No doubt about it; with regard to relationships, the holiday season can be a decidedly mixed blessing. On the one hand, we get to see friends and family that we missed over the past year and rekindle those bonds. On the other hand, the holiday season can also rekindle old animosities, brother/sister spats and a litany of other slights -- perceived or real -- that never got resolved in the first place. You don't really believe those sibling rivalries actually died when you left the sandbox or moved out, do you?
As a geriatrician, I get to see another stressful family byproduct of the holiday season (and the couple of months that follow as parents and adult children invariably assemble in my office): the realization that mom or dad may be "slowing down" in ways one or more siblings might not have recognized during the preceding year. This is especially true when folks live far apart from one another, and the holiday season brings them together in a kind of "freeze frame," that can be jarring if this is the first physical interaction you've had with a parent in the past year. Often those children who live close by (or with) an aging parent don't recognize concerning decline in their day to day interactions. In quiet whispers, the distant sibling contingent convenes in the holiday kitchen and express concern over "how old mom suddenly looks," or "how dad seems to have lost his memory or moves so slowly." Sometimes ire is directed at the live-in or nearby sibling for not communicating what's been happening over the past year, further stoking an already stressful family get together.
Typically, I see a slew of new patients in my office in January, whose families have brought them kicking and screaming for an evaluation based on the holiday "drive by." Since "tis is the season" for this phenomenon, I thought I'd offer a few thoughts on how to proceed not only medically with mom or dad, but also on how to preserve domestic tranquility if you find yourself involved in one of these holiday aging excursions:
- Remember that Mom or Dad is the (potential) patient, and that he or she has a right to privacy, dignity and autonomy. I'm sure you're all well meaning, but slinking around his or her back to arrange some kind of medical or social intervention will most certainly backfire, no matter how well intended. Calmly and lovingly explain your concerns to your parent, and ask them if they perceive any problem.
- Ask them if they've communicated any of this to their primary care doctor. Many problems that older patients face are missed by primary care physicians because they do not manifest themselves in the doctor's office. Falling is a great example. About 1/4th of people over 65 fall at least once annually, but many doctors don't ask, and if you're not falling in the office, the doc will not know. Encourage mom or dad to communicate problems like memory loss, falling, mobility problems, low mood and urinary incontinence, which get more common as we age, but frequently missed in "traditional" office practice.
- If you're accompanying mom or dad to the doctor, there are some helpful things you can do, but beware. Accompanying mom or dad to a doctor's visit is a double-edged sword; on the one hand you may be able to identify and articulate problems they do not. On the other hand, studies show that in so called "triadic" encounters, mom or dad sometimes becomes an object in the room, and the conversation is monopolized by the adult child, or the doc talks to son or daughter, inadvertently ignoring the patient. If the doctor does this, kindly redirect the conversation to your parent.
- Don't blame your local sibling. Its easy to blame a local brother or sister for being asleep at the switch when mom or dad is failing, but it usually accomplishes nothing and only serves to drive a wedge between siblings with the same goals: helping a parent. Most local caregivers are stressed out, and often provide care at the expense of their own mental health, career or family plans. Another point: family caregiving is a decidedly sexist business; caregivers are overwhelmingly adult daughters or other women in the family even when there are many adult sons. Men, step up to the plate, and at the very least don't criticize your sister if she's doing the heavy lifting until you do some yourself!
- If you or your parents are not getting satisfaction from your parent's doctor, find a geriatrician. Many primary care physicians are ill equipped to deal with the kinds of problems older patients have. Barriers include no training (geriatrics is a new specialty may not have been taught when they were in medical school) or lack of time to conduct the detailed assessments older patients need. In my book, "Treat Me, Not My Age" I explain to boomers and parents how to find a geriatrician (there aren't many of us) or at least a "gero-friendly primary care doc". One good place is thru the American Geriatric Society
- Consider Geriatric Care Management if no one is local. One increasingly common phenomenon is that there is no local sibling to do the day to day looking in on mom and dad; it's a function of our mobile society. Decades ago families lived together with several generations of family in the same home -- including mom and dad or grandma and grandpa. One modern day solution to this problem is the geriatric care manager. These are highly trained individuals who can coordinate the medical and social needs of a parent and report back to you if there is a problem. Find one through the National Association of Geriatric Care Managers.
- New Technology is coming to Help Boomers and Parents. A slew of innovative technologies are on the way and some are already here. In "Treat Me, Not My Age," I describe one of my older bachelor patients who hated having a live-in companion to assure his safety -- it was expensive and cramped his style. My solution was to install a WiFi based system that unobtrusively learned his movement patterns and now sends an email to his adult children across the country if he fails to get out of bed by a certain hour or doesn't open his fridge within a defined period. Major companies are developing divisions aimed at this need; GE and Intel recently announced the creation of a new joint venture to create products for boomers and their parents.
One last point here to my older readers. I hope I haven't offended you by arming your well meaning adult children with ammunition intended to assuage their anxiety while assisting you. I'm well aware that you're the patient, and you have a right to privacy and the prerogative to tell your meddling adult kid to take a hike. But let me add another perspective: I've cared for thousands of older people over my career that had very significant medical and social needs, many adult children, but none that would help them or even return my phone calls. So if your adult child is meddling in your life, I'd like to make the case that you must have done something right in raising them. Pat yourself on the back for some excellent parenting!
Happy Holidays to an Aging America.
Follow Mark Lachs, M.D. on Twitter: www.twitter.com/DrMarkLachs