How Do I Know If My Parents Need Help?

We are physicians.  We are trained to look for problems.  We are trained to think preventively. But….these are our parents.  That adds a layer of complexity.

Worrying about our parents can take a toll on our already stretched and thinned emotional resources. 

What do we do when we want to make sure our aging parents are safe and comfortable, while also respecting their independence and personal choices. It can be difficult to know where to start, but I think I can provide a frame for a quick check. From this checklist, you will be able to take some time to develop a plan of approach. 

Remember – this is just a thought experiment at this point! 

Key Areas of Focus

I may approach this a bit differently than other advisors.  Likely from my years of listening to both the parents and the adult children.   I will put these in an order for the most independent parent to those that may need more support.

Family or friend support

Is there a network of people that your parents can call upon IF they need help? 

Do they have friends from social interaction – clubs, sporting, church, work, family. 

Have they provided help to a group that you can remind them about if/when they may need help. I call this building the ‘safety net.’  When one is learning to walk a tightrope, the safety net is close (think childhood), but then the net is moved further and further away.  Sometimes we forget there is even a need for a safety net.  As we age, we must contemplate building that net again.  It can stay far below, but we should start weaving or at least contemplate that they may be needed.   Check out how to building a team that may assist you in providing a safety net.

Social interaction

Do they have opportunities to socialize with peers, family and friends?

Many adults worked for years and did not have time or energy for socializing outside their day-to-day.  

Socialization is vitally important for emotional health. If your parent is a socialite – wonderful. If more inclined to remain alone, are there opportunities in their community for increasing socialization?  

Consider senior centers, extended learning classes, library discussion groups, hobbies, sporting events or activities.  

We can talk with how you approach your parent to consider improving their social interaction, but at this point, let’s just consider if this is a need and start to scan for opportunities.  Check out expanding social interactions with your parent ADD LINK

Mobility

There are several layers of mobility. 

Does your parent have access to moving around their community? Do they drive? Are they safe driving (see blog about safety and driving).  Is there public transportation? Can they access the transportation.  Can they use taxis or Uber/Lyft – financially and feeling safe doing so? 

much of isolation may be due to difficulty with transportation.  (maybe beef this up with a resource or two) 

Mobility may also be changing due to physical changes.  Is there pain with ambulation or fear of falls keeping someone home? How can these be addressed?  See blog posts on these issues. 

One marker that physical changes may be impacting mobility is if they can walk ¼ mile. (Hardy et al.) .  This marker helps in understanding that disability may be looming and provides a framework for you to begin to address (see a more indepth blog on this matter).  ADD LINK

Medical needs

This is another area where I may be different from others advisors.  

Of course we need to know what the medical conditions are and if your parent is managing them.  You, as a physician, have this one covered. 

But…..have you begun to consider what your parents goals of care are? Have you addressed how you feel about their mortality? Consider checking out the blog on dealing with your parent’s mortality.  Check out the blog here.

Do you understand the end of this chronic disease that they see their physicians for?  As a child of your parent, have you addressed whether you can hear their opinions of what they would want in the end of their life?  More on this subject here.

And back from that aspect….how can you support their medication delivery or a good review of whether their medications should be addressed for side effects and deprescribing?   How can you help them manage their multitude of physicians or whether it is time to consolidate their medical care to one or two trusted physicians. 

Cognitive health

Do they have any memory, thinking or emotional issues that require assistance? 

Many of our parents will have cognitive loss.  

What will you be looking for to assess whether this is happening with your parent? An excellent resource to help you decide if the changes are real is the AD8, an 8 item questionnaire to address whether there have been changes seen by an observer. 

The AD8 is, however, quite sensitive to detecting early cognitive changes associated many common neurocogntive illnesses including Alzheimer disease, vascular dementia, Lewy body dementia and frontotemporal dementia. The 8 questions if there has been a change in the last several years in key areas: judgment; interest in hobbies or activities; repeating same thing over and over; trouble learning to use new tool, appliance or gadget; forgets correct month or year; trouble handling complicated financial situations; trouble remembering appointments; daily problems with thinking or memory.

If more than two of these have changed, a cognitive evaluation is warranted.

[Adapted from Galvin JE et al, The AD8, a brief informant interview to detect dementia, Neurology 2005:65:55]

Personal hygiene: 

Can they bathe, dress and perform other personal care tasks without help?

Are you noticing less careful care in their hygiene? 

Meal preparation: 

Are they able to plan, purchase and cook meals independently?

Are they beginning to eat the same foods? 

Are they no longer cooking meals for themselves? 

Home safety

Is the home free from fall hazards, such as slippery floors or uneven surfaces?

Have there been any falls? 

Can they safely get into and out of the shower? 

Is the laundry accessible without navigating stairs?

Just time to take stock

Once you’ve assessed your parent’s needs in these areas, you can begin to think about the next steps. 

The first step, of course, is to speak with your parents.  If there are no concerns, it is time to begin to lay the groundwork for prevention.  Start the conversation that you would like to plan for how you can support each other going forward.  

If you have concerns, just spend some time with them.  Nothing needs to be done emergently.  You will need to explore how to bring the concerns up with your parents to honor their choices.  

To honor your needs, you can 

• Determine what can be done by family members, friends or community organizations such as meal delivery services.

• Research resources like government programs, home care agencies and senior centers.

• Speak to your parent’s healthcare provider, who can provide guidance on medical issues and suggest appropriate support services.

• Consider whether your parent would benefit from moving to a senior living community that offers medical and personal care services.

But remember, these steps are done for you!  You will need to speak to your parents before pushing forward with any plan. 

Conclusion

This is just a beginning.  

Please take your time. 

This step helps you gather your information so that you can have meaningful and thoughtful conversations with your parents about their needs, concerns and plans.  

What is your intention?  Likely it is to have your parent have the highest quality of life possible within their goals of care.  

Thank you for taking time to make this happen.