How Do You Know When
Your Parents Need Help?
By Caroline Grannan
Mom can’t get
along all by herself in that great big house much longer. Or can she? And how
will I know?
It's the worry
shared by a generation, an entire middle-age demographic layer watching
nervously as their aging parents' ability to live independently declines. If
those older adults neglect to make decisions and plans for their own futures,
it's the grown offspring who must take on the responsibility.
Trying to assess an older relative's
ability to function is painful and difficult. "It's hard for all of us to accept
that our parents are no longer in charge," acknowledges Ann Von Essen, a
consultant on aging issues in Woodside, Calif. "The adult child is often in
denial. They just know they don't want to be the
caretaker."
"There are no 'six easy
steps' to feel great about taking care of your aging parents," cautions Harriet
Lerner, an author and psychologist at the Menninger Clinic in Topeka, Kan. whose
most recent book, "The Mother Dance: How Children Change Your Life" describes
coming to terms with her aging parents' increasing needs. "It's a profoundly
difficult emotional issue."
Even
professionals in the aging field have trouble facing their own parents'
situation, agrees Dorothy Howe, a senior program specialist with the American
Association of Retired Persons. "We find that in our offices, when it's your own
situation, you don't always deal with it any better than anyone
else."
Adult children need to initiate
communication, begin exploring options, and do their best to "proceed with calm
and clarity," as Lerner puts it. This is the time to tune into aspects of aging
parents' lives that we normally regard as their own business. That's not easy
for anyone, and it's harder when the parent lives far from the
child.
Sometimes only a crisis makes the
situation clear. "I've seen cases, especially when the children are far away,
where the older person gets sick and is hospitalized. That's when it suddenly
becomes clear that they can't live alone," says Dr. Cathy Alessi, a staff
geriatrician at the Sepulveda Veterans Administration Geriatric Research,
Education and Clinical Center in Los Angeles.
Specialists in the gerontology field
gauge abilities with a list of "activities of daily living," or ADLs. In the six
basic ADLs, loss of function is unmistakable: continence, feeding, getting in
and out of bed, getting to the bathroom, bathing and
dressing.
It's the eight ADLs known in
the field as "intermediate" or "instrumental" that may need to be monitored more
closely: using the telephone, shopping, preparing food, keeping house, doing
laundry, using transportation (whether driving or other transit), taking
medications and managing finances. These are vital abilities for maintaining
independence, but it's not necessarily time for the nursing home when aging
parents begin to lose them.
"A lot of
older people with impairments in these areas can remain relatively independent
in the community if they can get the right kind of help," Dr. Alessi points out.
The adult
child needs to find a middle ground between patronizing prying and full retreat
from the older adult's situation. Such an inoffensive act as opening the
refrigerator can provide clues to how someone is functioning. Specialists
suggest areas to keep an eye on, and some ways to spot
problems.
Poor nutrition poses a common
hazard to the elderly, especially those who live alone. "If the refrigerator
doesn't have food in it, that's a bad sign," says Von Essen. "Older people who
are in trouble also forget to finish their meals." It's not always poverty — the
apocryphal image of an old person living on cat food — that causes nutritional
problems. One older woman with a Mercedes in her garage was hospitalized after
living for weeks entirely on Pepperidge Farm cookies and tea. "That's really not
rare, even among the wealthy," she adds.
In the case of a patient of Dr. Alessi's, eating habits were the signal that she
was no longer competent to live by herself. "This woman had mild dementia. She
was buying all her meals from a small convenience store nearby, and losing
weight." At that point, her family realized it was time to make a change, and
she moved in with a son.
For adult
children living near their parents, it's not hard to keep an eye on the
condition of the house and personal grooming habits. It's also wise to be aware
of bruises and other signs of trauma, possible clues that the parent has fallen.
A common problem in the elderly, falls are both cause and symptom of an
inability to function independently. They can signal general weakness, balance
problems or other medical troubles, as well as possible
overmedication.
Not that every older
person will cheerfully tell the family about an embarrassing or frightening
fall. Indications that a person is at risk for falls include difficulty walking
and inability to get up from a chair without pushing
off.
It’s
not unusual for older people to try to hide problems, points out Von Essen, who
does regular assessments of the residents of a San Francisco Bay Area retirement
community. “If they aren’t telling you things, if they withdraw and insist
they’re doing fine, that’s an alarm signal,” she says. "Though they may
also withdraw and not want to see people because of hearing problems. It's
difficult to socialize when you can't hear the conversation." Becoming reclusive
and showing signs of paranoia can also be signals of depression, a common and
devastating — but often treatable — affliction among the
elderly.
