Aging was, and always will be, an honor. Growing old is a mark of the strength and wisdom that can carry a person through many decades.
But as modern medicine feeds our expectation for extended youth, watching those we love age can be jarring. “What shakes us when we see someone changing and we don’t know how to adjust with them,” says Paul Malley, president of Aging with Dignity, a non-profit based in Tallahassee, Florida. “We may want to be the best son or daughter, but we don’t know what that means.”
Because of that, when it comes to the realities of growing old, “the default is to say nothing,” says Susan Stiles, the senior director of product development and strategy for the National Council on Aging in Arlington, Virginia. But planning for old age is critical, especially when it comes to dealing with unexpected events late in life. So this holiday season, as you visit your family young and old, consider giving a different kind of gift: an open conversation about how they want to age, and ultimately pass on.
Yes, yes, it’s morbid, and this time of year is supposed to be all about rebirth and new beginnings and all that. But it’s that kind of perspective that keeps families putting off these talks until they’re too hard to have at all. With the help of a few experts in navigating the bumpy road of aging, Quartz has some tips for how to approach these tricky discussions.
Getting to know you
“It’s a bummer of a topic,” acknowledges Malley, who has been working in this space for over 20 years. Nobody wants to imagine a loved one reaching a crisis point in their care: a sudden fall, maybe, or rapid-onset dementia that leaves a family member unable to live on their own or make decisions for themselves. But it’s possible to plan for aspects of aging—even these unpredictable moments—and eliminate the stress of making educated guesses about what our older loved ones want.
It starts with easing family members into these conversations early, while they’re still well and able. It could be when they’re in their 40s or 50s—whenever you as a potential caregiver feel comfortable broaching the subject. Realistically, this won’t be just one conversation: Building up trust and compassion before you introduce the idea of advanced planning and priorities can take years.
Every time the topic comes up, the key is that the conversation doesn’t feel confrontational. If you put someone on the spot by asking them if they want to be on life support if they have a heart attack, the conversation won’t go very far. Focusing on a specific situation implies that you’re planning for the worst, and only adds to the idea that aging is inherently an unpleasant process.
Instead, you can ask your loved one what matters most to them in life. Frame the conversation in a positive light not just in the way you ask questions, but by choosing your scenery: Malley advises that you find a setting that makes the other person most comfortable, like going for a walk or sitting in a favorite coffee shop.
“What’s most important to you” doesn’t have to be a direct question, either: You could ask your family member to tell stories about different parts of their lives, or to share some of their favorite memories. It could even be about what their favorite comfort food is. Collectively, all of these questions acknowledge who they are, and recognize their individuality, Stiles says.
There’s no right time to have these conversations—except early, and often. But if someone says it’s the wrong time for whatever reason, it’s best to back off. It’s not about you, as a caregiver, trying to get these conversations out of the way; it’s about your loved one feeling supported.
The gift of planning ahead
Once they do feel safe enough to discuss these broader questions, though, they can be a gentle entry point into thinking about how they want to age, and how caregivers can support them. By asking your family member how they’d like to live as their health declines, you can give them back some of their autonomy—especially if you’ll be a primary caregiver in the future.
Ultimately, these conversations can carry a person through the end of their days. At Aging with Dignity, Malley’s team has come up with a document called Five Wishes, a plain-language living will that addresses questions about how a person may want to die. In all but six states in the US, it serves as a legal advanced directive (in those six other states—Oregon, Kansas, Texas, Ohio, Indiana, and New Hampshire—residents need an additional advanced directive).
Of course, while it can be a tremendous help for a potential caregiver to broach these topics, in the best-case scenario your loved one will be the one to bring them up, Stiles says. If a person can come to you and tell you what they want at all stages of their aging progression—whether it’s to maintain friendships, make sure they can cook their own food, or decline life-extending measures at a certain point—congratulations! Your job is simply to listen.
Both Stiles and Malley referred to advanced planning conversations as a gift you could give not only your older loved ones, but everyone around them. People hold back on these conversations because they don’t feel qualified, and that’s just not true, says Malley. You just have to be compassionate, and let your loved ones know that you want to do your best to help them live the way they want.
Correction (Dec. 20): This article has been updated to reflect that Aging with Dignity’s living will document is called Five Wishes, not Five Questions.