negotiating with the elderly

Negotiating with the Elderly

Negotiating with those over 65

Aging Population

• 1870– 3% of population over 40

• 1999– 12% of population over 65

• 2030– 20-25% of population over 65

• 1960 to 1980– 19% population growth in US, but 65+ grew at a rate of 35%

(over 25 million)• 1999

– New category of elderly - oldest old - over 85 (4.6 million)

Aging Population

• Fastest growing segment of population is 65 plus

• Of those, fastest growing is 85 plus

• 2020:– More persons over 65 than under 20.

Suicide Rates for Ages 65 to 85+

• Center for Disease Control: 2006– 60-69 yoa: 20 per 100,000– 70-74 yoa: 25 per 100,000– 75-79 yoa: 32 per 100,000– 80-84 yoa: 40 per 100,000

– 85+ yoa: 45 per 100,000

United States by Group

• GI Generation, 1901 to 1924 (6%)

• Silent Generation, 1925 to 1942 (15%)

• Baby Boomers, 1944 to 1964 (30%)

• Generation X, 1965 to 1980 (21%)

• Millennial Generation (Y), 1981 to 20?? (28%)

GI Generation

• History of great accomplishments - greatest generation• Builders• Organizers• Inventors• Maximum personal and social effort• Confident and optimistic• High standards of:

– Behavior– Morality– Values– Commitment

GI Generation

• Born to horses, saw US walk on the moon.• Isolationism to superpower

• WWII• Cold War• 2/3 of all Nobel Prizes• 7 Presidents• Will respect police but likely resent

negotiation process.

GI Generation

• Negotiation Tips– Will respect police but resist negotiations– Show respect

– Focus on accomplishment and completing job

– Reflect values, morals and manners (use Sir)– Problems are “challenges”– Reinforce often

Silent Generation

• Protected, affluent, consuming– Raised by GI Generation– Were well protected– Were not required to sacrifice or delay

consumption

• Not builders, they are re-modelers– Less judgmental, fairer, more open and

questioning society.

• Believe in polls and blue ribbon commissions• All problems can be solved by litigation

Silent Generation

• Unprecedented affluence

• “Hip” life style

• Reputation for indecision

• No presidents resulted from this generation

Silent Generation

• Negotiation Tips:– Will not trust police but trust negotiators– Must know reasons behind decisions or

process and want to be included– Very receptive to negotiated settlement– Want instant gratification– Afraid of losing affluence and reputation

Baby Boomers

• Largest group in society

• Most influential in US history

• Transformed society at every level

• Raised in permissiveness and affluence

• Never known poverty, true hardship

• Have taken life for granted

Baby Boomers

• Started 20 year slide in SAT, ACT and GRE scores

• Self-absorbed• Pursue personal goals instead of group

goals• Expect instant gratification/reward• Difficulty handling hardships and trials

(suicide risks).

Baby Boomers

• Visionaries• Moral perfectionist • High emphasis on personal values and

personal accomplishment, not group goals.

• Pessimistic by nature• Need to understand, question

everything

Baby Boomers

• Not builders or re-modelers

• Try to reshape the world into their expectation and values

• Great technical advances

• Make contributions later in life than other generations

Baby Boomers

• Negotiation Tips– Do not trust police or negotiators– Must understand all issues and decisions

– Will respond to your authority based upon expertise and knowledge

– Must explain “why”– Decision must benefit them personally– Must reduce fear and uncertainty in situation and

what will happen after surrender

Aging is a Time of:

• 1. Loss– What have elderly lost?

Job, identity, ability, mobility, friends, relatives, social contacts, independence, mental ability, senses (sight, hearing), communication skills.

Empathy, patience, control

– Time to grieve those losses– Awareness that more losses coming

Aging is a Time of:

• 2. Change and Adaptation– Many may refuse to accept change - they

don’t understand, can’t evaluate properly and retain degree of control.

– Appear stubborn but are resisting change– Places high stress on elderly

Aging is a Time of:

• 3. Reminiscing– Self and life analysis– Bring meaning to their life and accomplishments– Integration of choices that they made and life

missed• May have deep regret or guild over some and try to

rectify and justify

– Nostalgia and storytelling• Helpful but often interrupted by disease, relatives,

environment• Disruption can cause maladaptive or dangerous

behavior.

