My Dad is 91 years old and my Mom is 84. Both are in generally good health, and the years have been pretty kind to them. But their mental and physical conditions have inevitably changed.
One significant change – especially as we become more elderly and/or infirm – involves how we communicate and negotiate with others. This hit home with me recently when reading the groundbreaking New York Times bestseller Being Mortal: Medicine and What Matters in the End, by Atul Gawande.
Gawande describes a series of end-of-life circumstances in which the medical professionals and system have largely failed to effectively communicate with their patients about their goals and often fatal conditions.
As I read this powerful book, I couldn’t help thinking that many of Gawande’s recommendations are crucial negotiation strategies we should use with the elderly and/or those with potentially fatal conditions.
Here are four. Each should also be in our general negotiation toolkit.
1. Deeply listen to ascertain true goals
Our medical system is largely designed – and medical professionals are extensively trained – to solve health problems, treat conditions, give options, and keep our bodies and minds functioning and alive. But this is not what many elderly want or need at a certain point.
Gawande described his hospital’s chief geriatrician, Juergen Bludau, as telling him that the “job of any doctor is to support quality of life, by which he meant two things: as much freedom from the ravages of disease as possible, and the freedom of enough function for active engagement in the world.”
Importantly, every individual assesses “quality of life” and “active engagement in the world” differently. And it is the job of doctors and those who support the elderly to help them evaluate this. This changes over time, too, and includes physical health and what Gawande calls “sustenance of the soul.”
This is not easy. But it requires that we deeply listen to what the elderly say they want and fear, ask difficult questions relating to the end-of-life environment, and intently observe how they interact in health-related circumstances.
2. Probe fundamental interests
Neither of my parents currently drive. And it’s a good thing. But discussing their driving with them, when it was time for them to stop, was challenging. After all, each had been safely on the roads for over 60 years.
But these conversations needed to occur. Gawande notes “[t]he risk of a fatal car crash with a driver who’s eighty-five or older is more than three times higher than it is with a teenage driver. The very old are the highest risk drivers on the road.”
At a basic level, this negotiation and many others on life-altering issues with the elderly revolve around fundamental interests like independence, freedom, control, autonomy, socialization, fears, and safety. These are crucial elements impacting individuals’ quality of life and what makes life worthwhile.
It is easy to get positional here and just say “it’s time to stop driving” or “you need to move into an assisted living facility.” Don’t.
Instead, really explore their interests – WHY it’s important for them to find other ways to get around, etc.
How, when, and where should these conversations occur? Ideally, do it with patience, perseverance, in person, and when everyone can engage at length at a deep level, not in crisis situations.
3. Step into their Shoes
Let’s face it – it’s easy to say you should step into your counterpart’s shoes and empathize. But it’s exceedingly difficult to actually do it, especially when you have never experienced it yourself.
Gawande describes many assisted living facilities, for instance, as selling themselves to the children of the elderly – not the elderly. He notes they “tout their computer lab, their exercise center, and their trips to concerts and museums – features that speak much more to what a middle-aged person desires for a parent than to what the parent does. Above all, they sell themselves as safe places. They almost never sell themselves as places that put a person’s choices about how he or she wants to live first and foremost.”
See this through the elderly’s lens – a different perspective – not our own.
4. Sensitively Have the End-of-Life Conversation
A close friend of mine died at a young age from cancer many years ago. I vividly remember the last time I saw him, and he had accepted his situation and extensively planned for his remaining time.
How? Gawande spoke about this with one of his hospital’s palliative care specialists, Susan Block, a nationally recognized expert in training doctors and others for these conversations. She said “[a] family meeting is a procedure, and it requires no less skill than performing an operation. . . . A large part of the task is helping people negotiate the overwhelming anxiety – anxiety about death, anxiety about suffering, anxiety about loved ones, anxiety about finances.”
She also detailed guidelines, which include: “You sit down. You make time. You’re not determining whether they want treatment X versus Y. You’re trying to learn what’s most important to them under the circumstances – so that you can provide information and advice on the approach that gives them their best chance of achieving it. This process requires as much listening as talking. If you are talking more than half the time, you’re talking too much. The words you use matter.” (For specific words and questions, see pages 182-183 of Being Mortal).
I agree, and so do my Mom and Dad. The words you use matter – in all negotiations.
Latz’s Lesson: Negotiating with the elderly requires specialized strategies and tactics, including listening and a focus on quality of life goals, interests, empathy and the end-of-life conversation.