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Day #1

April 7, 2012

WoW! This is a first for me. The first day on the blog and all I can do is sit here in wonderment.  I have so much to say, but it will have to wait for future posts.

This blog is for you, the reader, your family members, and your friends. Please share the information here. My goal is to help you learn how to have more collaborative conversations with your aging parents about the life-changing events they will face as they age and the sometimes scary prospect of end-of-life preparation. Please ask me questions.

I will post on Sundays and Wednesdays with snippets of information in each post. All of us have busy lives and multiple things to do in our free time so in an endeavor to keep the posts short I’ll usually only touch on one topic at a time.  Conversations with family members can be difficult. Tread lightly and take baby steps. Please leave comments.

You can expect to find information here about aging issues, advocacy, building relationships, caretaking, developmental needs, emergencies,  end-of-life planning, finances, health care,  housing, respite, and safety, There are entire books written on each of these subjects, but I’ll try to give you the basics then link you with connections on where you can find more information. Please be interactive on this blog.

My background in home health and private duty nursing has shown me many families who have lacked information on how to proceed with love, respect, and dignity through the muddy waters of aging, Alzheimers, chronic illness, and dementia. Let’s work together to explore the information available so you can avoid the same mistakes.

Until next time…

All my best,

Laura

Starting the Dialogue with Your Aging Parents: Symptoms to Watch For

June 17, 2014

Have you noticed some changes in your aging parents? Here are a few that are usually associated with aging:

  • Blurred Vision
  • Hearing Loss
  • Fatigue
  • Irritability
  • Changes in Appetite
  • Frequent Urination
  • Skin changes

Are these changes due to aging, disease, or an acute condition?

Recently I read an article that described all of the above and attributed them to Diabetes Type 2 (formerly known as adult onset diabetes). Over the years the rise in the number of diabetes cases has been blamed on genetics and/or obesity. We now know that aging plays a huge role in the onset of diabetes so medical providers and health care workers are working diligently to alert people to the risks of prediabetes and how to reduce the rate of progression to full-blown diabetes.

Changes in vision can be attributed to many things such as cataracts, glaucoma, excessive exposure to glaring sunlight, eye strain and multiple other causes. Visual changes may also signal diabetes due to alteration in the shape of the lens of the eye caused by a build up of glucose in the blood (excessive blood sugar).

Hearing loss may be a result of diabetes due to nerve or blood vessel damage. If your aging parent starts saying that everyone around them is mumbling or they can’t hear as well as they used to get them tested for diabetes. Individuals with diabetes have twice the incidence of hearing loss as opposed to those who do not have the disease.

The body uses carbohydrates for fuel (energy) so when the body isn’t utilizing that fuel effectively, as in diabetes, fatigue ensues.  Chronic hunger is another symptom of diabetes for the same reason. Food may be consumed in large quantities, but if the body is not metabolizing the food into energy other senses in the body send signals to continue eating.

Irritability goes hand in hand with fatigue. Even those without diabetes get irritable when fatigued, but usually getting enough rest will erase the fatigue and irritability eases. If you notice ongoing fatigue and irritability in your parent the prudent response would be to have them tested for diabetes.

Frequent urination and excessive thirst have been known as hallmarks of diabetes for years. Don’t assume it’s just because of an aging bladder or summer heat. Kidney disorders are a serious complication of diabetes and can result in the need for dialysis if left untreated.

Skin changes may include dry patches, changes in color, or even textural changes. Sometimes areas around the neck and ankles may turn a darker color or feel velvety. Cuts and bruises may take longer to heal, or not heal at all, due to damage to blood vessels. There may be areas of numbness and tingling for no apparent reason especially in the hands and feet. All of these are sign of possible diabetes.

It should be noted that all of the above symptoms may also occur as a result of other chronic diseases or stroke.

I bring that to your attention because I do not want you, or your aging parents, to engage in self diagnosis. It is important that any of the above symptoms be evaluated by a medical provider and treated accordingly. My major point is to alert you that these are not just normal symptoms of aging and should be taken seriously. Early recognition and proper treatment can reduce the impact of these symptoms and also decrease the possibility of further complications.

The easiest way to decrease the risk of developing any chronic disease, regardless of your age or the age of your parents, is to engage in eating healthy foods in their most natural state and engaging in moderate physical activity for a minimum of 150 minutes per week. For more information please check out the extensive information available at http://www.cdc.gov/diabetes.

 

Thank you for reading my blog. Wishing you and your family good health.

 

 

 

 

 

Starting the Dialogue with your Aging Parents: Collaboration

June 9, 2014

“Hey Mom, we’re going to move you from the house to an assisted living facility. It’s just two blocks from my home and I’ll be able to visit you at least once a week. Doris and I decided this was the best way to keep you safe and it will be easier for us to manage your health care and other needs with you closer.”

