A Geriatrician’s Perspective on Aging Parents:
5 Common Areas to Assess When Visiting Loved Ones
Sometimes, reuniting with family can show how much Mom, Dad, or other aging loved ones have changed over the past months, or even, year. It can be surprising how much they seem to need our help. This time together can be an opportunity to assess their well-being and make changes, if needed.
A Place for Mom expert and geriatrician, Leslie Kernisan, MD, provides some guidance not only on how to spot common problems, but also how to identify which underlying health problems might be causing the issues.
A Guide to Assuring Senior Loved Ones Are Safe
Dr. Kernisan decided to go into geriatrics as she was interested in the policy and advocacy for primary care. The people who need primary care the most are seniors. She comments:
“Geriatrics is really the rocket science of primary care, as building the relationships and collaboration with patient and family is important. People need to be informed and educated and look at the big picture. I chose this subspecialty of internal medicine because the work requires us to step up the most, as physicians.”
Awareness to changes in your aging loved one is one of the first steps of the aging journey. During your visits, Dr. Kernisan provides a quick start guide to help families check for common health and safety problems in aging. This can help you decide whether your loved one needs assistance. Based on her own work doing house calls, she groups common problems into five areas to consider, when watching your aging family members:
Life tasks are fundamental self-care activities that need to be done, whether we do them for ourselves or have someone do them for us. Life tasks include two areas:
Activities of Daily Living (ADLs):
- Walking and getting around
- Using the toilet independently
Instrumental Activities of Daily Living (IADLS):
- House Cleaning and Chores
- Meal Preparation
- Using the Telephone
Check the cupboards for groceries and watch your loved one interact with family members and friends. Are they getting around okay and is their personal hygiene normal? If you notice that something is off with the above life tasks, it may be time to have a conversation. Dr. Kernisan notes,
“Be sure to get help understanding why your parent is having the problem. You have to understand why a problem is happening before you can get the right treatment or adapt their life. You need to clarify what’s going on in order to figure out what you can do in the present and expect in the future.”
Safety is a big one. But while safety may seem like a priority for families, older loved ones and family members may sacrifice safety or be in denial over the reality of the situation. After all, no one wants to see independence lost and the senior more than likely wants to remain autonomous. Here are the areas of safety to watch out for:
- Are there problems paying bills?
- Are you concerned about scams?
Memory and Thinking
- Have there been problems with wandering or getting lost?
- Have there been issues forgetting about the stove or other appliances / home equipment?
- Is there concern about poor safety awareness or poor judgment?
- Have there been any accidents or close calls?
- Do passengers feel worried?
- Have you heard of, or do you have any concerns about emotional, verbal or physical abuse?
- Do you have any concerns that someone is financially taking advantage of your loved one?
- Has your loved one had any falls?
- Have there been repeated trips to the emergency room (ER) or hospital?
Instead of being in denial, it’s important to address safety concerns in a timely manner. “You may want to visit your loved one’s physician, or seek clinicians with experience assessing older adults,” comments Dr. Kernisan. “Track back to any underlying thinking problems you may have noticed as this could be related to many safety concerns.”
There are ways to prevent falls in your elderly loved ones, as Dr. Kernisan has discussed with us in the past. But it’s important to first be aware of any safety problems before addressing how to deal with or avoid them.
Sadly, many seniors live with chronic health problems. But there are some problems that require your attention as they may be red flags or signs that quality of life is at stake or health may be at risk:
- Have there been frequent ER visits or hospitalizations?
- Are there obvious declines in health or strength?
- Have you noticed weight loss or a poor appetite?
- Has your loved one complained of pain or other uncomfortable symptoms?
- Is there decreased involvement in life activities related to health problems?
- Is there anything that worries your loved one about their health?
You may want to consider visiting your loved one’s doctor on the next visit or even do some online research about your loved one’s conditions to help you better understand the problems. Dr. Kernisan keenly observes:
“I work with families and there’s this idea that we’re going to cure people and keep them healthy; but the truth is that people have chronic illnesses and disabilities when they age. You have to ask the question, ‘how do I make my loved one’s health the best it can be?’ If you can help improve their well-being and daily functioning, that’s what is important. Many seniors suffer more than they need to. It’s important for both seniors and their family members to get the right information. So be an advocate for your aging loved one and help them optimize their healthcare for better quality of life.”
