When Your Aging Parent Needs Help: A Geriatrician's Step-by-Step Guide to Memory Loss, Resistance, Safety Worries, & More

By Leslie Kernisan and Paula Spencer Scott

It's scary and stressful when it happens…. noticing changes in your parent and becoming increasingly worried about their health and safety. Maybe it's Mom leaving the stove on, Dad getting lost on his way home, or unpaid bills that trigger this realization. Or perhaps there have been falls or emergency room visits. Whatever it is, you know something's wrong. You wonder about a diagnosis. And you want your aging parent to accept help, or perhaps move.

Helping an older parent can be gratifying. But it's especially hard if they're blowing off your concerns, refusing to make changes, or otherwise resisting your efforts. You want them to listen, but they get upset or withdraw when you try to talk about this. What to do?

You don't have to remain stuck in conflict with your parent (or other family members). You don't have to keep getting the runaround from doctors or feel stumped about next steps. Instead, use an expert's clear plan on how to help your aging parent. 

In this practical, step-by-step guide, geriatrician Leslie Kernisan, MD, walks you through what to do and what to say in order to offer respectful assistance and intervention to a declining elderly parent. 

Full of actionable advice and insider tips, When Your Aging Parent Needs Help provides practical and flexible steps that move concerned families toward effective elder care action, while respecting a parent's dignity and autonomy. 

You'll discover:

• How to communicate with your aging parent to reduce conflicts and enhance cooperation
• The A-B-C-D-E assessment framework for Alzheimer or other dementia concerns, safety issues, or independent living – and steps to implement change
• Strategies to overcome parental resistance, health provider reluctance to share information, and family disagreement 
• How to get a medical evaluation for memory loss and, if applicable, a diagnosis for Alzheimer's or another dementia
• What to know about possible mental "incompetence," powers of attorney, HIPAA, and other options for gaining legal authority as a caregiver
• How to find geriatric care managers and other eldercare professionals to assist
• Downloadable worksheets, symptom checkers, and checklists to bring to doctor visits 
• "What this looks like" family stories that show you what these action steps look like in real-world situations

Transform good intentions into workable solutions and improved relationships. If you're concerned about an aging parent's health, wellbeing, or safety, you'll find encouragement and direction for this next life stage in When Your Aging Parent Needs Help.

• Language: English
• Publisher: Better Health While Aging, LLC
• Release date: Feb 11, 2021
• ISBN: 9781736153215

Book preview

PART ONE:

TAKING STOCK

Why We Always Start Here,

Gathering Key Information

We get it: you want to jump in and make it better.

To get good results, though, it pays to understand just what’s going on and how your parent sees things. Sometimes our starting assumptions are wrong. You might be seeing only part of the story. And without a clear review of the situation, it’s easy to waste time and trouble or even alienate your parent, no matter how well intentioned you are. So whether you think you know where to begin or have no idea, the starting place is always the same. Step back.

Trust us: The best beginning to handling any concern about an aging parent (cognitive or otherwise) is to first clarify the problem. The specific information-gathering steps we’ll describe may not feel like active problem solving. But that’s what you’ll be doing.

In Chapter 1, we show you how to quickly assess thinking skills, safety, life skills, and more in a well-rounded way. This is essential to confirming (or sometimes calming) initial worries, putting them in a context and giving a clearer sense of what the underlying needs are. Chapter 2 adds one big, often-overlooked dimension: Getting your parent’s perspective. Whether they’re communicative or resistant, whether they’re aware of changes or oblivious (or seem odd or irrational about what’s going on with them)—even if they completely dismiss you—this is a super productive step. It fosters goodwill and provides critical information. When you know more about how your parent sees things, you’ll be better equipped to choose a course of action and to get them to go along with it.

All this deliberate setup guides your next steps—and boosts your odds for success.

Chapter 1:

Get the Facts on the Situation

Maybe you think you know exactly what the problem is and you might be right. Maybe you have only some suspicions (or frustrations) without being entirely sure what’s going on. Or you might have tried to step in—either after a crisis or gradually, over time—only to have your good intentions ignored or waved away.

Wherever the situation, try to resist the understandable itch to jump in and fix it today.

To improve your odds of helping your parent effectively, you’ll want to first run through a quick but thorough review that will help you assess just what the problems are.

You’ll need to act a bit like a detective: Gathering information and talking to key players. This will put you in a better position to later consider your options and plan your next steps.

Starting this way also allows you:

• To decide whether you really need to act right now or can watch-and-wait.

