It’s that time of the year again: first Thanksgiving, and then winter holidays. Which means this is the time of the year when families are most likely to get together with older parents.
Ideally, this means a time for families to bond and spend joyful times together. And no matter what is going on in your older relative’s life, bonding and joy are always possible. So I hope this holiday season brings you many opportunities to enjoy your aging relatives.
But there are two more challenging things that tend to happen during the holidays:
- Families — especially adult children who don’t see their parents often — may find themselves concerned about an older relative’s health or safety or well-being.
- Families often use the holidays as a time to get together and have “the talk.” Or otherwise try to plan and “get things in order.”
Nobody likes addressing these two situations. But they do come up a lot at this time of year.
In case any concerns or planning needs come up for you during the holidays, here’s what I’ll be sharing in this post:
- 3 useful guides, to help you address common aging and caregiving concerns
- Tips on what to do if you’re worried about an older relative
- 6 common problems that worry families, with resources on addressing them
3 Guides to Help You Have “The Talk” With Aging Relatives
Here are three online guides that can help you. They all include a printable PDF version.
- Prepare to Care: A Resource Guide for Families, from AARP.
- Has information on starting the conversation, forming a team, making a plan, finding support, and caring for yourself.
- Includes a resource list, several needs checklists, and a sample caregiving plan.
- 40-70 Rule: An Action Plan for Successful Aging, from the Home Instead Senior Care Network. This content was developed with input from a gerontologist and a geriatrician, among others.
- The printable PDF action plan (available here) includes information on discussing living choices, finances, health, driving, end-of-life care, as well as relationships and dating. It also includes a comprehensive checklist to help families track their progress.
- An “Interactive Conversation Tree” can help families quickly spot outstanding issues, and includes links to the relevant sections of the conversation guide.
- A special PDF guide on communication includes specific examples of how to start conversations on “sensitive senior subjects.”
- Tough Conversations Expert Guide, from A Place for Mom. (Note: I have no financial relationship with APFM. I do write unpaid blog posts for them and occasionally serve as an expert resource for them, as this helps me reach family caregivers who appreciate information written by a geriatrician.)
- Guide includes tips from an eldercare attorney, a financial planner, a psychiatrist, a geriatric psychologist, as well as an aging health section featuring yours truly. A printable PDF version is here.
- Most of the aging health section draws on my “Quick Guide to Checking Older Adults for Common Health & Safety Problems.” Get my actual guide if you want checklists and specific tips on how to get help with the problems you might find.
Bonus: if you’ve had conflicts with siblings regarding aging parents, I recently came across this website (also part of Home Instead Senior Care). The content seems well-written.
What to do if you’re worried about an older relative
If you are worried about an older person’s health, safety, or wellbeing, here’s what I suggest:
- Look for common red flags that indicate serious safety issues, difficulties managing daily life tasks, or declining health. Doing this helps you move from a vaguer feeling of worry to identifying very specific issues to investigate and troubleshoot. You can use one of the guides I mention above to walk you through this process.
- Make a list of all the issues you’re concerned about. For instance, you might identify difficulty getting groceries, falls, and loneliness.
- Get help identifying any underlying health problems might be causing the problems you’ve identified. I really can’t emphasize this enough. Do not just arrange a work-around for a problem, such arranging shopping and meals for someone who’s become too spacy to do her cooking. In this particular example, losing the ability to manage cooking is concerning for dementia. You should absolutely get an evaluation and make sure the person properly diagnosed and optimized. (To read about why this matters, see this post.)
- Identify options for addressing areas of concern.
- Health problems will need to be evaluated and managed. Many problems — such as Alzheimer’s — are not reversible, but optimal management can help a senior improve function and quality of life. (See “4 Steps to Get Better Advice From Doctors” for useful tips.)
- Services that provide help or safety monitoring can help a person remain home for longer.
- Your family may need to consider a move to different housing. You should try to optimize health problems first, and also find out what kinds of future health crises and declines to anticipate. Then you can weigh the pros and cons of different housing and support services plans.
Now, I know what many of you will be thinking. Some of you will be worried about someone who’s refusing help, or refusing to discuss the situation. Others of you are just concerned that your parent might get upset, or perhaps you’ve tried to discuss things before and it didn’t go well.