Aging is a Time of:

• 4. Change in Life Priorities– Material goods become much less

important– People become much more important– Values may become readjusted – Spirituality increases

Aging is a Time of:

• 5. Frustration– With themselves– May resent those close to them or

themselves– May be angry of life’s direction or tother’s

intruding into their life at this time.

Negotiation Issues and Concerns

• Multiple and permanent medications– Significant number are taken– Significant portion or budget

General Effects: Medications

• Majority suffering 3 serious medical conditions

• Taking 5 medications

• Estimates: 8% of prescriptions are incorrect or inappropriate

• Most have damaging side effects

• Many cannot afford to do without

General Effects: Care

• Lack of care structures:– Geriatricians

• Have 1/2 of number needed and will fall to 1/3 by 2025

– Caregivers• Only have 40% of number needed, will fall to 25% by

2015• 34 million are now cared for by relatives at a cost of 350

billion annually

– Long Term Care Facilities• 1/2 number needed• 15% close every year• 30% are below acceptable standards• Many now will not accept medicare/medicaid

General Effects: Lifestyle

• Drug and Alcohol Abuse:– Higher rates of alcoholism and drug abuse

among elderly than ever before– Increased biological sensitivity of alcohol

and psychoactive drugs increases with age


• Mental Illnesses: – Typically depression and paranoia related

disorders• High among elderly but many consider it

normal and do not get treatment

• Targeted by scammers and other crime schemes and become overly defensive and paranoid


• Fear of the world around them– Society changed around them– Don’t understand the world they live in– Not computer or technological “savvy”– Gated communities, fear of public spaces,

avoid crowds and places


• Loss of Memory– IQ does not decrease– Ability to filter distractions is reduced, so it

is harder to recall– Short term memory decreases, long term

memory can improve, especially for older memories

– Context for memory is critical• Elderly have difficulty with context

General Effects: Central Nervous System Disease

• Senility - all characteristics of older age

• Physical, mental, mobility

• Limited ability in one area does not mean all areas

General Effects: Dementia

• Dementia - general loss of mental abilities in old age

• 5-8% over 65 have noticeable dementia• 15-20% over 75• 20-25% over 85

• Serious Dementia - Alzheimer’s


• General signs and symptoms of dementia– Confusion and agitation– Problems with language and memory– Unsteady gait, causing falls– Urinary frequency, urgency or incontinence– Personality and mood changes


• Dementia - Stages:– Stage 1 - Loss of memory of recent event

• Lose items, get lost in familiar places, miss appointments, forget names

– Stage 2 - Loss of Abstract thought and complex tasks• Trouble paying bills, cooking, driving• Don not understand movies, books, news reports

– Stage 3 - Difficulty with words• Substitute phrases for words, misidentify people then

know (sister for mother) use empty phrases (“you know that thing”)

– Stage 4 - Loss of Behavioral inhibition• Impulsivity, socially inappropriate behavior, thoughtless

comments.


• Multi-infarct Dementia– Multiple strokes– May have series of “silent strokes”

– Various areas of brain become damaged

– In addition to other dementia symptoms, person may:

• Trouble following instructions• Trouble making monetary transactions• Laughing or crying inappropriately

General Effects: Alzheimer’s (ALZ)

• Alzheimer’s – Brain disease– Estimated that 1/2 population 85+ have

ALZ– 5.2 million total– 10 million Baby Boomers develop ALZ– 70% of all cases of Dementia– Number of cases will double by 2030

General Effects: ALZ

• Stage 1 - No Impairment

• Stage 2 - Very Mild Impairment


• Stage 3 - Mild Decline– 1st Diagnosable Stage– Word or name finding problems

– Reduced ability to remember names

– Performance issues noticeable to those close– Some memory loss– Decline in ability to plan and organize


• Stage 4 - Moderate Cognitive Decline– Decreased knowledge of recent events– Impaired ability to perform challenging

mental arithmetic – Decreased capacity to perform complex

tasks– Reduced memory of personal history– Withdraw socially and be subdued


• Stage 5 - Moderately Sever Decline– Cannot recall important such as address, phone

number– Confusion about day of the week

– Trouble with simple mental arithmetic

– Need help choosing proper clothing– Don’t Know their name and names of close friends– No assistance with critical taskes like eating


• Stage 6 - Sever Cognitive Decline– Loss awareness of recent experiences– Imperfect personal history recollections– Forget name of spouse and others close,

but can distinguish faces– Need help getting dressed– Disruption of normal sleep/wake cycle– Need help with critical tasks like eating


