By JUDD MATSUNAGA, ESQ.
One of my favorite TV shows in the 1970s was “The Odd Couple,” an American sitcom about two divorced men, Oscar and Felix, who share Oscar’s Manhattan apartment.
You might remember that Tony Randall played Felix Unger (the neat one) and Jack Klugman played Oscar Madison (the messy one). It is interesting to that IMDb (Internet Movie Database) calls Klugman “the epitome of the everyman.”
Before Klugman passed away in 2012, I was fortunate enough to see him on stage in a small theater in Burbank. The play was about a father-daughter relationship. In the final act, the daughter recites all the sacrifices she had made taking care of him, e.g., gave up her career, not close to her own kids, loss of her friends, etc., etc.
Unmoved, Klugman immediately retorts, “It’s not enough.” And the curtain drops.
More or less, the above pretty much describes the typical Japanese American father. However, not so with the typical Japanese American mother. For the typical Japanese American mother (especially the Issei and Nisei), everything is for the children’s sake (i.e., kodomo no tame ni). For example, I’d estimate (from my Crenshaw days in the early ’60s) that most Nisei mothers gave up pursuing careers of their own to stay home and raise their children.
“For the children’s sake” is wonderful when the children are young. BUT, things have got to change when the parents grow old. For example, one elderly Nisei woman (in her 80s) recently told me that she drove herself to the hospital because she didn’t want to be a burden on her children (who lived close by). This type of mindset, i.e., “the desire to not cause trouble for family members or children,” is also commonly found in Japan. (https://www.int.gisehs.okayama-u.ac.jp/research/human_care_innovation_03/)
Last week, I made a house-call visit to an elderly Japanese widow who wanted to rewrite her will. She was a hoarder. Her house was an absolute disaster. From the front door throughout the house were boxes stacked up 4-5 feet high. A small pathway was left to get from one part of the house to the other. If she were one day discovered dead in her home, I wouldn’t be surprised if the district attorney wouldn’t file charges against her two children for not taking better care of the parent, i.e., filial responsibility laws (California Family Code 4400-4405).
We all want our aging parents to be happy, i.e., to be physically healthy and active, to socialize to not be lonely. However, “geriatric syndromes,” including dementia, falls, frailty, incontinence, depression, and polypharmacy (taking multiple medications) are common for people in their 60s, 70s, and beyond. Unfortunately, these issues routinely fall through the cracks of usual medical care.
Doctors, family members, and even the parent themselves, assume nothing can be done. That these are simply just an “inevitable part of growing old.” Don’t believe that.
If you have an aging parent who doesn’t want to be a burden on you, my advice is to let mom be a burden this Mother’s Day. To help you make sure mom is “safe and sound,” I found some helpful advice online – “How to tell if an aging parent needs extra support” (Sources: the National Institute on Aging, and board-certified geriatrician Dr. Leslie Kernisan, MD MPH, https://betterhealthwhileaging.net).
It is not always clear whether an aging parent or relative needs help. Sometimes a person will recognize that they need help and request it. Others, however, may not want to cause worry. Still others are afraid that if they admit that they’re struggling, they’ll be sent to a nursing home and lose their independence. Therefore, a phone call, email, or text message is not always the best way to tell whether an older person needs help.
The best way to know if an aging parent needs some extra support is to visit and see for yourself — perhaps this Mother’s Day. While there, the experts suggest you look for changes in your parent or in the home. The National Institute on Aging (NIH) lists the following signs related to the person’s general health that can raise concerns: (1) Significant weight gain or weight loss; (2) Poor hygiene; (3) Confusion; (4) Falls; (5) Loneliness or social isolation; and (6) Trouble walking or getting around.
According to NIH, if you spot any of the above “signs,” your first step should be to talk to your parent about your concerns — without sounding critical. For example, while looking in the refrigerator, you might say, “Mom, it looks like you don’t have much food in the house. Are you having trouble getting to the store?” Then try to offer practical help and give specific examples of what can be done, e.g., “Would you like me to arrange to have groceries delivered on a regular basis?”
Make the home safe. Falls are very common in older adults. Falls can cause major, life-changing injuries, such as broken hips and head injuries, which are a major reason for people leaving their homes. Other falls cause only minor injuries, but they are scary and can cause older adults to restrict their activities. In fact, fear of falling is common and has been linked to decreased involvement in activities; it’s also a risk factor for future falls.
