Helping Older Parents

Wondering whether you should worry? Having trouble getting parents to accept help? Overwhelmed by challenges and concerns?

This part of the site is especially for you! It includes our hand-picked articles, tips, & resources for people helping older parents.

Financial Exploitation in Aging: What to Know & What to Do

by Leslie Kernisan, MD MPH 5 Comments

Here’s an upsetting situation that comes up a lot, and may have come up for you: is someone financially taking advantage of Mom or Dad?

It’s a pretty legitimate concern to have. To begin with, most people know that there are plenty of “scammers” out there, phoning or mailing older adults with deceptive information designed to hoodwink them out of some of their savings.

But there’s actually another form of exploitation that may be more common, and is often harder for families to address.

That would be exploitation perpetrated by a someone the older person knows and has a personal relationship with.

Sometimes the person suspected of exploitation is relatively new to the older person’s life, such as a new romantic interest, friend, or paid caregiver.

In other cases, family members become concerned that someone in the family – such as one of the older person’s children – is beginning to take financial advantage of things.

Exploitation in the context of personal relationships is often especially tricky for families to address. The older person may be quite attached to – or otherwise feel dependent on – the person that others perceive as suspicious or problematic. Or there may be concerns about stirring up family dramas and conflicts, by voicing concerns about a sibling or another relative.

People are often unsure of what exactly constitutes illegal activity, and what can be done if they are concerned about financial exploitation.

So in this article, I’ll cover the key things you should know, so that you can better evaluate and address a worrisome situation, should one arise.

Specifically, in this article I’ll explain: [Read more…]

7 Steps to Managing Difficult Dementia Behaviors
(Safely & Without Medications)

by Paula Spencer Scott 7 Comments

(This article is by my colleague Paula Spencer Scott, author of the book Surviving Alzheimer’s: Practical Tips and Soul-Saving Wisdom for Caregivers. I invited her to share an article on this topic, since many in our community are coping with dementia behaviors. — L. Kernisan)

The odd behaviors of Alzheimer’s and other dementias can be so frustrating and stressful for families.

I’m talking about the kinds of behaviors that try patience, fray relationships, and drive us in desperate search of help:

“First she thinks the caregiver is stealing her sunglasses and now she accused me of having an affair.”

“When I tried to help Dad wash up, he hit me.”

“My husband follows me so closely I can’t stand it. But if I go in another room he’ll wander out of the house.”

“Mom started unbuttoning her shirt in the middle of the restaurant!”

“Just when I’m completely exhausted at the end of the day, he seems to get revved up. He keeps peeking out the windows, convinced that someone is trying to break in. Now he won’t sleep.”

A common approach to difficult behaviors is to go right to medicating them with tranquilizers, sedatives, or antipsychotics. But that’s risky and often not what’s best.

In fact, experts recommend trying behavior management first, and for good reasons: It tends to be more effective in the long run than “chemical restraints,” has no dangerous side effects, and leads to a better care relationship. But people often don’t know how to do this.

I’ve learned how.

I’ve lived through five close family members’ experiences with Alzheimer’s and other forms of dementia. Lots of trial and error, and insights from dozens of top dementia experts (whose brains I’ve been lucky to pick as a journalist and dementia educator), got me through regular scenes with…

My father-in-law, who needed a walker to move yet spent hour after hour for several days straight hauling all his clothes and toiletries from his room to our driveway, insisting that his (imaginary) new wife was about to pick him up
My dad, a formerly sharp dresser who wore the same shirt and pants every day no matter how dirty
My grandmother, who insisted on going “home,” when she was home
And other relatives, in dozens of similar scenes.

In this article, I want to share what I wish someone had explained to me early on: the “Why-This, Try-This” approach to dealing with difficult behaviors.

This is a mental framework that can help you get unstuck from unproductive responses that get you nowhere or make things worse.

It can bring calm -– to both of you — whether the issue is verbal or physical aggression, agitation, confusion, wandering, disinhibition, delusions, hallucinations, or a restless or repetitive behavior (like pacing, shadowing, rummaging). It also works well with milder irritants like repetitive questions and indecision.

Then, I’ll boil down the Why-This, Try-This concept to a 7-step process you can use every time. These “7 R”s give you a basic platform for responding to any frustrating behavior: [Read more…]

Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check

by Leslie Kernisan, MD MPH 20 Comments

Have you been worried about an older person’s memory or thinking abilities?

Maybe your parent has seemed more confused recently. Or you may have noticed that your aging spouse is repeating herself, or struggling to do things that didn’t use to pose much of a problem.

