Most older adults don’t need much help from others.
In fact, many of them are quite busy assisting others and otherwise contributing to their families, communities, and/or workplaces.
But of course, many older people eventually do need some help from others, especially if they live into their 80s, 90s, or beyond. After all, only a minority of people transition from being fully independent to deceased, with no intervening period of needing assistance.
(Wondering how to get an older person to accept help? That’s covered here: 6 Steps to Take When Aging Parents Need Help – Even if They’re Resisting.)
When an older person does start to need help, it tends to be close family members — assuming the person has family — that step in: spouses, adult children, siblings, nephews or nieces, grandchildren, and so forth. In fact, family members are by far the number one source of “long-term care supports and services” for older adults.
Sometimes providing this eldercare support can be fairly straightforward: a little help with transportation, or arranging for some assistance with shopping or household chores.
But in other cases, family members find themselves having to take on quite a lot. This is often due to health issues affecting the older person’s ability to remain independent and manage various aspects of life.
Some situations that commonly bring this on include:
- An older person starting to develop dementia, such as Alzheimer’s or a related condition
- Advanced chronic illnesses that limit daily function and/or cause frequent hospitalizations, such as advanced heart failure, advanced chronic pulmonary disease, or a progressive neurological condition
- Sudden disability after a fall, stroke, or other health emergency
- Difficulty recovering from a hospitalization, especially if the older person experienced delirium or other complications
- Advanced age, which can eventually bring on general frailty and loss of physical strength. Very advanced age also tends to bring on more noticeable age-related cognitive changes, and is a strong risk factor for developing dementia as well.
Most people are happy to be able to help an older parent or other loved one in need.
But it’s also common for people to find it…difficult. Especially when the older parent is reluctant to accept help or make changes. (Which is probably the norm rather than the exception.)
Trying to help an older parent tends to bring up lots of different issues that people haven’t prepared to address. And many people must continue to tend to their jobs, children, and other responsibilities, as they also start trying to figure their new caregiving role.
Over the past several years, both in my in-person doctoring work, and as an aging health expert writing online, I’ve seen countless people struggling to sort out just what their older parent might need help with, and how to help.
So in 2019, I created a Helping Older Parents online program to guide people through this.
As part of the related Helping Older Parents Course, I created a list of the key domains that family caregivers usually have to address at some point.
Since most of our members find the list really useful, I thought I’d share it below.
9 Domains to Consider When Helping Older Parents with Elder Care
Here are nine types of issues that tend to come up, when helping older parents.
- Helping with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs)
- These are key daily life tasks, which I describe in more detail here: What are Activities of Daily Living (ADLs) & Instrumental Activities of Daily Living (IADLs)?
- Older adults often first need help with IADLs, which include things like managing transportation, finances, shopping, home maintenance, and meal preparation.
- An older person’s need for assistance with ADLs and/or IADLs often determines what kind of care arrangements or housing arrangements a family might consider.
- Safety issues
- This includes addressing issues such as financial vulnerability (or even exploitation), falls, driving concerns, and more.
- Medical and health issues
- Medical concerns are fairly common in late-life. Many older adults have chronic conditions that require medications, monitoring, and other forms of ongoing management.
- Older adults may also develop new symptoms or health concerns, and may need their family’s assistance in getting evaluated. Family members often help bring up questions and concerns to the health providers.
- Most people will also need help when recovering from an illness.
- Serious illness or certain chronic conditions can cause older adults to lose the ability to make their health decisions or oversee their own medical care. Family members must often make decisions due to a health emergency or mental decline.
- Legal and financial issues
- Some older adults may lose the capacity to manage certain types of financial or legal affairs.
- Even cognitively-intact older adults are vulnerable to financial exploitation.
- Family members must often consider assisting with legal and financial issues.
- Planning ahead and completing the necessary legal paperwork can make it much easier for a family to assist, if/when it becomes necessary.
- Housing issues
- An older person’s housing situation often affects quality of life, safety concerns, the ability of others to provide assistance, and more.
- Families must often consider questions such as:
- Is the current housing situation a good fit for “aging in place”?
