but that I couldn’t be bounced back and forth across country. I couldn’t afford to get this wrong.
Very carefully, I decided to try employing with my beloved Dad some of the coaching techniques I’d already developed for patients who were POParenting. Soon thereafter, I would flesh out these techniques to create the curriculum for the POP Family Coaching program. Today, there are certified POP Family Coaches helping families—like yours—nationwide. As a result, I was able to “multiply myself” by sharing my successful POP coaching tools with many more families so their POPcycles could be both more workable and more loving. We continue to expand the numbers of certified POP coaches, many of whom have themselves been POParents; and, all of whom aim to do their part to undermine the damage of the silver tsunami we’ve already begun experiencing.
The first technique I tried with Jack was the “test question”: “What age is your parent behaving as, right now?” I found that even asking that question calms POParents down by allowing them to put a little distance in place. Interestingly, by taking a moment to consider your aging parents’ “childish” ways, and perhaps also recalling similar ways your kids acted, you can find an actual number your parent is behaving as: a very powerful tool, I had observed many times before, in my office.
Now, I thought to ask myself: “What age is Jack now?” And somehow, quite naturally, my mind answered. I instantly knew the age that seemed closest to how Jack was acting. It was about eight. If you’ve ever seen an eight-year-old boy act somewhat irrationally, desperate for his mother’s attention, that was pretty similar to what Dad was evoking in that moment. How does a parent treat an eight-year-old boy who’s feeling needy?
Over time, I’d also seen how helpful it was for me and lots of POParents to use the technique of underreacting. I applied that technique as well. Then, I took the deepest cleansing breath I could muster and made myself sound as kind and normal as I could: “Do you think you could wait all the way until next weekend, Dad, for me to come back and for us to spend some time together? I’ve just returned home and that means I just can’t turn around and return to New York without at least seeing my office and some of my patients. I know the weekend may seem like a long time, but I promise that if you won’t be too sad until then, I will come back this weekend. Can you work with me on that?”
I set a boundary but was still holding my breath to hear his response. I had no idea if my approach would work or if he would hang up and try to hurt himself. I hoped he would give in to the reasonableness of my request and get that I’d heard his neediness and would soon be back.
“Okay. I’ll wait. And Jane, thank you.”
As it turned out, Dad’s depression was not remedied. Over a period of months, he would try to kill himself on three separate occasions—once by plastic bag and then twice more by leaning out the window of the fourteenth-floor duplex apartment he’d fought so hard to get into. The last attempt he almost jumped, knowing I was in a cab across town on my way to see him. But he didn’t jump, thank God!
Over those months, I’d unearthed various specialists for Dad to meet with in addition to his prescribing psychiatrist. He saw psychologists, clinical social workers, and religious men. He took biofeedback treatments, psychiatric medications, and herbal supplements to prevent future harm, alleviate existing symptoms, and function better. But, poor man, he still seemed to be crying out for additional help.
One way I hoped to provide him help was to relieve him of the burden associated with his music publishing business. Perhaps if given the chance, I could sell off the valuable assets he’d written and published but now lacked the energy to exploit commercially. After having appropriately compensated Dad for his copyrights, perhaps the new, younger publisher would also want to use Jack’s considerable veteran expertise to further advise him. With fewer responsibilities, the pride associated with unexpected funds in the bank, and the respect that came with being a consultant, Jack might experience a reason to live, an RTL.
It took me a long time to accomplish, but eventually I was able to sell Dad’s published work to people who continued to share it with the listening public. His joy in that transaction and all the accompanying benefits of it lit up my world.
Another way I hoped to relieve some of Dad’s emotional burdens, and Mom’s too, was through the mentoring and support I got from colleagues. Throughout my POP journey, I was blessed to have Dr. Michael L. McGrail as my geriatric guru. A devoted friend and my office partner, Michael was a highly gifted psychiatrist with an amazingly kind heart and a devilish sense of humor, who was beloved by his patients and students. Having him by my side while parenting my parents was a gift, as Michael always provided me both the information I needed for POP and the wisdom to interpret the data accurately. I would call him day or night from the emergency rooms of hospitals—sometimes desperate and always grateful for his sound advice.