That may sound like something you would hear in a bad movie script, but I’ve actually heard family members visiting an aging parent in the hospital make similar statements.

Any idea how the aging parent usually responds to such a statement? It doesn’t take a genius to realize that this kind of approach is only going to get the hackles raised and a streak of strong resistance and entrenched independence flaring.  Whether the scenario plays out in a hospital room or at home over a holiday dinner this is definitely not the approach to take when you want to help a loved one make a transition of any kind.

No where in the above quote is there any indication that the adult child cares how mom feels about moving from her home. There is also no questions of where she might like to live if it is imperative that she move from her home for safety reasons. In addition, it’s all about convenience for the adult child and no hint of ease for the parent.

Granted we don’t know the circumstances surrounding this particular case, but here are a few possibilities:

  • It may be that the home mom lives in is unsafe due to steep stairs and her frail status after her latest fall precludes her returning to that environment.
  • In addition, she may have used up all of her hospital and rehabilitation days that Medicare will pay for and she has to be discharged within a few days.
  • Further, the family may have never had a past discussion about  mom’s wishes if she ever needed a level of care that she couldn’t receive in her home.
  • Finally, no one in the family is willing or capable of caring for mom as she ages and needs monitoring, assistance and increasing care.

As we continue to have more people aging and living longer it is important to face the realities of what the future might hold. As I’ve advocated before in this blog, and basically the entire purpose for the blog, it is important to start the discussions about parental wishes while mom and dad are still healthy.

One very important factor is to get them thinking about alternatives before the need arises. This allows for financial planning, consultation with legal professionals and health care providers and most importantly an acceptance that circumstances might change as aging occurs.

Another reason to start the discussions early is so that family members can also plan for what might be expected of them. If there are multiple adult children in a family then future caregiving and assistance roles can be planned for as suited to individual geographical locations, financial abilities, time availability, and willingness.

Forcing someone to conform to plans they haven’t had a say in is not going to make any transition pleasant for the players. Please take this to heart and start talking with your aging parents about their future.

  • Listen to their desires.
  • Offer suggestions, but don’t dominate the conversation.
  • Be open minded and flexible.
  • Remain realistic about the financial impact.
  • Take time to think things over before making final decisions. This is planning, not implementing, if you have these conversations before a crisis occurs.
  • Most importantly, maintain a loving and gracious attitude. After all, this is your parent.

Thanks for reading my blog. Feel free to share your family experience in the comments. I’d love to hear from you.

 

Starting the Dialogue with your Aging Parents: What’s Causing the Changes?

May 5, 2014

Every day in the news there’s a new article about the rising cost of care related to Alzheimers and Dementia services, the signs and symptoms, the huge number of people expected to be diagnosed with either condition, and ways to cope as you watch your parents decline into a world you can’t begin to comprehend. As adult children of aging parents you may be scared, vigilant observers wanting to catch the first signs of change, or totally ignoring the possibility that this could impact your family.

Regardless of where you stand and how you feel let’s stop and take stock of some different scenarios and possible causes.

  1. You live over 600 miles away from your mom. She lives alone in an apartment building in a safe area and has many friends and activities she’s engaged in socially. Most of the time she appears much younger than her 82 years, but this week during your regular Monday night call she couldn’t remember what day it was and why you were calling.
  2. Dad lives across town from you in the house you grew up in and that he shared with mom for 63 years before she passed away. You stop by two or three evenings a week to check on him and spend some time reminiscing about years gone by. He has a caregiver who comes in to assist him with bathing, housekeeping, and to fix his lunch and supper. When you arrive you see his evening meal in the refrigerator ready to be heated in the microwave and wonder why he hasn’t eaten yet. It’s 8:00 PM and he has eaten dinner at 6 PM all of his life. When you ask him why he hasn’t had supper yet he tells you that he just had breakfast, why would he want supper. He then laughs and quips back at you, “Why would I eat supper so early in the morning?”
  3. Mom and dad moved out of the family home last summer in a small Maine harbor town and into a smaller home in Arizona to enjoy the warm sunshine and dry weather. This year you, your husband, and your three children will visit in late spring to see how things are going and enjoy some extended family time. You have lots of plans to explore the desert gardens, retail outlets, and maybe take a cooking class with your mom at one of the high-end restaurants. Your husband plans to “talk shop” with your dad about his former career as an architect in order to get some fresh ideas about the addition you want to put on the house this fall for a home office. You’ve driven 2200 miles to see them and plan to sleep in your 5th wheel since there isn’t room in the small home your parents live in to accommodate everyone comfortably.  On arrival your parents are surprised to see you and seem reluctant to let you into the house. You’re astonished to see that in less than a year the small home has become cluttered with piles of newspapers, magazines, boxes left unpacked from the move, and a total sense of neglect and chaos. There’s little food in the refrigerator, the sink is filled with dirty dishes and there are overflowing trash bags scattered around the kitchen.  This is not what you expected from your normally fastidious and organized parents.

