Saturday, October 31, 2009

Things Most Parents Won’t Tell Us… and Why

(Because of responses to Tuesday’s post, this replaces the planned "Food" post.)

The following situations and reactions are truly not exclusive to older people. We’d probably react the same way; but when older people are involved it's different, or does it just seem different? OK. Most parents won’t tell us--

--They’ve fallen. Reason #1 for a remarkable 88-year-old mother: PRIDE. By the time her daughter found out, her mother had fallen many times and bounced back to normal without anyone’s knowing; or if they knew, they’d been sworn to secrecy. This time she broke her 88-year-old hip. It turns out a simple corrective device, placed in her shoes, was all that was needed to solve the balance problem that caused the fall in the first place. But the solution came after enduring hospitalization and rehabilitation for her hip. While she’s still a spunky and amazing 88-year-old, it did “take her down a notch.”

Reason #2: for more older parents than we realize: FEAR--of being forced to give up their home and go to a place where their adult children think falls are less likely—be it moving from a home with stairs to a one-floor apartment or to independent or assisted living, or coming to live with their adult children (granted, much less likely today than it was in previous generations)

--They’ve had a driving incident. Reason: older parents FEAR they'll have to stop driving. This fear is very prevalent. But it but needn’t be if adult children are smart like Kim (Archives: Driving Part 1); rule out medical issues that prevent people’s driving; and know about resources that enable older people to drive well longer (Archives: Driving Part 2). If it's determined that parents are no longer qualified to drive, it will be based on solid evidence. On the other hand, it makes everyone's life easier and happier if safe-driving parents continue to drive (possibly aided by programs like CarFit, http://www.car-fit.org/), as long as it remains legitimate for them to do so.

--Their problems and concerns. Reason #1: THEY STILL FEEL PROTECTIVE TOWARDS THEIR CHILDREN and don’t want to burden them, especially if the adult children are dealing with problems of their own.

Reason #2: They DON'T WANT TO BE TOLD WHAT TO DO, they just want someone to listen and someone who they know cares, to bounce ideas off of.

And to a lesser degree, depending on their children's way of responding---

--What they’re doing. Reason: NO ONE WANTS A LECTURE or being told what to do, be they children, young adults or old adults. One independent-living, 80-something-year old father said: “I told my daughter I was going to the movie with a friend and immediately was told it wasn’t wise because of swine flu. Come on. Children and people with certain conditions and are most at risk and I’m neither.” Another 80-year-old sums up the feelings of many when she confidently says “I still think I can make my own decisions.”

Basically, it seems when parents have reached a certain age and consider themselves independent and able to make good decisions, some may be protective of their adult children and most—if not all—resent unsolicited, even if well-meaning, advice for the reasons above. There is a little poem in my yet-to-be published book that goes something like this:

Our children have knowledge of important things
Things that they think we should know
Forgetting we told them those very same things
When they were young-- years ago.

Something to think about.











Tuesday, October 27, 2009

Dallas Wedding

The family wedding in Dallas included at least one 90-year-old. A psychiatrist, still with a part-time practice, she looked splendid at the wedding in a red dress and flattering make-up! And she didn't hesitate to dance and was still dancing when I left!

It was heartening for all and reinforces my belief that empowering older people results in remarkable senior citizens.

I'm feeling a bit like Julie in the "Julie and Julia" movie (I don't know how many people are reading my blog), so I want to use today's post to do a quick check. Would you click "Follow" (above HELP!) at the top of this blog or http://helpagingparents@gmail.com/ (which is also the e-mail address near the bottom of the right sidebar [column]) and let me know you're reading this blog. You can give your name--or not. And if you want to tell me about your older parents, or you are an older parent, or have questions or ideas you'd like discussed-- about relatively healthy, independent older parents-- do include them in the e-mail.

Until Saturday, then, when I think I want to talk about food.

Sunday, October 25, 2009

DANGEROUS--or NOT

Three Sundays ago an allegedly drunk mother left a party in New York City with seven young girls in her car—to take them to a slumber party. According to the New York media, people were very concerned about her driving. One person unsuccessfully tried to prevent her from getting into the car, but no one stopped her. Her car sped out of control and crashed. An 11-year-old girl was killed; others were hospitalized. A radio news report a day or two later, said that the mother had regained consciousness, was distraught, and was under suicide watch.

