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How important is it??? This is tough because to deny your loved one social and spiritual and emotional inclusion and thereby putting that well-being into jeopardy is actually abuse. The problem is knowing what level of inclusion they actually want. One thing I do know is that you cannot base it on what they always did before the disease took hold especially when we talk strokes and dementia. Example: Mum wants to see everyone every day and would gleefully have me drive her from one to another - isn't going to happen not in a million but she does go to church every week and she does go to a guild meeting every week and we have at least one friend come for the day each week and I feel in that way I have done my bit. I take her out for a walk along the foreshore if it is fine or we go for a drive. Example 2 Mym mother's friend has had a stroke and doesn't want to go out she doesn't want to speak to people - She has always been been the snappiest dresser the wittiest of people and the sharpest of brains and now although it is all inside she cannot move smoothly and cannot speak well and she doesn't want to meet people anymore so all the work her family do is familial based and she is happy with that and is moving away from her home to be nearer them and people who don't know her.....different horses for different courses.
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Recently I got mom all set up in a cute quiet apartment while she waits for her senior apartment to become available..her current apartment is not a senior apartment..so there's no real interaction with other folks..and I feel bad about that..so I bring her to our home to visit...HOWEVER I never know which mom I'm going to get..the pleasant one...or the negative complaining argumentative one who appreciates nothing...so while I feel bad she is lonely..I can't be responsible for her attitude that wants to be doomy! In fact her meanness is the last straw..the demanding..is affecting the tranquilty of my home. I encourage her to contact her friends..so she has started to do this...but they don't seem to come visit. I take her to a seniors group once a week...where she complains how mean I am to her...and she is believed. My sanity hangs by a thread. So I avoid her other than making sure her physical needs are met. Emotional health is important but she refuses counseling. In fact I need counseling to help me with guilt!
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My mom has no social life to speak of in AL although there are ample opportunities.

But--and here is the significant part--she had no social life before. We visited her and she played bridge. Without bridge, she would have seen no one but us. And she routinely broke off relationships with people--all her life long. She expected people to come to her and she went to no one to suggest get-togethers.

So, do I feel that I have to fix or improve this??? Not one bit. I visit every day. My mom is now struggling to have a conversation because her memory is so bad. But, God love her, she tries to be peasant and cooperative--thanks to her new meds.

It is what it is.
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As important as your aging loved one wants them to be.

My mother froze out all her friends with pretenses of being "too busy." Turns out it was brain changes from early dementia and a Parkinsonian syndrome. Her reclusiveness bothered others (myself included) more than it bothered her. The stimulation of conversation and questions made her agitated and befuddled. She preferred to be alone.

I also know several other elderly folks who are in their right minds, and have no social life outside of placing demands/expectations on their adult children and grandchildren. I haven't known these folks long enough to know if they never had friends.....or this is the old-age shut-down.

I find this syndrome disturbing. But it sure is prevalent. Maybe I'll understand when I'm that age. Altho I hope not.
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We have many needs, and they fall into a hierarchy. We need oxygen and water and food. But if you are suffocating you really aren't focused on the fact that you are hungry! The first and only priority is getting out of the situation that is preventing you from getting air.

Survival comes first.

We have social and emotional needs, too. I think they may be more important than we sometimes acknowledge. If someone needs help with ADLs, that comes ahead of emotional needs. Someone who can't feed himself or toilet herself needs that taken care of first. It is hard to be emotionally happy while suffering malnutrition or sitting in soiled pants.

I think it is very difficult as the primary (and often only) caregiver for a loved one with severe medical and physical needs to have enough energy to get beyond meeting the essential survival needs. I think it is a very good thing to arrange for the loved one to interact with other people, such as at an adult day health program, church, senior centers, or appropriate social groups.
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CG, a little more detail might help. Your profile says you are only dealing with age related decline, but if you are having to deal with medical problems and provide assistance for ADLs then I think there is a lot more going on.
When you are in the middle of a medical crisis all thoughts turn to surviving the next days and weeks. As the days pass thoughts naturally turn to living with the new reality, not just surviving but really living with the best quality of life possible. There are options available depending on your circumstances that can nurture their social and spiritual needs... sorry duty calls, I will leave details for others :)
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