In all three instances the adult children of these aging parents immediately assume the worst and think they are facing a diagnosis for their parent(s) of Alzheimers or age-related dementia. Their world starts to crumble and they are panicked.

Now, let’s step back a minute and look at what might be the cause of any one of these three situations:

  • Dehydration
  • Confusion caused by multiple medications interacting in negative ways
  • Infection
  • Fear
  • Pride
  • Covering for a spouse
  • Misuse of prescribed medications leading to negative side effects and confusion
  • Overwhelm
  • Depression
  • An actual diagnosis of Alzheimers or age-related dementia which hasn’t been shared with the rest of the family.
  1. In scenario #1 above this actually happened to my friend Cassie. She got on a plane the next day and went to visit her mom. As an only child she felt guilty about not being able to care for mom herself so she dropped everything to go check out the situation. On arrival at her mom’s house she saw 12 pill bottles on the kitchen table. At first this didn’t raise any red flags for her, but the next morning as she watched her mother take her medications without even looking at the labels to see when she was supposed to take them she became concerned. She tried to remain calm as she asked her mom how she knew which ones to take at which time. When her mother answered that it was all too confusing so she just took a pill from each bottle every morning and every night before bed a light bulb went off in Cassie’s head. She called the pharmacy and asked the pharmacist what could happen with such behavior. The pharmacist indicated that with the three new prescriptions he’d filled just a few days earlier it would lead to increased confusion, possibly some heart palpitations, and an increased desire to sleep. If continued for long periods it could lead to serious complications. Luckily, Cassie’s mom had only been doing this for 3 days. Cassie then got on the phone to a local home health agency and made arrangements for the company to lease a medication dispenser to her mom and to provide a nurse to come to the house every two weeks to fill the dispenser. The pill dispenser had a timer and would dispense the appropriate medications at the appointed time so her mom didn’t even have to think about it. Cassie then had her mother sign an authorization allowing the doctor to contact the home health agency whenever a new prescription was written and added to the regimen so the nurse could be sent out to add this to the dispenser. Cassie stayed with her mom for a total of 5 days to be sure everything was running smoothly with the new dispenser and also to spend some time catching up with her mom and visiting.  Since her mom wasn’t homebound the home health services weren’t covered by Medicare but Cassie’s mom had enough money to pay for the services privately. Within 24 hours of starting with the pill dispenser Cassie’s mom was back to her normal self and was no longer confused. She and Cassie enjoyed the remaining days by shopping, lunching, and planning a beach vacation together for later that year.
  2. Scenario #2 above is one experienced by my friend, Hadley. Her dad had always been so independent and rigorous about keeping to his schedule. Hadley was very concerned about his confusion and immediately called the caregiver who was with her father every day. She asked if the caregiver had noted any changes in her dad over the past few days. The caregiver said that she was concerned because it appeared her client had not been drinking enough water. The weather had changed recently and temperatures had quickly gone up into the 90s, but Hadley’s dad refused to drink water. In addition, he had been outside for long periods over the past two days and came in flushed and perspiring heavily. When the caregiver suggested that he should work in his garden early in the morning when it was cool he had told her everything was fine and that he had always worked hard during the middle of the day. Also, he had complained of a severe headache the day before and taken a nap in the afternoon which was not part of his usual routine.  Hadley went into the bathroom to wash her hands and noted that her usually fastidious father hadn’t flushed the toilet. As she reached over to push the handle she noted that the urine in the bowl was very dark, almost brown and that it had a strong odor. Hadley called and made an appointment for her dad to be seen at the local clinic the next day. The medical provider checked Hadley’s dad over very carefully. Immediately he noted that the skin on the forearms was tented for >3 seconds. He ran some blood tests and took a urine sample as well. Later that afternoon when he called Hadley with the results he indicated that her dad had become severely dehydrated and needed to have some fluids infused intravenously to restore him to a normal hydration status. Hadley sat with her dad in the outpatient clinic as he received his fluids. The medical provider met with them again when the infusion was completed and encouraged Hadley’s dad to drink plenty of fluids (especially in the warmer weather), avoid working during the heat of the day (between 10AM and 4 PM), and to call immediately if he felt ill. Hadley passed this information on to the caregiver who was asked to monitor carefully and call Hadley immediately if she noticed any changes at all. Once re-hydrated Hadley’s dad returned to his normal routine and thanked both Hadley and the caregiver for looking out for him.
  3. Monica and Ted were the ones who drove to Arizona to spend vacation time with her family. After Monica’s initial shock she took her mom out for lunch and gently probed to see if she could get a handle on the huge change that had taken place since the move. During lunch Monica noted that her mother couldn’t concentrate on anything, she was incapable of making a decision of what to order from the menu, she would lose track of what she was talking about mid-sentence, and she would often just sit staring through Monica as if she wasn’t there. That was the hardest lunch of Monica’s life. Meanwhile Ted was back at the house having a chat with Monica’s dad. The kids were outside playing oblivious to all the chaos swirling through their parent’s heads. During Ted’s conversation Monica’s dad confided that he just didn’t know what to do. He stated that his wife had not been able to cook or clean for the past three months. She had always run the household so he assumed she was still doing so until he discovered that she hadn’t paid bills in over four months. He had been too embarrassed to say anything to Monica about the situation and had forgotten completely that they were coming for vacation. That evening, once the kids were asleep, Monica and Ted shared their respective experiences  from earlier in the day. It was decided that Monica would make an appointment with her mother’s medical provider and they would explore options from there. Meanwhile they both set about cleaning up the house, organizing the bills, and paying those that were of highest priority. Multiple discussions took place about how to handle the future. In addition, Monica prepared large batches of stew, spaghetti sauce, chili, and other things she put into individual serving dishes and then put in the freezer. She posted written instructions on the fridge for her dad so he could pull them out and heat appropriately for meals. Ted and the kids stayed for the originally planned week, but Monica stayed on for an additional 3 weeks in order to be present during the medical appointment for her mom and then the appointment with a specialist a week later. The diagnosis for mom was middle stage Alzheimers at level 4/7. Mom was started on medication which seemed to help, but Monica knew that eventually things would deteriorate and further decisions for care would need to be made. After talking it over with her father it was decided that initially they would hire a cleaning service to come in twice a week to clean and prepare meals that could be frozen and thawed for use as needed. Monica made plans to arrange to visit at least every three months and spend 4-5 days with her parents to monitor the situation. She also  set up a regular time to call each week to check in and made her father promise not to keep any changes in her mom’s behavior from her. The final thing she did before heading back home to Maine was to get Health Care Proxies signed by her parents allowing her to obtain information about their health status and make decisions regarding their care if they became unable to make their own decisions. Currently, mom is holding her own on her medication regimen. She has regularly scheduled visits with the neurologist to track the progress of the disease. Monica spends time each week researching the best facilities for end-stage Alzheimers care. The need isn’t there presently, but Monica wants to be prepared to move quickly if the time comes where alternative care is needed for her mom. Dad remains devoted to mom and for now they are aging in place with assistance.