These are very common concerns, and they often lead to questions such as:

Is this normal aging or something more significant?
What is wrong?
Could this be Alzheimer’s? Or some other form of dementia?
Can this be treated or reversed?
What should we do about this??

The answer to the last question is this: if you are worried about memory or thinking, then you should seek out some kind of medical evaluation.

That’s because when families worry about an older person’s cognitive abilities, there often are some underlying health issues affecting the mind’s function.

Those need to be detected, and treated if at all possible. So, you’ll need to request help from a health professional, and in this article, I’ll explain what that initial help should consist of. This way you’ll know what to expect, and what the doctor might ask you about.

Technically, these kinds of problems are called “cognitive impairment.” This is a broad term that means some kind of problem or difficulty with one’s memory, thinking, concentration, and other functions of the conscious brain, beyond what might be expected due to normal “cognitive aging.”

(For more on “cognitive aging” and what types of changes are considered normal aging, see here.)

Cognitive impairment can come on suddenly or gradually, and can be temporary or more permanent. It may or may not keep getting slowly worse; it all depends on the underlying cause or causes.

In this article, I’ll share with you the more common causes of cognitive impairment in older adults.

I’ll then share a list of 10 things that should generally be done, during a preliminary medical evaluation for cognitive impairment in an older adult.

Common causes of cognitive impairment in older adults

[Read more…]

Q&A: What to Do About Unintentional Weight Loss

by Leslie Kernisan, MD MPH 39 Comments

Q: My 88-year-old father lives in his own home about 100 miles from us. He’s been living alone since my mother died five years ago. I thought he looked rather thin last time we saw him. I’m starting to feel worried about his nutrition. Should I be concerned? Would you recommend he start drinking a supplement such as Boost or Ensure?

A: This question comes up a lot for families. It is indeed very common for older adults to experience unintentional weight loss at some point in late-life.

The brief answer is that yes, you should be concerned. But I wouldn’t recommend you jump to purchasing Boost or Ensure.

Now, in most cases, some nutritional supplementation is in order. But before focusing on this, you should first get help figuring out why your father is losing weight.

For doctors, unintended weight loss is a major red flag when it comes to the health of an older person.

So in geriatrics, we usually recommend that an older person — or their caregivers — monitor weight regularly. This enables us to spot weight loss sooner rather than later.

Once we’ve spotted unintentional weight loss, the next step is to figure out what might be causing it. And then we’re in a better position to recommend a treatment plan, which might well include a nutritional supplement.

In this post, I’ll go over each of these steps in more detail.

Why you should monitor for unintentional weight loss

[Read more…]

How to Evaluate, Prevent & Manage Constipation in Aging

by Leslie Kernisan, MD MPH 30 Comments

Constipation is not a glamorous topic, but it’s certainly important, especially in older adults.

As anyone who has experienced occasional — or even chronic — constipation can tell you, it can really put a damper on quality of life and well-being.

Constipation can also cause more substantial problems, such as:

Severe abdominal pain, which can lead to emergency room visits
Hemorrhoids, which can bleed or be painful
Increased irritability, agitation, or even aggression, in people with Alzheimer’s disease or other forms of dementia
Stress and/or pain that can contribute to delirium (a state of new or worse confusion that often happens when older adults are hospitalized)
Fecal incontinence, which can be caused or worsened by having a hard lump of stool lodged in the lower bowel
Avoidance of needed pain medication, due to fear of constipation

Fortunately, it’s usually possible to help older adults effectively manage and prevent constipation. This helps maintain well-being and quality of life, and can also improve difficult behaviors related to dementia.

The trouble is that constipation is often either overlooked or sub-optimally managed by busy healthcare providers who aren’t trained in geriatrics. They are often focused on more “serious” health issues. Also, since many laxatives are available over-the-counter, some providers may assume that people will treat themselves if necessary.

Personally, I don’t like this hands-off approach to constipation. Although several useful laxatives are indeed available over-the-counter (OTC), I’ve found that the average person doesn’t know enough to correctly choose among them.

Also, although in geriatrics we often do end up recommending or prescribing laxatives, it’s vital to start by figuring out what is likely to be causing — or worsening — an older person’s constipation.

For instance, many medications can make constipation worse, so we usually make an attempt to identify and perhaps deprescribe those.

In short, if you’re an older adult, or if you’re helping an older loved one with health issues, it’s worthwhile to learn the basics of how constipation should be evaluated and managed. This way, you’ll be better equipped to get help from your health providers, and if it seems advisable, choose among OTC laxative options.

Here’s what I’ll cover in this article: [Read more…]

Helping Older Parents

Common causes of cognitive impairment in older adults

Why you should monitor for unintentional weight loss

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