AGING WELL IN EMERGENCY MEDICINE INTEREST GROUP
Caring for Aging Parents: Challenges and Skills Isabel A. Barata, MS MD MBA
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s I write this article, we are blessed that we just celebrated my mom’s 91st birthday on January 1, 2023, and my mom-in-law celebrated her 98th birthday October 2022. Reaching old age is something to be celebrated but it comes with its own set of challenges. My mom still lives independently in Florida and has a beautiful flower, fruit, and vegetable garden. She gives fruits and vegetables to all her much younger neighbors. However, she has become frail, has had some serious falls, and overall, we are finding managing on her own is becoming much harder. We are at the crossroad of deciding what to do next. My mom-in-law has dementia and has lived for several years now in assisted living.
years and now needs the help of others. Support them in adjusting to their new environment. Maintain an open dialogue of what they need and how they are coping with the sudden change in their lifestyle.
In the domain of safety, major concerns are related to falls, driving, and financial vulnerability. Create a safe environment in which they receive support in tasks they are not capable of doing. Another important decision is retiring from driving. This carries significant consequences in terms of privacy and spontaneity for the person. It can bring in the fear of even more isolation. You need to prepare them for this difficult transition. Help them maintain a sense of dignity by engaging them to create a sense of purpose and respect. Even cognitively intact individuals may fall prey to financial exploitation and be vulnerable to scams and fraud, aid with day-to-day finances As an older person develops more made more complicatcomplex medical issues, frailty, ed by the fact that bill paying, and investing and loss of physical strength, is done online now. people start encountering more Continue to help them to take control of their complicated issues that they finances as long as are not prepared to address. possible. This can give them reassurance and security.
Most older adults are probably like our moms that initially do not need much help and contribute to their families, communities, and workplaces. Eventually as people live into their 80s, 90s, and beyond, there comes a point when they do need assistance. As an older person starts to need help it is usually close family members that step in. Family members find themselves having to take on more and more eldercare assistance. At times it may be straightforward such as helping with shopping, household chores, and transportation. However, as an older person develops more complex medical issues, frailty, and loss of physical strength, people start encountering more complicated issues that they are not prepared to address. There are several domains to consider and areas to help with some of these challenges: activities of daily living (ADLs), instrumental activities of daily living (IADLs), housing, safety, medical, legal, and quality of life.
The needs of ADLs and IADLs determine what kind of living arrangements which in turn ties in with housing decisions such as age in place (you may be able to seek support to enable them to live more independently via programs that focus on balance, safety, mobility, and fitness, in addition to considering hiring a professional caregiver to help your loved one remain in their own home and ensure their needs are being met), move in with a family member, or assisted living, each choice carries their own financial and lifestyle implications. You need to understand how difficult it is for a person who has been independent for many
Medical issues are prevalent in older individuals due to chronic conditions, loss of ability to make health care decisions, and overall mental decline. It is often difficult to navigate the health care system and elderly people may see a lot of different medical professionals. You may need to help coordinate appointments, medication delivery, and medical supplies they may need. If possible, accompany them to the doctor to give them comfort as well as getting to know the treatment plan and medications. However, even when planning medical care where we may feel we are the experts we should check their preferences and make sure they are comfortable and do not have concerns. Legal concerns are to be considered and we need to prepare ahead for significant decisions in health care and other matters. You need to have conversations about end-of-life options, advance directives, palliative care, organ donation, the financial implications of their passing, and how they wish to be honored when they pass away. Finally, quality of life is an important consideration and keep in mind their autonomy, need for connectedness, and dignity. Give them space Countinued on page 40 >>
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COMMON SENSE MARCH/APRIL 2023