An Instruction Manual for Our Parents

Don’t you wish your parents came with an instruction manual?  When you were young, your parents likely uttered a very similar phrase in regards to you; wondering how to keep you happy and safe, comfort you when things went wrong and care for you when you were sick.  Now that the roles may be reversing a bit, you may have similar questions playing through your mind.

The plus side of the situation being reversed is that, in a way, your parents DO have an instruction manual!

Unless your parent suffers from memory loss, their ‘manual’ is their verbal and non-verbal opinions and actions.  An adult can tell you what they want, reason out an appropriate course of action, tell you their likes and dislikes.  A few families are fortunate – they have parents who pre-plan and who discuss these sensitive topics with their families.  Most families aren’t so fortunate.  Adult children are often faced with the tough job of broaching the subject of the visible signs of aging, of diminishing physical and mental capacities, even the ability of taking care of oneself.  Frequently they have to make decisions on their parent’s behalf because a plan was not put into place prior to the need for care.  The things our parents don’t say are sometimes more powerful than the things they do say.  Taking action to “stay put” is a very powerful stance many older adults take.

No matter what the situation, even if your parent has experienced some memory loss, you have to begin the process by having honest and open conversations about what your parent or parents want:

• If you weren’t able to do your own laundry any longer, what would you want to see happen?
• If you weren’t able to prepare a meal any longer or if you weren’t safe being alone, what would you like me to do?

You also have to be willing to share with your parents your own concerns and your own willingness (or lack thereof) to help in the event of a change in health status or in the event of an emergency.  You need to be very frank and completely honest what you would be able to do for them, what you would be unable to do… and why.  Explain the limitations you would have, because of your availability, your commitments and your willingness to become a caregiver to your parent.  Also take time to explain for what period of time you would be willing to do which chores.

Keep in mind that what your parents want or think they want, may be quite different from the choices you feel they should make.  Remember, your parents are in charge of their own decisions, and they may choose to live in a different way than you would like them to live.  This doesn’t mean you can’t bring up the subject of a possible change down the road, though.  In fact, the more times you can bring up the subject over an extended period of time, the more likely it is that your parents will be receptive to your message.  But… just because you’ve expressed your opinion, your parents still have the final say; you can’t force a parent to become accepting of your opinion.  Some parents have to be given the opportunity to fail on their own or to experience a fall or a sense of vulnerability before they recognize the fact that they do, indeed, need help.

Today, our parents don’t have to wait until their health takes a downturn before making a move from the family home.  Retirement living and active senior communities are available which offer varying levels of service, safety, and comfort.  These are not care communities – they are lifestyle communities, much more like a resort or pleasant vacation spot.

A good alternative for many families is that, if parents need a little support, in-home care can be arranged or services can be brought into their home.

Several aspects of living alone do place a person at higher risk for injury or harm.  For those families with a senior living alone, here is a list of warning signs to be aware of:

• Is your parent talking about the possibility of a future move?
  If they are, what they are most likely saying is that they feel it’s time to move right now, but they want to gather your opinion and they want to discuss the topic first before taking action.  Most seniors have to firmly understand the entire process and envision the steps of moving before committing to a move.  If your parent is bringing up the subject, chances are a move is overdue.

• Difficulty walking or unsteady on their feet

Falls lead to much more serious injuries, particularly if the fall is undetected and treatment is not sought within a short period of time.  People fall regardless of where they live, but the response to the fall is what is important.  If a person is at risk for fall (and most older people are) then wearing an alarm pendant or alarm wristband is a very important step to take.  A move to a community that allows a person to be checked in on more frequently may be in order.

• Change of appetite or weight loss

As people age, it’s normal to not eat as much but it’s not normal to skip meals.  It’s also normal to not experience thirst any longer; water intake continues to be of great importance to good health.  When seniors lose weight without trying or have a change of appetite, a doctor should become involved.  There may be medical or physical reasons behind the change.  There may also be a need for a focus on reducing depression or increasing the amount of human interaction a person is receiving if there is a sudden decrease in appetite.

• Reluctance to socialize

There are many reasons why older people become less interested in socializing, but some of the reasons are warning signs of underlying problems:

• • Hearing – people tend to self-isolate and they may not even be aware that they have a hearing problem.
  • Concern about being near a bathroom – incontinence of bladder and bowel are extremely common issues of growing older.  Family and friends need to be cognizant of the fact that older adults need access (and easy and quick access) to restroom facilities.
  • Memory loss – people who are beginning to experience dementia frequently self-isolate.  They may be aware of their memory loss, or they just may not feel comfortable any longer being out and about.  People with memory loss fair much better in a small and known environment.

