Summer Ideas for Getting Isolated-Feeling Parents Out of the House

Short trips ideas to help aging parents enjoy a change of scenery
Part One: general truisms and short outings.

  • If parents can get out to have you drive them to the doctor, they can manage these short trips.
  • A change of scenery adds something to life; we know that. While we take for granted the many changes of scenery in our every-day-life, older people who don’t drive and/or lack initiative often complain they “look at the four walls.”
  • “Feeling “isolated” can make anyone “dumb down,” lose interest, feel cranky.
  • Inertia can easily set in–an effort becomes too much of an effort.
  • Yet an invitation may provide a jump start.
  • If an invitation to accompany you some place doesn’t meet with enthusiasm or acceptance, trick them into going.  How? Using the “I need your help” plea, have them accompany you on a quick errand, then add one of the suggested short trips. Or attach a short outing after an appointment at the doctor’s office.
  • Provide something appealing to eat/drink–as simple as an ice cream cone or as elaborate as a meal.

I accidentally learned the next-to-last last truism after taking my–we-thought-almost-dying–mother for her first geriatric appointment at the teaching hospital.  She went in like a limp rag.  After tests and time with the geriatrician we wheeled her to the car, carefully seat-belted her in the back seat, and began the short ride home.  We passed gorgeous rose bushes that mother noticed and quietly commented on.  I asked if she had enough energy for me to drive her past some other homes with beautiful flowers. She responded “yes, if you make it short.”  Voila!

Short Summer Outings:

Sweet Memories–Picnic by the Ocean: Mother (79) and Me
Photographer: Dad

  • A scenic and relaxing drive. Final destination could be a place to eat. Every city and town has restaurants (sitting in a restaurant provides entertainment–people watching) and parks.  (Check Parks and Recreation Department for picnic tables, other amenities and handicap access if applicable.)  Possible sites: overlooking water, gardens, beautiful views. Nature is renewing.
  • Major botanical gardens, zoos, and museums (art museums, regional museums, specialized museums) often have facilities for lunch, have wheel chairs and are handicapped accessible.  Tailor length of visits to parents’ needs (which obviously don’t include waiting in long lines), so it makes sense to avoid busy times.

Stimulation helps parents age well. Pulling an unmotivated parent out of a funk feels good.  We need to remember people change, not much.  So an unmotivated, cranky young person will no doubt be an unmotivated cranky old person. We cannot perform miracles–alas! But when parents feel better, don’t we feel better?

Helping Aging Parents and Aging Pets. Deciding–Is it Easier/Better for Us or Easier/Better for Them

This is not about the life and death of an aging parent; but then again, it is.  Our 18-year-old cat was a parent of four before she came under our care—a stray one-year-old, who we found struggling to get suet we’d hung from a limb for the birds during the March 1993 blizzard.  She came fleetingly and sporadically at first– to eat chicken I put out for her–and ultimately worked her way into our garage, our home, and our hearts.

She was fiercely independent; resisted any obvious help we tried to give for many years. Inclement weather or not she refused to enter our home.  She enjoyed roaming around our property but was accustomed to handling her own affairs.  Only the food did she accept, but not if she thought we were watching (which we did through a window).

As she aged, her needs gradually changed.  She accepted more from us, on her terms of course.  Protection from other animals, who sometimes ate her food, sent her into our heated garage when we put her food there.  A cat door enabled her to come and go at will.  And in winter she jumped up on a box near the radiator, where we immediately added a carpet remnant for her comfort.  She kept us at arms’ length but obviously knew we were there for her.

When her life and limb were threatened after a cat fight, we trapped her and took her to the vet’s.  He suggested she might be better as an indoor cat in another home—translated: I was a bad mother.

But my husband and I knew this cat well.  She was miserable cooped up. When we tried putting her food in our kitchen, not one paw would cross the threshold unless we left a nearby door–or the door to the garage–open for a quick get-away.

When another cat found the cat door and thus our cat’s food, she became secure eating in the kitchen with her get-away-doors closed—until she was finished eating.  Then came the meow to leave. Of course, we complied.

During another bad winter several years ago, she decided to explore the main floor of our home and ended up sleeping on the carpet in front of a floor to ceiling window.  It was then—at age thirteen or fourteen—that she started to become a house cat.  While she spent as much time as possible outside, she came in to eat and sleep and began to let us pet her on a regular basis.  She expanded her territory in the house until she had explored every room from basement to attic.  She had favorite places to sleep, but never on the furniture.  And catching her for her yearly check-ups at the vet’s became less of an ordeal.

We came home one March night and saw her sitting in the living room, looking out the floor to ceiling window.  But she didn’t move—didn’t hear the door shut it seemed.  We called her name. She didn’t hear that either.  At 18 years of age, we knew some aging event was taking place.

And so we learned she was almost deaf and had kidney failure.  We were told we could give her fluids and it was easy to do.  We tried—it was easy—but it involved holding her.  Although she finally loved being petted, she never liked being held.  And she evaded us for days after catching her and doing the fluid routine.  So it came down to: is it better for her to live a little longer, feeling threatened by us and the life-extending fluids; or should she live less long and feel secure.