• Stage 7 - Very Severe Cognitive Decline– Final stage of disease– Lose capacity for recognized speech

– Need help with eating and toileting

– Lose ability to walk, then sit, ability to smile– Reflexes become abnormal and muscles grow

rigid– Swallowing is impaired

General Effects: Other CNS Diseases

• Other diseases may mimic dementia or ALZ, but person may react differently in Negotiated Situation– Huntington’s Disease– Parkinson’s Disease– Mixed Dementia

Risk of Suicide

• Highest among elderly

• Living alone

• Social isolation

• Hopelessness/helplessness

• Depression

• Fear of institutionalization

• Poor health

Risk of Suicide

• Losses– Spouses– Life’s work– Finances– legacy

• Watch for Impulsivity• Local Suicidal Clusters• Cultural “honor” associated with suicide• Disabled male receiving care

Risk of Suicide

• Homicide/Suicide Increasing – Usually with firearm– Mostly males– Spouse usually disabled or terminal


• Make generational assessment– Assess attitudes, values, outlooks, and

expectations

• Negotiator and elderly - good match– Both trying to slow things down– Consider older negotiator– Be respectful

• Priorities changed– Future is less important– Loss means something different


• Low and Slow– Short, simple sentences– Pause often

• Use familiar and common words• Watch questioning tactics

– Many require short-term memory and may embarrass or become irritated when they cannot answer

– Complex thought may be beyond ability


• Maximize active/creative listening – Elderly are more emotional– Communicate with emotions– May not be able to verbalize emotions they are feeling

• Repeat, repeat, repeat– May not remember earlier conversations or thoughts– Use same words or phrases often– They may repeat often

• Be empathetic– Be genuine – Will open them up an the will work hard to communicate


• Do not interrupt of rill in blanks when they struggle for word or phrase– May be wrong word– Shows impatience– Increases frustration

• Do not finish sentences– Wait– Seen as rude and condescending

• Monitor tone of voice– Even if they cannot understand words, then can

read emotional messages like irritation and anger

Negotiating with Elderly

• Meaning of “No”– Make sure you understand it - could

express• Inability to understand

• Unknown context of consequences• To establish control • refusal


• Give Extra Time– Hear, interpret, and assess– Determine response, finds words, speak

them– Not giving time can be demeaning and

embarrassing.


• Force attention to you– Forgetfulness common– Help them remember

• Learn triggers– Generated over a lifetime– Sensitive to triggers

• Memory “wanders”– During down times– During conversations– They want to direct conversations


• Minimize all distractions– Environmental surround– Sensory inputs– They are easily distracted

• Determine physical limitation– May affect negotiations or resolution

• Use name often– Include your name often– Use orienting names (your daughter, Ruth…)


• Do not interrupt– Affect ability to remember and communicate– Much worse in elderly– They easily lose train of thought– If the interrupt, let them

• Anger and frustration if you cut them off

• Do not contradict– With dementia or ALZ will be met with emotional response or

anger

• Keep conversations and decisions short– Short-term memory is poor– Longer sentences and thoughts confuse, anger and

frustrate.


• Single Issue Only– May be unable to process more than one issue – Force focus on single topic– If they get off topic, let them drift and then pull

back to the topic

• Only 2 Options– Options are confusing and frustrating– Only give either A or B

• (I.e. do you like to watch tv or read the paper, not what do you like to do?)


• Don not treat like children– Emotions and behaviors may be child-like– Will resent you if demeaning

– May be hyper-sensitive or paranoid about this issue

• Don not make decisions for them– Find opportunities for them to make decisions– Let them provide input into resolution

– Orders may anger him/her


• Encourage reminiscing – Contains hook– Lets them tell you who they are and what they

ewer before they became old– Provides intelligence– Hooks are in pride, guilt, unfinished issues of

reminiscing

• Don not try too hard to help them recall events– Frustrating and embarrassing – Hinder memory


• Time of day is important– Attention and cognition varies significantly during

day

• Sun-downing - late day confusion– Symptom that often occurs in people with

dementia and ALZ• Caused by fatigue, low light, increased shadows• Reduce by:

– Keeping lights on– Using familiar items and surroundings– Give quiet time

negotiating with the elderly

Self Improvement

personal values

personal accomplishment

segment of population

population growth

trust negotiatorsmust

groupgi generation

generation x

us historytransformed