Questions: under what circumstances should we force people to do—or not do—something for their own good? What are the consequences of doing nothing in potentially life-and-limb-threatening situations--because we think nothing will happen? And when do we act too quickly and change people’s lives unnecessarily and not for their own good?

There’s no question, we must intervene in situations that threaten life and limb. That’s easy to say, but may be difficult to do. And I know, from a school counselor’s viewpoint, it takes discipline—not easy when we know someone well. As a counselor there is no choice, however. Child abuse and potential suicide, among others issues, require immediate intervention, just as certain issues with parents require immediate intervention.

Denial, an emotional mechanism that operates without our being aware of it, can keep us from acting. (Remember denial protects us from having to deal with a reality until we’re ready to deal with it.) Could that be the excuse for the people at the party? Can that be an excuse when older parents are clearly a danger to themselves and/or others and no one intervenes? Should we do a reality check with our parent’s doctor or a trusted friend, who knows our parents, to rule out our possible denial in questionable situations? It seems that would serve everyone well.

Knee-jerk reactions, on the other hand, cause us to make major changes quickly, possibly unnecessarily. So how do we determine necessary from knee-jerk?

A highly respected head of elderly services at a family counseling agency tells us, for example, that adult children are quick to rush their parents into assisted living when they see, for instance, “food rotting in the refrigerator, mail piling up, and the home or apartment a mess.” But, she says, “these parents most likely need ‘care management, not assisted living’ and could probably remain in their home for quite a while (by getting help from a social worker or someone experienced in working with the elderly).

In one case new prescription glasses were the answer. A home aide hired to clean up a few hours a week, solved another problem. Forgetfulness was caused by easily changed medication, not dementia. Bottom line: if it isn’t immediately dangerous, make haste slowly.

While we can’t be perfect, it seems we can save ourselves and our parents unnecessary problems and unhappiness if we keep the above in mind. And these websites may help:
http://mayoclinic.org/, http://www.helpguide.org/, http://www.familydoctor.org/ (American Academy of Family Physicians, click 'seniors'), http://forms.lighthouse.org/hny/search
www.afb.org/seniorsite, (American Foundation for the Blind), http://www.alz.org/ (Alzheimer’s Assn)

Tuesday, October 20, 2009

Dignity Diminished at Bridal Shower

This weekend is a family wedding. Grandfathers have passed away, but grandmothers on the groom’s side will be flying to Texas for the occasion. I haven’t met the bride or her family so I have no idea of the generations that will be represented on her side. One thing I do know, weddings are almost always intergenerational events, giving old and young the opportunity to interact easily, sharing a common, celebratory feeling during that brief period of time.

I’m reminded once again of Katy’s mother, who we met in the last post. But this time she had a diminishing experience, that even Katy couldn’t have predicted, when she attended a bridal shower for her granddaughter several years ago. Katy’s mother was 86 at the time, without wheel chair and a bit younger than she was in the last post. After the shower as they were driving home she reported to Katy (who sat no where near her mother at the shower) that a “young girl” (actually an adult in her early twenties) came over, introduced herself, sat down, and they had “a really nice conversation” until the end when the “girl” was getting ready to leave and said: “I really enjoyed talking with you, Gran.”

Katy’s mother was incensed at being called “Gran” (a name even her grandchildren didn’t use). No amount of explaining or rationalizing that this was probably the endearing term the “girl” used with her own grandmother, could erase the negative effect of a young woman’s well-intentioned conversation with the bride-to-be’s grandmother, who considered herself a capable, normal woman--not an old lady.

It’s hard to get into the head of older people, but older people have shared with me so that a wider audience can understand certain ways of thinking. For most, the importance of being respected and not considered "old" top of the list (along with independence, decent health and good friends).

Thursday, October 15, 2009

Diminished or Dignified

A good friend's mother died last year at 104. A proud, strong woman with pride and standards, she became less easy to get along with and more set in her ways as she aged. She was fiercely loyal and I loved her. However, there was a fine line that no one should cross if they wanted a relationship with-- and/or cooperation from--her. That was the line that diminished dignity.

