Aging parents: do these changes mean something? Part 2
by Kathryn Kilpatrick
"Are these red flags or just normal aging?" This is a frequently asked question by the adult children of aging parents. Being alert to how changes in functioning might impact the life of a loved one can mean the difference between being proactive or missing the opportunity to begin some of those important conversations.
What I am seeing in recent years are more older adults that are living alone. Their families are living out of the area or are very busy, and some may be emotionally unavailable. It really takes more than a quick visit or a few phone calls to notice the subtle changes, some of which are already impacting the safety and quality of life of the parents. Family members might try spending at least three or four days with their loved one, not only in their environment but away from home, overnight if possible. Many older adults can function fairly well in familiar surroundings, as long as they adhere closely to their routine. Taking them into a different environment with unfamiliar or hectic routines can be quite revealing.
Recently. several families whose loved ones had a diagnosis of Alzheimer's disease shared their perspective with me and it was the same in each case. Each had concerns about what was going on long before they stepped in. Either they did not see what was happening, or the parent was able to compensate very well for the short periods of time the families were together.
Now they were dealing with a more serious situation from the standpoint of safety and major decisions needed to be made. When there are short term memory and cognitive issues, sometimes loved ones, set in their ways, will resist what needs to be done. If a person's judgment and problem solving skills are compromised, that person is unlikely to see the implications of the choices that are being made in their day to day routine.
Based on decades of talking with families and caregivers who have shared their experiences, concerns and frustrations and then assessing patients in their homes, these are some key questions I feel might help you get started. Even if you think the situation is not of concern at the moment, this information will help to increase your awareness as you support an older adult to be as safe and independent as possible.
- Are you hearing frequent complaints of forgetfulness, references to senior moments or have concerns that the person's memory seems to be getting worse? The first step is learning more about the causes of memory loss including those that are reversible, and what the appropriate resources might be for a particular situation. Often memory strategies and communication tips are needed that are geared to the person's strengths and their daily routine. A complete physical is essential, and in some cases, a geriatric assessment may be indicated. It is important to look ahead on ways to enhance the parent's safety and quality of life if there are more serious concerns. Being proactive can be beneficial for all involved.
- Do you notice frequent word finding difficulties, repeated questions, and repetition of the same information? Is there less participation in conversations? Is there a hearing loss? With normal aging comes increased word finding difficulties. However, when changes are noted that begin to interfere with communication, there are many strategies that can be used to compensate for the difficulties. Frequently a person will start to withdraw from activities which can greatly impact their quality of life. In some cases, a person with a hearing loss may also have some significant memory loss, but it is not as easily recognized. If a further assessment indicates Alzheimer's disease or some other related dementia, a referral to a speech-language pathologist might be beneficial for communication strategies.
- Have you noticed increased moodiness, agitation, and changes in their behavior? In some cases, this may be the first sign of some increased cognitive and memory difficulties. Sometimes this behavior may only be noticed when there is too much activity going on, too much noise, or when things are at a faster pace than can be handled. Further assessment might be indicated. Tips on how to modify communication and daily routines may decrease overall frustrations and perhaps reduce some of their difficult behaviors.
- Do you notice less involvement in activities that require a lot of thinking, planning, and/or problem solving? Is there an overall decreased interest in doing things or going places? If a person has significant memory problems, they may only get involved in activities if someone plans the activity and does it with them. A geriatric assessment may help to determine if these subtle changes are caused by some decrease in hearing, cognitive functioning, or perhaps other areas that might need to be considered, including depression or fear of falling.
Look for future blogs on the subject of challenging family dynamics, because unfortunately this occurs quite often and takes away from the focus on the older adult's situation. One person in the family may pick up more readily on the inconsistencies or the behaviors, while others may not think it is a problem. The person may not be in denial, they may just not really understand what is happening. It is possible that someone thinks it is normal aging while another has a pertinent background, or has done more research and is beginning to use that information to be more observant. What is important to remember is those caring about a loved one could benefit from an attitude of co-operation. There can be a sharing of observations with the purpose of finding appropriate professional resources to address the concerns and options. Additional questions are addressed in part two of this article.
"To teach is to understand. To learn is wisdom. To learn together is understanding wisdom." Sid Mendenhall