Coping Strategies for Those Aging into Disabilities

Question: My husband had polio when he was three. He’s now 74. About two years ago, his body started breaking down. Long story short, he now uses a power chair to go all but the shortest distances. We moved into a ranch and made some modifications so that he could get around better. Things are better now, but for a long time he was angry and depressed by his worsening health. Several people remarked to me during that time that he needed to develop better coping skills. I understand the concept, but it was never suggested what, specifically, he could have done to adapt better to his new limitations. What are some coping strategies you would suggest for those now aging into a disability?

Response from Rhoda Olkin, PhD: I’m going to address what it is like as a person with polio when your body starts to fail you. My colleague will address the issues about coping. You say your husband has been “angry and depressed by his worsening health.” Let’s parse this: Angry? Of course! Those of us with polio worked hard to keep our bodies going strong. To watch ourselves have more impairments and be less agile and functional, well, that sucks. And to have others judge how we are coping?

Completely unacceptable. Does the butterfly say to the caterpillar “You really should be flying, you know?” Depressed? Hopefully not clinically so, but if it is indeed a diagnosable depression that should be addressed as depression is treatable.  But if it’s really sadness, and does not reach the level of clinical depression, that is very understandable. Diminution of functions lead us to new phases of life, ones in which we are frailer.

His worsening health? Not necessarily. Health and disability are related but not entirely overlapping conditions. One can have significant limitations in activities of daily living (ADL) and still be in very good health. However, poor health tends to bring with it limitations in ADL. So regular check-ups that don’t let polio overshadow other health factors should be yearly events.

But how are you? How is it to watch someone struggle with declining function? How does your husband’s anger and depression affect your relationship? You are in this with him, and your wellbeing should not be overlooked. Nor should the importance of the relationship be minimized—social support is one of the most important factors in aging well. So, what about your emotions? Are you angry or depressed? Fed up with others making silly suggestions? Finding your own coping stretched to limits? Remember to take care of yourself just as much as you help your husband.

“Coping skills” is one of those buzzy, nebulous phrases people throw around, taking for granted that the person it’s being thrown at knows what it means. But what are they?

Coping skills are the learned strategies we use to function in our lives. They are formed by the interaction of circumstances and life experiences with hereditary traits. We may develop new ones in response to novel situations, and the ability to do this flexibly could itself be considered a coping skill. We are more likely to be aware of them when we are trying to develop new ones, but once developed, they tend to function automatically. Depending on circumstances they may be adaptive (“good”) or maladaptive (“bad”). Those that were once adaptive can become maladaptive when circumstances change.

Like all polio survivors, your husband developed a set of coping skills that served him well for many years. In the process of rehabbing he was taught to persevere in spite of pain and push himself past his physical limits. These skills helped him navigate the world as it was then and to have the best possible life, forming his identity as an overachiever always striving to overcome.

Post-polio syndrome changes everything. Finding out that the skills that served them so well may have contributed to the development of severe symptoms can leave polio survivors feeling betrayed and cheated, even uncertain who they are. They may experience anger or grief. Memories of their polio experiences can also surface.

These are valid reactions. Like all polio survivors your husband needed to have them. Being able to do so is a coping skill, as is learning when and where to express them, and how to use them productively. For example, anger can provide energy for making needed changes. Grieving the loss of something important, including changes in our health, helps us move forward into the next phase of our life.

It’s normal for these feelings to come and go over time. However, getting stuck in them drains valuable energy. If this is happening to your husband, there are a variety of therapies and techniques that can teach him specific coping skills, such as cognitive behavioral therapy (CBT) and mindfulness. There are many self-help books and classes that teach the basic techniques and apply them to various problems. If your husband needs more help, working with a therapist experienced in issues around adjusting to aging and disability and/or grief could be helpful.

The coping skills we most often encourage polio survivors to develop are energy conservation and pacing. Using them well involves not just cutting back on activities and resting more. Being aware of how his energy levels and pain wax and wane through the day can help your husband develop a pattern of activity and rest that works for him. Within this it’s important that he finds ways of doing the things that give his life light and color, even if this means he needs to rest more afterwards.

Post-Polio Health (Vol. 36, No. 1, Winter 2020)