Caregiver Decision Fatigue
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Caring for aging parents brings with it a new kind of exhaustion called “decision fatigue.” While its cause has a number of contributing factors, two in particular stand out as primary sources:
- Sustained engagement with dilemmas
- Decision volatility in family systems
Although demanding and stressful, the problems of aging can be contained or eliminated. Lost prescriptions can be refilled. Unsafe staircases can be modified. Transportation for an unscheduled medical testing can be arranged. Solving problems means eliminating uncertainty and most caregivers are well versed in how to do this.
But the ongoing decisions one confronts with aging defy containment or elimination. They demand sustained engagements with uncertainty, challenges most caregivers are ill equipped to handle. Consider the following example:
An 84-year-old woman is scheduled to be seen by her doctor at her family’s request due to her unwillingness to use a walker. She has an unsteady gait, a history of falls and significant bone loss. She lives alone with the assistance of home-care services. Her family has tried a number of approaches to get her to use the walker, but she has rejected all of them because she feels the walker makes her look old and frail.
This situation typifies the nature of the dilemmas, which present as:
- Complex and messy
- No-win options
- Decisions must be made
As the family of the 84-year-old woman scrambles to head off a disastrous fall, their challenge goes beyond solving a dilemma. They must also address how decisions regarding the walker will play out in the family system.
By definition, families are complex systems whose behavior impacts the receptivity and response to intra-family decisions. These behaviors include:
- Non-linear reactions – Seemingly minor decisions can carry major consequences. The decision to have the family’s matriarch see the doctor was made by her two daughters without consulting their brother. The daughters were certain their brother would agree with their plan. He and his wife didn’t, and it provoked a heated argument between the siblings’ families about who has the authority to make these kinds of decisions as well as who has the authority to override their mother’s wishes.
- Resistance to dictates – Solutions in family systems cannot be dictated. Rather, they must emerge through an idiosyncratic consensus ritual. The flair up over the doctor’s appointment is emblematic of how seemingly benign dictates can rain havoc in the system.
- Structural instability – Even the most promising solutions fall apart without warning. Collective consensus in family systems is fragile with emotional crosscurrents and unsettled agendas poised to collapse even the most adventitious decisions. Push back from family members about the lack of communication and consensus regarding the need for the doctor’s appointment resulted in bitter recriminations and the appointment’s cancelation.
The Caregiver Decision Fatigue Mind Map below outlines the primary causes of caregiver decision fatigue along with coping strategies. It is useful in conversations with clients about unique challenges of eldercare planning.