This post is much longer than my usual posts. I hope you see how important it is to be aware of what is happening with your aging parents. In sharing the experiences of friends of mine I hope you also see that jumping to the conclusion that because there is a change in condition it doesn’t necessarily mean an Alzheimers or dementia diagnosis. Only one out of the four people discussed above received a diagnosis of Alzheimers.  The other three were things that were easily remedied after proper assessment by a medical professional.

Feel free to ask questions or share your own experiences in the comments section. I appreciate all who read this blog. Thank you for sharing with me.

 

 

Starting the Dialogue: Understanding the Health Status of your Aging Parents

April 28, 2014

How often have you been sitting at a family dinner, or on the phone, when mom mentions her migraine headaches or dad talks about his aching knees? What about a passing remark about the high cost of blood pressure medications or diabetes test strips? Are you aware of the medical conditions your aging parents deal with daily? Do you know who their medical providers are, what prescriptions they take, their daily routine n terms of physical therapy or therapeutic programs? Is there someone in the family who can make health care decisions if your parent is unable to do so?

These may seem to you to be invasive subjects that are best left unexplored. I highly recommend that you become aware of all of these things and anything else that may be affecting the health of your parents.

It is important in these discussion about health, medications and therapies, as in all conversations about your parents’ personal lives, to not come across as the Spanish inquisition. This is not a situation to be asking nosy questions for your own self-satisfaction, but rather as another layer of protection for your parents as they age.  Calmly asking questions and explaining why you are asking is more likely to be taken in the manner it is meant to be received than being pushy and aggressive with an attitude that your parents can’t handle their own lives.

Consider this: mom has been experiencing one or two migraine headaches each month since you were a child. You know this because you grew up with it. In the past she always retreated to a darkened room, put a cold cloth on her head, and hopefully fell into a deep sleep that lasted anywhere from a few hours to most of the day. You, your siblings, and your dad learned that this is what was needed for her to return to her normal self.

Lately however, mom has mentioned to you that she’s having more frequent migraines and the pain is sharper, her vision get blurry, and she feels as though they come on without warning whereas before she always had a buzzing sound in her ears before one materialized.

This is the time to ask questions.

