By JUDD MATSUNAGA, Esq.
After a lifetime of taking care of you, it’s only natural for the adult children to want to assist their aging parent as they grow older. Some aging parents simply begin to seem more withdrawn. Others start leveling accusations at others, claiming someone took or moved something, or acting paranoid. Perhaps you’ve noticed trouble with keeping up the house, managing stairs, paying bills, or driving.
If you have noticed any of these “worrisome” changes, chances are you have brought it up, e.g., why they shouldn’t drive. However, it’s quite possible that it didn’t go as well as you had hoped for. Parents are afraid of losing their independence, becoming a burden on loved ones, or being taken advantage of as they start to relinquish control over their lives.
So if you’ll be visiting your aging parent(s) over the holidays, this article is for you. Knowing when and exactly how much help an aging parent needs isn’t always easy. After all, either overstepping or being too “hands off” can lead to trouble. The following advice comes from experts on the best ways to intervene once you’ve determined that a loved one might need additional support.
Geriatrician Dr. Leslie Kernisan suggests to start with what to stop doing. She says, “Stop explaining and trying to get them to understand. Explaining why they’re concerned, or explaining why the aging parent should do this or that, tends not to be productive and goes nowhere. When families focus on not trying to get them to do something, it makes it possible to do a lot more things.” (Source: www.betterhealthwhileaging.net)
“Instead,” Dr. Kernisan says to “spend some time figuring out what’s going on and what specifically you are dealing with. When we notice something concerning, gather information through observation and talking with others. Talk with the parent with the aim of listening and understanding them before I try to get them to understand me. How does the parent see the situation and how do they feel about it?”
“Step back — become a detective,” says Dr. Kernisan. “Take stock of the situation, spend some time gathering the facts on the ground, and spend some time having some nice conversations with your parent where you’re going to try to learn more about them and get their perspective. Use this as a nice opportunity to connect with your parents and learn more about how their life is right now, what’s most important to them, their hopes, their dreams, their fears.”
In other words, “Start building a foundation that will allow you to step in and be more effective in assisting them,” says Dr. Kernisan. “The truth is if you’re starting to get worried about your aging parent, you are probably at the beginning of this journey that they are going to go through as their life changes and you’re going to accompany them on it. And I’ll tell you right now that it is usually not your job to fix everything for them.”
Dr. Kernisan says, “What your parent actually needs most of all from you right now is your presence and you accompanying them on this journey. By asking questions, parent feels heard, understood and validated. Your goal is to increase the sense of connection that increases relationship capital that will make easier for you to take action later on.”
If you find yourself currently contemplating whether to step in or continue celebrating your loved one’s independence, you are not alone. In an online article I found on Care.com, writer Lauren Levy consulted experts who shared the following signs to be on the lookout for
that might indicate a loved one might need additional support. (Source: https://www.care.com/c/9-signs-your-parent-needs-help/)
Changes in Weight: Unexpected weight loss can be a sign of something “simple,” like lack of nutrition from forgetting to eat, just not eating enough or an inadequate diet. “This is commonly seen in early dementia or untreated depression,” says Dr. Norm Goody, an emergency room doctor, pain and palliative care specialist and former hospice medical director. “Or it could be the sign of a serious underlying medical condition that is being neglected, like cancer.”
Emotional Changes: A shift in moods with both familiar and new people may point to pain or struggles with chronic conditions that they don’t want to share but that might need medical attention, notes Dr. David Hatfield, chief medical officer at Hatfield Medical Group, a network of doctors who specialize in providing primary care for people on Medicare in Arizona.
New Bruises: Parents may or may not share their mobility challenges, and bruises can indicate that they’re having trouble. “Doctors can support them and even provide advice on increasing strength to prevent falls,” adds Hatfield.
Increased Confusion: Some cognitive signs can manifest themselves in increased confusion with everyday tasks, such as putting groceries away or making their bed, says Hatfield. If their response to these lapses is emotional upset, Hatfield says this could also be a sign that this is more than regular forgetfulness that can happen to anyone while doing everyday things.