Mood and Brain Health
Does your loved one suddenly seem different? Is there a hint of depression or anxiety that wasn’t there before? Maybe memory problems are affecting their mood. Dr. Kernisan discusses things to watch for in this important area:
- Does your loved one have sudden or frequent sadness?
- Is there a loss of interest in activities they used to enjoy?
- Has there been a personality change?
- Does your loved one have hopelessness?
- Is your loved one experiencing excessive or unusual worrying?
- Are there memory problems?
- Have you noticed a difficulty in their learning new things?
- Is organization a problem?
- Are there new difficulties with mental tasks?
- Have you noticed problems in driving?
- Have there been mistakes with finances?
- Is there unusual spending of money?
- Is there a lack of social or purposeful activities?
- Does your loved one suddenly seem or feel lonely?
Depression and cognitive changes can be common in older adults; especially if there has been a loss of a spouse or other traumatic event. Consult a doctor, look for a geriatrician, geriatric psychologist or geriatric psychiatrist for help in evaluating and diagnosing the problem. According to Dr. Kernisan, disengagement and change in behavior are big warning signs that something is off with your loved one.
“I always think of the serenity prayer when it comes to helping people with aging: ‘Please grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.’ Unfortunately, that last part is often hard to sort out when it comes to seniors, but getting help from people with geriatrics training can help. And family members are key to helping their loved ones sort through the challenges of aging.”
Medication Safety and Management
Last, but certainly not least, medications can play a crucial role in a senior’s life. They can be vital for keeping certain health conditions under control, but can also create side effects and a plethora of other health problems. Medications can also take a lot of time and money, so it’s important to be aware and proactive when it comes to your aging loved one's medication safety. Dr. Kernisan recently discusses key tactics to identify problems:
- Can your loved one afford their prescriptions?
- Are they having trouble taking all the prescriptions as recommended?
- Are they refilling their medications regularly?
- Are they skipping medications?
- Are there side effects or worrisome symptoms related to medication?
Dr. Kernisan mentions that there are ways to eliminate unnecessary pills. If you take the medications and ask the pharmacist or doctor to simplify, your loved one can take pills fewer times during the day. Kernisan notes that there are also common problems, such as pain, depression and arthritis, that can be treated with non-drug methods. Asking your loved one’s doctor about non-drug alternatives, and being aware of some of the risky drugs for seniors, is also important.
What Can You Do When Your Parents Are Resisting Help?
Problems in each of these areas listed above make your loved one susceptible to problems in other areas, so it’s important you ask questions and be his or her advocate before things get worse. However, sometimes your aging parent or loved one doesn’t want your help. If this sounds familiar, there are steps you can take to help reduce frustration and stress for everyone involved. After all, when you’re home, it’s important for you to be prepared if you do notice any problems and be aware of potential communication issues.
Being human and understanding will take you a long way. Sometimes cognitive impairments are to blame and sometimes stubborn family members are the culprit. Whatever the problem, it will most likely be a challenge; but it’s important to separate what you need from what your parent needs. If you and your siblings or family members are all on the same page, this is a huge help.
Dr. Kernisan stresses the importance of caregiver coaching. “People don’t want to spend time getting training to be a caregiver. But the information is underestimated and can greatly improve the situation — especially for those with loved ones suffering from dementia or Alzheimer’s. If your family has the money, occupational therapists, such as Dr. Teepa Snow or others, can be a great help.”
About Leslie Kernisan, MD MPH
Dr. Kernisan is board certified in Geriatrics and Internal Medicine and Clinical Instructor at UCSF Division of Geriatrics. She is also author of GeriatricsForCaregivers.net, a blog with practical aging health advice for family caregivers, and sister-site, HelpingOlderParents.com, which provides information for boomers worried about aging parents. She is the former site medical director of the Over 60 Health Center in Berkeley and Graduate of the VA Quality Scholars Program and the UC Berkeley School of Public Health. Dr. Kernisan completed her residency, clinical fellowship, and three years of research training at UCSF, and earned an A.B. degree from Princeton University and her M.D. degree from Case Western Reserve University School of Medicine.
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