Most falls in older adults are due to a combination of underlying risk factors or health problems. Insufficient strength or balance is usually one of the problems. The experts suggest that seniors regularly schedule strength and balance exercises, such as tai chi. You could say, “Mom, would you like to take a tai chi class at the local Japanese American Community Center?”
To make Mom’s home safe to navigate without falls, here’s a list of things to look for to reduce the risk of falls (Source: (https://www.healthinaging.org/tools-and-tips/tip-sheet-preventing-falls):
- Keep cords away from areas where you walk
- Add “grab bars” near the toilet and bathtub, and no-slip decals or a rubber mat in the tub or shower
- Remove loose carpets and rugs or tack down the carpets and only use rugs with non-skid backing
- Add lighting in dimly lit areas and at the top and bottom of stairs
- Use nightlights in bedrooms, halls, and bathrooms and travel with a nightlight
- Clean up clutter, especially near staircases
- Put handrails on both sides of any steps or stairs in or outside of your home
- Wear firm shoes with a back and a good grip on the bottom, even inside your home
- Avoid loose slippers or socks
Review Prescription Medications. Be concerned about medication side effects, such as confusion and/or dizziness. According to the CDC, every year 177,000 older adults visit the emergency room due to falls from medication problems. Polypharmacy means taking multiple medications. It’s a problem mainly because as people get older, they become especially at risk for harm from medication side-effects or interactions.
Geriatrician Dr. Leslie Kernisan, MD MPH, says. “The main thing you should know is that many older adults are taking medications they don’t really need.” It’s basically much easier for doctors to prescribe medications than to “deprescribe.” Research has documented that inappropriate prescribing of medications is common.
A careful medication review will often identify medications that are marginally useful or no longer necessary, but you may not get such a review unless you request it from your doctor.
Polypharmacy also burdens older adults because purchasing all those drugs can be costly. Plus, it can be a real hassle to have to take medications at several times every day. Last but not least, when people have been prescribed many medications, it’s harder for them to take them correctly. This can lead to worsening of a chronic condition, or even misguided medical care as doctors may fail to realize that a patient hasn’t been able to take all medication as directed.
Isolation, Loneliness and Depression. Both isolation (not having a lot of social contact with others) and loneliness (the feeling of lacking social connection) have been linked to declines in physical health. A 2012 study found that 43% of older adults reported feeling lonely; over the next six years, they were more likely to lose physical abilities or die.
Loneliness and isolation have also been linked to decreased immune function and greater risk of depression. Another study found that isolation seems to be a stronger risk factor for premature death.
Older adults who live alone or have been bereaved are at particular risk, especially if health problems are interfering with their ability to get out and about. But even people who are in proximity to others may suffer from feeling lonely. Arranging more social contact usually helps. For example, you might say, “Mom, the local Japanese American Community Center sent me a list of activities for seniors. Would you like to sign up for bingo night?” Or, arranging for volunteering can be even better.
Depression is still a common problem that is easily missed. It’s more common in those who are struggling with illness or socially isolated. It’s important to spot and treat depression, as this is key to better quality of life and greater involvement in social activities. It can also enable older adults to better manage any health problems they have, such as chronic diseases or pain.
One important sign of depression in older adults is “anhedonia,” which means one stops enjoying activities that used to bring pleasure.
If you notice this in your parent (or yourself), it’s important to get help. Studies show that medication and psychotherapy — including mindfulness — can help reduce feelings of loneliness and in mild-moderate depression. But, non-drug treatment often isn’t offered by your doctor unless you ask.
Ask your doctor — it’s also vital to address any health concerns (including fear of falling, incontinence, or pain) that may be keeping an older person from getting out and about.
In conclusion, if you spot one or more “signs” that mom could use some extra help, have an open and honest conversations about their needs, fears, and concerns. Be patient, understanding, and compassionate, especially during times of difficulty. You’ll get better results if you involve your parent in the decision-making, i.e., include them in discussions about their care and choices whenever possible.
Finally, there may come a time when your mother can no longer live independently at home. Learn as much as you can about housing options, which may include moving to a residential facility (such as a board and care, nursing home or assisted living) or living with a family member. These choices may depend on the mom’s health, ability to perform activities of daily living, financial resources, and personal preferences.
If mom needs help paying for the extra help, contact your local elder law attorney to see what public programs Mom might qualify for.
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.