Sometimes it's money issues
that bring out paranoia symptoms. "Some people accuse family members and other
people around them of stealing," Von Essen says. "That could be a way of
covering up for areas of uncertainty, covering up that they can't balance their
checkbook.
"Then you see the opposite
situation — people giving money away," she adds. The predator taking advantage
of a confused older person is most often a caretaker, a political cause or a
purported church official. ("What seems to happen is a church member getting the
money for themselves," Von Essen notes.) Occasionally an older person gives
money to every junk-mail solicitation that lands in the mailbox. Others fall for
scams and get on "sucker lists," which put them in the sights of other
swindlers. Phony sweepstakes are a common ploy. Any talk about sweepstakes or
prizes should raise an immediate alarm.
Visiting adult children can keep an eye out for overdue bills lying around or
fishy-looking mail being saved, both signs that the senior needs help. "Once the
problem is in the open and there's cooperation between the adult child and the
older parent, you can just keep a small amount of money in their checking
account," Von Essen suggests.
Unusual
behavior can also signal loss of memory. The AARP'S Howe sums up the kind of
forgetfulness that signifies serious decline: "Forgetting where you put your car
keys is not a problem. Forgetting what the car keys are for is a
problem."
But less drastic memory loss
can still be serious, as in the classic hazard: forgetting to turn the stove
off. One woman in her 60s who spent years dealing with elderly parents suggests
casually checking the kitchen cabinets for blackened pots.
Medical illness can mimic symptoms of
decline, as can overmedication. Von Essen recalls assessing one woman whose
withdrawn behavior turned out to be a sign that she was taking overdoses of a
sleeping pill. "When I rang the doorbell, she peeked around the door in a very
tentative way, almost hiding, and I found that she couldn't walk without holding
onto the wall. I asked if I could look at her
medications."
A prescribed sleeping pill
piqued Von Essen's interest. The woman was apparently taking an extra pill when
she woke during the night. Von Essen has since worked with the woman's physician
to make sure she takes medications as
prescribed.
In one cautionary horror story, a California man appeared to be in
terminal decline three years ago, until his grown daughter asked his doctors
what all his pills were for. Eugene Daly was dazed, immobile, in diapers
and not eating when his daughter, Adair Lara, insisted that his medications be
stopped. A week later, an enraged Daly got out of his wheelchair and stalked out
the door in an attempt to escape from a nursing home he describes tartly as "far
worse than jail." Now 77, he's back in the Marin County, Calif., apartment that
Lara and her siblings had begun clearing out.
Lara, a writer at the San Francisco
Chronicle who described the episode in her newspaper column, says her father had
"started to slow down like a train" after his doctor prescribed a tranquilizer.
Unaware of the drug, Lara took him to the San Francisco Veterans Administration
hospital, where he was put on a powerful antidepressant. He fell rapidly into
decline, and Lara blames the VA.
"They
said he was senile," Lara says. "When I asked how it could happen so suddenly,
they showed me a brain scan." It was after he was transferred to a nursing home
that Lara questioned her father's prescriptions. When the drugs wore off, Lara
says, "He awoke in a fury." Against medical advice, Daly's children moved him
back to his apartment. "He's living fine on his own," Lara says, "even though he
has a form of senility and he's confused sometimes. " A VA spokesman said he
couldn't comment on an individual patient's
case.
Whether the error is the patient's
or the health-care provider's, overmedication is frequently mentioned as a
hazard of aging. Some experts suggest routine "brown-bag" consultations: Put all
medications in a bag and take them to the doctor for
evaluation.
When the parent insists
everything is OK in the face of all evidence, that's a red flag, Von Essen
warns. "If they're falling and forgetting where their car is and making
accusations about their money and taking two sleeping pills instead of one and
they deny that there's a problem, that's an inappropriate response and it's time
to take action," she says.
But whatever
is done next needs to be done with respect for the parent as a decision-maker
and as a human being, Dr. Alessi cautions. "In general, I find older people are
extremely wise," she says. "They're the survivors. They've thought about death
and what to do.
"Your parent is still an
independent person, "she emphasizes. "Even a person with early or moderate
dementia still has needs and wants and opinions, and they need to be respected."
PART I How Do You Know When Your Parents Need
Help?
PART II What to Do When Your Parents Need Help
