Content

The Expert Perspective

 
Dr. Michael Gordon, Geriatrician

Dr. Michael Gordon is a prominent Geriatrician at Baycrest, a major health sciences facility in Toronto for the care of aging adults. He has seen many families learning to manage aging, and is co-author of "Parenting Your Parents".

Independence, competency and control

Dr. Gordon explains that, as a child, you assume that your parents do safe things. As they age, however, and their abilities are diminished, adult children then become concerned about their parents' safety.

The natural reaction is to want to protect. However, parents may feel that they are fine. This can result in a period of discord between what the parent and child feel is a suitable life style. Adult children have to accept that parents do things with an element of danger, that activity and independence are very important to them, even though bad accidents can happen.
Living alone in the family home often becomes an issue. Rather than pushing too hard for a move to a seniors’ facility, children have to look for ways to improve safety in stages; using technology such as personal alarms, handrails, scooters, and even hiring people to come into the home and help. If necessary, trying out solutions on a temporary basis can help introduce new solutions.

Independence goes beyond the functional definition of doing something with as little help as possible. It can also be defined as doing what you want to do, regardless of how much help you engage.
For aging people, independence is probably best defined as being able to decide what you want to do and being able to get it done, and often that means organizing other people to help you get it done.
Aging generally does not affect all faculties at once; people can have a range of being independent in some domains, and dependant in others.

Memory loss

Everyone who ages experiences some loss of memory capabilities, but we learn to compensate for normal aging losses.
For instance, highly competent people are very good at multitasking. As time goes on, they find they can’t do that as well, and accommodate by doing less multitasking, or by leaving notes to remember where we left off on each task.
Another common challenge is remembering peoples’ names. People should not feel that they are experiencing dementia if a life-long difficulty remembering names has become more pronounced. They need to put more effort into techniques for remembering names.
Adult children may recognize memory problems when they see a significant change in their parents’ behaviour with respect to short term memory; such as having to discuss recent news over and over again with a parent who had no such difficulty in the past.

Long Term Memories

People with dementia generally experience reduced short term memory, but even in very late stages, their memories of events in their past lives are still there and accessible. As long as older people can communicate, there are means of bringing back good feelings. Stories, photographs and music can bring back good memories and provide great satisfaction.
When someone has reached the stage where they have lost the ability for verbal expression, children should assume that the they can still hear voices and feel their touch.

Personality change

Generally, an individual’s personality remains quite consistent as they age. However, there are some circumstances which will cause changes in behaviour.
People who moderated their behaviour a great deal to fit into their social environment may loose their ability to moderate, and difficult aspects of their personality may become evident.
For others, when loss of various abilities impairs their ability to express themselves, or to get things done, the frustration they experience may result in atypical outbursts.

Siblings

Although siblings may have common values and experiences, they will disagree on many things.
In Dr. Gordon’s experience, children will express different views about what is going on with their parents, be concerned about different things, and bring different abilities to the table.
If siblings as a group develop a framework as to who will be responsible for what decision-making in various situations, and respect each others’ roles, they can generally manage well despite their differences.

Communicating

In order to help our parents enjoy a good life in their final years, we need to understand what they want. Communications between children and their parents may or may not have been great in the past, and may have avoided difficult personal topics, but while parents are still well enough to talk, the adult children need to establish a new level of communications to understand their parents' perspective on issues such as the extent of life support treatment they would want.
These are difficult topics, and children may need to try a variety of techniques to help their parents be comfortable in talking about end of life care, so that they have guidance in the event of a severe illness that takes away the parents’ ability to communicate.

3rd party help

Third parties can play a useful role in making difficult decisions, particularly when there is disagreement among siblings, or differences between what the parent wants and what the children think is right.
The third party advisor can be a friend or a professional who has known the family a long time, or often the family turns to a health professional involved with the parent at the time.
The role should be to mediate and help the family work through the decision with respect for all parties, and come up with at least an interim decision, with a plan to come back and review the decision at a later date.
Some health professionals go beyond the mediation role and “prescribe” a solution for the patient.

 

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