How to help a depressed, elderly, sick parent

March 18, 2016 1:17 AM

My beloved dad recently got diagnosed with lung cancer and is now depressed. How to support him, when his internal world seems so bleak? I feel a little like a punching bag for all his frustration and depression, too - how to mend this?

Dad is very depressed about his medical condition. Anyone would be. He is in his late 70s.

As well as anxious about his health, he is bored and lonely. He is too weak to exercise, and will not admit his need for therapy and/or meds. Due to his illness he doesn't have the attention span for books or movies. He also finds it hard to focus on or retain information thanks to "chemo brain" which is extremely frustrating for him. All he can watch is CNN, he is transfixed by the Trump circus, but that is not particularly healing viewing. As a result of the chemotherapy, his fingers are very trembly, so he finds it hard to type or use his phone. It's just awful.

He forgets that he's had visitors and claims that no one cares about him or visits him, or that I never see him - he has a pretty constant stream of visitors and I see him every day, for 5-6 hour stretches of time.

He is extremely difficult to deal with and I always leave his house feeling spiritually exhausted from hours of keeping schtum while he gets mad. If I have lunch with a friend one day, it's "All you ever do is socialise!", if I stay at home with him the next day, it's "Are you just going to sit around at home all day?". Whenever I try to look to his well-being by, say, urging him to eat something, or drink more water (he doesn't drink ANY water), or try to do the exercises the physiotherapist recommended, he gets really angry with me.

I know that he's mad, lashing out and just has to SAY stuff, but it's tough.

What are some practical solutions to help someone elderly, unwell, depressed and with good reason to be depressed? Normally I'd say exercise, meds and CBT, but none of those appear to be an option. So far, I've found that Youtube videos of songs he likes seem to cheer him up, but he doesn't have the manual dexterity or familiarity with websites to navigate to these himself.

Also, what are some good online support groups for people in caring positions for elderly, depressed parents? I know I can google it, and I have, but there are so many - does anyone have good personal experience of any?

Thanks for your previous advice into this situation, Mefites.

posted by sockandawe to Health & Fitness (15 answers total)

Is there a hospice program in your area? They can help you and your Dad, in so many ways. Please talk to them. It is not wishing your Dad dead. It's turning to experts who can help you through a hellish time.

Normally hospice does not accept patients who are actively fighting a disease, but lung cancer in someone in his late 70s might qualify. Do his doctors expect him to finish his course of therapy, regain some of his health, and live another 10 years? This is a very hard conversation to have with the doctors, but it's essential to help you find the kind of support you're looking for.

I'm so sorry you're going through this. I've gone through it with my father and my husband, and although it's worse for them, it's horrible for you. Feeling angry or resentful (and sometimes even a saint would feel that way) while your heart is breaking is ... there are no words.

I'm not sure you'll be able to find specific things to help your Dad. But all the things you list -- exercise, hydrating, eating, finding books to read and music you like -- please be sure you're doing them yourself. It's essential, but it's easy to overlook from fatigue and frustration.
posted by kestralwing at 3:10 AM on March 18, 2016 [9 favorites]

Small ideas:
- create a youtube playlist for him, and see if you can get him to leave the window open, so all he has to do is press play and they will keep on coming
- make sure his fridge is always full of tasty juice, and the least hideous kinds of soda. if he won't drink water, he might drink nice (non-caffeineated) things that taste good. you can also make sure there are juicy fruits around if he will eat those. in a previous situation similar-ish to this, my friend would not drink much but would eat melon and grapes and those contain plenty of water, plus sugar for energy.
- is he a gambling man? you could place a couple of bets for each of you and watch a sports event to see who comes off best. EVEN BETTER get him to bet on something and if he wins you buy him an awesome bottle of the booze he likes and if you win he has to go exercise for 30 minutes.

I'm sorry you are going through this yourself. Make sure you look after you, too.
posted by greenish at 3:12 AM on March 18, 2016 [5 favorites]

Get a visitor book. Get everyone who visits to sign it and write a note. Sign it yourself each day. Then he can see who's come to call even when he can't remember.

My dad and his partner always had one, for 37 years. Now that they're gone, I have all of them and they are very nice to have.
posted by DarlingBri at 3:29 AM on March 18, 2016 [15 favorites]

For remembering visitors: could you set up a wall area for visitors to attach messages/cards/something when they come? Then your Dad could see the love, and the messages/cards could be dated, too.

For hydration: will he eat soup?

Can you take him for walks outside? The sun will give him some vitamin D (of course not very recommended if he's on meds that involve photosensitivity), it will probably help his depression, and exercise is the #1 way to fight depression.

If there's any way you can increase his connection to his neighbors, that would probably help a lot. Maybe you could have one or two over for tea + fruit + cheese plate one afternoon, when he's in a slightly better mood.

Finally: if you guys could possibly handle a calm pet, maybe getting a cat? Or dog? Think about the level of maintenance required, but pets are really fun.
posted by amtho at 3:48 AM on March 18, 2016 [1 favorite]

The visitor book and cards thing are both excellent ideas! If you can show him that all these people do care that's got to help his loneliness a lot.