After so many attempts to treat Dad weren’t helping, Michael convinced me that Dad’s form of depression would best be halted by carefully administered electroshock treatments (EST). No longer the frightening experience portrayed in 1950s movies, EST had become an acceptable last-ditch way to permanently relieve intense psychological pain. When Dad tried suicide a third time, I agreed to the treatment. I can recall few sadder moments in my whole life than leaving my daddy to be prepped for these shock treatments.
Tied down to a “geri-chair”—one of those hospital high chairs where old people look like young children waiting for lunch—Jack’s eyes were deeply sunken and radiated terror. I wanted so badly to comfort him, to make it all better for the man who’d been there to comfort me and my “boo-boos” in his day. I let Dad know that he would feel better again soon and would function more like himself after the treatments. I suggested he talk frankly with the nice young woman who was the social worker, confiding that she shared my training and might become one of his best allies on the road to recovery. He said he would try.
With a very heavy heart, I left him sitting in that high chair and headed back to their apartment. There I bid farewell to Mom who was a bit confused with all the psychiatric attention now focused on Jack. I checked in again with Florence and told her to be on the lookout for Mom’s need for some special attention. Then I went down to the building superintendent and instructed him to install bars on the windows of my parents’ elegant apartment. That would assure that neither parent could use their fourteenth-floor windows as an exit point from this world. Then I boarded another plane, thankful to escape back to my home.
How much any of those treatments or professionals helped my father is frankly hard to assess and may not matter. I was grateful for anything that brought him some respite. Participating with these methodologies provided Jack a variety of tools to manage his stress and the more “single” life he would increasingly live as Mom retreated into her dementia. Jack never suffered a recurrence of his symptoms, to my great relief.
Hopefully, you will never have to be on a call like mine rescuing a potentially suicidal parent or loved one. But it is possible that you will as a part of doing POP. If it does happen to you, hopefully reading this information will alert you to handling it more effectively.
If you or your parent are having a personal crisis and need help right now, call this toll-free number: 1-800-273-TALK (8255). Your call goes directly to the National Suicide Prevention Hotline. All calls to this line are always confidential. Even if it seems totally unlikely, you should keep the number handy for future use.
POP, in reality, is a life-and-death mission with the end point your parents’ departure from the planet. There will be times when, for everyone’s sake, you may wish the end to come sooner rather than later. Seeing people you love in any kind of pain—physical, spiritual, or emotional—is hard, and sometimes you may want the suffering to end. If you have had such thoughts, do not feel bad. I repeat: do not feel bad. They are just thoughts. Thoughts are real and they are measurable, but they are not actions. Research teams have estimated that a person has as many as ninety thousand thoughts each day. And we all have thoughts from time to time that don’t represent our finest hour. So, don’t start punishing yourself for your thoughts.
If you are doing the primary family caregiving, like my Dad felt he was, there’s a lot of information and many resources available about taking care of you! Family caregiving may often result in depression or some other health issue to the caregiver who rarely pays sufficient attention to him/herself. This is not an exaggeration. Like my Dad, one of your parents may already have joined the more than sixty-five million Americans (more than three in ten households) who provide unpaid care to an elderly or disabled adult family member.[1] These family caregivers provide an estimated 80 percent of the long-term care in the United States.
It is not at all uncommon for live-in family caregivers to develop serious health problems. Research has shown family caregivers are more likely than non-caregiving family members to:
display symptoms of depression or anxiety
have a long-term medical problem
show higher levels of stress hormones
spend more days sick with an infectious disease
have a weaker immune response to flu vaccines
heal wounds slower
suffer from obesity
show a higher risk of mental decline, including problems with memory and concentration (the precise areas one doing POP would most want most to have)
A few years ago I tried unsuccessfully to set up a support group for people doing POP. Prospective members told me they definitely wanted to feel better, could absolutely use support from fellow caregivers, and knew they should give some loving attention to themselves. But they were unwilling to commit to regularly attending a group whose focus would be on their own well-being and not their parents. Just as you and I, when we were young parents, set our “default” to attend to our baby first, when parenting aging parents, many family caregivers similarly take care of parents first, bathing, feeding, and attending to ourselves much later, if ever.
