Common challenges

Family conflicts during aging, caregiving, and end-of-life transitions are common and can significantly impact both the well-being of older adults and their caregivers. Research demonstrates that disagreements about care decisions, roles, and responsibilities are frequent and can disrupt family unity and caregiver health (6,7).

Differing Perceptions of Needs
Family members often disagree on the severity of a loved one’s decline, appropriate care levels, or safety risks, especially in dementia, where needs are complex and evolving. Structured communication and objective assessments help align perspectives (1,8).

Uneven Caregiving Responsibilities
One family member frequently becomes the primary caregiver, leading to burnout and resentment over unequal contributions. This dynamic is associated with increased psychological strain and negative health effects for the primary caregiver (6,2).

Unresolved Past Conflicts
Old rivalries and unresolved family issues often resurface during crises, complicating decisions and increasing stress. Mediation and structured communication can address these tensions and foster collaboration (7).

Communication Breakdowns
Avoidance of difficult conversations-such as end-of-life wishes or advance care planning-can escalate misunderstandings and hinder effective decision-making. Structured sessions create safe spaces for open dialogue (1,3).

Financial Strain
Disputes over care costs, inheritance, or financial responsibility are common, especially without prior planning. Financial stress can have ethical and health implications for both the patient and family caregivers (6).

Value or Belief Clashes
Generational, cultural, or ethical differences-such as preferences for hospice versus aggressive treatment-can create rifts within families. Facilitated discussions help honor diverse viewpoints while focusing on the patient’s wishes (4).

Decision-Making Power Struggles
Conflicts over legal authority (e.g., power of attorney) or whose voice matters most are frequent and can delay or derail important decisions (6,7).

Caregiver Burnout and Stress
Emotional exhaustion from caregiving amplifies frustration and conflict, especially when caregivers feel unsupported or overwhelmed (2,5).

Denial of Decline
Some family members may dismiss cognitive changes or safety risks, delaying critical decisions and increasing the risk of crisis (1,8).

Why Structured Facilitation Strengthens Families
Structured facilitation-such as family meetings or mediation-addresses these challenges by:

• Ensuring all voices are heard and reducing power imbalances,
• Building consensus through guided problem-solving,
• Honoring the autonomy and wishes of the aging loved one,
• Preventing crises through proactive planning.

By navigating these challenges together, families not only make better decisions but also deepen trust and connection, fulfilling the common wish among aging parents to see their loved ones united.

References

1. Virdun C, Luckett T, Phillips J, Agar M, Davidson PM. Role of patients' family members in end-of-life communication: a qualitative metasynthesis. BMC Palliat Care. 2023;22(1):20.
2. Semple SJ. Family conflict as a mediator of caregiver strain. Gerontologist. 1992;32(5):618-626.
3. Back AL, Arnold RM, Tulsky JA. Family meetings in palliative care: benefits and barriers. J Pain Symptom Manage. 2022;63(3):e1-e7.
4. McIlfatrick S, Hasson F, McLaughlin D, et al. Decision-making in palliative care: patient and family caregiver concordance and discordance. BMJ Support Palliat Care. 2023;13(4):374-380.
5. Lillo-Crespo M, Riquelme-Galindo J, Macrae R, Riquelme-Galindo J. Impact of the caregiver burden on the effectiveness of a home-based palliative care program. Palliat Support Care. 2020;18(3):316-322.
6. National Academies of Sciences, Engineering, and Medicine. Families caring for an aging America. Washington, DC: National Academies Press; 2016.
7. Kissane DW, Bloch S, Dowe DL, et al. The management of family conflict in palliative care. J Palliat Med. 2008;11(2):235-242.
8. Eggenberger E, Heimerl K, Bennett MI. Determining evidence for family caregiver communication strategies in dementia care. J Commun Healthc. 2022;15(4):247-257.