What to
know to become your parents’ advocate
by Sharona Hoffman |June 25, 2019
The population of
people age 65 or over in the United States neared 48 million
last year and is steadily growing. Consequently, millions of adult children
find themselves taking care of their parents’ medical needs.
This can be a
daunting task because many older individuals have complex health conditions.
According to the National Council on Aging, almost 70% of seniors have two or more
chronic diseases. As a result, they see an average of four different
specialists a year.
Taking a lot of
different drugs can lead to troublesome side effects or drug interactions.
Having specialists who do not necessarily communicate with each other can lead
to other complications.
What can you do to
try to avoid these problems? The answer is: Learn to ask questions and become
your parents’ advocate.
I am a professor of
law and bioethics and was involved in my own parents’ care at the end of their
lives. As I wrote about in my book, “Aging with a
Plan: How A Little Thought Today Can Vastly Improve Your Tomorrow,” I
have learned that you can do a great deal to help oversee loved ones’ health
care and to avoid some of its pitfalls.
Here are five key
questions that you should not hesitate to ask.
1. Does my parent
really need this many drugs?
Be familiar with your
loved one’s full medication list, and keep track of any changes. If the list is
long and a doctor wants to add another drug, ask if it is really necessary.
You should also
request that your parent’s geriatrician or primary care physician review the
complete medication list periodically. Does it raise any concerns?
In 2012, about a year
before she died, my mother suddenly seemed to lose her mental capacities. In a
matter of two days, she went from being a frail but clear-minded 83-year-old to
acting as though she had advanced dementia. She stopped wanting to eat, stopped
communicating and slept most of the day.
After an agonizing
period of trying to figure out what was wrong, it turned out to be a drug-drug
interaction. She was 83 and weighed only 104 pounds.
Yet, she had been on
12 drugs, and a doctor added an unlucky 13th. We slowly eliminated most of the
drugs and got her down to five essential medicines.
She slowly regained
her cognitive capacities, but there were two months during which she had no
memory.
My mother’s story is
not unique – I have since read and heard others like it. It should be a
cautionary tale for anyone with a very long medication list.
2. What are the side
effects of the drug you are recommending?
Drug side effects can
cause serious discomfort and mental deterioration. You need to know about side
effects and think about them when considering new drugs for your loved one.
My husband was
diagnosed with Parkinson’s disease at the age of 55. Early on, we consulted a
physician who recommended that he try a particular medication. I noticed that
the doctor did not mention side effects.
I asked about the
medication’s side effects, and the doctor responded that most patients tolerate
it beautifully. Nevertheless, I asked, “What about those who don’t tolerate it
well?”
The doctor
acknowledged that one in five patients find that it dulls their mind. That was
an unacceptable side effect for us. Andy is a computer science professor and
enjoys his career, so we could not take a 20 \% chance that his mind would be
dulled. But we would not have known of that possibility if I had not asked the
question.
3. Are there other,
less aggressive alternatives we should consider first?
In some cases, there
is no alternative to surgery, and it will be lifesaving. However, in other
instances, there are a lot of options, such as physical therapy, acupuncture
and other interventions.
Some experts believe
that surgery and anesthesia can cause cognitive
decline in elderly patients, especially if they already have
dementia. If the doctor recommends surgery or another aggressive treatment in a
nonemergency situation, it is worth asking about alternatives.
4. How can we reduce
her or his discomfort?
While patients often
get too much treatment, at times they do not have their painful symptoms
treated adequately. Some people do not want to complain to their doctors and
ask for relief even in the face of acute suffering. They are shy about
asserting themselves or do not want physicians to think less of them for being
unable to tolerate discomfort.
In other cases,
doctors hesitate to provide additional pain relief. They fear that patients
will become addicted to powerful drugs. Yet pain can slow healing and
cause significant mental stress for patients and their caregivers.
If you know your
loved one is suffering severe pain, nausea or other discomfort, press the
doctors to provide more relief.
5. What would you do
if this were your parent?
At the same time,
doctors might provide you with several options and little guidance as to the
best course of action. They may say, “We can do tests to rule out various
illnesses, or we can wait and see if symptoms improve. What do you want to do?”
If you have no idea, consider asking, “What would you do if this were your
mother?”
You may be surprised
by how helpful their answers are if you ask them to step into your shoes.
Our time with health
care providers is precious and often scarce. When you see a doctor with your
elderly parent, feel empowered to be an advocate, ask questions and express
your needs.
This article is
republished from The Conversation under a
Creative Commons license. Read the original article.
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