Q. I’m very concerned about my 81-year-old mother because she spends so much time at home alone, watching TV. Lately when I come by after work, she’s still in her nightgown. I can’t seem to interest her in anything. I’ve tried taking her to church for card games, to lectures at the local community center and I’ve even persuaded her to call a few friends for lunch. I know she enjoys herself when she finally does something, but she won’t take any initiative herself. I have suggested she hire a companion to accompany her on errands or just take a walk together, but she flatly refuses. No matter how much we argue about this I don’t seem to be able to get her to come out of her shell. What can I do to help her get out more?
Lisa S., Orlando
A: What you are observing in your mother’s behavior — her apathy and overall lack of motivation — is something I hear often from family caregivers. Unfortunately it is a common scenario among seniors and it has many potential causes.
While you continue to encourage your mother to participate in activities outside her home, I recommend that she be evaluated by a geriatric physician. I asked Dr. Marc Agronin, a geriatric psychiatrist and the Director of Mental Health and Clinical Research at the Miami Jewish Health Systems, how he would approach a patient like your mother. Here’s what he told me:
“My first question would be whether her behavior is a change from earlier years or is consistent with how she has been all along. Someone who was not involved in many social activities earlier in life will not likely start doing so later in life. If anything, they might become more isolated.
“Second, does she seem depressed? Look for changes in mood such as sadness or irritability, crying, loss of appetite, lack of interest in things previously enjoyed, poor sleep, and poor concentration, to name a few of the more common symptoms. Depression can rob someone of interest and motivation, but it is treatable, regardless of age.
“Third, does she seem nervous or panicked when out in public or with other people? Anxiety disorders may drive someone to seclude themselves at home as a way to reduce their discomfort.
“Fourth, is there memory or other cognitive impairment? Sometimes personality changes and apathy can be early symptoms of Alzheimer’s disease and other dementias.”
Dr. Agronin added that if there is no clear psychiatric cause, it may be that she needs a lot of external motivation and structure to get her involved in more activities. He suggested that you try various activities to see what stimulates and interests her the most.
“At the end of the day, if she has poor motivation but seems generally content, you may not be able to reasonably push her beyond this point,” he explained. “But it is worthwhile to keep trying. Do not get angry and blaming as this only will make her feel badly and will not accomplish your goals.”
I highly recommend Dr. Agronin's book, How We Age: A Doctor’s Journey Into The Heart of Growing Old.
Nancy Stein, Ph.D., is the founder of SeniorityMatters.com, a local caregiver advisory and referral service for South Florida seniors and their families. You can contact her at firstname.lastname@example.org.