On your next visit, look for these clues to know when to step in
and seek help.
By Lisa Esposito Staff Writer March 30, 2016,
at 11:03 a.m.
"I'M DOING
FINE." IT'S reassuring
to hear when you call a parent who lives far away. But the fact is, seniors
living alone in their 70s and beyond may keep serious problems to themselves
because they don't want to worry you or feel like a burden. Sometimes it takes
a crisis – like a call from the hospital – to realize how far from fine a
family member really is. Visiting in person is the best way to see what's what,
experts agree. And witnessing the gaps in a parent's well-being is the first
step to getting
the right help.
Pride and Independence
Amoke Alakoye, of Silver Spring,
Maryland, is a dedicated family
caregiver. Alakoye lives with and looks after her mother, a multiple stroke
survivor. She also acts as the long-distance caregiver for her aunt in
Philadelphia. The two elderly siblings are in daily contact, Alakoye says, by
phone or online. During her own frequent phone chats, Alakoye says, her aunt is
more likely to say "I'm fine" than speak frankly about any
difficulties.
It took a weekend family celebration for
Alakoye to get a truer picture. In their shared hotel suite, she could see her
aunt struggling
with arthritis and other health problems, affecting her hygiene and
grooming. "I said, 'Oh, we're going to have a spa day,'" Alakoye
recalls. "So she wouldn't be upset with me. So I could bathe her and show
her how, if she lived in an assisted living facility, they'd have a roll-in
shower." But her aunt still lives alone in her home with its standard
bathtub, so Alakoye has arranged for a home health aide who comes in several
times a week.
Alakoye's personal experiences with caregiving
have motivated her to become a gerontologist. But as many experts in
helping professions find, Alakoye's most challenging cases are her own flesh
and blood. It requires tact and diplomacy to suggest changes or solutions.
"I can't tell you about the level of cajoling that goes into it at
this point, because there's a lot of pride," she says. "They cared
for you. How dare you tell them now what to do?"
What to Look For
Nora Jean Levin, executive director
of Caring from a Distance,
says holidays are prime times for concerned adult children to notice problems
and reach out to her organization.
"Suddenly they have noticed as they're in
the house: The mail is piling up; the garden hasn't been tended to; the laundry
is all over the place; the house doesn't look good," Levin says. "Or
the family member looks very pale; they may not be taking their medications as
they're supposed to be."
Sandy Markwood, CEO of the National Association of Area
Agencies on Aging, says transportation is a huge issue for seniors and
the top reason people ask about elder care. Scrapes on the car door can be
clues indicating trouble, she says. Parents may limit driving at night or
make excuses not to go to the doctor because it's raining. The issue becomes
how to prevent accidents while keeping parents' worlds from shrinking.
In the kitchen, ominous signs include charred
pots and pans or burn marks on the stove or countertops. Expired food in the
refrigerator can signal problems with regular grocery shopping and good
nutrition.
Unfilled prescriptions or chaotic
medicine assortments suggest needed treatments are being missed or the
potential for dangerous drug mix-ups. "The other thing is
bruises," Markwood says, "when somebody is bumping into the furniture
or falling." Taking a tour of the house can reveal fall-related
hazards and suggest solutions.
Face-to-face conversations can give you a lot
of insight. You could pick up on a parent's disorientation or confusion,
Markwood says. Parents who don't want to do things they've always done, display changes
in mood or personality or don't get out anymore could indicate early-onset
depression.
Caregivers in a couple may be struggling, too.
"The stress of caregiving can often impact the quote-unquote 'well' spouse
to the point that they become ill and they're both in a compromised health
situation," Markwood says. "If you've got an 85-year-old caring for
an 89-year-old, they probably both need some support."
In a recent study of senior housing, nearly 35
percent of the older adults interviewed were classified as socially isolated
but unrecognized as such by staff, says study co-author Harry Owen Taylor, a
doctoral student in social work at Washington University in St. Louis.
There was a strong connection between
subjective isolation – when people perceived themselves as isolated – and
symptoms of anxiety and depression. Seniors with friends and family living
nearby did significantly better, Taylor says.
Neighbors Know
"My feeling is that aging in place works
until it doesn't," says Alice Fisher, founder of the Radical Age Movement.
She's seen several elderly relatives cross that line.
Until last year, Fisher's mother-in-law, then
91, lived alone in Delray Beach, Florida. During previous family visits, she
appeared a bit frailer each time. "The last couple of times we begged her
to let us move her to New York," Fisher says. "She was a very
independent, forceful woman who said, 'Absolutely not.'"
Last October, an alarming phone call changed
everything. Fisher's mother-in-law reluctantly admitted she had fallen on the
floor and lain there several hours before somebody found her. After the
hospital staff bandaged wounds on her legs and released her, a
next-door neighbor brought her home.
To the couple's shock, the neighbor later told
them there had been several previous fall-related incidents in which Fisher's
mother-in-law promised to inform the family but never followed through. This
time, Fisher says, "Her neighbor told her, 'I want you to call your
children now, while I'm here. Because I'm not leaving until you do.'"
Robin Levine, a retired medical geriatric
social worker who worked in New York and now resides in Florida, sees many such
situations. Parents don't want seem needy, Levine says. "The children are
busy; they're working; they have kids. So they say, 'Yeah, everything's fine.'
And when a child eventually does come down, they say, 'Oh my gosh, you're not
fine – you're not fine at all.'"
Start seeking help when you first feel uneasy.
"You will realize after that you should have done it a while ago,"
Levine says. Her other advice to adult children living at a distance:
"Open your eyes. Try and really see what's going on and not what you want
to be going on."
Pressure to Age in Place
Society sends a strong message that successful
aging means living continuously in your own home for as long as possible, says
Stephen Golant, a University of Florida gerontologist and
geographer and author of "Aging in the Right Place."
It may take a crisis or major upheaval to make
people rethink the matter, Golant says, such as the death of a spouse, a
serious fall, a bad car accident or repeated hospitalizations. The challenging
gray area is when less-dramatic events begin to add up, he says.
Hired caregivers can fill gaps, Golant says.
But it's hard to substitute for a family member during the vulnerable period
after a hospital
discharge, for instance, when someone needs to talk to health
care providers and make sure the patient receives follow-up treatments
and is taking medicine properly.
There can be a tipping point when it's clear
that aging in place isn't working. For the older person, Golant says, it's when
the feeling of incompetence and being out of control trumps the familiar
comfort and attachment
to home – memories, friends and possessions.
From the perspective of the concerned family
member, he says, "It's when your uncertainty level reaches a point where
you dread receiving a phone call at any time of the day or night."
"As much as possible, recognize you're
dealing with someone who has had a very rich and competent and wonderful
life," Golant says. "And as much as possible, respect their integrity
and desire to age in place." At the same time, he adds, recognize when
living on their own puts parents' security and quality of life at risk.
Editor's Note: This story was written with
support from the Journalists in Aging Fellowships, a program of New America
Media and the Gerontological Society of America, sponsored by the Silver
Century Foundation.
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