Promise yourself that you won’t fall into this pattern of self-neglect. Find ways to set some boundaries or space between you and the loved ones you take care of. Schedule at least some activities that are focused on you alone. Make some time every day to attend to you, even if it’s only a quiet cup of tea as you listen to a favorite piece of music. You will recall that on airplane flights, when instructing about emergency oxygen masks, they always remind parents: put your own on first. Similarly, with family caregiving: if you don’t take care of you, you may not be ready when it’s time to help your parents!
If you’re a spouse to a senior or an older adult child of one, remember that your poor self-care may eventually make you more at risk than the person you’re attending! Yes, some caregivers will die before their charges. And what good will you be to your loved ones—and what sort of model—if you become ill or disabled and then need a caregiver of your own?
If your senior parents are still living with a partner, the fact that people age at very different rates may have an effect on them as a couple as well as individuals. People decline at different rates, partly because of genetics and partly because of different lifestyles and mental attitudes. Even if your mother and father have the same number of years on the planet, as mine did, they may now be functioning at and feeling themselves to be very different “ages.” I see many situations where the husband persists in his provider role by taking care of his same-age or even younger wife. Contrary to many of our stereotypes, one in every three American family caregivers is male.[2]
Your parents may conspire, consciously or less so, as mine did in the beginning, to keep their limitations hidden from you, the outsider. That may take the form of covering up what’s forgotten and then compensating by trying to fill in the blanks when they can’t recall details. For example, your dad may claim he phoned you yesterday as promised, even supplying details, when he doesn’t really remember. Partners will often camouflage each other’s disabilities, making your detection of conditions like depression harder. This is a version of how your teenage children may have acted, although for very different reasons. Perhaps back then you honed your “parental detectors” and can now utilize them for POP. Your aging parents may be falsely reasoning that they can hold on to their autonomy, their home, and their lifestyle if they don’t let any outsiders know about “weak links in their chain.” But as we’ve seen, that is rarely, if ever, in their best interest.
Depression among the elderly is a very serious matter. It is widely associated with suicide. Older Americans are disproportionately likely to die by their own hand. White non-Hispanic men over seventy-five pose an unusually high risk for self-destruction.[3] This phenomenon is under-recognized and undertreated. Disturbingly, some health professionals and even some seniors themselves mistakenly believe that persistent depression is a normal way to live because of the serious illnesses and financial hardships that often accompany aging in our society. Many older adults who die by suicide visited a physician within a month before death, yet the signs of depression apparently went unheard. As a result, it’s even more pressing for those doing POP to be alert to our parents’ wake-up call.
This underscores the urgency of improving your ability to detect your beloved elderly parents’ mood disorders. One of your goals in being a proficient POParent is to train yourself to use your “observing eye” in service of your aging loved ones. As you become attuned to the symptoms of geriatric depression, perhaps you can help avert a family crisis. Take the time now to review your parents’ reactions—over the past several weeks. Note if your parents have had any changes in
appetite
weight
energy
concentration
sleep
mood patterns
or feelings of:
hopelessness
helplessness
lack of pleasure in things usually pleasurable (anhedonia)
Elderly people with severe depressive bouts are still overwhelmingly in the minority. If a number of these symptoms persist for two weeks or longer or they get worse over the weeks, your parents may be abnormally depressed. It is always worth checking out your concerns with their doctors since depressive disorder is not a normal part of the aging process. You will likely want to reevaluate any geriatric professional who tells you it is.
While everyone experiences sadness, grief, feelings of loss, and the occasional blue mood, persistent depression is different, and it is not normal. And although your parents may be very sad if and when their partners and long-standing friends die, generally speaking, people often feel more secure and content as they mature.