I thought back to a friend’s 90-something-year old mother who liked to have a drink or two but wasn’t allowed because of a medication—whereupon she stopped taking that medication.  When her child (my friend) asked my opinion, I put the question to her to answer.  Live longer or live happier?  She continued to drink and lived a very long life.  My friend helped her parent age well.

We watched out for our cat for 17 years.  She died just outside the door to our bedroom the other night.  And now she’s gone—leaving an unimaginable sadness.  When you put a lot into something, it means a lot to you.  And when you put even more than a lot into something, over time it penetrates and infiltrates every fiber of your being. Those who are dedicated caregivers know this.

We help aging parents; we help aging pets.  And it’s very hard to say goodbye– even when we’ve done our best and feel good that we let her (in this case) live life and ultimately leave life her way.

Helping Aging Parents Find “Best” Hospitals

When  there’s a serious medical emergency it’s probably safe to say few aging parents live near a hospital specializing in whatever caused the emergency.  Most of us–even those living near aging parents–don’t know the particular specialties at hospitals located nearby. A sudden emergency may leave little time to do the homework.

Three no-doubt-common scenarios follow, involving different situations and actions taken.  All happened in my family; all caused great concern; all turned out well.  All present strategies to help parents continue to age well.

#1.  Mother’s stroke experience: initially memorable for the emotional stress; equally memorable for the relief and sense of some control we felt once we found out–and got her to a place– where she could obtain appropriate treatment.

It began with phone call. Parents in California for the winter. Mother’s speech sounded “funny.”  Phoned my brother with concerns and a plea to fly to California immediately if possible (he was moving into a new home that day).  He got there quickly, phoned saying Mother was on her way to the hospital. I should fly out asap.

When I arrived at Mother’s bedside her speech was still garbled. Dinner was on a tray. She was eating the food with her hands. I’ve forgotten other details. A  terrific nurse updated me and said Mother’s physician would be in the next morning with test results. We learned they had limited the “damage;” there was nothing more they could do. Mother could go home later that day or the next with a caregiver, or go to a nursing home.  Dad would be unable to manage her care alone…a nursing home would be inevitable at some point.

I needed time to think.  Decided not to get a caregiver for that day.  Knew Mother would be safe overnight at the hospital.  I called a NY friend knowledgeable about medicine.  After some research, he phoned back. He said get her out of that hospital, which lacked neurology expertise, and to a neurologist at UCLA asap, and gave me a phone number. With great difficulty I got an out-patient appointment for the next day.

The next morning we picked Mother up at the hospital and drove to UCLA with films and reports. UCLA had newer technology.  New films were taken. The extent of the damage was clearly pin-pointed and Mother was given different medications, a prescription for physical therapy, and an appointment to return in a month.

There have been many advances in stroke treatment since.  I know Mother benefited from some because the neurologist said some were not widely used yet.  I also know a month later the improvement was so dramatic most people wouldn’t have known she’d had a stroke. Nor did she have any further strokes.
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#2.  A family member, also living in the west, was diagnosed with advanced colon cancer there. Treatment was about to begin. “Not there,” said my husband, who wanted to check Sloan-Kettering and knew we could be supportive if the family member came back.  Indeed Sloan-Kettering had top colon cancer people. Convincing someone to come all the way to NY, however, isn’t easy.  It’s easier when offered as “leaving no stone unturned”–making the trip to get a second opinion. That works.

While chronic health issues complicated things, Sloan-Kettering took charge: a top oncologist; an 8+ hour difficult surgery performed by a top surgeon (who had done complicated surgeries countless times); a while to recuperate in NY.  Instructions for additional “whatever” were given to the doctors in the west. Routine check-up visits show the surgery was a success.  Note: insurance often covers most everything done in hospitals.

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#3. Then there was Dad’s heart event in California shortly after his 76th birthday.  At the movies he began feeling dizzy, went to the theater lobby and sat down on the floor.  Someone came over to see if he was alright.  He wasn’t; his blood pressure was low. Paramedics were called. He was taken to the hospital where his internist practiced.  While it wasn’t the right hospital for my mother, it had a first-rate heart team whose surgeon did heart surgery on a former president several years later.  Dad had 5 bypasses on a Friday and went home the following Wednesday.  He aged well, lived to be 94, and his death was not heart-related.

So how do we generalize? When helping aging parents is a part of our life and our parents live long enough, the odds of serious medical problems necessitating hospitalization are great. Getting them to a hospital with the appropriate experienced specialists can increase the odds for a successful result that helps parents continue to age well…and medical insurance may make it more affordable than one might think.

Aging Parents, Best Hospitals, 16 Specialties, 5 Reasons to Consider Them

Mt. Sinai Hospital Ranked #1 in Geriatrics–2010-2011

PLEASE GO TO JULY 2013 POST FOR MOST RECENT UPDATES

Mt. Sinai Hospital’s Geriatrics Department, started by Dr. Robert Butler in 1982, (last Tuesday’s post) was ranked #1 in the August 2010  US News & World Report’s “Best Hospitals” issue, on news stands this week. An additional 49 hospitals’ geriatric departments complete the list.