Find out what his favorite shows were when he was younger (if you don't know already) and get them on DVD or Blu-ray. Stuff that hasn't been endlessly rerun could be good. If it's just a half hour or an hour, maybe he could last through that. If you can get him watching Jack Benny or Gunsmoke or whatever, there are a bunch of them you guys can watch together. Also, your dad is old enough that radio dramas and stuff were a thing when he was a kid. If you know what some of his favorite shows were, maybe download a few episodes and listen to those with him. Old radio can be super fun, and stuff from childhood can be a good escape. Does he handle CDs OK? Maybe you could put a bunch of his favorite songs on CDs.

I'm really sorry you guys are going through this, and it SUCKS your dad is being mean to you. Your dad is addled by chemo so maybe we can't hold him fully accountable for saying shitty stuff, but when he starts that stuff you are well within your rights to say, "Dad, I know you're going through something terrible, but I'm trying to help and you're being mean to me." Say that enough, and hopefully it'll sink in.
posted by Ursula Hitler at 5:03 AM on March 18, 2016 [3 favorites]

I think it might be time to lay it on the table for him. Ask if he plans on fighting this illness, remind him this is his choice and if he chooses not to it is time to focus on comfort. If he insists that he wishes to fight, remind him that things like drinking water and taking helpful meds are part of that. I am dealing with my own father who has dementia. It took me a while to realize that my version of comforting was to downplay the negative and focus in the positive things he still had going. Once I saw that I needed to put my time into really acknowledging his suffering, it gave him a chance to talk about it and he didn't have to keep trying to convince me that, no, it is all terrible. My father can be very mean and when he is I call him on it, I figure if he took his pants off in the grocery store I would understand that it was because of his illness but I would still inform him that he cannot do that. Take care of yourself.
posted by InkaLomax at 5:14 AM on March 18, 2016 [5 favorites]

Would he be able to use a larger tablet device for an Audible account to listen to audiobooks? The previous generation of iPads are pretty cheap used and if they have survived are straight up tanks, and they have good accessibility settings you can utilize, and apparently people who are not comfortable with computers often take more naturally to the iOS tablet setup.

He might not have the attention span for listening to a novel, but there are many books of short stories and non fiction essays as well as classics he might have read many times and would like to listen to again.

You can also set up apps for listening to online radio stations (lots of the Radiotopia podcasts are about twenty minutes long, and full of interesting things that don't matter if he forgets them later) and for maybe even watching live cameras on things like foster kittens, nesting eagles, sunsets over lakes - my dad has a one-click icon on his iPad that pops up the live cam of the weather in the little town he spent summers in as a boy, for example.

Anyway that's all spitballing. What you can definitely do is ask your doctors for resources and help. There are absolutely support groups and therapists that focus on helping the loved ones of cancer patients. You can vent and get ideas for turning your frustrated energy into productivity and listen to the stories of other people who are going through similar problems so you don't feel so alone. You can ask the oncology people who are helping your dad for information and they might even have a case worker who will be happy to help you learn your local options. If you have a good relationship with your own doctor, or a preferred nurse, you can ask them. This is unfortunately a common issue.

You deserve support, and there are ways to get it.
posted by Mizu at 6:07 AM on March 18, 2016

Maybe try setting up Pandora or Spotify with some of his favorite music to seed the playlist recommendation engines. My dad found music to be soothing when going through treatment for bladder and prostate cancer. He was listening to everything from classical to folk Vietnam protest anthems. Seconding making a YouTube playlist for him, too.

On the technology front: To help my older mother use her computer more effectively I make icons on her desktop with direct links to websites and services she uses often. (It's sort of adorable when she gets a new laptop and asks me to "install her banking," which literally just involves making a link to the bookmark for the website on her desktop.) You could directly link to playlists from various services so he doesn't have to navigate. You might be able to combat the slightly wobbly fingers with a stylus for his phone/ipad. I found a 6mm nib to work just fine on my mother's iphone 5s.

My dad was also unbearably cranky and mean when he was doing cancer treatment. I think part of the problem is that it doesn't matter how old you are--you will always be a subordinate in your parent's mind because you are the child. My dad responded *much* better to professional caregivers asking him eat ice chips, take short walks, do activities, etc. I would look into getting professional help so that more of your time with your dad is focused on being pleasant company and not a "nagger" who wants him to do healthy things when he's angry and frustrated.
posted by xyzzy at 6:48 AM on March 18, 2016

I sometimes get a mood lift from stroking a very fuzzy piece of fabric (minke) or cushion. Hey it doesn't take eyes, or very much hand control to do it. But it's certainly possible that your dad would find it infantilizing and reject the idea. And speaking of infants... a water bottle is easier to drink from than a glass if you have shaky hands. (Some of these things you don't need me to tell you.) I liked the suggestion for watery fruits.

A TV remote with really big buttons might be an improvement over what he currently has.

