Our annual eldercare advice for the holidays

This seems to be a big favourite year over year:

Suggestions of how to bet support aging parents and loved ones through family events.

Please take a look, and share with your friends, too.

Here it is:  http://www.parentingyourparents.ca/plan-good-holida…derly-loved-ones/ ‎

Have a wonderful holiday season and we'll be back posting more in January.

Minimize emotional pain among the elderly and aging

 

One always hopes that as medical practitioners, we will be able to focus our attention on the medical issues faced by seniors and help families cope with the fears, disappointments and tragedies that are faced by loved ones in the midst of what are often life-altering illnesses. In short, as physicians, we want to minimize emotional pain among the elderly and aging.

Throughout our initial medical training, and most often during post-graduate training programs, the primary focus in general is: what is the “best of medicine” and what does “evidence-based medicine” tell us about treatment decisions and their ultimate impact on health, well-being and, often, the likelihood of death? 

This is particularly the case in the care of the older adult – whether in geriatric medicine or eldercare.

What is often surprising and baffling, especially to younger physicians, is the situation where the core of what appears to be the challenge in care provision is negatively tinged by what might be called family “strife.” 

At times, however, a more appropriate term would be venomous, hateful actions—actions that ultimately will be destructive to the family fabric. This should not be 
surprising to anyone who has even a modest understanding and familiarity with the world of literature—whether limited to English works, or more broadly including European or other literature.

Those medical trainees who have worked with me have in all likelihood heard me either seriously or humorously say, “If I were king, all first degrees would be in English literature.” Or when there is a complex family dynamic playing out, I might say, “It’s King Lear—if you have not read it ever or lately, read it or read it again—it’s all there.”

Sometimes I feel like that great American comic Jimmy Durante, who was quoted as saying, “I have a million of them, a million of them,” referring to his often delectable jokes. According to an online biographical history, it has been said that “I’ve got a million of ’em” is what Durante (1893-1980) often said after telling a corny joke. Durante was credited with “I’ve got a million of ’em” in a 1929 newspaper story.

I say this when referring to complex family situations in which what appears to be the worst in human interactions seems to be playing out. Often the issue is related to money (or property), and if one is in a position to hear the story from all the parties, it often becomes clear that, for whatever reason, the pot has come to a boil at this juncture of life.

This is usually because the flame heating the water that’s not boiling has been on for what appears to have been many years. Most of us know of such stories, hopefully not in our own families, but it is unlikely that there is a family who is not familiar with a “Lear-like” scenario in someone close to them. 

Greed, jealousy, hurtful memories, mean-spirited personalities, events that occurred—sometimes decades earlier— that were never resolved or that left indelible scars are often the reasons cited for the enmity I have had the good fortune to observe that, on some occasions, especially when a parent, in particular, is dying, though it could be another relative, there is the possibility of repairing long held animosities and bringing long-estranged family members back together. 

It does not always succeed, but I have witnessed the monumental efforts of health-care staff—especially those in social work, nursing and medicine, although any and all of the health-care staff can be key—in bridging the emotional moat that often separates family members. It may not always work, but I believe it is always worth the effort.

Living with the result of lifelong family strife is often disabling, and the scars that occur and that are left can have long-lasting negative effects on people’s lives and their own abilities to have meaningful and binding relationships with their siblings and offspring.

A last wish: to die at home

Have you heard this from an aging parent? "It's a last wish: to die at home".

I've heard that from hundreds of families.

And it's not an unrealistic wish.

There is a certain comfort and dignity to being able to die in one's own bed, in one's own home. Clearly this is not an option for a parent whose been institutionalized in a hospital or nursing home. Howevever, it seems that dying at home with the appropriate care for someone who is sliding toward the end can be accommodated. 

Hospic-like arrangements can be provided in the home, and ideally as much of the broader family would be engaged in the process.

This also can allow time to share memories, and if possible photos.

