Your Caregiving Path is Just A Fall Away

Life was good for Mary. Her two teenage children had just moved out of home to start college. Even though she missed them, she was excited to retire this year, and start traveling the world with her husband of 36 years. They had both saved money for this phase of their lives, and to fulfill their travel dreams, for which they had had no time or money for while their children were young.

Mary’s Mom, Elaine, lived alone in her home in the same town, where she had been managing well. Mary’s Dad had passed away from a heart attack 2 years ago. One day, Mary got a call early in the morning while she was still asleep. It was her mother. She said she had fallen and couldn’t get up, and needed Mary to come over and help. Mary rushed to her mother’s home, worrying all the way. When she reached there, she found Elaine lying on the bedroom floor, whimpering in pain. As Mary tried to get her up, Elaine screamed. Wondering if she had had a fracture, she decided to call 911. Elaine was taken to the hospital, and was found to have a hip fracture. While in the hospital, Elaine suddenly started acting strangely, even forgetting that her husband had already died. She also could not recall her grandchildren’s names anymore. The doctors told Mary that her mother was having delirium, and will need to assess for dementia after the discharge. Elaine was sent to a rehab hospital. There she was assessed by a geriatrician, who diagnosed her with early dementia. At discharge, they advised that Elaine was no longer safe to live by herself at home, given her falls, dementia, and now weakness. Elaine had no choice but to bring her mother home with her, and become her full-time caregiver.

Mary and Elaine’s story may resonate with some of you. It is often easy to miss the signs of aging syndromes blooming in elderly parents. We live in a society where nuclear families are the norm, and when we meet our parents infrequently because of time or distance, it's only just enough time to play catch up. Parents often don’t want to bother their children with their “minor” problems, believing that their children “have busy lives of their own”. Given this backdrop, it usually takes a major event such as a fall, an accident, an injury, or a phone call from a doctor to make us realize, that there exist real colossal problems that cannot be ignored. Just like Mary, we are often forced into caregiving roles, voluntarily or involuntarily. But the truth is, problems DON’T develop overnight. There is ‘many a slip between the cup and the lip’. It is pivotal to recognize the onset of problems in a timely manner, so you and your parents can prepare for and prevent adverse outcomes. Here are some of the things you can start doing as a child of an aging parent: 1. STAY IN TOUCH Instrumental activities of daily living such as housekeeping, shopping, and meal preparation are usually the first tasks to start getting neglected. Staying in regular touch with your parents, not just through phone calls, but weekly visits to their home, allows you to observe their living situation. If you live in another town, then asking a friend or a relative to do the same on your behalf is the next best option. Talking to them regularly will give them the opportunity to share their challenges with you.

2. HOME Observing their home and helping them make ergonomic changes will make living conditions more comfortable for them. These changes could include having walk-in showers instead of tubs, shower chairs, raised toilet seats, grab bars, non-skid flooring, fixing, or removing any loose rugs, moving furniture out of the way can all help prevent falls, and making daily tasks easier to accomplish. If the home now feels too big for them to manage, then they will need your assistance in downgrading to a smaller home. 3. ATTEND DOCTOR VISITS Taking permission from them to accompany them to their doctor visits will allow you to learn about their health, and any developing ailments, which you may need to prepare for. This may meet you with some resistance initially, but start as an observer, without making them feel threatened about any interference. Oftentimes the doctor may pass on important instructions, which you can remind and reinforce later if needed. Their provider may also be able to warn you of early signs of dementia. 4. MEDICATION MANAGEMENT Older people tend to have more and more medical problems, and as a consequence are on several medications. With an aging brain, it is often difficult to keep track of all these medications. Medication management includes picking the right medications from the pharmacy, ordering refills in a timely manner, setting up the pills such that they take them with correct instructions, and most importantly remembering to take them on time.

Depending on how well they can handle this, you may have to step in, sometimes even to the point of supervising medication intake several times a day. Even when that degree of involvement does not seem necessary, still do verify medications from the medication lists of their doctors. 5. OBSERVE THEIR WEIGHT If your parents are losing weight unintentionally, it could be a sign of difficulty obtaining or preparing meals. Financial constraints, difficulty driving to the grocery store, difficulty preparing meals, or even lack of motivation could all be causative factors. Unintentional weight loss also occurs because of loss in muscle mass. Some loss of muscle mass with age is expected, however rapid muscle loss could happen from disease or inactivity. It is an important could foreboder of future falls and loss of independence. 6. NUTRITION Often elderly people are unable to manage meals and maintain nutrition because of various medical conditions. It is important for older people to have a diet rich in protein to maintain muscle mass. Calcium and Vitamin D in diet are important for maintaining bone health, in order to prevent osteoporosis and falls. If you find them not being able to manage good meals, then you could help them sign up for grocery or food delivery services. The older generation is commonly unaware of or digitally challenged to access these services.

7. EXERCISE Most elderly feel it is sufficient to be active and keep moving, not realizing that exercise is much more than that. Aerobic exercise which allows your heart rate to rise in the target range for at least 20 mins to achieve cardiac benefits. Strengthening or resistance exercises must be a part of exercise as it helps maintain muscle mass, consequently maintaining balance and preventing falls. Several insurances will pay for or discount gym memberships, including Medicare’s Silver Sneakers program. In the post-COVID era there are numerous exercise apps that allow home based workouts, which is a good option for those that do not travel. You could not only encourage and remind them to build good exercise habits, but could also help purchase exercise equipment for home use such as treadmills and stationary bikes. 8. SAFE DRIVING Becoming a passenger in your parent's vehicle occasionally will allow you to observe their driving. Where concerns about safe arise, getting an objective formal driving evaluation with an occupational therapist ensures that you don’t jump the gun on stopping them from driving and losing their independence in traveling when not yet necessary. On the other hand, with onset of dementia, driving becomes unsafe for elderly without them realizing it. In these cases, driving evaluations may also help support your case in stepping up and taking away the car keys. Remember, you will need to bestow your driving services in such situations.

9. SOCIAL LIFE Older parents start losing friends or family to death which can be a trigger for depression. Retirement, living alone, restricted movement or restrictions on driving can affect their avenues to socialize. Allowing regular contact with your children (their grandchildren) gives seniors umpteen joy, at the same time contributing greatly to your children’s emotional and cultural development. Inviting your parents to your parties, gatherings, etc will give them an opportunity to meet new people and make new bonds. Help them find meetup groups of their interests, or assist them in joining a club or a fitness center. 10. FINANCES Elderly often end up becoming the target of various money laundering scams. Warning parents to double-check these with you may prevent any such losses. If they do run out of their savings, then assisting them either go back to work part-time may offset their income. If worst comes to worst, you may even need to help them financially. Eyeball their accounts to make sure they are not forgetting to pay their bills, as that could be another sign of early dementia. It takes some time and effort in order to flip roles from being a child who got taken care of by their parents, to a child who takes care of their parents. And this role reversal may seem unnecessary or unnatural initially. After all, they are the ones who took care of you till now! But undoubtedly, it is the natural way of life. Hence, the earlier it starts, the smoother the transition, and the lesser the chances of it taking an alarming event for you to get involved in your parent’s life and well-being. After all, “old age is a second childhood”. So, start early, be prepared, and hopefully that will result in a happier, safer and healthier old age for your parents.