Transcription:
Caring for an Aging Parent

Melanie Cole (Host): Life expectancy has increased due to advances in medical science, but as a result, diseases of the aging population have increased as well and accidents such as falls are becoming more common. We’re talking today about caring for an aging parent and what’s involved in that. My guest is Dr. Percy Bracamonte. He’s board certified in both Internal Medicine and Geriatric Medicine at Baycare Health. Dr. Bracamonte, first let’s start with first what is Geriatric Medicine and how can a geriatrician help to take care of our aging loved ones?

Dr. Percy Bracamonte (Guest): Good morning, geriatric medicine is a subspecialty of primary care, both internal medicine and family medicine and the bread and butter of geriatric medicine is to maximize the quality of life of older adults and we do this with great respect to our patients, particular preferences involved, we tend to stereotype older or elderly people but in reality what we see is a very diverse group that sometimes, in terms of medical care, do pose significant clinical challenges.

Host: Well they certainly do, and I love that you use the term with great respect because certainly our seniors and our elderly loved ones deserve that respect as much if not more than anybody else. What are some of the most common health issues that seniors are confronted with because as you said, it is a challenging group to deal with.

Dr. Bracamonte: One of the top challenges is to distinguish normal aging changes from actual disease. See as you grow older, your physiology, that means your ability to tolerate stress, both physical and psychological stress diminishes. There is a narrowing of your functional capacity to tolerate stress, and sometimes distinguishing, for example the symptom of fatigue can be many times attributed to normal aging, just the typical comment of, oh it’s just my age, I’m just getting old, but at the same time that could be the initiation of a new medical ailment – illness – ailment such as, for example, just to cite a typical example, depression or Parkinson disease, conditions that in the early stages are practically indistinguishable from normal aging.

Host: That’s so interesting.

Dr. Bracamonte: Yes, in addition to that, patients in this age group accumulate multiple medical conditions, and that leads to the use of multiple therapies, among them of course, pharmacotherapy, multiple medications and sometimes when an older person experiences a new symptom, and that older person is taking multiple medications, you have to wonder if this new symptom is a new disease or is actually a side effect from that medication.

Host: Wow, doctor you’ve explained very well some of the common issues that could go on with seniors as they age. Now if someone is taking care of their loved ones, let’s start because I would like you to give some tips for people who have elderly loved ones. You mentioned medications and multiple ailments. Keeping track of those multiple medications is quite a job for anybody. What do you recommend if you’re taking care of your aging parents, helping them to mind their medications and to stay with them for adherence?

Dr. Bracamonte: If you have a loved one who has reached this age and you are fortunate enough to have a good relationship with that particular parent, you have to first understand that you cannot impose your own particular goals or views about health care. For example, what you as a middle aged person might consider a healthy diet, an older person may simply for a number of reasons, might consider that healthy diet too bland, and if we want to keep in mind the important goal of preserving quality of life, you have to be a little bit flexible that way. You have to once again, we just go back to the concept of respect and preservation of autonomy; that is very important. Don’t just assume that what is important to you is going to be exactly the same thing that is going to be important to your elderly parent. So for those who reach advanced age, every day counts, and just to mention an example, it is typical that as we grow older we lose our sense of smell. Well for those folks, an elder who may not experience this yet, when you lose your sense of smell you cannot taste the food very well. That forces you to actually use more spices and maybe more salt or more sugar and sometimes older folks are criticized by their children because they’re not eating a healthy diet. So you have to flexible. You have to be bold. You have to be respectful of their particular priorities and preferences and you know, most people that I know when they feel respected, they open up. They say things to their children without the fear of being criticized or judged. So establish a good relationship with your elderly parent is paramount and get involved, spend time with them is really the important thing here.

Host: As far as health care, many seniors worry about that as they grow older. How is the health care different for seniors as it is for their middle aged children?

Dr. Bracamonte: So when you’re in your middle aged, 30s, 40s, 50s – you tend to see the doctor when you have your annual physical exam and when you get sick. When you get sick, you get treated and you get better and you go on with your life. An elderly person on the other hand tends to accumulate illnesses over the course of several years. So for them, it is important to establish a good trusting relationship with a healthcare provider who is knowledgeable and compassionate about this particular specific and special needs. So that’s the most important thing, while in the younger population, we just tend to have episodes of illness. In the older population we see more chronic conditions. Now, less paint the example of osteoarthritis, is an illness – is a condition that doesn’t have a – we don’t have a cure for that, but we have ways to promote quality of life, preserve function, and that is the approach. A long term approach rather than an episodic approach that you apply to younger people.

Host: It’s true and so interesting. Now so tell us a little bit about speaking with your parents. You mentioned having a good relationship, and I think that’s so important, doctor, but sometimes it’s difficult to speak to them about the importance of planning for health issues later on in life or advanced care directives, how do we start that discussion?

Dr. Bracamonte: So that is one of the most important and perhaps touchy subjects because it is a subject that people prefer not to talk about and understandably so. I will invoke the principal of autonomy and explain that while you love your father or your mother and you do not want to do things that he or she will not approve and one way to preserve that autonomy is to write down what are your preferences are if you are affected by a terminal illness and you are unable to make your own decisions, who among your loved ones, usually the spouse or the children, who is the one who is making the final decision? Sometimes what I see in some families is children have different opinions, different perspectives and they don’t agree about the decision that is being made, so it is important for your mom or dad to designate someone who will make the final decision. Maybe your older brother or sister can have an opinion that if you know that this particular person is the one who knows you the best, that can be your best healthcare surrogate, then make sure that document spells that name very clearly.

Host: So doctor as we wrap up, please give the listeners some strategies for assisting their elderly loved ones so that they can age in place, have that autonomy, and be safe because one of the things that we children of seniors worry about is falling and safety and depression and mood. Please wrap this up for us with your best advice as a geriatric medicine specialist, what you want us to know about that worry about the safety about our elderly loved ones and yet giving them that autonomy, how we can balance that and help them at the same time.

Dr. Bracamonte: If I would have to wrap my advice, because this is actually a very long topic, but if I would have to say just a few words about this is first try to understand and accept the fact that priorities are things that are sometimes at odds with each other. Let me say the priority of safety, for example, could be at odds with the priority of independence and the typical example is driving. If you’re afraid about the safety of your parent when he or she is driving and you want to discuss that with your parent, you have to also consider that by removing his driver’s license is going to significantly diminish his quality of life. So the first thing is to recognize that sometimes, sometimes you have to accept a little bit of risk with the goal of preserving quality of life. Of course, this is a balancing act. I would strongly recommend that if you have safety concerns about your parents, you just make the time to come along with your loved one to the doctor’s visit and have an open discussion about what it is that you can do to preserve his or her independence while maximizing, as much as possible, the safety. Now you cannot have everything. It’s never going to be a completely win/win situation. It’s going to be a negotiation process and acceptance of that, less than perfect reality is paramount here.

Host: It’s so important and thank you so much, Dr. Bracamonte, for coming on and showing us that yes our senior loved ones need that respect and the autonomy but there are things that we can do to help them as we care for our aging loved ones. Thank you again for joining us. You’re listening to Baycare Health Chat. For more information, please visit baycare.org, that’s baycare.org. This is Melanie Cole, thanks so much for tuning in.