++Trouble Managing Medications: “From refilling or remembering to take them or even expressing frustration at the number of medications from different specialists, this could be a sign your parent needs a primary care doctor to manage their prescriptions,” says Hatfield.
Inability to Follow Medical Directions: Are they intentionally or unintentionally ignoring doctors’ recommendations? Skirting a doctor’s advice could lead to a readmission, which might also be a red flag, according to Judith Sands, a registered nurse and author of “Home Hospice Navigation: The Caregiver’s Guide.”
A Home That Isn’t Being Maintained Properly: You might also notice that the house isn’t as well looked after, explains Laura Horton, a registered health professional. “These chores can become overwhelming, and all these are signs that your parent is not managing their lives very well,” she notes. “It may be an indication of physical illness which has not yet manifested.”
Missing Doctors’ Appointments: Failure to schedule or to attend follow-up appointments due to confusion or lack of caring can be problematic. Not scheduling or following through with preventive appointments can also be a red flag.
Lack of Grooming: A decline in their personal hygiene can be a sign of depression, change in their health, inability to care for oneself, or need to change a previously trusted doctor, explains Liz Barlowe, president/certified care manager of Barlowe and Associates, which offers aging life care management and patient advocacy in Florida.
Noticeable Difference in Dexterity: “The parent may seem more clumsy and drop things a lot and may even have an altered gait,” said Danielle DiBlasi, a full-time caregiver. “These signs can be hard to recognize at first because they can be easily written off as stemming from tiredness or stress — especially if close family doesn’t want to accept something may be wrong.”
Changes in Overall Appearance: Examples of changes to note include appearing pale (which could indicate circulation issues or anemia) and making unusual facial expressions or bodily movements (which could point to a stroke), explains Lisa Owens, a registered nurse and vice president of clinical operations at Cosán Group, a healthcare organization offering concierge home care for older adults.
Changes in Sleep Patterns: Are they struggling from sleep disturbances or have delayed waking times each morning? A significant change in sleep patterns may indicate declining health.
Once you realize that an aging loved one needs additional support, you’ll want to figure out how you can best support them during this transition. Here’s what experts recommend:
• Spend more time with them. Begin by connecting more in-person or over FaceTime, according to Dr. Namita Sahai, an internal medicine and palliative care physician. Consistent calls will give them something to look forward to and serve as a reminder that they are not in this alone.
• Ask questions instead of making statements. This approach works because it avoids putting the older adult on the defensive. Being gentle with a curious question instead of making an accusatory statement allows them the opportunity to share their perspective and feel heard, says Alicea Ardito, a licensed clinical social worker. To get started, use “openers” — “I noticed ______, or I heard ____________. Can you tell me more about it?” To continue, use “Tell me more…” or “Hmm, how do you feel about that?”
• Listen. Although it’s safe to assume parents are likely going to deny and disagree with observations we make during the initial conversation, Sahai suggests being patient and just listening. “The process of accepting any suggestions of change will take time,” Sahai adds.
Dr. Kernisan warns that it could take more than one conversation. “Don’t argue if their version of reality is different than what’s been observed and don’t try to correct. Back off if your parent gets upset or defensive and come back to it later. See if you can validate or provide empathy.”
Finally, don’t take on more than you can handle. Just because you’ve identified that your loved one needs extra support doesn’t mean that it has to be provided by you exclusively. “You can only help them if your own life is balanced, so do what you can,” says Horton, who encourages family caregivers to bring in professional help whenever they feel the time is right.
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Judd Matsunaga, Esq., is the founding partner of the Law Offices of Matsunaga & Associates, specializing in estate/Medi-Cal planning, probate, personal injury and real estate law. With offices in Torrance, Hollywood, Sherman Oaks, Pasadena and Fountain Valley, he can be reached at (800) 411-0546. Opinions expressed in this column are not necessarily those of The Rafu Shimpo.