Minding Our Elders®

How much do adult children owe their elderly parents?

Today, we hear about the toll elder care takes on families as routinely as we heard the former dialogs in the 70s. Adult children are being faced with choices (or seemingly, assignments) they never thought about before. They are raising children or teenagers and holding down a job, when suddenly they find that their aging parents need an ever increasing amount of attention. 

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How to talk about end-of-life issues

Sex and death. It’s odd that those two topics should bring so much anxiety to parents and children. But, there you have it. One – sex – is about the beginning of life. The other – death – is about the end. Both are a part of the life cycle but if anything sex is easier for many to discuss than death. 

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Start early talking about parents' views on care

If your family is among the many that gather during the holidays, this time of celebration can give you the opportunity to jumpstart a conversation of this kind.

You are likely aware that bursting through the door Christmas Eve and thrusting this brochure into your parents' hands as you deliver your holiday hug isn't a good idea. However, tucking a few copies of the brochure into your suitcase could be a good plan. Then after the celebrating is over and everyone is reacquainted and mellow, you can start this important conversation with as little stress as possible. It's very likely that your parents would like to share their wishes with you, but aging and the attendant decline are often difficult topics to approach. Often, all that's really needed is a nudge in the right direction.

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Have we made progress with Alzheimer’s management and treatment?

A recent Huffington Post article on what we’ve learned about Alzheimer’s disease during the last 30 years caught my eye because it’s easy to think there’s been no progress. We can’t reliably prevent the disease, though lifestyle seems to work into the prevention strategy for many health ills. We can’t cure the disease, though we have some medications available that can slow the progression of cognitive decline in some individuals. So where is the progress?

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Talk to parent about care preferences and legal documents

Dear Carol: My mom is 90-years-old, lives alone and does quite well. She’s always been very independent, and has never been willing to talk about her preferences if she needs care. My siblings and I want to do the best we can for her, but she doesn’t even have a living will or Power Of Attorney. We feel like our hands are tied since she won’t discuss finances or the kind of care she’d like when she needs help. Whenever we bring up the issue, she says “she’ll get to it.” - Franny

Dear Franny: Your mom has likely outlived most of her friends, and those who are left are probably battling illness or frailty. 

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On Oct. 25, PBS will air Bill Moyers’ exploration of end-of –life issues “On Our Own Terms”

Emmy and Peabody Award-winning journalist Bill Moyers interviewed dozens of terminally ill patients to create a four-part exploration of end-of-life issues that span thoughts about everything from health care to cultural attitudes.

A press release that I received from PBS notes quotes of high praise:

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Stephen Ministers can help with grief support

Dear Carol: My mom has multiple sclerosis and Dad took care of her for years. Eventually, she had to go into a nursing home, but it was near their apartment and Dad remained a dedicated caregiver. Things went well until Dad died of a sudden heart attack. Since there was no one left for mom, and the three of us kids live in different towns, we decided to move mom to a very nice nursing home near me, the oldest daughter. Mom is so devastated by Dad’s death that she doesn’t care about anything, including the move. Her doctor here has her on an antidepressant which doesn’t seem to do much. She’s a very devoted Christian and just wants to “join” Dad. How can I help her live a better quality of life? - Freddie

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Should we take a person with dementia to the funeral of a loved one?

A common and heart-breaking question I receive in forums and in e-mail notes is, "Should I take my parent to their spouse's funeral?" When someone is in the later stages of dementia and there seems to be no real memory left, people often feel that to take the person to the funeral of a spouse or other loved one may be at best, a waste of time, and at worst, cruel. There are as many situations like this as there are families who have an elder with dementia. However, I, personally, have some opinions on this issue that I can pass on.

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Tips on initiating the talk about end-of-life issues

I've found in my experience that it isn't always the elders who shy away from end-of-life talks. Some do, of course, but many would like to discuss the arrangements they've made for finances, as well as their opinions about what measures they would want taken if they needed someone to make their decisions if they can't, however the adult children often find excuses to put off that particular "talk."

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How to cope when a loved one has Alzheimer’s and a second serious disease

Dear Carol: My mom was recently diagnosed with ALS (Amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease). She has mid-to late stage Alzheimer’s disease. Mom saw several doctors, but it took a long time to diagnose her ALS. Meanwhile she’s lost most of her muscle control and can scarcely communicate. I know there are devices and medical interventions to help people with ALS, but because of her dementia, it's hard to convince her of the need to have treatment or use helpful devices. She doesn’t really understand what's going on. Maybe it will be a blessing in the end if her mind is not totally clear. The doctor says she only has a couple of months to live, but I get scared when I think about her life ending this way.  - Sam

Dear Sam: I’ve witnessed ALS

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Books offer advice for people living with illness, and their caregivers

Most of us know a version of the saying that while we are busy planning our lives, life happens. We’re aware, at least as we mature, that our Plan A hasn’t happened and likely won’t. A version of Plan B may be happening, but again, it’s likely that even Plan B is different than what we thought it could be. That’s why life is an ever unfolding journey.

