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My father is 93 years old. He does not have a relationship with his younger sibling and has not had any contact with her or her family in over 50 years. He is the middle child of 7 children. Due to circumstances out of his control their family had been separated when they were young. He has slight dementia and his health is declining. He's frequently sad and states he wants to die. He always mentions that he feels guilty that he has lived so long when his other siblings have passed away. He has one younger sibling alive. It was decided by a distant relative in the other country and myself that we would hold back this information because of concern for his mental health and well-being. I am now having second thoughts whether or not this was the right decision. Should he be told and for what purpose?

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Oof! Always a difficult one.

Not to sound callous, but what happened to the other four deceased siblings, when, and how did he cope with hearing about them?

Does he ever talk about the other branch of his family, or about this individual in particular?

I must admit can't see the slightest benefit to him in saying "you know that sister you had nothing to do with for half a century and never talk about? Well, she's died." But then again, I wouldn't lie. If the sibling or her part of the family tree comes up, and the opportunity felt right, I would say something like "I am afraid we had some sad news about x" and then take my cue from his response as to how far to go into the details.

There is a but. What were the circumstances of the family schism? Political upheavals or something? Are these events much on his mind? How much he is thinking about the past might influence what you feel he needs to know now. If you're concerned about your agreement with the other relative, revisit the conversation and explain that you want to be more flexible in your approach.
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My question would be what are you trying to accomplish? To me, it's about the comfort and well being of the senior who has dementia and not my comfort that is the priority. My approach is to keep them as happy and content as possible. Since, you say that your father is quite depressed and talks of wishes to die, I'd discuss providing him any kind of upsetting news with his doctor.
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I would let him know. At least when he is gone, you will not have any regrets.
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I wouldn't. As you say he really never knew her.
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I'm not sure there is a "wrong" choice here. In general I believe in respecting our competent elders and not withholding information from them or attempting to force our choices on them; sometimes that means a lot of negotiation. When dementia enters the picture and we begin a care giving role, then maybe we withhold some information because it will not help our elder and might cause problems. If your father has only slight dementia and no relationship with the deceased sibling, I would be inclined to tell him because (1) it will probably not be that upsetting (even considering his upset over living longer than siblings - that is something God decides), and (2) if he were to learn you withheld this information it would probably be more upsetting, injuring his faith in you.
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