- Is a more supportive environment, such as moving in with a family member, potentially necessary?
- What other options (e.g. assisted living) would be financially viable, and could be considered?
- Quality of life and helping your older parent thrive
- Beyond meeting basic needs, most families are also concerned about their older loved one’s quality of life.
- This means considering issues such as social connectedness, purpose, autonomy, and dignity.
- It’s also essential to learn more about what matters most to the older person, and what kinds of things they consider less important or would be willing to trade-off.
- Planning ahead
- Things to plan ahead for include future declines, emergencies, and end-of-life care.
- Planning ahead tends to reduce later stress, hassles, and sometimes expenses.
- Managing relationships and family dynamics
- Trying to help an older parent often brings on relationship challenges and difficult emotions.
- Well-intentioned people often inadvertently treat older relatives in ways that threaten their autonomy or dignity, or otherwise strain the relationship.
- It’s also common for family caregivers to experience relationship challenges with siblings, a caregiving parent, or others who are involved.
- Most people benefit from learning and practicing better communication skills, to better manage these relationship dynamics.
- Self-care
- Helping an older parent is rewarding but can easily become a source of chronic stress.
- Because family caregivers are often busy, they can easily neglect their own needs and wellbeing, which can jeopardize their own health, and also affect their ability to care for and connect with their older parent.
- Family caregivers can use a variety of self-care strategies to keep their caregiving strain manageable. These include joining a support group, asking for help, setting boundaries, allotting time to tend to one’s own health and other needs, and more.
- I’ve also found that family caregivers can benefit from learning strategies to organize and prioritize what they are working on.
As you can see — and as many of you already know from personal experience — helping an older parent in late life can be a pretty complicated endeavor.
This is in part because all the above domains tend to interact and overlap with each other. Some examples:
- An older person’s medical situation often affects their ability to manage ADLs and IADLs, and their caregiving needs.
- The intensity of the medical situation also affects how much time an older person and their family spend with health professionals, which affects everyone’s quality of life.
- A family’s legal permissions to assist determine how easily they can help with medical issues, housing issues, financial issues, and more.
- Relationship dynamics — and a family caregiver’s self-care — affect caregiving stress, which then affects one’s ability to help a parent, and the type of energy and patience one is able to muster when communicating with others.
- Sorting through decisions — whether about safety, medical, housing, or anything else — should always involve considering the older person’s quality of life and what matters most to them.
And so forth.
Are you currently trying to help older parents?
If so, I hope you’ll find this list useful.
There is a lot on it, but with some persistence, you’ll eventually sort your way through it all. Just don’t forget to address your self-care, ok?
And if you’re having trouble getting a parent with memory loss to accept help: be sure to check out my free online training posted below!
In it, I teach a simple but effective method that will reduce conflicts and make it easier for you to help your aging parent.
Thank you for doing what you do for your older parent!
This article was first published in 2018, and was last updated in December 2023.Â
Derek says
My 85 yr old Dad won’t let ANYONE access into his house for last 20 years. Smell coming from house is awful standing at porch talking to him. He is living in squalor and refuses any district nurse visit.. I can’t even get a personal pendant alarm because it requires a technician to install a box inside his home. Any advice please
Nicole Didyk, MD says
That sounds frustrating, especially when you’re trying to help.
I would recommend a couple of resources. First, the Helping Older Parents Membership, which is the only online educational resource for children caring for older parents offering sessions with a geriatrician, Dr. Kernisan. There’s also a wonderful community of support as well as downloadable resources. Check it out here: https://betterhealthwhileaging.net/education-and-support/helping-older-parents-membership-waitlist/
Also, Dr. K has recently written a book: When Your Aging Parent Needs Help: A Geriatrician’s Step-by-Step Guide to Memory Loss, Resistance, Safety Worries, & More. You can get it here: https://www.amazon.com/Aging-Parent-Needs-Step-Step/dp/173615320X. It’s very practical and covers issues similar to the one you’re describing.
