If you need to have a discussion about end-of-life decisions.

This can be an especially difficult conversation for you to have with an aging assertor. You may want to be gentle and talk around the idea, but most assertors find that approach offensive. Get to your point. Be prepared for a dismissive attitude from your assertor, since they don’t like to dwell on weakness. Be ready to respond with calm, fact-based arguments for why these decisions need to be made now.

After Ramona’s mother died, she worried about how her father would fare during a hospitalization. She needed to know his wishes now, so she could act on them in the future. To facilitate the conversation, Ramona put together a questionnaire with questions like “Under what circumstances would you want to be placed in hospice care?”, “Who do you want to have medical power of attorney if you’re unable to make your own decisions?”, and “Would you want a DNR order in place?” The question format helped focus the discussion and let her father know that he was still the main decision-maker for his medical care.

If they are in denial or ashamed of their condition.

For an assertor, aging and the health issues that can come with it can be particularly difficult. They’ve always been in charge, now they have to let other people see them in moments of weakness, which is why assertors are especially likely to be in denial about health problems. They often try to hide them, and it’s particularly problematic when dealing with the issues surrounding mental health and memory loss. Even with delicate problems like this one, assertors need a direct, fact-based, and solutions-oriented response to their struggles.

Rebecca’s mother had worked for years as a corporate lawyer in a time when most of her colleagues were men. She was used to being tough, decisive, and in control of large amounts of information. When she started forgetting names and appointments, Rebecca wanted to have a conversation about Alzheimer’s. However, her mother was furious at the thought, and had a long list of excuses to explain these out-of-character lapses.

Rebecca realized that her mother knew something was wrong, but didn’t want to admit that her memory was being affected. To persuade her mother to go in for testing, Rebecca gathered information on the treatments and therapies available to slow the progression of Alzheimer’s and dementia. She put together a clear case for immediate action over waiting as things got worse. She especially focused on the ways that a trip to the doctor would not be a waste of time, but would actually be helpful. Her mother agreed to go once she could approach her lapses in memory as a problem to be solved.

If you think they need to see a specialist.

If your aging loved one is having issues that you think need a specialist’s opinion, do your research first. Make a list of the kind of tests they might need, or the kind of help a specialist could provide. Because assertors value efficiency, they probably won’t agree to yet another doctor’s appointment unless they believe that there is value in the information they will gain from it.

Jim’s dad was getting short on breath while doing normal activities and suffering from frequent coughing fits. Jim wanted him to see a pulmonologist, but his dad brushed off his request with the excuse that he was just getting old and there was no reason to bring doctors into it. Besides, his internist had given him a clean bill of health not three months ago.

Jim researched symptoms, and then found a list of pulmonologists who were covered by his father’s insurance. He presented this list, with their pictures, qualifications, and patient reviews, to his father. His father acted irritated and picked one ‘just to get you off my back,’ but Jim could tell that the irritation was actually masking a fear of a serious diagnosis.

If you think they’re having problems with their medications.

You may notice that your loved one has had more side effects since he started certain medications, or worry that the schedule she’s taking them on is causing negative interactions. He may be adding supplements to his medication regimen without consulting a doctor, or she may have trouble remembering the requirements. All of these issues can cause serious harm to your loved one’s health, but your assertor may be convinced that they know better than their doctor.

When Philip was cleaning out his mother’s medicine cabinet, he was appalled to find an entire shelf of supplements that had never been prescribed by a doctor. Instead of jumping into a lecture on over-supplementation, he prepared for the conversation. He asked her what she was taking each one for, and recorded information on the dosages and intended purpose of each pill.

Then he took that list, along with the list of her prescribed medications, to her pharmacist and asked for information on drug interactions and side effects. When he finally sat down to talk with his mother, Philip had hard facts on his side, and was able to persuade her to drop some of her supplements.

If you think they don’t understand their diagnosis or aren’t following doctors’ instructions.

For assertors, information is power. Think in terms of providing an ‘executive summary’ of their condition. For instance, if your loved one is on a low-salt diet but continues to eat fast food daily, you may want to provide facts and figures to help them understand why they’re making a poor choice.

When Anita realized that her dad wasn’t checking his blood sugar regularly, her first impulse was to yell at him and to demand immediate change. However, she quickly realized that an emotional response would just cause him to ignore her concerns as irrational and overwrought.

Instead, Anita spent a few hours researching her father’s condition. Then she sat down to discuss it with him in the style of a ‘corporate meeting,’ presenting him with the information, and explaining the likely results of various food and behavioral choices. She knew she couldn’t force him to make a good decision, but she could at least nudge him in the right direction.

If you think they’re not taking proper care of themselves.

If you’ve noticed that your loved one has been neglecting nutrition, hygiene, or exercise, it’s important to have a conversation. However, an assertor will feel attacked if you simply tell them they’re not doing an adequate job with self-care. Remember, assertors have been problem-solvers all their lives. Give them a problem to solve, don’t treat them like they are the problem to solve.

After a visit to the dentist, George became worried about his uncle’s oral hygiene routine. His uncle had been a lifetime brusher and flosser, but now it looked as if he was neglecting his self-care. George needed to have a conversation with his uncle, a former military man, about this delicate topic.

He decided to pursue it in a straightforward way, from a perspective of problem-solving. “Uncle Dave, the dentist mentioned that you need to spend more time brushing and flossing. What obstacles are keeping you from caring for your teeth?” This conversation opener let Uncle Dave identify problems and possible solutions without feeling attacked or challenged.

When you think they need extra help.

At some point, every aging person needs extra help, whether it’s just an occasional companion, a home-health nurse, or a move to an assisted living facility or senior housing. However, if you bring the idea up casually, your assertor is likely to brush it off. After all, they’ve taken care of themselves this long, and they certainly don’t need help now. To make the conversation go more smoothly, address specific concerns. For instance, if your loved one has trouble climbing stairs, you might want to point out the benefits of a one-level home.

When Melissa had to talk to her mother about having a health aid visit in the evenings, she expected a fight. Her mother’s first response was “You should do it yourself.” Melissa remained calm, and explained why her schedule wouldn’t allow for such a regular commitment.

Then she presented her mother with information on each of the available services, and helped her mother arrange times to interview prospective caregivers. This gave her mother power over the situation, because by conducting the interviews, she would still get to act as a leader. Choosing who would help her made it easier to accept the necessary help.