It's worth exporing if the circumstances are right.

Our annual eldercare advice for the holidays

This seems to be a big favourite year over year:

Suggestions of how to bet support aging parents and loved ones through family events.

Please take a look, and share with your friends, too.

Here it is:  http://www.parentingyourparents.ca/plan-good-holida…derly-loved-ones/ ‎

Aging and engaging: what can that mean for the elderly?

Aging and engaging: what can the mean for the elderly?

This interesting article can offer good insight.

Take a read. You'll find in helpful!

http://business.financialpost.com/news/economy/japan-in-transition-how-older-workers-can-help-ease-japans-growing-labour-issue

Plan now to plan ahead for the right substitute decision maker

Choose the right substitute decision makers (SDM) now.

With all the recent focus on what is now called advance care planning (ACP) in the medical and social work literature, it is important for people especially middle-aged and older people to understand what is at stake.

Using the old terminology of a "living well" there has been a transformation from what used to be a few words in a document somewhere or as a conversation with the family member likely to be the SDM that for example the parent "would not want any heroics" if they develop a terminal illness. The reality is that is no longer enough to help those empowered to make such decisions on your behalf. The new world of medicine has many things that can be done that are no longer considered "heroics" but just part of contemporary every day medicine.

Continue reading “Plan now to plan ahead for the right substitute decision maker”

A parent facing the loss of the driver’s license

One of the biggest challenges your parent may face is the impending or actual loss of the ability to drive, or the loss of the driver's license.

Some elders have enough insight to realize that driving is becoming too stressful or perhaps dangerous and gradually decrease the nature of their driving.

I have seen many who on their own cease to drive on major highways or do not drive after dark or when the weather is inclement. Some decide on their own to give up their car because owning it has become a hassle, what with the costs, the repairs, the parking issues depending on where they live.

I recall the challenge to my late father and the early indication of his cognitive decline when he began getting parking tickets for failing to move the car to the correct side the street when the city introduced alternate side of street parking for street cleaning. As often happened, he correctly moved the car, but failed to recall he did so and then moved it back to the "wrong" side of the street with the subsequent hefty parking fine.

The most challenging scenario that you may be called up to assist your parent is after a visit to a physician, such as a geriatrician for an assessment of cognitive decline where the issue of driving comes up, which is not expected by the patient and by the end of the visit, your parent discovers that his or her driver's license is either in jeopardy pending a more in-depth driving assessment. Or, of a report that is going to be sent to the licensing authority reporting significant cognitive impairment or dementia which in most jurisdictions results in the cancellation of the driving license. This often leads to outrage, fury or disbelief on your parent's part as they try to dissuade the doctor, or put the blame on you for taking them to the appointment.

It is not easy to deal with this, but with time and repeated explanations by the doctor as to the necessity of following the law the anger may wear off. Moreover, if you do a good accounting of the cost of keeping the car, the cost of insurance, repairs and parking, it often turns out that the money saved will more than pay for any taxi trips required by the person to do what they were doing with their car. Many local taxi companies happily create accounts with elders that avoids having to pay for each ride and many provide assistance with walking devices for example. It is a challenge, one that occurs often, but will usually wane in time–it cannot be avoided but can also be dealt with in a supportive and compassionate manner.

All our best wishes…

At this holiday period, we extend all our best wishes to you and your family.

Thank you for engaging with us.

Most importantly, thank you for caring about your elderly parents and other aging loved ones.

It is a journey that is not easy. We always say it's a journey of discovery. We all can and will learn so much. We will grow. We will eventually hurt and grieve. And we will recover and move on with loving memories.

Caring for aging parents is not something most of us plan for.

But it comes, happens, consumes us.

So again, all our best wishes as we all move forward with our lives and worlds.

          Bart & Michael

 

How to communicate with someone who has dementia

How to com­mu­ni­cate with some­one who has de­men­tia is a terrific recent Globe & Mail article by Renée Henriques.