  • When was the last time she saw her medical provider? Did she mention these new phenomena at that time?
  • What did the medical provider recommend?
  • Were there any tests run? What were the results/ Did she understand the results? Can you review a copy?
  • Have there been any medication changes? While you’re at it with this question ask for a list of all medications your parent is taking and when they are scheduled to be taken. Find out who the prescribing doctor is and which pharmacy fills the prescriptions. In addition, ask about over-the-counter medications and supplements.
  • Ask when the last episode occurred of these new phenomena and get a date when they originally started with the new pattern.
  • Find out if symptoms occur at the same time with each occurrence and if the symptoms are always the same or if they vary.
  • Make sure that you, one of your siblings, or a local caregiver have the ability to discuss with your mother’s medical provider her medical condition and her treatment. In other words, have a Durable Power of Attorney for Health Care on file with every medical provider she sees, the local hospital, a copy in her home and copies for every member of the family so that there are no misunderstandings.

If you think this is a bit alarmist or a lot of work for something that might not be important consider how difficult it will be if it turns out that mom has what is now a fast growing tumor that needs immediate surgery, but she becomes too disoriented to make her own decisions. Yes, it’s happened to people I know.

I’m not trying to be overly dramatic, but I do want you to understand how important it is that you be aware of the medical conditions your parents deal with, their prescriptions, their over-the-counter medications, their supplements, who their medical providers are, and who can make decisions for them in case of a health crisis where they are not able to make their own decisions.

While you’re at it, consider putting these same precautions in place for yourself even if you are young and healthy.

 

Your comments and questions are always welcome. Thanks for reading my blog.

 

 

Starting the Dialogue with your Aging Parents: Spring Safety

April 21, 2014

The calendar told us a month ago that spring was here, but for some parts of the country it seems that spring’s arrival still hasn’t gotten the message. For those of us enjoying sunny days and warmer temperatures though I want to remind you of the need for safety as it pertains to your aging parents.  With the warmer temperatures, sunnier days, and greening of the lawns people of all ages get a hankering to get outside and dig in the dirt. That includes our aging parents.

For some of you that won’t be a major concern because your parents may still be young and fit enough to get around unassisted and with little to no impairment. For those using walkers, canes, or with arthritic joints the joys of being outdoors can be a bit tougher. You can do a few things to help make it easier for those you love with ambulation difficulties to get around and enjoy the season. Here are a few tips:

  • Check that handrails along stairs (indoors and out) are sturdy and free of wobbles.
  • Walk along patios and pathways to be sure that the surfaces are even and free of raised roots, rocks, or other  uneven disturbances that might create a tripping hazard.
  • Be sure that wooden boards on patios and decks are nailed securely in place and evenly sanded.
  • Assess tree branches and shrubbery for low hanging or protruding limbs and remove any that are in the  way.
  • Pull out the garden tools, lawnmower, leaf blower, and pruning shears. Check that the edges are sharpened correctly, add fresh oil to the mower (if a gas powered mower is used) and check that it is easy to start for your parent, oil handles on gardening tools and pruning shears, then store things in the shed or garage in a manner that is easy for your aging parent to access without hurting themselves.
  • Another thing to look for with gardening tools and mowers is whether your parent can still manage the weight of the implement. The heavy non self-propelled mower used for years may be too heavy for dad to push these days so an alternative will need to be discussed. Maybe the hoes and rakes that mom has used in the flower beds since before you were born are to heavy and long for her so lighter tools will be needed. The wheelbarrow wheels may need oiling, or maybe a different type of wagon is needed for ease of use. These items are simple to assess and replace, but troublesome and dangerous if left for use when they can no longer be handled safely.
  • Pull out the lawn chairs or patio furniture and make sure that the seating surfaces are without holes and any wooden surfaces are sanded smooth.

Obviously if you do not live close to your parents you will have to hire someone to look into these safety factors and let you know what needs to be replaced. If you do live close enough, or can make a visit to assess the situation, then be sure to include your parents in the process. They are more likely to take your suggestions and make the changes for optimal safety if they share in the assessment and discussion.

If your parents live in an assisted living facility, condominium unit, or nursing home they will not be involved in lawn care or garden maintenance but they may wish to have some potted plants in their room or on a small patio. Assist them in choosing items that are easy to care for and that can be placed in a manner where they do not impede ambulation.

Most important of all, get out and spend some quality time with your parents in the warmth and sunshine. Be sure that they are dressed appropriately and have proper skin protection from the sun, but enjoy the season with them. You will all benefit from the warmth, the sun, and the sharing.

Do you have any tips to share on springtime safety? I’d love to hear from you in the comments section.

Thanks for reading my blog. Feel free to share with all your friends and family. I hope you’ll check in weekly on Mondays for new posts.

 

 

Starting the Dialogue Between Your Aging Parents and Your Children

April 7, 2014

Starting the Dialogue Between Your Aging Parents and Your Children.