• Difficulty concentrating – A doctor may be able to shed light on this issue, but it is also a normal part of aging. As a person’s energy level decreases, the ability to take in, process and respond to information decreases.  Concentration can lead to injury if a person is beginning to practice poor judgment in keeping house, preparing meals and doing daily tasks.

• Medication errors and skipping medications

Did I take those pills or not?  When we’re younger, skipping a daily dose of medication may not be a big deal, but for older adults, too little or too much of any medication can cause great complications.  It is highly common for older adults to require assistance with managing their medications.

• Unopened mail

Unless the person has never been interested in opening mail, this may not be an issue, but if the change occurs suddenly and the person has been opening their mail up until now, this is likely a sign that something is wrong.  The person may be depressed or overwhelmed.  It is also possible that the person is suffering from memory loss due to illness, fatigue, medication interactions, or a lack of proper nutrition or hydration.

• Lack of food in the home or spoiled food

This is one of most every adult child’s greatest worries.  It is true, when a person grows older and is less mobile, it is much easier for food to spoil or for older adults to go without something.  When food is spoiling or there is an apparent lack of food in the home, this is a warning sign that a person is becoming in need of support services.

• Poor grooming

When people are feeling well, they tend to prefer to be well showered or bathed.  When they are not feeling well, they tend not to be so interested in good hygiene.  This change in grooming may also transfer into how clothes are kept and how dishes are washed and stored.  Failing eyesight may be a primary reason for poor grooming, but there are other medical and psychological reasons for not keeping up on things.  Help from a doctor may be required.

• Driving becomes worrisome

Without transportation, seniors can easily become isolated.  Living on or near a bus line or having access to public transportation, transportation from friends and family may be of help.  When a person begins to have numerous “fender benders” or speaks about not being able to see well any longer, or they feel that they are no longer safe driving, friends and family should encourage the person to give up the car.

• Personality changes

Some people go through extreme personality changes due to illness, disease, mental illness, medication issues, depression or even bladder infections.  When a personality change occurs, it can be a very difficult time to convince an older adult to visit a physician.  Without medical help, the older adult may become more dependent and even more fragile, as the personality change may be an indication of a much more serious issue.  If an older adult has a personality change, you may consider not being so blatantly upfront with the person about your concern.  It is likely that the older adult is not aware of the change in their personality.  Instead, consider one of these approaches:

• I’m concerned about your health and well-being. I know you don’t like to go to the doctor, and I think I really need to set up a time to get you in to get some help.
• You just don’t seem to be doing well to me. I’m not a doctor, but I sure would be grateful if you allow me to set a time to get you to see one.  Can I take you on Tuesday or Wednesday to get in?

• The surviving spouse

When one parent passes away, the other will inevitably start thinking about moving to retirement or assisted living.  There is definitely no “hard and fast” rule in dealing with the loss of a spouse with regards to the grieving process.  Years ago, the general consensus was that a person should not move for at least a year after a spouse’s death.  While this adjustment period will be helpful for some people it can be detrimental for others.

• If the upkeep or expense of the home is too much for one person to handle, it may be a welcome relief for the surviving spouse to consider a move. Also, having ready access to social interaction with other people could be of immense help to a person who has recently gone through a loss of spouse.
• For other people, making a move before completing the grieving process can be far too overwhelming. This topic needs to be discussed in depth with the older adult to be certain that their interests and wishes are understood.

The final thought regarding a possible move is that the senior needs to be reassured that they will not be solely responsible for the entire process.  Family and friends can be great resources when going through possessions and boxing items for the move.  There are also agencies available to seniors to help with the entire process; deciding what to keep and what to take with them, handling the packing up, moving all the belongings, setting up the new home, even putting sheets on the bed!  Help is readily available.

The main thing to remember is this: You’re not alone in what you’re experiencing.  Many people have and are dealing with the exact same situations you are.  Remember that parents are adults with their own set of likes and dislikes and values and opinions and that relinquishing any part of their independence will not be an easy process.  Keeping parents as involved as they can be in the decisions that need to be made will go a long way in helping them accept and adjust to their changing world.