Transcription:
Signs That an Aging Loved One Needs Help

Melanie Cole (Host):  Physical and mental health decline often surprise family members, especially if aging relatives seemed fine the last time they were seen but what are some signs that indicate something may be wrong so you and your loved one can properly prepare for the future? My guest today is Dr. Lori Archbald-Pannone. She's a geriatrician with UVA Health Systems. Welcome to the show, Dr. Lori. I think that we want to start with some common signs. If you've been with a family member two three weeks ago or a month ago and then you see them, what things should you look for that might be different that would signal a few red flags?

Dr. Lori Archbald-Pannone (Guest):  Thank you. Things to look for when you're visiting with your family member who you may or may not see very frequently are to ask them how they're doing, and not just assume things are going well all the time, but to really sit down, take the time and ask what's new or different? What we do in the clinic is, we often ask and recommend family members to ask about falls. Have you had any fall? Have you had any almost falls, where you feel unsteady? Sometimes, we can have big falls that we don't know about and that's important to know but, more importantly, those little missteps, those almost falls that we have are important to know about before we have a big fall so, hopefully, we can intervene. Falls are important to know about, also keeping up with day to day activity, what we would call our activities of daily living. Things like dressing, feeding ourselves, being able to go to the bathroom and take a shower. How are those going for someone? Are you able to do that? Also, keeping up with medicine. Sometime our family members can be on so many medicines that it's a lot to keep up with for anybody, especially if we're starting to get a little bit of functional or cognitive decline. So, ask them about how the medicines are going. Looking at the pill bottles, looking at the system that we have in place to remember when to take which medicines, and seeing if we're up to date. If we're getting our medication refill, if we're going through the bottle at a rate that's appropriate, and then checking in with physicians, too, to see how they're doing.

Melanie:   If we're at the person's house, is it acceptable for us to be looking around to see if it's disorganized, if there's expired groceries that don't get thrown out, or if there are any of those kinds of things around the house that we notice? Do those signal something?

Dr. Lori:  Well, they certainly can, and it's important to pay attention to the day to day, and to see how someone is able to take care of themself, to see how they're able to take care of their house. Again, all of us are very proud people and we want to continue to do what it is that we've done but sometimes we need a little more help, and it's hard sometimes to be able to initiate that, to either ask about it, or ask for help. So, being aware of signs around the house can be very helpful, again, in terms of those day to day activities. Kind of beyond just our activities of daily living, there are the ideal, the instrumental activities of daily living, which represent our ability to care for ourselves in the community. Those are things like shopping. So, exactly right, are the things in the refrigerator fresh and new? Are they expired? Have they been there for a while? Is the trash getting taken out? Things that are important in terms of taking care of a home or local environment on a day to day basis. To make sure that we're eating well, and we're in a healthy environment are important as well.

Melanie:   So, then, if we do notice those things, then comes the difficult part of having that conversation, as you said, doctor, we are proud people, and if you have an aging relative and you say, “I'm starting to notice some changes,” or “I'm noticing you haven't been taking your medication,” sometimes those conversations are very difficult to start because people get very offended. What do you recommend to your patients and their loved ones starting that conversation?

Dr. Lori:  I think the most important is to really approach all of these difficult conversations with respect and love. The reason we're having these conversations are because we love and care for someone and we want to make sure that they're safe and well taken care of. That's the most important thing often that needs to be said, so that nobody thinks that we're trying to be sneaky or find out some sort of weakness, or some other ulterior motive. Just be up front, that this is because we love you, we respect you and we want to make sure that you're safe and well taken care of, and we're doing everything we can to participate in that. That is generally a way to start a conversation that can be better received than certainly any sort of accusation. If somebody feels that you've been kind of sneaking up on them and have some secret information, then people can get defensive if that happens. But, really, just try to be open, try to say that this is really coming from a place of love and caring, which is where it's coming from. And, then, to hopefully move together forward in terms of finding a plan that works for everybody. Not dictating a plan that “This is what it's going to have to be and this is how it's going to have to be,” but really to come up with a plan as a team together.

Melanie:   What are some options people have because some people say it's better to stay in the home, and have a caregiver come to the home;  some people say that assisted living are different nowadays. What things should you consider when you're trying to decide how your loved one is going to get the help that they need?

Dr. Lori:  There are a lot of different factors to consider and really sitting down with somebody who's familiar with your local resources can be the most helpful. Here at UVA, we have our geriatric outpatient clinic, the University of Physicians at geriatric clinic where we can sit down with our patients and their families to say, “Well, what are your medical conditions that may need assistance? What's your functional level? What's your cognitive level? What are your needs and where are those best suited?” We can explore with our social workers, our colleagues over at JAVA, and other services locally as well to say, “Could these be provided in a home? Is there a structure of support when those services can't be there overnight?” For example, it can be difficult to find overnight care. So, will somebody be safe in their home alone at night? That's something that's very important to consider and so knowing your local resources is really important. There are other resources such as assisted living, in and around the Charlottesville area, we have a multitude of different assisted living facilities. Assisted living facilities are all very unique places. They serve different unique needs. So, it's not a simple conversation to say, “Does mom need to be in assisted living?” Well, what assisted living are we talking about and what services can be provided because each facility can provide different services, and even within a facility, there are different levels of services available.  So, again, becoming familiar with that and really sitting down as it's a lot of information to go through and to process. So, really, to sit down with a physician or social worker or somebody in the community, where these resources can be helpful to really go through what are your personal needs; and then, what other resources and how can we match those together best?

Melanie:   If dementia enters the picture, which it doesn't always, but if it does enter the picture, does that change the narrative for the loved one in how they pick an assisted living, or how they have that discussion, or what care and needs that person has?

Dr. Lori:  Well, any medical condition is going to have specific needs associated with that particular one. But, the basic discussion I think is still the same. It's still that this decision of coming from a place of love and with full respect for the person as an individual; coming together as a team to find the best place so they can be well taken care of in all of the dimensions; and, ensuring, if you are talking about a facility, that the facility is well-equipped to deal with the progression that we can often see with dementia as well.

Melanie:   Wrap it up for us, if you would, Dr. Lori. Just give us your best advice when you're dealing with families and they come to you and they say, “We've decided that now my loved one needs a little bit more help.” What do you tell them are the most important things to start to consider? Our advanced directives, our wills, planning their affairs. What do you tell them really that they need to do while they can have these conversations?

Dr. Lori:  While having these conversations, I think that some of the most important things to focus on are making sure we're physically safe so that we're not having falls and that environment around us is safe; and that we're getting taken care of medically in the best possible way--on the right medication and not on excess of medication, on the right dose and that medically we're stable. In addition to that, looking forward, thinking about how we are going to manage our finances? How are we going to make those medical decisions if we're unable to? And, so, having the discussions about advanced directives and code status while we're doing well is really the ideal time to have those discussions. That way, if something were to happen when we're unable to make our own decision, our family or friends or whoever we appoint to make those decision for us, will know what we would have wanted if we were able to make that decision at the time.

Melanie:   Thank you, Dr. Lori. It's really great information and so important to start that conversation with your loved one, hopefully,  before you need to have that conversation. You're listening to UVA Health Systems Radio. For more information you can go to www.uvahealth.com. That's www.uvahealth.com. This is Melanie Cole. Thanks so much for listening.