Starting the Dialogue Between Your Aging Parents and Your Children

April 7, 2014

This morning I was thinking about how much I miss my grandchildren. Then my thoughts turned to how much I enjoyed my grandmothers while I was growing up. I left out my grandfathers because one was dead long before I was born and the other died while I was very young. It bothered me that I never got to know my grandfathers, but I truly enjoyed both of my grandmothers.

My maternal grandmother worked well beyond the age of 65 so I didn’t get to see much of her, but when I did it was always enjoyable. Her house seemed huge and the holidays we spent there were always filled with good food, laughter, and lots of competition between the children.  When I was older I realized that the memories of the house were well out of proportion to its actual size, but that didn’t change my experiences there.

Grandma had a player piano in her living room, a large dining room table that was great for playing under, and a mysterious basement full of interesting items. There was a beautiful lilac bush next to the driveway and to this day I can still recall the beautiful sent of lilacs in the spring. My favorite part of visiting her was going to the store to pick out what we would have for supper. If I was spending the week visiting (my aunt was home with me during the day on those occasions) Grandma would stop by the house to pick me up after she got off work. Then we would drive to the store and pick out the meat for supper and head back home to prepare it.  Later in the evening there would be a trip up the road for ice cream.

The ice cream store was run by a family who made their own and hand scooped it from round cartons in the freezer display case. My favorites were mint chocolate chip and peppermint candy. As I grew older I became increasingly fond of jamoca fudge. For holiday dinners Grandma would cook a turkey or ham and a goose because my uncle liked having goose. There was always something fun to do and I looked forward to my infrequent visits with Grandma.

Visits with my paternal grandmother were more frequent. She and my uncle came to our home almost every Sunday afternoon. We all called her Nanny in an effort not to confuse the two grandmothers. I don’t ever recall seeing Nanny in pants as I was growing up. When I became an adult and had children of my own she converted to wearing pants, but on those Sunday visits in my younger years she was always dressed in a skirt and blouse with stockings and dress shoes.

Nanny took me to my first movie-Mary Poppins. She also took me to my second movie-The Sound of Music. Trips to the movie theater were a big deal and a coveted treat. We would go on a Saturday afternoon to the matinee. Afterward we’d go next door to the ice cream parlor and each have an ice cream sundae. There were four of us children in the family so these excursions were usually only once or twice a year. Nanny tried to be sure that we were all treated equally.

Now that I have grandchildren of my own I look back on those years and realize how lucky I was. Both of my grandmothers lived within a 45 minute drive of our home. My own grandchildren are spread out across the country and long periods of time pass in between visits.  I try to remain in touch by sending letters once a month or so, remembering birthdays, sending treats when I can, and acknowledging special occasions. The grandkids respond by sending me pictures they’ve drawn or items they’ve made in craft classes. It’s a start, but it’s not the same as getting to spend frequent time with them.

Regardless of how far away your parents are they will enjoy contact with their grandchildren. Building relationships over long distances can be difficult, but it’s not an insurmountable task. Please enrich your life and the lives of those you love (both older and younger) by encouraging communication and making connections. If you are lucky enough to live close to your parents be sure to arrange time for them to spend with your children. The gift of sharing between the generations has priceless rewards and makes memories for a lifetime.

Do you have something special in your family that builds ties between the generations? I’d love to have you share in the comments section.

Thank you for reading my blog. I hope the items discussed here are helpful to you.

Starting the Dialogue with Your Aging Parents: Take it Slow and Build

March 31, 2014

I’ve been writing this blog for exactly two years now. This will be post #93. Originally, I was going to write twice a week, but found that the pressure to do that was a bit high given my full-time job, outside activities, teaching schedule for diabetes prevention, and family commitments.  I still haven’t attracted many readers or comments, but then I haven’t made an overly concerted effort to connect. Time seems to spin too fast for me to get everything done.

I do feel, however, that the information in this blog is relevant and needed by many. Thank you to those of you who have commented and passed it on to your friends. I beg your assistance in continuing to do so.

One thing I realized I haven’t really made clear in all the posts about diet, exercise, health, safety, medications, senior housing, end-of-life planning, and all things related to aging parents is that this is about “Starting the Dialogue” not dictating it.

A dialogue requires input from more than one party. In this case I would consider you and your spouse, significant other, or siblings as one party. The second party would be your parent(s).  Of course your siblings and their spouses might not be part of the first party, but actually might have input that makes them a third-party. Again, the idea is “dialogue”.

At no time am I advocating that you rush in and start telling your parents what to do. That is the quickest way for them to shut down and refuse to listen to anything more you have to say on the topic. More than likely you will never be able to sit down with them again and engage in a conversation about their ideas and wishes for their future. So how do you get past this?

