Why Older Adults ‘Fake It’ in Front of the Doctor


One of elder care's most perplexing puzzles is the ability of adults with cognitive decline—either as a result of the aging process or caused by some form of dementia—to function normally in certain situations, despite their impairment.

Family members are left to wonder how their loved one can pull it together and act like nothing's wrong in front of a doctor, but find it challenging to perform everyday tasks when they return home.

"My mom was a supreme example," says former caregiver and AgingCare.com expert, Carol Bradley Bursack. "She fell in her apartment—often more than once a week. She had memory problems. She was taken advantage of by telemarketers. She had digestive issues. However, when I took her to the doctor, what I called her ‘hostess personality' took over. While she may have complained of pain in the car during our drive, the minute she had a chance to tell her doctor how terrible she felt, she was perkiness personified."

Bursack cites fear and denial as the top two reasons many elders engage in "showtiming" behaviors to fool their physicians and the rest of the outside world. But a new paper published in Perspectives on Psychological Science offers another theory called "selective engagement."

Developed by Tom Hess, Ph.D., professor of psychology at North Carolina State University, the theory of selective engagement argues that, in the face of flagging energy levels, older adults often start to pick and choose which activities to devote their restricted personal resources to.

"There's a body of work in psychology research indicating that performing complex mental tasks is more taxing for older adults," says Hess in a press release. "This means that older adults have to work harder to perform these tasks. More work often translates to a longer recovery time from these performances, which is why caregivers say that their loved one will sleep for hours after returning home from an outing.

Aging adults become especially motivated to work hard to overcome their cognitive shortcomings in situations that they find personally relevant or important, according to Hess. It's not surprising, therefore, that doctor's visits—which could make or break a person's ability to remain independent—are high on the list of instances that inspire older adults to rally their mental resources.

Understanding why a loved one is acting a certain way doesn't make it easier to cope with the effects of their behavior.

"Even though we know why they do it—for attention or to prove their independence—it does not lessen the frustration," remarks a caregiver on the AgingCare.com Community Forum. "We get to hear them harangue about how awful they feel all the time. I then feel guilty because I get so exasperated…Everyone else gets to see the ‘sweet old lady.' Her kids think we're making it all up."

So what's a frustrated family member to do?

Bursack suggests beginning with a frank conversation with your loved one. "Remind them that you are on their side. You want their safety and health to be the first consideration." Of course, the outcome of this conversation will largely depend on your preexisting relationship with your loved one. It's not uncommon for aging adults to become suspicious of nearly everyone in their lives.

If your loved one isn't receptive to the conversation and persists on faking it in front of their doctors and other family members, then you may want to try pulling these individuals aside and explaining what's really going on.

Whatever the cause of an aging adult's selective engagement, balancing a loved one's dignity with their need to receive the right care can be hard to strike. See these articles for more information on handling a loved one's challenging behaviors:

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