October/November 2012 Print - Aging Well Eldercare

Five signs your parents may need help

It’s easy to know what to do when a parent has a medical crisis: Go to the ER. But without the red flags of an emergency, it can be hard to know if there’s a health problem that needs attention.

Often, there are subtle signs of trouble brewing.

Have your parents lost weight? Unplanned weight loss may indicate a medical condition, such as depression or cancer. Or vision problems that make cooking difficult. Or dental problems that make chewing painful.
How is their appearance? Are their clothes clean? What about bathing and grooming? Unkempt appearance may signal depression or dementia.
Do they seem safe in their home? Are there signs of falls, such as dents in the walls? Is there a system for making sure pills are taken? Scorched pans in the kitchen? Spoiled food in the refrigerator?
Have they lost interest in their usual activities? Are they withdrawing from friends or dropping hobbies? These could signal pain, depression, or another health issue.
How well are they getting around? Are they steady on their feet? Able to walk without problems? Any difficulty climbing stairs or getting out of a chair?

When you have concerns,

talk with your parents. Tell them what you’ve noticed and why you are concerned. Ask them how you can help, and then LISTEN.
get the doctor involved. If your parents refuse a doctor’s exam, send a note to the doctor outlining what you have observed. That way, the doctor can follow up at the next regular appointment.
solve problems together. Explore their preferences for handling the situation. Consider a family meeting so everyone can share in the discussion. You might also consult a geriatric care manager for help identifying possible solutions.
be patient. If you encounter resistance, take a step back. People often need time to think about what has been discussed. Rushing can just build resentment.

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Talking with Dad about his hearing loss

Hearing loss affects 50% of people over age 85, most commonly men.

Poor hearing diminishes quality of life. It may bring on frustration in daily interactions with others. It can even be at the root of withdrawal from social activities. Hearing loss also carries risk, because your relative may not notice a shouted warning or may misunderstand a doctor’s instructions.

Even so, many elders deny they have problems with hearing or don’t seem to want to deal with them. One common reason is stigma. They may feel that people with hearing loss are stereotyped as older, less capable, and dull. (Who wants to join that club?) Not admitting the problem helps maintain needed self-esteem.

But your loved one does need a checkup. Getting to that point may require some time.

If you suspect your father or other family member has hearing loss:

Learn if he thinks there is a problem. Explore gently. “Dad, you’ve gotten very quiet at family dinners. Has something changed?” See if he is disturbed about times he’s not heard something and been confused or frustrated afterwards.
Learn what he knows about solutions. If he identifies problems with hearing, explore the topic of solutions. (More on this in next month’s newsletter.) See what reasons he gives for not taking action.
Acknowledge the stereotype. Don’t discount what might appear to be vanity. Instead, talk about how small hearing aides have gotten. And about other, less expensive options, such as personal amplifiers.
Identify others with hearing loss. Give examples of people he knows and respects who have addressed their hearing loss. If he has hearing loss, is there anyone he would feel comfortable contacting for tips and lessons learned?
Recommend an exam by a doctor or audiologist. Is the problem just a buildup of earwax? Or a medication side effect? There are many possibilities that have very simple solutions.

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What is hospice?

Hospice is a practice of specialized care for individuals nearing the end of life. But it is not just for the last few days. In fact, Medicare pays for months of free services to patients and their families. For instance:

Do you wish you had help with bathing your loved one?
Are you worried about keeping your relative comfortable and out of pain or suffering?
Do you wish you had 24/7 access to medical advice?

Hospice offers these services and more. Its goal is to support the patient and family emotionally, physically, and spiritually.

With hospice care, your relative receives regular home visits from

a nurse who comes to manage pain, nausea, and other uncomfortable symptoms;
a social worker with advice about local programs to help with special needs;
a trained volunteer who can stay with your relative once a week so you can have a needed 2-3 hours off.

Such services are free to persons on Medicare who meet these eligibility requirements:

An incurable condition
A doctor’s assessment that the patient is not likely to live longer than six months
Willingness to let go of curative treatment

With an emphasis on quality of life, hospice is the choice for patients who would rather enjoy the time they have left than continue with repeated hospitalizations and ER visits. It’s also good for patients who are tired of dealing with the side effects of treatment that offers only a slim chance of recovery.

If you think your loved one could benefit from hospice care, ask the doctor a simple question: “Would you be surprised if [your relative] were to die in the next year?” If the doctor says “no,” then it’s wise to talk about if/when hospice would be a good choice. In hindsight, many families say they wish they had signed up sooner.

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