She remained independent in her own apartment with part-time help, until she was 102 and her unsteadiness led to falls. So it was a choice: caregivers in her apartment or a care facility of some kind. While she chose caregivers, she balked at having them. They, of course, didn't dare call her honey or sweetie or dear, but then they couldn't call her "chief or boss" either (POST 1). So they addressed her by her formal name: they called her Mrs. Miller. That suited her just fine.

Her trips to emergency increased with her age and age-related issues. Her son was at-the-ready, leaving instructions at nursing stations and the like saying "She wants to be called Mrs. Miller," after he informed appropriate people individually. If there was to be cooperation, Mrs Miller needed to be treated with--and know she had--respect.

I think about the many alert, mentally capable elderly people whose lives are untentionally diminished by people who assume if you're old, you can't be treated like a normal functioning human being. It's not ill-spirited. Is it thoughtless or a response to a stereotyped idea of older people? We could say it's not politically correct. But most likely many would not listen because old people won't have a loud enough political lobbying voice to be heard on this subject until baby boomers age a bit more.

Yet calling older people well-meaning, but diminishing, names is just one example. I think about Katy's mother who, in her late-80's, needed a wheel chair when there was a lot of walking involved. She was a smart and with-it woman, but Katy noticed that if they were going shopping, for example, the sales associate or clerk would address remarks to Katy, even though Katy's mother had initiated the conversation. This can happen in doctors' offices, at hospital registration sites, you name it. On the other hand, if we go shopping with our smart, with-it teenager (who's in a wheel chair for some not-observable reason) and he/she initiates a question, our teenager is answered. Check it out!

If we are sensitive and find ourselves involved in an experience like Katy's with her mother, Katy's response, "You know, Mother asked the question," is a good model. In a nice, but straight-forward way, it redirects the conversation to her mother so that the sales person or whoever is aware of his/her unfounded assumption. (And even if he/she doesn't "get it" completely, our parent isn't excluded from the conversation.)

We are so often on fast-forward that these diminishing experiences are easily ignored. But older parents, who usually have less going on in their lives and therefore may attach greater significance to things we hardly notice, say:"It chips away a little at a time." If your parent is not as strong as Mrs. Miller and empowering is a goal, these kinds of slights may be well worth recognizing.

* * *

If you have older parents and wish to share other examples for a future post, e-mail me (address at right sidebar).


Tuesday, October 13, 2009

Remarkable Parents

A man turned 100 recently and gave up riding his motorcycle! An e-mail from a reliable friend (after reading the driving posts), informed me of that fact because that man, who had a very distinguished career by the way, was her friend’s father.

And we worry about our aging parents driving cars.

We learn about increasing numbers of amazing old people all the time it seems. Is it because of medical advances and health information causing people to live better longer and/or because of technological advances and instant communication? In any event I'm going to tell you about a woman people call "remarkable" who never drove a car, much less rode a motorcycle. Today, October 13, she is 96 years and one month old. 

Facts: R. was widowed at 51. Her only child, my husband, lives far away. She flies unaccompanied to see us. She doesn’t use a cane. Everyone comments that she still has style, always looks well put together. The 40 birthday cards and phone calls she received a month ago are testimony to the love and admiration she has earned over the years. She is the wise octogenarian in my yet-to-be-published book.

R says she had to be independent from an early age. Independence is now a highest priority; she doesn't want to be taken care of. So she exercises (still uses the tread mill she bought right after her husband died) and "I don't abuse myself.” Translated: she eats right, rations her energy for what’s important and she makes the effort to be with people she cares about. She uses taxis and handles all of her affairs, and reads widely so she knows what’s going on.

Living in the same home since the 1940’s, R has welcomed many young families and babies to the neighborhood--always with a small gift for the babies. The babies have graduated high school and college and new families have filled homes that the others have left. She’s a surrogate grandmother, mother and wise friend to young and old. Who else would have a turkey sent to a neighbor’s son at college to share with friends who couldn’t be home for Thanksgiving?

