Stereotypes about older adults abound, and one of the most prevalent is that the majority of seniors are just plain stubborn. Once we get to a certain age, the prevailing wisdom goes, we become set in our ways, unwilling to try new things or new ideas, with our heels firmly dug in.

While this notion can convey a certain strong-willed charm, the idea that all seniors tend to be “just plain stubborn” has some definite downsides. It’s one thing if Mom or Dad refuses to change their mind about a political viewpoint, a favorite food, or a worn-out sweater. But what if a senior who actually needs some help refuses to accept it? What if an older relative won’t give up the car keys or talk about the difficulty of maintaining their house properly? In situations like that, we have to ask – is this stubbornness, or is it something else?

Recently we discovered this insightful guest column from the Washington Post, written by Houston-based geriatric psychiatrist and medical educator Steven Starks. Starks, also a medical doctor, wrote his column in response to a question sent in by a reader. We think Stark’s answer sheds some important light on the relationship between adult kids and their aging parents and grandparents, and it helps explain why a stubborn attitude might really be a smoke screen hiding something deeper. Let’s take a look.

A Reader Asks, “What’s Up with the Stubborn Senior?”

The Washington Post column includes this question from a reader. “Current events, national and local, have me wondering about a trait seen in the elderly. Faced with a situation that clearly requires a change, or at least honest reevaluation, they just dig in their heels and refuse to budge. What is going on?”

The questioner offers some examples, such as a senior who can no longer walk stairs safely refusing to consider a stair lift, or not allowing the addition of handrails to the porch. It could be an older homeowner who can no longer clean the house or do yard work, yet they refuse to let anyone else do it.

“Maybe we don’t notice this kind of self-sabotaging stubbornness in younger people because we are less involved with the consequences of it,” the reader asks Dr. Starks. “But my experience is that it is a hallmark of the elderly. Can you explain it?”

Addressing Myths About Seniors While Controlling the Risks

In nis reply, Starks first notes that, as a psychiatrist, he has observed a rise in ageism combined with fewer opportunities for intergenerational dialogue in recent years.

“Work in clinical practice is often collaborative and involves shared decision-making with families,” he writes. “When I hear a spouse, child or care partner express these sorts of frustrations, I first address myths and misperceptions about aging.”  He adds, “The imperative is to balance maintaining the autonomy of the [older] individual and mitigating any risks or potential harms.”

Guard Against Stereotyping the “Stubborn Senior”

First, Starks advises against overgeneralization. “Children can be stubborn, adolescents can be impulsive, and middle-aged adults can make rash decisions,” he writes. “All of us have the capacity for rigidity and making mistakes, big and small, in every phase of life.”

It’s key, therefore, to recognize that “stubbornness” in older adults might have a deeper source, and we should take steps to understand what might really be going on before passing judgment.

Is “Stubbornness” Masking a Medical Condition?

Starks explains that while self-sabotaging stubbornness should not be considered a hallmark of older adulthood in general, a certain group of older adults might struggle with decision-making as a signal of potential health problems, both physical and cognitive.

“Older adults with this level of functional impairment may be experiencing frailty, a syndrome characterized by weakness, low endurance and reduced physical activity,” Starks writes. “One study showed that physical frailty is linked to brain changes that may cause impairments in memory and thinking processes.”

Along with this, getting older can often bring on the increased risk of developing mild cognitive impairment (MCI). “Individuals with this condition may function relatively well in day-to-day life, but they may display reduced capacity in certain skills and abilities,” Starks explains, and this can have an effect on finances, health, and other everyday issues. Mild cognitive impairment can also develop into eventual dementia.

Avoid the Temptation to Assume the Problem is Medical

Starks advises caution when tempted to “pathologize” older adulthood. Certain behaviors may indeed raise red flags for medical problems, but that shouldn’t always be the assumption.

He offers the following ways to reframe “stubbornness” in older adults:

Understand their emotions: How we process information changes over time, and there is greater emphasis on emotional states in decision-making as we get older. Don’t ignore the emotions around changes. Sadness, fear, or anger might need to be addressed first.

Actively listen to their concerns: Americans really value independence. That doesn’t change as we age – in fact, it can increase. Today’s culture tends to center on younger people to the point that we overlook and ignore the norms and values of older adults, and it is all too easy to have a false impression about older adults or stereotype them.

Approach each situation by actively listening. While it’s tempting to avoid someone who is disagreeable, it may be critical to lean in when things appear difficult. Also, if their rationale doesn’t fit your viewpoint, ask yourself why that might be. If yard work or grocery shopping keeps them connected to their community, validates their identity, or gives them a sense of purpose, it may be difficult to make a change. Can you find a creative solution that provides security while preserving independence?

Examine how they approach change: When someone appears less adaptable to change, it may be a sign that they need greater emotional support or reassurance. Being present and open to dialogue despite disagreement may be the only support they need. Being there might also protect them against loneliness, which has been linked to personality changes; people who are lonely may become less agreeable and conscientious over time.

Consider accessibility in adaptations: Think about whether your recommendations fit the needs of the older adults in your life, and are user-friendly and accessible. For example, people of generations where telephone support was readily available may find the use of Internet and mobile app technologies impractical or confusing. Some adults may also have safety concerns about supports and solutions that allow unknown individuals (or “strangers”) access to their home to deliver goods or services.

Helping the “Stubborn Senior” Feel Supported, Self-Sufficient

Starks writes, “Social cognition [the ability to process and interpret social signals] appears to decline as we get older, so the character of our interactions may change as we age.”

Because of this, we may lose our ability to recognize certain forms of expression (like facial expression) over time, and therefore may be less open to suggestions or appear more isolated. This inability can be compounded by grief, especially in the loss of a loved one through either death or distance.

Starks suggests that partnership and community should be emphasized when encouraging older adults to adapt to certain limitations in their physical or mental health. “Involvement in senior and other community centers or fitness programs designed to meet the needs of older adults could provide a reliable source of support,” he writes. “Studies show that social supports and interventions that improve self-sufficiency promote health and lifestyle improvements in older adults.”

Is Someone Else Better Suited to Have the Conversation?

While it can be difficult to accept that we might not be the right messenger for the job of approaching a loved one for a challenging conversation, it can make all the difference to step back, especially if we are engaging in a way that makes it seem like we’re trying to solve a problem.

“Older adults don’t want to be perceived as burdensome,” Starks writes, and adds that receiving advice from someone who hasn’t had their experiences can be difficult to accept. 

“Try locating a trusted source to deliver the message,” he suggests, “perhaps a close friend, someone similarly positioned in life, or a person whom they perceive to have the expertise needed to address their particular concerns. You might attempt to facilitate transportation or travel to allow an older adult to have a face-to-face visit and reconnect with an acquaintance.”

He adds that faith-based organizations can offer another form of meaning and connection for those who prefer the wisdom of a spiritual leader. And your loved one’s doctor shouldn’t be discounted, either. “[W]hile privacy laws may make it difficult for health professionals to provide health information to anyone other than their patient, they can receive information,” Starks writes. “You might call the doctor’s office and share information about your concerns for their evaluation and review.”

In Responding to a “Stubborn” Loved One, Exercise Patience  

Starks concludes by encouraging us to have patience and grace with our loved one, and discern whether the decisions they’re making are truly problems or rather just preferences.

“If there are true safety concerns, you might seek professional help,” he writes. “If it’s simply a matter of opinion, be patient and don’t lose hope. It may take persistence and reinforcement to motivate someone toward meaningful change.”

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(originally reported at www.washingtonpost.com)