Those who lived into their eighties and nineties reported that their emotional happiness increased as they aged and, despite the high valuation we place on youthfulness, older Americans report being happier with their lives than younger people. A sample of twenty-eight thousand people interviewed from 1972 to 2004 revealed that the happiest sector of Americans is the oldest.[4] As they aged, older adults rated their life satisfaction much higher, with happiness ratings rising gradually and steadily from age fifty through the decade of the nineties. Researchers are calling this process the “U-curve” of happiness.[5]
A big part of POP involves your becoming watchful of your parents in a different way
than you’ve ever been before. That may look like doing “watchful” things—examining
their personal effects in ways that might have seemed like an imposition on their
privacy when they were younger. You might look over their mail, check the contents
of their cupboards and refrigerator, and
inspect their medicine chests for information about undisclosed diseases and a better
understanding of how much and which medicines they’re taking. You may even wish to
do some POP research by going online to read up on their prescription drugs and their
side effects.
In your POParental role, your watchfulness may have to take on a subtler form as well. The next time you’re around a caring parent with a very young child, watch the parent’s eyes track the child’s eyes and any change in the facial movements of the child. Similarly, as you watch a caring POParent mopping the brow of a dad who has forgotten his child’s name, it is likely the POParent’s eyes will also be tracking the father’s eyes and any changes in his facial movements.
If you’re going to do POP well, you may also need to supplement your own eyes and those of other family members with professional help, full-time or part-time. If so, your TEAM POP will need to address these questions now and again over time.
What do our mom and dad require help doing now?
How many days or hours/week do they need this help?
When do we need to start to give them that help?
How much will that cost and how are we/they going to afford it?
If there isn’t enough money, how else can we use our talent and resources to get them the help they require?
In order to oversee these various POP tasks and your parents’ aides, you or someone in your family will soon be learning the ins and outs of these systems: Medicare, Medicaid, long-term care insurance, pensions from employment, geriatric dosages of medication, home health care workers, and more. We continue to provide updated resources, links, and blogs at the POP website (http://www.ParentingOurParents.org) so you can further explore what you will need for your folks. Online governmental resources also make it easier today for POParents to become conversant with terms like: eligibility guidelines, waiting periods, deductibles, and waivers. Your designated family member can apply for many programs online, including Social Security, and get much helpful information directly from the providers of the services.
You will want to be creating a TEAM POP contact list. Include as many people as you can on your list so that you have backup choices if needed. Make sure you get the cell phone numbers and email addresses for your parents’ neighbors and close friends for the TEAM POP contact list you’re developing. You may be pleasantly surprised at the kindness of neighbors who’ve lived across the hall from your parents for the last twenty years. They can sometimes add extraordinary eyes and ears where you can’t be. Remember to keep your contact list updated with changes and to send the updated lists to everyone.
But no matter how many people you hire or who they are, you are still the one leading POP. As such, you need to remain watchful as things change, and they will change, of that you can be certain. If your parents have a good geriatric care manager (GCM), you may only need to be in regular and ongoing contact with one centralized source of information. Even if they have a GCM, you may be the type of POParent who wishes to have more direct and/or written protocols with your parents’ caregivers and others to better monitor any changes. You may be watching as carefully as you can, but be aware that sometimes things change quickly in little ways that end up changing everything.
National Alliance for Caregiving, Caregiving in the U.S. 2009, a report conducted in collaboration with AARP and funded by the MetLife Foundation (Bethesda, MD: National Alliance for Caregiving), https://www.caregiving.org/data/Caregiving_in_the_US_2009_full_report.pdf.
National Alliance for Caregiving, Caregiving in the U.S. 2009.
National Institute of Mental Health, “Suicide Prevention,” https://www.nimh.nih.gov/health/topics/suicide-prevention/index.shtml#part_153178.
Yang Yang, “Social Inequalities in Happiness in the United States, 1972 to 2004: An Age-Period-Cohort Analysis,” American Sociological Review 73, no. 2 (April 2008): 204‒26.