R didn't want a celebration for her 95th birthday. This year was different. A neighbor in her 40’s was giving R a birthday luncheon. The 11 guests’ ages were 13-96. The hostess’s 13-year-old daughter wanted to be there as did her 25-year-old sister (recuperating from an ankle fracture).

No gifts; only memories shared around a large dining room table. One guest expressed how fortunate she felt to live across the street, saying after her mother died, she turned to R for understanding and wisdom. Another shared a time her husband and son were having difficulties and R suggested writing a note of explanation, instead of arguing while emotions heated up. It works! The 13-year-old said R was responsible for her New York trip with her class last spring, when her parents were uncertain about financing it. R explained to her mother why it would be a worthwhile experience (and gave the child a bit of spending money for the trip). R was as dear to these younger and older women as they were to her.

R has lived a long time, making the effort (it gets harder every year, she says) to remain involved, always thoughtful with words and deeds. Is that what enables her to so successfully span generations? Is it her genuine interest in others or the fact that you hear wisdom and feel a solid connection to what matters when she talks with you? Is it because she’s an inspiration and remarkable? Well, everyone and every birthday card says she is.
* * *
Do you have or know a remarkable, older parent? E-mail and tell me why. I'll try to use it in a post (with or without her/his first name).

Saturday, October 10, 2009

The Astors and Us

Media attention is focused on the Astors this weekend: Brooke, the elderly--now deceased--mother, her old adult son, and his adult son...three generations whose current situation might have been astonishing to imagine several decades ago.

Today things we assume to be rock solid or think could never happen, surprise us. I got to thinking about end-of-life issues—about my Dad and I discussing what I needed to know because I was his healthcare proxy (also called healthcare representative). I thought about problems that developed among siblings I know after parents died and the will was read. I wondered if there is a way to reduce that potential for conflict among family members, assuming the family members get along well to begin with.

I spoke with an attorney, a friend who has practiced trust and estate law for many decades and has excellent instincts about family relations. He says it’s better if adult children know certain things ahead of time: for example, who will be trustee or have power of attorney. That prevents second-guessing the rationale after the will is read. He advises parents to bring adult children into the process (assuming they are responsible in the ordinary sense) so they are not "left in the dark." At the minimum, he suggests that adult children know:

1. who the key advisors are (accountant, banker, casualty and life insurance agent, doctor, lawyer, and stock broker)

2. where the important documents are located.

If this isn't possible or desirable, adult children should at least know whom to contact. And lastly, ideally adult children should also know if there is a living will and in general what the will provides.

He continued with this idea which I really like: Parents who don’t want to discuss anything with their children ahead of time can write a letter, separate from any formal estate documents, explaining his or her thinking when the will or estate planning was done. It should be kept with other important documents with instructions “Not to be Opened Until My Death.”


To go a step further, I know of instances among my friends, where the mother dies and the father remarries. I imagine you do too. Then the father dies, leaving his adult children's relationship with the second wife in shambles. The reason: wills that seem (and perhaps are) unfair to the father's biological children. Could a letter, assuming a direct conversation before his death was too uncomfortable, be helpful?

We talked about second marriages. "Situation that include children from other spouses literally cry out for careful thought and planning, to be carried out by expertly-prepared life and estate-planning documents," he counseled.

If our parents haven't discussed anything with us yet, do we have the kind of relationship where we can initiate something? Can we use this post as a springboard for discussion?

Perhaps the above thoughts and information can help avoid some of the pitfalls.

If you have ideas, thoughts, insights, or questions, e-mail me at the gmail address (right sidebar) and I’ll get back to you before the next post.

Tuesday, October 6, 2009

Pets and Parents

This week’s New Yorker magazine (Oct.12) presents three covers showing the progression of a well-dressed woman’s purchase of a fast food hamburger, for—it turns out—her French poodle.

An article in today’s New York Times Science Section (page D5), "Exploring the Health Benefits of Pets" discusses the effect of pets on children's well being. While it focuses on children, the next-to-the-last paragraph mentions an Alzheimer’s patient’s recognition of her beloved dog.

If we’ve had a pet, we know the inexplicable bond. This is no doubt a reason why gifting a pet to older parents who seem to need a jump-start, or are lonely, has crossed the mind of many adult children. That may—or may not—be a good idea.

