Practices to Support Apathy in the Elderly
Monique Newton is a Yoga Therapist, C-IAYT, Mind-Body Coach, and Conflict Coach. As a trauma-informed somatic practitioner, Monique works with the embodiment of our individual and collective lived experience.
“I don’t care.” This is often the response I have heard from an elderly parent. It might be in response to a question about what they would like for dinner, where they would like to go for a walk, or whether they would like to sit inside or outside. Or it could be in response to something related to their healthcare, discussions about weight loss, or talking with a doctor about the results of a computed tomography (CT) scan.
Experiencing my elderly mother’s increasing apathy after a heart attack, I have felt a mixture of grief, confusion, worry, and frustration. I try to make sense of the contradictions between her wanting to address a health concern or have more social interaction with friends and, in the same moment, disdaining any suggestions about well-being and even declining invitations from friends.
At a doctor’s appointment, she may suddenly minimize or shrug off symptoms that she had earlier highlighted and complained of to me.
I have learned that what can feel like challenging and frustrating behaviour from my perspective may be experienced by my elderly parent as something else. As health declines in older adults, they may have overwhelming physiological experiences that are better understood through the lens of chronic health conditions and declining well-being.
Elderly parents are not just being difficult! Physiological patterns and symptoms create real barriers for elderly people. For example:
Fatigue due to chronic conditions such as COPD, heart disease, or moderate kidney dysfunction can create a barrier to doing things. Dismissing friends or ideas for going out might mask a deep inner exhaustion.
Declining mobility can also present a misunderstood barrier. Avoiding activity that requires movement may show up as not wanting to pay for parking or dismissing a medical appointment as being “a waste of time.”
Saying “I’m fine” or minimizing symptoms in front of a doctor may be a way of hiding fear about health changes or shame about not being able to cope anymore.
Apathy in aging adults can be a sign of early neurodegenerative decline or disease.[1]
Experiencing a change in health status is challenging for anyone. An elderly person’s living situation can change quickly after an incident or fall. After my Mum fell and broke her hip, she had to move out of her house. Pointing out that she is safer in an apartment with no stairs is not very helpful. Now I practice pausing and reflecting on what it means for her to lose the agency to sit in her own garden and enjoy the afternoon sun.
I have learned to reflect differently every time I hear “I don’t care.” I make different choices about my presence and how I show up for my mother, instead of trying to understand for myself, I navigate conversations with her in ways that focus on her self-determination.
Here are four key practices that I have found supportive:
Ask open-ended questions: When the doctor expresses concern about her weight loss, and she says “I don’t care,” Instead of saying “Your weight is important, Mum” or “Eating is good for you,” I ask, “What would make food more interesting to you?” or “How can I help you eat more regularly?” In this way, empathy looks more like genuine interest rather than an admonishment about what should be done.
Encourage agency: I purposefully wait until my Mum asks me for my opinion before I offer it. If I do feel it is important to give advice, I first ask her, “May I make a suggestion?” or “Can I offer a thought about this?" Validating her views about her experiences is also important. For example, when she says she is fed up with going to see the cardiologist or taking her medication, I acknowledge her frustration: “That makes sense, it is no fun to keep going to medical appointments!” Instead of saying, “All this medication is keeping you alive,” I might say something like, “It is a lot of medication, and I really admire the way you have organized it and how you continue to take it.”
Prepare for medical appointments: Medical appointments can be disempowering. To support empowerment, I encourage my Mum to create a list of what she wants to address with the doctor. Then I ask how I can support her during the appointment. Because my Mum tends to downplay her symptoms once she is in front of the doctor, I also make sure I have her permission to make a point or add information when we are with the doctor.
Focus on relationship: After two hospital stays and many medical appointments, I noticed myself in a pattern of being task oriented when I am supporting my Mum. I became accustomed to the lists of tasks she had for me whenever I visit, so I forgot we could also have conversations unrelated to her healthcare or her apartment. I started intentionally making time when I didn't bring up anything related to healthcare. Just hanging out together in a park or sharing more about my life and work is a welcome respite for both of us.
These beautiful lines from Mark Nepo’s poem, Yes, We Can Talk, remind me of the preciousness of this moment in life:
No longer trying to make sense of pain, / but trying to be a soft and sturdy home
in which real things can land…
And we can churn at all that goes wrong / but then we must lay all distractions down, / and water every living seed.[2]
Read more from Monique Newton
Monique Newton, Yoga Therapist-C-IAYT & Mind-Body Conflict Coach
Monique Newton is a Yoga Therapist, C-IAYT, Mind-Body Coach, and Conflict Coach. Monique believes in the generative power of somatic awareness for social justice, conflict resolution, and personal transformation. She has dedicated her own healing journey to becoming more self-aware, decolonizing her presence and body, and living with humility. Monique supports individuals and teams with intrapersonal and interpersonal conflict and working through change. In providing services and support, Monique focuses on trauma-informed approaches and emotional and mental well-being.
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