  • Start slowly with open-ended questions. Let your parents do the talking and express their ideas.
  • Pick one topic at a time. You don’t have assist your parents in mapping out their entire retirement years  in one sitting.
  • Start with simple topics and build trust. For example: an early conversation would be where your parents would like to retire? or do they see themselves traveling? or what is their retirement dream?
  • As trust is built, and the conversations are easier, you can move on to more touchy subjects such as health finances, and planning.

Looking at the four points outlined above I hope you see that the earlier the “dialogue” is initiated the easier the conversations flow as the years go by. In other words, if you’re in your 20s and your parents are in their 40s or 50s it is not too early to start the conversation. Yes, there’s probably lots of time and that makes it all the easier. The trust is established early and the conversations flow naturally. Waiting until there is a crisis, illness, or death is the least likely to lead to positive outcomes.

Keep in mind that change is an integral part of living and that just because your mother stated 10 years ago that she wanted to always remain in the two-story family home doesn’t mean she will feel the same way as she ages. She may develop bad knees or dizziness so needs a single story or wants to be in an assisted living facility with round-the-clock access to care if she falls. The takeaway is to always remain flexible and open to change.  If the dialoguehas been open and ongoing this won’t be a barrier.

One other very important thing to remember is that Safety is Always the Priority! If you find that your parent(s) is in an unsafe situation then you need to intervene despite their wishes. The scenario might be failing health, dementia, an unsafe neighborhood, coercion by a friend, inability to handle finances, lack of food or standard utilities, or hazardous living conditions.

If you must intervene in the essence of safety then please do so in as gentle a manner as possible. Rushing in, taking over, giving orders, and placing blame will get you  no where and cause chaos, stress, and ill feelings. Be as gentle, yet firm as possible. You may need to involve someone to act as middle man with your parents. This can be a church leader, adult protective services, a medical provider, or a geriatric case manager.  Keep your cool, remain respectful, and allow your parent(s) the dignity they deserve.

Once again, the best time to Start the Dialogue”  is before it is necessary. Start early, keep it going, and build the trust.

All comments and questions are welcome. Please feel free to leave a comment. Thanks for reading my blog.

 

Starting the Dialogue with Your Aging Parents; When is the Right Time?

March 17, 2014

I get asked all the time when should someone start having the discussion with their aging parents and how long will it take?

The question is a bit ambitious and misses part of the point of my message. First off it should be stated that “Starting the Dialogue” means just that. It’s a start and there may never be an end until death knocks at the door. I don’t mean to be flip about this, but honestly the “dialogue” is one that is ongoing and should occur many times over the course of a lifetime.

My second point is that there is no right time to initiate the conversations around health care, living arrangements, finances, safety, healthy lifestyle, and end-of-life preferences. Hopefully, you have a close relationship with your parents and these discussions have been ongoing since you were still living in their home and learning about life. Unfortunately, for many, that isn’t the case.

Regardless of what the current state of your relationship is with your parents now is the time to start building (or in many cases, rebuilding) the relationship to a point where these discussions occur easily and without stress for either party. Waiting until illness, a crisis, a death, or other major life-altering event occurs is not the time to start the conversation.

Some of the topics are easier to discuss than others and I suggest starting with those. It’s easier to ask at a family  dinner where your parents envision themselves living when they retire than it is to ask who they would like to be their executors of the estate when they pass away.

In other words, if you have a good relationship with your parents you may be able to jump right in and ask about their finances and how they want them handled after their death, or who they want to be their Durable Power of Attorney for Health Care if they become unable to make health care decisions for themselves.  On the other hand, if your relationship isn’t especially close I would start out by letting your parents know how much you love and care about them and their well-being. Move the conversation forward slowly over time (and multiple conversations) until there is a comfort level on both sides.

If your parents haven’t retired yet, are in good health, or are relatively young (say in their 50s or 60s) you might just start with general conversations about their retirement goals and where they would like to live. As they move toward retirement or eligibility for Medicare and Social Security benefits you might want to bone up on those topics and have general discussions with them to show that you are aware of the issues they face, but not necessarily feeling a need to be involved other than conversation.

If however, you are the one approaching retirement age and your parents are already in their later years (late 70’s on up) the discussions take on a bit more urgency and need to be more in-depth. Sometimes having a doctor, religious advisor, or financial advisor present eases the tension especially if your relationship isn’t particularly close.  Each family, each topic, and each situation require different approaches and some advance planning on your part.

Regardless of when you “Start the Dialogue” or what age your parents are here are a few things to keep in mind:

  • Do some research on the  topic you’d like to discuss.
  • If your parents are very independent or the relationship isn’t close be prepared that your parents may not be ready to have this discussion with you. This doesn’t mean you give up, you will simply have to approach it from a different manner at another time.
  • If you think you are going to come up against resistance then have some articles printed and ready to show your parents backing up whatever you are discussing. This way they will feel less resistance and recognize that you are not just trying to take over their lives
  • If things start getting heated then back off, find a neutral topic, and try again another time. Sometimes getting the advice of a professional, or better yet, having them present during the discussion eases the conversation.
  • This is about love and caring for your parents so leave your ego out of it.