“Social connectedness,” according to the major studies, is one of the three most important factors in successful aging. It is such a normal part of living that we take it for granted. If we are alert we will know when the social connectedness void begins to infiltrate our parents’ lives.

Whether pets qualify as offering social connectedness no doubt depends on the people and pets involved. We know pets provide companionship; their antics provide entertainment. They “stir up the dust;” usually give unconditional love, and give purpose to their owner’s life. A 2002 study found that older people who had pets experienced better overall physical and mental health than those who didn’t.

Halise Diamond, DVM at the Animal Referral and Emergency Center in Mesa, Arizona, reminds us that pets add so much to people’s lives, but they’re also a responsibility. She emphasizes that their care should be in keeping with an older person’s strength and mental ability. For example, a forgetful pet owner who doesn’t feed or overfeeds a pet, neglects its medications or overmedicates, can cause a pet serious problems, even death. If older parents have a pet and are becoming forgetful, Dr. Diamond recommends a calendar on which a pet’s needed medications are written and then crossed off once given.

If we contemplate giving a pet--to anyone actually--we need to consider:

Does the person want a pet? (Dr. Diamond emphasizes this is true no matter the age of the intended recipient.)

If an older person is on a fixed income, consider the cost of medical care—even routine check ups can be expensive.

If mobility is a problem, a dog that needs a lot of exercise is a problem.

Puppies require a lot of training and older people aren’t as forgiving as younger people when their possessions are chewed and scratched.

Rescue cats and dogs are older and more mellow.

The staff at a good shelter knows why pets have been relinquished and should be able to select pets that are appropriate for older people.

Some birds live a long time and may outlive an elderly owner. Hmmmm. Do I want a bird?

Saturday, October 3, 2009

Driving (or Not) Part 4

I’ve forgotten whether Dad’s driver’s license came up for renewal the year before or the year after his 90th birthday. What I do remember is the fact that it was renewed for 8 or 10 years!

Also surprising: Dad went to the DMV bureau in a smaller town (he lived in a city) 20 minutes away. It was easy to park there; they were nice. He had a habit of keeping his driver’s license and all credit cards, but one, hidden in the trunk of his car. As he began the renewal process he realized he didn’t have his soon-to-expire license and told the DMV person that it was in the trunk of his car; he’d get it. No problem--the computer could access data. He only needed proof of who he was. The only “document” that had his name: a Safeway Grocery Store club membership card in his pocket. Proof of ID accepted. Renewal granted.

Fact: Some older drivers (and others) drive under “ify” circumstances.
Fact: When it’s threatening to life and limb, prevention is key.
Fact: Parents resent being forced to do something, just as we would resent our children forcing us to do something.
Fact: The entities and agencies, you would expect help from, may be of little or no help.

We all agree that we must stop parents who drive dangerously, but how do we do it without straining family relationships? If you're an only child, it's your burden. If there are siblings and the majority or all agree, great! If you don't agree, see information in #4.

#1. What seems like a major problem, may be easily solved (could be medications or a case like Kim’s mother). Remind mentally able parents of this. By pulling then into the situation and saying the problem may be easily solved, it's respectful, empowering, and helps them buy into whatever may come. To rule out serious problems, with your parents agreeing and perhaps making the call, first consult the primary care doctor, which may lead to additional testing (eg. vision, neurological).

#2. If it’s not correctable, the doctor is in the best position to deliver the message. This is a huge loss, a chunk of life is being removed. Doctors have practice in delivering bad news and hopefully do it in a kind, objective manner.

#3. Many adult children have phoned police, insurance companies, DMV etc., in efforts to curtail parents’ driving, and the results vary. It’s sneaky, which is disrespectful and undermines self-esteem among other things. Understandably children usually don’t feel good about it. Only as
a last resort, it may have merit.

#4. If we must deliver the no-more-driving message, how can we give facts, affirm our parents’ ability to participate in the decision-making and arrive at a no-more-driving result? If we're uncomfortable with that responsibility, a social worker experienced with the elderly can be a big help. Contact a local family counseling agency or an agency whose social workers specialize in geriatrics. It definitely won't be the first time they've helped adult children with this problem.