I've been curious about Jane McGonigal's "SuperBetter" app. I read her book. She wrote about having a concussion and not being allowed to read or watch TV or do much else for many weeks while her brain tried to recover. I think she was even forbidden to listen to music. Her app concept has you create a team of super heroes that you use as a virtual support squad. I don't think this would work for him, but it sounds like YOU could use both emotional and practical support and some of the emotional support could actually come from inside your own head. If you can get this book from library loan, and read one chapter to your dad, he might identify with the not being able to do anything and not knowing if you will actually recover parts where she describes how she used a virtual team to motivate herself to do and not do the things her recovery required. (McGonigal was on Colbert. You can find that, and her TED talk about videogames on YouTube.)
posted by puddledork at 7:36 AM on March 18, 2016

I know that he's mad, lashing out and just has to SAY stuff, but it's tough.

Everything you describe is pretty classic cognitive dysfunction - dementia or brain damage - which is generally accompanied by rage, paranoia, horrible confusion, and the terror that comes with not being able to retain information plus the very weird gap-filling the brain does to try to cover those missing pieces up. This is not CBT territory. He can't politely talk his way out of his brain not working properly, nor is he likely to ever comprehend that he's "lashing out" rather than "defending himself from everyone who is out to get him for some reason."

Antidepressants are commonly prescribed for elderly cancer patients (in part because most of them stimulate appetite, but they also even out their moods a little), as well as anxiolytics to soothe the fear a little. This is not really "meds" in the classic sense but "just a few more bottles added to the arsenal" of cancer treatment.

The thing is, this may be cancer-related or chemo-accelerated, and might get a little better if chemo ends, or it might not. But this is a thing you need to treat as a condition, not a symptom. Get him to a neurologist if you can, talk to his oncologist if nothing else (oncologists are generally assholes, in my experience, but their office may be able to refer you to a social worker with a geriatric specialization). Get yourself some books on dementia or traumatic brain injury, and get yourself some caregiver support so that you can come at this understanding it's something bigger than "dad's bummed that he's sick" and not get ground into a paste under the pressure of dealing with it.
posted by Lyn Never at 8:08 AM on March 18, 2016 [5 favorites]

I'm sorry you and your Dad are dealing with this. Depression is often more prevalent and severe with lung cancer. Seconding contacting palliative care or hospice services. They have experience in working with people with serious illnesses, pain, drug side effects, depression, and so on. They know what kinds of questions to ask so that they can give him the help he needs.

I would also recommend that you read Being Mortal by Atul Gawande. It is all about death, dying, and end of life care and how modern medicine is dealing (or not) with it. It can be an emotional read, particularly since you are currently caring for your aged, ill father, but he is good at dealing with these issues in plain speech and has suggestions for having conversations around what people want most while dealing with their illness--independence? Mobility? Social contact? No risky surgery? No pain?--and how to help them achieve what level of that they can. Gawande is proponent of palliative and hospice care. His focus and most examples are from the USA, but the overall ideas and messages are broadly applicable.

For support groups:
If you're in the USA, you could try the National Family Caregiver Support Program (part of the Administration on Aging; phone # [phone]).
If you're in the UK, it looks like Carers Trust would be a good place to start.
posted by carrioncomfort at 8:17 AM on March 18, 2016 [3 favorites]

He forgets that he's had visitors and claims that no one cares about him or visits him, or that I never see him - he has a pretty constant stream of visitors and I see him every day, for 5-6 hour stretches of time.

An idea that a friend uses to combat this very same issue with her partner (also fighting lung cancer) is that every time there are visitors she asks them to take a photo of themselves with him, and email the photo to her. (I believe she has posted a sign in the room.) Then, every day, she uses an app on her phone to email the photos to a drugstore one hour photo place and has them printed. He now has a wall of photos of him with his visitors, clearly taken in the hospital, and the photos do help remind him about the visits and that he is loved.

Also, encourage people to send him cards. Mail call, every day, can help.

Also, re trouble focusing on media, she's found that a) nature films (think Planet Earth) and b) sports (if your dad is a sports guy) have been helpful as "background entertainment".

Getting him a BIG ipad or tablet may help with the typing thing.

Best wishes to you and your family. Cancer sucks.
posted by anastasiav at 9:15 AM on March 18, 2016 [3 favorites]

Get help for you. If you don't take care of yourself won't be able to help him. Check at his oncologist's for a social worker. His lung cancer will eat you alive unless you are some fantasy superchild. I really hated what lung cancer did to my brother and had a hard time just accepting there wasn't anything I could do some days except, be there as much as possible. Good luck and take care.
posted by ridgerunner at 10:46 AM on March 18, 2016 [2 favorites]

Inspired by an earlier comment about touching soft things -- mink -- how about one of those comforters that's made of/covered with thick fake fur? Those look so nice...
posted by amtho at 6:13 AM on March 19, 2016

Has his kidney function been checked? Confusion and agitation can be induced by kidney failure. It's common in certain kinds of cancer patients, though not sure if it happens regularly with lung cancer.
posted by praemunire at 10:34 PM on March 19, 2016