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Estranged family members could forgive the past

Dear Carol: Many years ago my grandmother, because of uncontrolled diabetes, had mental issues and tried to commit suicide.  Two of her children thought she just wanted attention. They had a huge argument with her and walked away, seemingly forever. My mother, Grandma’s only other child, has always tried to help, but has little money and lives across the country.  

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When a cure Is not possible we may have to settle for contentment

Most caregivers would do nearly anything to cure their sick loved one. However, we know that we are not going to cure our father of Alzheimer's disease, nor our mother of Parkinson's disease. There are many illnesses that attack our elders that can't be cured. Aging in general is eventually fatal. Therefore, after all medical options for cure have been tried, we often have to accept the fact that the person will not get better. What then? For me, as a caregiver, the answer was to try to help my loved ones feel as content with their quality of life as possible.

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Two very different books about life, death and spirituality agree on major theme

Two books I’ve recently read make an odd pair, but a pair none the less, because both are about living, dying, and accepting the cycle from birth to death. They, on the surface, are quite opposite in their take on spirituality. Yet, in the end, they say the same thing – that a spiritual connection is vital for most people in order to accept the concept of death.

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According to study, blood infection can affect elderly even after they “recover”

Most of us are aware that hospitalization of the elderly comes with risks. Of course, there are many times when there is little or no choice but to have someone hospitalized, no matter what their age.  This was brought to my attention, once more, by an article published by The National Institutes on Aging titled Severe sepsis associated with later cognitive, physical decline. Generally, we feel that if someone survives a serious illness such as sepsis, which is caused by the body’s overwhelming immune response to severe infection, the person will then fully recover.

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Second guessing our decisions after someone dies

Dear Carol: My mother died at age 95 after years of declining health and moderate dementia.  I have mixed feelings about final decisions I made. Mom had been very intelligent and talkative, but in her last two years she would only speak when asked a question, and then would often only answer yes or no.  She was unable to let health workers know how she felt.  Until the last few months, she knew who I was and was glad to see me. Mom faced many hospitalizations during her last years which always had a negative effect on her. After the last time, she no longer wanted to eat or communicate. She just seemed to give up.

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Caregiver alert: today’s middle-aged women first generation not expected to outlive male counterparts

We've read the statistics repeatedly. Stress shortens life. Caregivers are generally stressed by the many demands, emotional and physical, on their time and energy. Many are of the sandwich generation, those who are defined as caregivers for both the young and the aged. Several studies show that 30 percent of caregivers will die before the people they care for. This is not just true of older caregivers. All ages are at risk since stress levels, combined with self-neglect because of time constraints and exhaustion, can lead to undetected cancers, depression, auto-immune diseases, high blood pressure and other health risks.

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Extreme heat puts elders at risk for illness or death

This heat wave is affecting nearly the whole country.  I expect soon to read articles about our large metro areas sending volunteers to check on elders who live in small apartments without air condition.

My mother-in-law was always a worry in the heat as she couldn’t understand why she had to leave her AC on, though she’d sit in her hot condominium under stifling conditions. When I went to her home for my daily visit, I'd adjust her AC and try to explain that she needed it set at least on low for some air movement. However, the next day when I visited, she’d have turned it off. She was again sitting alone in a virtual oven.

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Hospitalization of elders can lead to delirium or worse

We’ll never really know what happened to my dad. He went into the hospital to have a fairly simple operation. Doctors were going to insert a shunt into his brain to drain fluid building up behind scar tissue left from a World War II brain injury. Shunt insertions are considered quite safe and effective.

Whether the failure was caused by Dad’s age, excessive scar tissue, a surgeon who had a bad day, the anesthetic or the trauma of hospitalization will ever be a mystery, but Dad as we knew him disappeared and we brought home a man with severe dementia. He was to live in that world of dementia for a decade, before he died.

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Is hospice care right for my dad?

Dear Carol: What exactly is hospice care? What can I expect? I just talked to my father’s pulmonary
doctor, and my dad is at the point that there is nothing more that can be done. The doctor thinks we should consider hospice care. I'm not really sure what hospice is. I'm scared they "help" people die, and I do not want that. Does Medicare cover hospice? Is home hospice available? I'd appreciate some information. Don

Dear Don: Like any other care provider hospice organizations are unique, however they should all follow the basic premise that “no one need die in pain.”

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