Ok, here are two articles that might be helpful:
- QA: What You Can Do if You’re Worried About “Incompetence”
- 4 Things to Do When Your Parents Are Resisting Help
Resources to Help You With 6 Common Problems That Worry Families
Here’s what these are in my own experience, along with some resources to help you look into these:
- Cognitive impairment, including signs of memory problems, financial mistakes, or worrisome decisions. If you are concerned about anything like this, it’s important to take action, especially to protect an older person’s financial assets and physical safety while you figure out what’s going on.
- See How We Diagnose Dementia: the Practical Basics to Know and 8 Behaviors to Take Note of if You Think Someone is Getting Alzheimer’s
- For signs of financial decline — which is common even in people who don’t have Alzheimer’s — see 5 Things to Know About Aging & Financial Decline.
- Driving difficulties. We sometimes discover these are due to thinking problems, but they can also be due to vision difficulties or other issues.
- See When Driving Skills Change, from the National Institute on Aging
- Falls. Falls are common, and some older adults may brush them off. But a serious fall can cause life-changing injuries, so it’s a good idea to try to reduce fall risk. Seniors should also have a safety plan in place, so that they can get help in the event of a fall. (It’s really bad to be stuck on the floor for 24-48 hours, which I have seen happen.)
- For information on fall prevention and what should be checked after a fall, see my Falls Topic Page, which has links to several articles. I would especially encourage you to identify risky medications, as well as over-treatment of high blood pressure.
- A Personal Emergency Response System (PERS) is often a good idea for older adults who live alone. For help choosing one, I recommend the thoughtful tutorial and guide at Tech-Enhanced Life.
- Depression and social isolation. Both of these problems are common, and can exacerbate each other. They can also often overlap with cognitive impairment. Some good resources:
- Depression in Older Adults, from Helpguide.org
- This New York Times article covers research on loneliness in seniors, and this article suggests 14 ways to help older adults avoid isolation.
- Note that isolation is often worsened by pain, incontinence, or other physical health problems that make it harder for older adults to go about their usual lives. Treating these problems can enable seniors to participate in more social and purposeful activities.
- Caregiving stress. Many older adults are caring for a spouse or other older relative. This can create a lot of stress and burden, especially when caring for someone with Alzheimer’s or another dementia.
- For information on the signs of caregiver burnout, and how to relieve caregiver stress, I like this HelpGuide.org page. HelpGuide also has a page specific to supporting dementia caregivers here.
- If you are an adult child concerned about a caregiving parent, consider helping your parent get some respite (meaning, time off from caregiving).
- Physical frailty and/or accelerating health problems. This comes up for many families at some point. Partly it’s the nature of things for older adults to eventually become frail, or chronically ill. But you should also know that it’s fairly common for older adults to experience sub-optimal healthcare. In particular, seniors often get a lot of healthcare that is actually harmful or burdensome (e.g. test and procedures that are unlikely to improve their health), and at the same time it’s common for health problems to fall through the cracks (e.g. medication side-effects, under-treated pain, overlooked diseases). To address this:
- Learn to become more engaged in double-checking healthcare. This means asking questions, doing more homework, and considering second opinions. A good resource for this is “Be a Prepared Patient,” from the Center for Advancing Health.
- Consider a consultation with a geriatrician or another doctor experienced in older adults. For help finding this, see “How to Find Geriatric Care — or A Medication Review — Near You.”
- Set up a personal health record for your parent. See “How to Use a Personal Health Record to Improve a Senior’s Healthcare.”
But Don’t Forget to Enjoy Yourself Over the Holidays!
I know, I’ve given you far too much to think about and read. Well, don’t read it all right now! Instead, use this as a resource when you need it.
In truth, helping an older parent or managing complex health problems is a long, complicated on-going project. Unless there’s a bad crisis afoot, you want to make sure you keep chipping away at things. A family conversation this week. Perhaps checking for financial problems — or simply trying to review and simplify finances — next week. A review of advance care planning documents next month.
Do a little bit, end with a note to yourself and to your family regarding next steps, schedule a time to address those next steps, then pat yourself on the back and enjoy some good food and good company.