• To move from vague worries to specific issues that you can problem-solve or bring to the attention of professionals.

• To find out what others have observed, which usually gives a rounder picture of things.

• To learn what family members and other key players in your family think because they’re part of this, too, and are best brought in early.

• To document changes you’re seeing, which will be useful in measuring any deterioration (or improvement) over time and in communicating with doctors, family members, and others. This can also be useful down the line if there’s any concern about legal activity (like selling a house, changing a legal document) or financial exploitation, or if the courts get involved. (Even if this doesn’t sound relevant to you now…you never know.)

• To, above all, wind up with solutions that are effective because they address the right needs in a respectful way.

We’ll show you how to gather the info you’ll need.

Before we go any further, though, let’s name the elephant in the room: the common concern that your parent might be slipping mentally and therefore is doing things that they wouldn’t if they were in good cognitive health, and that those choices are unsafe for their physical, emotional, and/or financial well-being.

This concern lies at the heart of most adult children’s impulse to Do Something.

Some of you may be wondering if this could be Alzheimer’s or dementia. That’s a legitimate concern, given that about one in five adults over 65 have mild cognitive impairment, a form of deterioration in how the brain manages memory, thinking, and other mental processes that doesn’t necessarily impair everyday function but can be noticed by friends and family. Some cognitive impairment, though not all, progresses to dementia. (Dementia is a term used to describe a syndrome of progressive mental decline that’s bad enough to interfere with daily life. For a list of types, one of which is Alzheimer’s, as well as some types of cognitive decline that are reversible, see RESOURCES.)

You may very well be dealing with some level of cognitive impairment. It’s often at the beginning of someone needing more help. Or there may be another issue at work.

That’s all the more reason to begin by getting a sense of what’s going on.

There are four basic steps:

1. Check for worrisome signs that could indicate real memory and thinking problems.

2. Check for signs of problems with life tasks and safety.

3. Talk to family members and other informants.

4. Double-check to see if any red flag safety issues are present.

Let’s look at each.

Step 1: Check for Worrisome Signs That Could Indicate Real Memory and Thinking Problems

Almost everyone experiences brain changes as they age, just as they experience other physical changes. (You might have already experienced tip of the tongue syndrome yourself, where a word is…just…out… of…reach.) When should you worry?

Certain brain changes are more worrisome than others. Here’s Dr. K’s list, based on what geriatricians usually ask about when checking for concerning cognitive symptoms. The first eight items are based on the AD-8 informant interview (a brief measure widely used in the medical community). Research has found that when it comes to detecting possible Alzheimer’s, asking family members about the presence or absence of these eight particular behaviors can be just as effective as certain office-based cognitive tests. Then we list seven additional signs and symptoms that are also linked to cognitive impairment and are good to document and later report to a health provider.

TOOL AND DOWNLOADABLE CHEATSHEET: COGNITIVE SYMPTOM CHECKER

You can find a link to a downloadable cheatsheet, Cognitive Symptom Checker, to use for this exercise at the end of the book in RESOURCES.

For each of the following eight items, think about whether you’ve noticed…

• A change from how your parent has typically been in the past. (If your parent has always been absentminded or bad with money, that’s not as relevant as if this is new behavior.)

• Issues that seem related to thinking ability, rather than related to physical limitations (like pain, shortness of breath, a chronic ailment, or other physical disability).

If any item(s) seems to apply to your parent, write it down, along with:

• When you first noticed the problem.

• Specifics about what you’ve observed.

Have you noticed…

1. Signs of poor judgment? This means behaviors or situations that suggest bad or inappropriate decisions. Examples: worrisome spending or giving away money, making driving mistakes, choosing inappropriate clothes or wearing the same ones over and over, or not noticing a safety issue that others are concerned about (heat turned on much too high, trying to cross a busy road on foot, driving despite poor vision).

2. Reduced interest in leisure activities? This means being less interested and involved in one’s usual favorite hobbies and activities (like volunteering, seeing friends, club meetings, walking, sports, reading, writing). You should especially pay attention if there isn’t a physical health issue interfering with doing the activity.

3. Repeating oneself? Has your parent started repeating questions, comments, or stories more than he or she used to?

4. Difficulty learning to use something new? Common examples include having trouble with a new kitchen appliance or gadget. This can be a tricky one, given that gadgets become more complicated every year. But if you’ve noticed anything, including difficulty operating something that was previously not a problem, like a microwave or phone, jot it