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Keeping Your Parents Healthy
By Sheryl Gay Stolberg
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5. Watch for signs of depression. It's a prevalent problem among the elderly, yet it is widely under-recognized and undertreated. Depression often occurs alongside other illnesses, including heart disease, stroke, diabetes and cancer, so many health professionals mistakenly conclude that it's a normal consequence of these problems, and they fail to treat it. Brummel-Smith remembers one patient who was confused and lethargic; the primary-care doctor had dismissed her problems as old age. "The family was told she had dementia and nothing could be done," he says. "She came to us after the baby-boomer daughter thought this was an inadequate evaluation." The older woman was actually suffering from a thyroid hormone deficiency (a common physical cause of depression among seniors); her condition improved with proper medication.
The symptoms of depression include memory problems or confusion, social withdrawal, change in sleep or appetite, rumination over past mistakes or hurts, guilt and excessive negativity. Dr. Diane E. Meier, a geriatrician and director of the palliative-care program at Mt. Sinai School of Medicine in New York, says the best screening test is one simple question: "Are you depressed?"
If you suspect your parent is suffering from depression, inform the primary-care doctor. He or she should test your parent for a thyroid disorder and other undiagnosed illnesses. In most cases, elderly patients with depression respond well to standard antidepression therapy, says Meier. If they don't, then you should request a referral to a geriatric psychiatrist. You'll find referrals and more details on depression at the National Alliance for the Mentally Ill (800-950-6264; www.nami.org) and the American Association for Geriatric Psychiatry (301-654-7850; www.aagpgpa.org).
6. Prevent medication errors. The average 75-year-old may take seven or eight different drugs at once to treat various illnesses, and sometimes to treat the side effects of other medications. Dealing with so many prescriptions greatly increases people's chances of falling victim to dangerous or fatal drug combinations, either through their own mistakes or those of their physicians.
A complicating factor is that people metabolize medicines differently as they grow older. Their kidneys don't function as well and become less efficient at clearing drugs from the body.
"The whole system is just more sensitive," says Linda Phillips, co-director of the Center on Aging at the University of Arizona (520-626-5800; www.aging.arizona.edu). "And there are some medications—including certain sleeping pills and pain medications—that just don't do well with older people." Errors by doctors and pharmacists are frequent; a recent study in The Journal of the American Medical Association reported that one-fifth of all elderly Americans have been prescribed drugs deemed dangerous for older people.
Signs that your mom or dad may be overmedicated include unexplained weight loss, frailty or diminished function. (Medication errors are often to blame for falls, which are a leading cause of death in elderly people.) If you spot any of these symptoms, ask your parent's doctor (who may not have written all the prescriptions) or a geriatrician to re-evaluate your parent's drug intake. Also, ask the doctor what each drug's purpose is, and—importantly—when it can be discontinued. Many physicians are content to keep renewing an older person's prescriptions so long as there is no evidence it's doing harm. But, "the geriatrician's philosophy," Brummel-Smith says, "is to ask, 'Is there any evidence this medicine is still helping?' If not, then I try to stop it."
7. Be prepared to take control. It's crucial to know the specifics about what treatment your parent would want should he or she become gravely sick and unable to make decisions, because these decisions usually end up being made by family members, says Meier.
You should have a copy of your parent's advance directives—documents that give written instructions about your parent's wishes in the event he or she becomes incapacitated. This can take the form of a living will, a health-care proxy or health-care power of attorney. Typically, advance directives designate a health-care proxy (often a son or daughter) to make medical decisions for the patient. You'll find examples of advance directives, and specific forms for your state, at www.partnershipforcaring.org. Be certain that you inform your parent's doctor and hospital officials about the orders in these documents.
Without knowing your parent's wishes, doctors may provide unwanted treatment. As devastating as it is to lose a parent, adds Meier, it can be worse if you feel you haven't done what your mom or dad would have wanted.
8. Understand hospice care. Hospice offers comprehensive home care with health aides, social-worker visits, prescription medications and other forms of comfort to Medicare beneficiaries (as well as those with private health insurance) who are terminally ill. It may be the best-kept secret in medicine.
To qualify for hospice care, a doctor must certify that if a patient's disease follows its usual course, he or she will die within six months. Upon entering the program, the patient waives the right to insurance coverage for so-called "curative therapy." Patients typically consider hospice care when other treatments no longer hold promise for them. Yet most enter hospice too late to really benefit from it; many patients and doctors avoid it because they think signing up for a hospice program is tantamount to giving up.
That is not the case, says Dr. Joanne Lynn, of the Washington Home Center for Palliative Care Studies, a research organization that studies the end of life. Patients can switch back and forth between hospice care and the regular Medicare program. And many improve, living longer than expected, because of the excellent care provided by most hospice programs.
"Hospice is the only widely available comprehensive service" for the terminally ill, Lynn says. She tells patients to ask their doctor to certify them as soon as their condition justifies it. Patients who don't qualify for hospice may be eligible for "palliative care," which is a hospital-based option that emphasizes quality of life for patients with chronic and advanced illnesses.
For details on hospice and palliative care, contact Americans for Better Care of the Dying (202-895-2660; www.abcd-caring.org), the Hospice Foundation of America (800-854-3402; www.hospicefoundation.org), the National Hospice and Palliative Care Organization (800-658-8898; www.nhpco.org) and the Hospice Association of America (202-546-4759; www.hospice-america.org).
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