There is no magic potion that makes it easy to deal with your parents and their affairs as they age. Keeping love and calm as your focus points will always get you much further than if you become demanding and bossy. Remember how it feels to have someone telling you what to do and don’t go there.

If you have something to add please leave a comment. I read all comments and reply to them and very much appreciate your input. HAPPY ST. PATRICK’S DAY

Starting the Dialogue with Your Aging Parents: Food Ramblings

March 10, 2014

I’m a foodie (foody sp?). I fully admit it. I love food. I love reading about it, growing it, preparing it, eating it, and most of all sharing it.

I’ve owned restaurants, taught classes in food preparation, taught classes on proper foods for various chronic illnesses and diseases, and I’ve worked my way across the country and back many times based on where my food preferences were leading me.

Here’s what I’ve learned about food:

  • There’s always more to learn about food.
  • Food is often expressed as love.
  • Food is the easiest way to remain healthy.
  • Eating natural foods is an experience many people don’t realize is as nurturing as taking a walk in the forest.

Let me expound a bit on these concepts.

Food knowledge: I have read hundreds of books, magazines, and articles on food. Some were about growing it while others were about preparing and serving it, and even more were about the effects on the body of different foods. As much as I’ve learned I come across something new and interesting about food every day.

Currently, I have the good fortune to be teaching diabetics and pre-diabetics about food choices they can make that will prevent the development of Type II diabetes and it’s attendant complications within the body. It’s a joy to hear the excitement in the voices of my participants as they share new discoveries on their journey to healthier lifestyle decisions about food.  The joy they experience as they lose weight without cutting out food and the new energy they have discovered because of healthier eating is a testament to how important food is in our relationship with our bodies.

Food as love: Think about food as love. Did you have a favorite food that your mom prepared on your birthday or grandma made when you went to visit her? How do you celebrate major holidays? Many people do it with special dishes prepared lovingly to share only on those special days.

When my children were little we would make a monthly trip to visit an elderly extended family member. She would spend days preparing treats for our visit. She didn’t speak much English, but even with her broken Italian we all knew she loved us because of the care and devotion she put into preparing those foods. When we would leave to make the three-hour drive back home the trunk of the car would be laden with boxes full of veal cutlets, bacon wrapped chicken legs, meatballs in homemade sauce, cheesecakes, and special cookies. Every one of the boys knew that the love she expressed was through the food she prepared for us. To this day the kids still talk about the food she made for us even though she’s been deceased for over 13 years. How many kids can say that about a present they received from an elderly family member?

Food for health: As a nurse I have had many conversations with patients about food. Those who eat healthier foods tend to have healthier bodies. They also have more stamina, less chronic disease, and often a greater appreciation for life than those who just eat because they have to. Of course there are exceptions, but overall the more thought and effort one puts into the food they put into their mouth the healthier that individual ends up being in the long run.

As part of my reading on food I often come across articles that state that eating certain foods, or avoiding other foods, leads to better health. Newspapers and the media flood us with information about cutting out salt, increasing our consumption of fruits and vegetables, the benefits of lean protein, and the rewards of increasing whole grains. Of course there is alot of competing advertising for prepackaged and sugar laden foods, but follow the more scientific studies and you will find research that will point you in the right direction. Basically eat plenty of fruits and vegetables (fresh or frozen is best), whole grains rather than super processed cereals and flour, lean meat in smaller portions than what our “super sized” society is now consuming, nuts and seeds, healthy oils, and watch portion size.

Drinking plenty of water plays a huge role in the process as well. We need both food and water in order to survive and keep our bodies functioning at their optimal performance levels. We also need these things to keep our immune systems fighting off infection and disease.

Food is nurturing: Have you ever seen someone who is incorporating healthy eating into their lifestyle? Usually their skin is pink and moist as opposed to pale and dry, their eyes sparkle rather than being framed by dark circles, and their zest for life is infectious. Wouldn’t you like to feel that way? Wouldn’t you like your aging parents to feel that way and maybe help them regain some of their excitement and joy for living rather than watching them sitting around waiting to die?

The concept of eating for better health and a happier life is one that can be started at any stage of life. Past gastronomic experiences may have led to disease and decline, but with something as simple as dietary changes some of the debilitating effects of chronic disease can be decreased, and in some cases, reversed. It’s worth a try don’t you think?

Feel free to leave a comment, ask a question, or share your own story about dietary changes and how they impacted your life or the lives of others. I appreciate your comments and will respond to any inquiries or comments. Thanks for reading my blog.

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