Navigating Health and Aging: Aging loved ones allowed to make their own bad decisions

"You're only as happy as your least happy child." That's what my former intern and unofficial column editor told me last week. As a parent, I think this holds true. We love and worry about our children and ultimately wish for their happiness. It's a given: You will worry about them for life.
This phrase holds true alternatively when an aging parent has children worrying about them. The table turns, and the shoe is on the other foot. I talk with aging people every day. I have the advantage of a clean slate, no baggage. I can listen with open ears and an unslanted view of their feelings. The one thing that I hear often is, "My children treat me like I'm a child. They stop asking what I want and start telling me what I need. They think they know best."
This frustration that aging loved ones feel is often justified. Too often, family members become aware that their aging loved ones are having difficulty with their normal activities, and then feel that they know the best solutions and have all the answers. That's when the problems begin.
When is it appropriate to step in and start making decisions with or for your loved one?
There is a term used by nurses, social workers and health-care providers that is highly regarded: self-determination, or free choice of one's own acts or states without external compulsion.
Who is allowed to make decisions? What if we don't like them? There are people living alone all over this country who have problems caring for themselves. Some of them are going as far as "self-neglect." When does someone else have the right to step in and tell them what to do and make him or her do what they think is best?
We all make decisions that may not be in our best interest - smoking, eating fattening foods, drinking, not getting enough sleep, working too hard. Take your pick! We are all guilty of some behavior that is really not good for us. With this thought in mind, if your mother hates how she feels when she takes her medicine and doesn't want to take it, and if your father smokes despite a cancer diagnosis, COPD or heart disease, that is her or his choice. Yes, they may be bad decisions in your eyes, but they are their decisions.
This is called self-determination. They get to decide how to live their lives and choices they want to make. Our aging loved ones are allowed to make bad decisions. You and I will continue to sometimes make bad decisions as part of our days. Yet, as we age, others often start to tell us what not to do.
Self-neglect comes in all shapes and sizes: People do not take their medications because they are too expensive. Others do not want to spend their savings for their care because they are saving it for the children's inheritance. Some people keep saving for their rainy day when that "rainy day" has actually come ... You just name it! There are people living in homes in disrepair, eating unhealthy cheaper foods, not receiving health care - the list goes on for various reasons. We can worry about our loved ones all we want. Regardless, the bottom line is: self-determination.
It is a very frustrating situation to just sit back and do nothing about unhealthy or unsafe situations. It is similar to experiencing your children make bad decisions. Sometimes you have to stop controlling the outcome and let them figure it out - you are only as happy as your least happy ...
When does self-determination and bad decision-making cross the line into becoming a danger to self or others, and when is it appropriate to intervene? The answer is when your loved one no longer has the capacity (a medical term) or competency (a legal term) to decide for themselves, and their behaviors are putting them or others at imminent risk for harm. This is not an easy thing to prove, and the criteria are very clear. Two physicians must agree that someone does not possess the ability make choices due to illness or dementia. Only then can a loved one step in to help. However, I emphasize that it is appropriate to offer assistance, not to rule your loved one's life. While a court may appoint a guardian for decision-making, that guardian is charged with making decisions on behalf of their loved one based on what they (their loved one) would want, not what the guardian deems to be the right thing. The Alzheimer's Association has a very powerful statement on respecting the rights of an impaired person.
So what does this add up to? Listen, talk, communicate and treat your loved ones with respect to make their own decisions. Remember they are "allowed" to make bad decisions. After all, they watched you make plenty of bad decisions as you grew into the person you are today. Give your loved ones the same dignity. If they have a medical or psychiatric problem that causes you to intervene, this is a reminder to act out of respect and dignity, always valuing the worth of your loved one. We would all want nothing less. We are all on the journey of aging.