One of the best tools for gracefully handling the transitions that face your aging parents is communication. Talk to them.
If you go into the hospital, what do you want us to tell the doctors, Dad?
If the house gets to be too much work, where do you want to live, Mom?
How can we make sure you’re taking your medications, keeping up with home maintenance, not being scammed by con artists, driving safely and staying connected with the people you care about?
They’re all critical questions for adult children of aging parents and they’re best addressed ahead of a crisis, when everyone is calm. It is a way of reframing the discussion about aging so that it’s not threatening.
“My goal is to empower people so they’re not afraid of aging,” says Carrie Rubenstein, M.D., a family physician and director of the geriatric medicine program at Swedish. “We want to give older adults the best quality of life as long as possible, to live in their homes as long as possible and to stay socially connected.”
Start with the advance directive
To plan ahead for the transitions that come to most of us eventually, it’s helpful to treat the subject as if it’s perfectly normal, which it is. Even when the conversation touches on the loss of independence, it doesn’t have to be frightening.
“Advance care planning – that’s a big initiative in our office,” says Renee MacLeod, D.O., a family physician with Providence Medical Associates in Manhattan Beach, Calif. Every person who comes in to Dr. MacLeod’s office for a medical visit for any reason, from age 18 on up, is asked to think about preparing an advance directive. Such a document tells your family, friends and health care team your preferences for how to handle your care if you are unable to express your wishes.
An advance directive helps to get everybody on the same page, Dr. MacLeod says. “We need to know what people want.”
Dr. Rubenstein aims to drive conversations that ask an aging adult “What’s your vision for aging?”
Discussions should also align advance care planning with what is most important to each individual.
“Another important part of advance care planning is having ongoing conversations about one’s values, priorities and preferences — checking in on where those stand now and projecting ahead for how those will look in future health states,” said Ursula McVeigh, M.D., medical director at Providence Medical Group Palliative Care in Anchorage, Alaska. “Professionally, we are trying to change the mindset from just thinking about end-of-life planning to also include ‘living with a serious illness’ planning.”
Preparing for future changes
Drs. Rubenstein and MacLeod say some themes recur when they talk with families. One is that older parents are frightened of losing their independence. And the other is that they fear becoming a burden to their families.
“If discussions take place early and consistently, that can take the burden off a child,” says Dr. Rubenstein.
Both doctors try to frame the conversation as a way for an older person to make decisions for him or herself. Take the question of driving a car.
“I ask, ‘When is the time for you to retire from driving?’” says Dr. Rubenstein. “How can we plan for that?”
Dr. MacLeod agrees. “I don’t want to take away a patient’s autonomy,” she says. “Medicine is a two-way street. For me, it’s making them know they’re valuable; that they’re in charge.”
The Swedish and Providence doctors suggest some ways families can prepare for the changes ahead:
- Open the lines of communication.
- Ask about family medical histories.
- Ask what’s most important to the older parent.
- Get connected to the right care team, from physician to social worker, if warranted.
- Watch for signals that things are changing. Is the older parent struggling to keep up with bills? Has he fallen? Is she forgetting things?
- Keep the older person connected to his or her social network. People who are isolated are at risk for depression.