The Wall of Indecision

A wall from the Basilica of Santa Maria in Trastevere, Rome, Italy.

---

I recently discovered with one of my clients that “I will decide later” really means “I am having trouble making a decision and need your help to facilitate sorting through my options”.

​I have a client who has spent a lifetime being sharp, capable and in command. In the past six months, she has had a cognitive decline which is causing a new level of confusion and inability to make decisions. This recent change is hard for her family to reconcile with the person they have always known, hard for me as a care partner to not overstep my role and yet offer timely and constructive assistance, and hard for my client whose husband had Alzheimer’s, so any cognitive jumbling is compounded with fear. It is also complicated by having to not only admit needing help, but recognizing a new need that is hard to define and articulate.

So, my role as a care partner is to patiently identify when we are hitting that decision-making wall and then try to navigate around it. I communicate to the family the changes I am seeing, how I find myself having to do more “hand holding”, so that they do not expect as much of her; but still allow her to do what she can - which is plenty! I let them know the ways I am facilitating the decision-making process so that they can employ some of the same tools when they need to have a discussion. I validate them when they express dismay about how much their mother has changed because it is not their imagination, but it is also not the same as what they experienced with their father. Change is hard and reassurance is vital.

I have to be creative when confronted with this wall and understand that she does not know that she is having a problem. She is convinced if she just puts it off until she has time to think, she can arrive at a conclusion. The reality is that there is a hamster on a wheel that is not actually reaching a destination where she can then declare a decision with confidence. She needs to talk it through aloud, have things written down, use a physical not virtual calendar, and have someone else check back to see if there was any follow through or provide visual reminders. So, I become the external processor of information and checklist checker and scribe and question asker and whatever other role needs to be played to move my client to a decision. Then we confirm the decision and communicate the decision and if necessary, document the decision as a reminder later on.

Thoughts are so easily derailed! Additionally, for the elderly, there are other considerations to factor in because often one decision also involves engaging help with transportation that needs to be scheduled or planning around medication, warmth or nutritional needs, as well as a host of other issues. It is the thought-equivalent to when leaving the house on an errand became more drawn out for your elderly loved one. No more grabbing your keys and hopping in the car!

Encourage your loved one to be candid with you when they find themselves having difficulty with decisions. Give them a phrase to use that clues you in to what is going on for them such as, “I am on the hamster wheel,” or “I need your help thinking this through,” so that you can help. Reassure them that the decision is still theirs, you are just there to help them organize their thoughts and come to a conclusion that is actionable. Sometimes they may actually ask you to decide for them if they feel too overwhelmed. You just need to be available and recognize that they are not procrastinating (unless they are!) but need your help to get unstuck. Try to build in time to ask questions and listen so you can reach a decision together.