In terms of the odour coming from your dad’s place, it might be a good idea to call the Health Department about that, especially if you’re worried that it might be affecting his health. Unfortunately, it sometimes takes a “crisis” to get services in if there’s a longstanding pattern of isolation. The “system” usually respects a person’s right to make choices for themselves and there’s a high bar for them to force an intervention.
I hope the above suggestions are helpful and you’re able to make some progress with your father.
Heather says
Our parents are 84, our mom has Parkinson’s and early onset dementia. Our dad is more ambulatory, a little healthier, and stubborn. Our dad has the attitude that as soon as you stop moving, you’re done. So he likes to go go go, even though his vision isn’t the best and it’s difficult for our mom (who should be using her walker 100% of the time).
He has an unofficial “bucket list” of things that sometimes aren’t realistic for our mom to participate in, but he won’t do them without her. I should add, that she has expressed that she doesn’t want to be dragged somewhere everyday. Our dad though, unfortunately, will make her miserable if she doesn’t go with him or if she complains to us kids about how it’s hard on her.
When we address the fact that the walker isn’t used everywhere they go, even though she falls frequently and he has expressed that of course, he can’t catch her if she does, he’ll say “she doesn’t need it” or “she can do it”.
Our dad is very proud and doesn’t like to show any sign of their aging and that things have become more difficult for both of them.
His stubborness and denial is hard enough to address, but even more so given the toll that it has taken on our mom.
Any advice on how to talk to him?
Nicole Didyk, MD says
This must be frustrating as you try to support both your parents.
Two things to consider:
1. Is this the long-term pattern of your parents’ relating to each other? If so, it may be unrealistic to expect that to change.
2. Is your mom capable of consenting to go on these outings and accept the risks that go along with them?
If the activities are truly dangerous or unhealthy, getting a doctor to weigh in might be helpful. You can also let your dad know that he may be harshly judged if your mom has a mishap while out doing an activity solely to avoid disharmony with her husband, even if he isn’t being intentionally neglectful.
In the end, it may be best to support your mom to speak up and advocate for herself.
Dr. K’s new book : When Your Aging Parent Needs Help: A Geriatrician’s Step-by-Step Guide for Memory Loss, Resistance, Safety Worries, & More has lots of practical communication tips, and I would recommend taking a look. You can find more info here: https://betterhealthwhileaging.net/education-and-support/when-your-aging-parent-needs-help/
sham hegde says
I am 50 year old and diagnosed with high BP 3 years ago. I am on Nebicard 2.5 mg. I check BP once in a month most of the times it is between 13-140/80 rarely it showed 150/90 should i be worried about this occasional hike. I felt very dizzy this week and My BP was 150/100 whereas my BP that was taken couple of days back (before it showed 150/100) and it was 124/75 and it was about 10 mins after taking meds in the morning
Please advise
Nicole Didyk, MD says
I’m not familiar with Nebicard, but it sounds like it might be a combination of Nebivolol (beta blocker) and Valsartan (Angiotensin receptor blocker), or just nebivolol. Both are blood pressure medications (antihypertensives). I can’t give specific medical advice over the internet, but some variation in blood pressure from day to day or hour to hour is normal.
A good way to sort out if blood pressure medication is at the right dose may be a 24 hour ambulatory blood pressure monitor, which can give a reading of average blood pressure over a longer period of time. In general, brief, modest increases in blood pressure are not harmful in the long term.
Karen Austin says
My mother was my father’s care giver while he was going through chemotherapy, He has low vision and she would take him to all of his appointments. She recently had total knee replacement and I moved back home to help out while she recovering. Due to my father’s health conditions, he is unable to provide the level of care she needs post- op. Her other knee also needs to be replaced and I want to provide the same help but my father has stated I am not welcome back in their home. Is there any legal way to prevent him from restricting access to her.
Nicole Didyk, MD says
Hi Karen. I’m glad your mom is back home after her surgery.
I’m not a lawyer, but I think that if your mother is capable and she wants to see you, she can decide that for herself, in spite of your dad’s wishes. Of course, this could be awkward if your parents are in the same house and have opposing views. It may also relate to who owns the house. Calling a lawyer might be helpful if you can’t work out a compromise as a family.