Good morning. It can be hard to talk with aging parents about their health, but it’s important. Today, some advice to make those conversations easier.
The talk
Americans are living longer. But many adult children don’t know what’s going on with their parents’ health — until after a fall, an ambulance ride or a hospital stay. This lack of communication hurts everyone, said Dr. Louise Aronson, a geriatrician at the University of California, San Francisco. In an emergency, adult children may be overwhelmed about what to do and may clash with siblings. For parents, silence can mean that their wishes aren’t understood and that their children are needlessly put through the stress of guessing. To avoid these scenarios, we asked experts what you need to learn about your aging parents before a crisis. And they identified three clear steps you can take to make sure you’re prepared. 1. Ask about their health.The first step is having a difficult conversation with your parents. In an emergency, a doctor may have only a snapshot of your parents’ health. So it’s important for you to get a clear picture. If you understand their routines and medical history, you can help the health care team treat your parents more effectively. Start with the everyday stuff — what does a normal week look like — and then ease into questions about mobility and memory changes. Sometimes, it’s best to circle around the issue. Ask what they avoid now — taking the stairs, going on long walks, driving at night — and what’s gotten harder, like managing bills or keeping track of appointments, said Dr. Sabrina Taldone, the chief of general internal medicine at University of Miami Health. And explain why you’re asking: You’re not prying, you just want to be able to help in the future. It’s also important to build a simple “in case of emergency” list: medications, physician names, allergies and prior surgeries. Include your parents’ pharmacy name and number so that, if needed, a doctor can verify what’s been filled. Save this list on your phone. Doctors say it’s important to keep a paper copy in your wallet, too, in case you run out of battery in an emergency. 2. Discuss their living environment.The second step is to ensure their home is still safe for them. Parents often end up in hospitals or care facilities because their abilities no longer align with their house, Dr. Aronson said. So, talk to your parents about ways to extend their independence, like clearing clutter, removing loose rugs, improving lighting or adding handrails. A fall can set off a chain reaction — hospitalization, rehab, a nursing home — so frame these tweaks as a way for your parents to stay in control. It’s also worth discussing where your parents could live if they ever needed to move. Would they want to stay in their home at any cost? Would they be open to downsizing? Would they consider moving in with family or trying assisted living? Having these conversations early can help maximize your parents’ options, since facility waiting lists can be long, and some places can’t accommodate people with more serious illnesses. 3. Make a plan.Finally, prepare for a medical emergency. While you can’t rehearse every possible decision, you can be clear about who will speak for your parents if they are incapacitated and what they care about most. Ask your parents to designate a point person, and make sure everybody knows who it is. When families aren’t aligned or no one’s clearly in charge, messages can get muddled, and care can get delayed. This isn’t about picking a favorite; it’s about choosing the person best positioned to carry out your parents’ wishes, even under pressure. And that may not be you or one of your siblings. Just as important, talk to your parents about their goals and values. “In an emergency, you’re rushing through the decisions — it’s emotional,” said Dr. Namita Seth Mohta, an assistant professor of medicine at Harvard Medical School. “This is a chance to reflect ahead of time.” Explore what brings your parents joy and meaning, what their biggest worries and their priorities for medical treatment are, and what they want to avoid. For example, a parent might want to maximize time spent at home, do everything possible to survive or avoid being kept alive by machines in the intensive care unit. (You can make this a group activity to avoid your parents’ feeling singled out.) It’s normal to want to avoid these conversations. “It feels like you’re putting them through something hard, but it’s avoiding something that is far, far worse,” Dr. Aronson said.
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