Her recommendations are very sound and mirror the ones in our Parenting Your Parents books. Please read, absorb, and apply.

I own a senior home-care company in Toronto, and most of our clients have some form of dementia. Last week, one of our clients, who I will call Mrs. Smith, called to cancel her caregiver for the following day:

“I feel like I am doing better, Renée, and I just want to see if I can get through the afternoon without a caregiver.”

“Sure, Mrs. Smith,” I said, and cancelled her caregiver.

The next day Mrs. Smith called and angrily demanded why her caregiver had not shown up. I apologized for my oversight. I told her that we would ensure that her caregiver was there within half an hour. Trying to explain what really happened would have been like trying to convince her that her name was not Mrs. Smith. Rule No. 1 of dealing with people with dementia: Never argue.

According to the most recent count from the Alzheimer Society of Canada, 747,000 Canadians suffer from Alzheimer’s disease and other dementias. That’s 14.9 per cent of Canadians 65 and older. For those living with dementia, life can be very frightening. Every interaction feels like a big question mark. For those of us who work with people with dementia, and those people who have loved ones or friends suffering from dementia, a few changes in the way we communicate can bring great comfort, and diffuse potentially anxious situations. Here are some key tips that have helped me over the years:

1) Never argue. Ever. Drop your need to be right. If Dad says he wants to call Aunt Eileen, who died 50 years ago, just pick up the phone and dial. Be creative; leave a message somewhere. Trying to convince Dad that his aunt passed away a long time ago will be confusing and distressing. In our industry, we call these little white lies “therapeutic fiblets.” They preserve our clients’ dignity and peace of mind, two things more important than having a firm grasp on reality for many dementia sufferers.

2) Redirect. After your therapeutic fiblet, try to get Dad thinking about something else. Get Dad to tell some stories about Aunt Eileen, and then use something in that conversation to direct the conversation elsewhere: “Aunt Eileen used to walk every day? Did you want to take your walk now?” Talking about anything not having to do with Aunt Eileen may take Dad’s mind into a different place and he may lose the need to call his longdead relative. And if he does not forget, then just check messages to see if Aunt Eileen has called back and repeat.

3) Be aware of your mood and your body language. People with dementia read your body language to pick up cues. If you are distressed or frustrated about anything, your mom will read that discomfort and surmise that something is wrong. She won’t know what it is and may assume that she has done something wrong. When you are calm, she will be calm. When you are anxious, she will take that on, too. Check yourself at the door as much as possible.

4) Strike the phrase “remember when” from your vocabulary. “Remember when we talked about this yesterday Mom, and you said you wanted to go to dinner?” Mom does not remember, and this question could make her confused and embarrassed.

5) Offer options and ask yes or no questions. Phrase questions simply, and ask questions that require a yes or no answer, not a narrative response. Always offer choices when possible, and present no more than two options. People with dementia are likely to pick the last choice, so craft your questions accordingly. The need to choose and feel autonomous and in control stays with us, even if our memory is fading. Offering Dad choices will give him a sense of control, a hot commodity in a dementia sufferer’s life.

To paraphrase Bob DeMarco of the Alzheimer’s Reading Room (a respected website about dementia-care issues): “If someone with dementia thinks something is true, it’s true.” Mrs. Smith was right to think I had forgotten to send her caregiver, because she did not remember that she had cancelled. It was my job to accommodate her reality, admit my “mistake,” and fix it. Honouring the reality of the dementia sufferer in your life will create empathy, smooth difficult interactions and create opportunities for moments of surprise and joy. Who knows? One of these days, Aunt Eileen might pick up the phone when you call.

Renée Henriques is a registered nurse and the owner and managing director of ComForcare Home Care Toronto, providing personal support services to seniors. Her passion for seniors and their families stems from her past work as a neurosurgical nurse, and her experience going through a lengthy caregiving journey with her own family members.

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