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Keeping Your Parents Healthy
By Sheryl Gay Stolberg
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2. Consult a geriatrician. These physicians specialize in dealing with seniors and are attuned to the quality-of-life issues (Can your father get out of bed in the morning? Is he incontinent?) that may be more important than disease. If the primary-care doctor does not seem to be adequately addressing your parent's concerns, ask that he or she refer your parent to a geriatrician for a consultation; Medicare will cover the cost as it would any other specialist visit.
The geriatrician's evaluations can offer insight into the quality of care your parent is receiving—and suggest improvements. It's a good idea to accompany your parent to the geriatrician, because most of them prefer a family member to be present to help with fact-gathering. You can find experienced geriatricians at most university medical centers or get a referral through the Foundation for Health in Aging (800-247-4779; www.healthinaging.org), which is part of the American Geriatrics Society (212-308-1414; www.americangeriatrics.org). Also helpful is the National Association of Professional Geriatric Care Managers (520-881-8008; www.caremanager.org).
Case in point: Daniel Perry, executive director of the Alliance for Aging Research (202-293-2856; www.agingresearch.org) in Washington, D.C., was worried about his 84-year-old mother in California. She had suffered a series of falls and was on pain medication. Perry also knew she was exhausted from caring for her husband (who has Parkinson's disease), and she had been taking sleeping pills. Following a hunch that the primary-care doctor wasn't doing all he could, Perry arranged for his mother to visit the geriatrics clinic at the University of California at San Francisco.
After the geriatricians performed an assessment of her health history and sent Perry a six-page letter detailing the results, the clinic recommended a series of neurological tests to find underlying reasons for the falls. They suggested that Perry's mother quit taking the sleeping pills and cut down on her pain medication. She did, and the falling stopped. Perry had to pay $600 for this special evaluation, as his mother's health insurer considered it beyond normal geriatrician services, but he feels it was worth the expense. The cost of comprehensive geriatric assessments ranges from about $200 to $750 across the country, and, depending on the situation, Medicare or private health insurance may cover it.
3. Learn to talk to doctors. That sounds easy, and it is—if you are the patient. But when you are coordinating your mother's medical care, you're the third wheel in the doctor-patient relationship. This situation can be delicate at best, as Kathy Timcho recently learned. A 47-year-old legal secretary in Atlanta, Timcho is helping to care for her mother-in-law. The older woman has grown so forgetful she can no longer be left to care for herself. But when Timcho takes her mother-in-law to the doctor, she has trouble convincing the physician that there are any problems.
For example, when her doctor asked "Are you able to pay all your bills?" Timcho explains, her mother-in-law replied "yes," and he wrote this response down in her file.
"Yet here I am, caring for her, and I see that she is completely incapable of caring for herself," she says.
You can keep the doctor informed through better communication, says Suzanne Mintz, president of the National Family Caregivers Association (800-896-3650; www.nfcacares.org). She suggests setting up a time to talk with the doctor privately, with your parent's consent if possible, so you can share your concerns and provide helpful information that your parent may not have passed along. You could use the following pitch: "Yes, my mom is your patient, but she doesn't tell you everything that happens when she comes here to see you. I can serve as your eyes and ears, as her health-care advocate."
To make interactions go smoothly, Mintz suggests learning the physician's preferences. What is the best time to call his or her office—say, early morning or late in the day? Is fax or e-mail an option? Can a nurse or a social worker handle less urgent questions?
"You want to build a sense of collaboration between yourself and the doctor," says Mintz. "You want to focus on common goals. The common goal is mom's health."
For tips on communicating with doctors, check
www.aarp.org/confacts/
caregive/healthprof.html.
4. Make every doctor's visit count. When you accompany your parent to the doctor's office, come armed with two lists, says Dr. John Cacciamani, a geriatrician at the University of Pennsylvania. The first list should provide the doctor with an overall snapshot of your parent's health care. It includes all doctors your parent has seen, all medications being taken (including the name of the prescribing physician and the reason each drug was prescribed), any allergies (especially medication allergies) and a list of current and past diagnoses, surgeries or any other relevant medical information.
The second list will state the reasons your parent is coming in for this particular visit. "I encourage patients to take a significant amount of time reflecting on problematic things that happened since the last office visit," says Cacciamani, who works with the nonprofit organization Children of Aging Parents (800-227-7294; www.caps4caregivers.org).
Two bits of advice: Keep a brief journal for yourself. When you talk to your parents, jot down their medical complaints. When they are prescribed new drugs, photocopy the label. Then you'll have your own record in case your dad's paperwork disappears. Next, bring all your parent's pills in their original containers, including over-the-counter medications, to every office visit. This lets the physician know when the prescription was written and by whom—two key details for determining whether any drug is still necessary. If you live far from your parent, ask a sibling or a trusted family friend to assist with these tasks.
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