Fifteen other specialty departments are also ranked. And Johns Hopkins Hospital ranks #1 as the top hospital in the country–having 15 of the 16 specialties ranking at or near the top. US News & World Report compiles this list every year (and has done so for over 20 years) “to guide patients who need an unusually high level of hospital care” (which includes high-risk patients).  Can’t this information be of enormous benefit to help aging parents?

Life takes on a more delicate balance as people age.  Making well-informed decisions ups the odds in our efforts to help parents age well.

5 reasons to consider the best hospitals’ specialties to help aging parents

1. Approximately the same time is involved, be it for procedures done in excellent hospitals or less than excellent hospitals; with excellent doctors or less excellent doctors. Only the outcomes may be different.

2. Quality of life is at risk; the more experienced the hospital and medical professionals are (the more times they’ve done your parents’ needed procedure) the better the odds to have encountered  and handled well unexpected problems.

3. Older people don’t bounce back so quickly. Patients lose independence in hospitals. It’s important they gain the confidence to feel some control. Ideally professionals working in the best hospitals’ specialties departments should have done “it” (what ever your parents’ medical situation is), worked with “it,” handled “it”–over and over and over.  Thus, they can instill confidence in you and your parents based on countless experiences with the expected and unexpected.

4. It takes hard work to recover well from certain procedures.  The skill of the professionals in the follow-up is a significant factor in hastening recovery and instilling a positive outlook. Elderly parents need to do whatever is necessary to move forward so the hospital experience doesn’t take then down a notch.

5. And yet–there are emergencies when we do what we must in a hurry. And there are times when we know the decisions we make are crucial and we may get only one chance to do it right. But even then, the professionals in the best hospitals can come to the rescue.

Have you had this experience?

Two true stories will bring the “best hospitals” theme to life in this coming Tuesday’s post. One an emergency (stroke); the other a well-thought out (after arguments and pressure) plan to treat advanced colon cancer. While not planned at the outset of the each health crisis, the best hospitals figured prominently in both. In the meantime, US News & World Report is at your newsstand now.

 

Robert Butler MD, 1927-2010: Helping Aging Parents–Yours and Mine

Every aging parent today and every child with an aging parent today has, I believe–whether aware of it or not–reaped benefits from Dr. Robert Butler’s work.  He brought the subject of “aging” and an awareness of our biased view (“old geezers”) to the forefront in the mid-1970’s and worked tirelessly throughout his life to research, impart information, and influence policy that ultimately changed attitudes and the way we support old age.

As we strive to help aging parents, we need to recognize that Dr. Butler pioneered the groundwork to help older people, then created, built and led organizations aimed at helping every senior to age better. To that end, let me share a personal experience as it pertained to helping my parents age well.

I remember, probably in the early 80’s, a friend telling me about a group who met at Mt. Sinai Hospital in NY, to talk about aging parents and family members.  I was asked if it interested me. Of course it did. I was acutely aware of living far from my parents who were aging and was also sensitive to aging parent/grandparent issues in my counselees’ families.  On the other hand, my Helping Children of Divorce book had been accepted for publication and my job at the high school plus family responsibilities made another commitment impossible. Never-the-less Mt. Sinai and “aging parents” remained on my radar.

In 1982 Dr. Butler founded the first department of geriatrics at a US medical school (Mt. Sinai’s). I heard Robert Butler’s name again and again…and the term “geriatrician” but couldn’t differentiate it from “gerontologist.” It wasn’t until the late 90’s when my mother suffered (and recovered from) a stroke, followed by a fall in an unlit movie theater and a difficult recovery, that I understood the difference.

After receiving a phone call that Mother was dying and making long-distance, ultimately successful efforts to change her doctor to a geriatrician at a research/medical school hospital in Oregon, Mother made a miraculous recovery. Reason: a geriatrician who, among other things arranged to have Mother’s catheter removed (the catheter made life easier for the caregivers), and rebalanced her medications (she was small and was taking doses probably appropriate for an NFL tackle). I was “sold” on having geriatricians as part of a team to help every medically-needy aging parent in the country.

I subscribed to a Tufts U. health newsletter in 2002 and read in an interview with Richard Bennett, MD, (a Johns Hopkins geriatrician and professor of geriatric medicine) that: “geriatricians have special training in diagnosing older people, whose disease symptoms may differ from those of younger adults…and that they may work harder to treat other problems often dismissed as inevitable (in older people) such as incontinence or memory loss” and that they are often part of a team.

Unfortunately, geriatricians are few in number compared to the aging population.

  • Reason: becoming a geriatrician requires additional years of training and not many medical schools offer this specialty; Mt. Sinai of course does.
  • Reason: $.  Geriatricians make far less than other specialists.

So while the need is great, the number of specialists is small.

The NY Times (July 7, 2010) obituary section published many tributes to Dr. Butler.  I quote from the end of the (Washington DC) Leadership Council of Aging Organizations’  tribute: “Dr. Butler did as much as any leader in our time to advance the cause of protecting and helping older people in America and throughout the world.  His gifts remain beyond his lifetime.”

As we try to help our parents age well, we recognize Dr. Butler’s gift–to our parents now; to you and me in the future.

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