Visiting Your Aging Parents Over the Holidays: What to Watch For and When to Worry

When you visit your ill or aging parents over the holidays, you might be in for a surprise. Maybe your mom seems confused or your dad is having trouble with driving. Maybe you're not sure if the changes you're seeing are something to worry about or are just normal aging. 

What should you look for? What should you worry about? What changes are not actually concerning?

In this episode of The Integrative Palliative Podcast, Dr. Delia Chiaramonte discusses what to look for when you visit your aging parents and when you should worry.

Do you know someone with an aging parent? Send them this episode.

Knowledge is power.

Happy holidays!

Dr. Delia

Delia Chiaramonte, MD

https://www.doctordelia.com

Coping Courageously: A Heart-Centered Guide for Navigating a Loved One’s Illness Without Losing Yourself is available here: www.copingcourageously.com

Please review this podcast wherever you listen and forward your favorite episode to a friend! And be sure to subscribe!

Sign up to stay connected and learn about upcoming programs:
https://trainings.integrativepalliative.com/IPI-stay-in-touch

I'm thrilled to be listed in Feedspot's top 15 palliative podcasts!
https://blog.feedspot.com/palliative_care_podcasts/

Transcript

SPEAKER_00: 0:00

Welcome to the Integrative Palliative Podcast, where we bear witness to both the tough stuff and the blessings that come with caring for people who are aging or ill. Their well-being matters, but yours matters too. I'm your host, Dr. Delia Chiaramanti. So you're seeing your aging parents around the holidays, and you're vaguely worried about them, but you're not really sure what you need to look for, whether you should be panicked, whether you shouldn't be. That's what we're going to talk about today. Welcome to the Integrative Palliative Podcast. I'm Dr. Delia, and we're going to talk about when you see your parents at the holidays, what should you look for? When should you panic? And when should you let it go? So everybody has a different approach. Maybe you're the I worry about everything kind of person, or maybe you're more like the head in the sand ostrichy kind of person where you just, la la la, you don't want to think about it. Your parents are getting older, but you just don't want to think about it. Neither of these approaches is the ideal. You don't want to worry about everything, but also you want to keep your eyes open. So that's what we're going to talk about today is how do you know? How do you, what should you look for when you see your parents over the holidays? And how do you know when you need to take some kind of action? It's patterns over time that can give you the most information. So if you haven't been spending a lot of time with your aging parents and then you show up for the holidays, you may be seeing a snapshot and it may look very different than the last time you saw them. But do just keep in mind that this is an isolated data point and it may give you important information, but it doesn't necessarily mean that it's going to tell you an answer. So mostly if you haven't seen your parents in a while and you're going to see them over the holidays, you want to be alert for things that might be concerning and then you want to follow them over time to see if there's a trend most of the time. Now, if your parents are coming to you or you're or they're traveling somewhere else and you're meeting them there, do just be aware that the stress of travel and disrupted routines and messed up sleep and having tons of company or tons of social interactions all can make behavior a little bit different. So if that's happening, don't be necessarily concerned if it seems like, gosh, they're so different than before. Just be aware that the stress of travel can make things look worse than maybe they are. So overall, your question is, is this a change? The thing I'm seeing, is this a change from their baseline? That's really what's most important. Is it a change from their baseline and is it persistent? If it's only showing up because they had to take an overnight flight and they're exhausted, and then as soon as they get some good sleep, it goes away, then you're not really so concerned about it. So is it a change from their baseline and is it persistent? And then most importantly, is it impairing their function or their safety? And we're going to talk in a minute about specifics, but I just want you to think big picture first. Change from baseline, is it persistent and is it impairing their function or safety? These are the big picture concepts that you want to keep in mind when you see your aging parent over the holidays. So let's start off with some things that might seem concerning, but probably aren't really that concerning if if they're the only thing that's showing up. So, number one, if the house looks messier than you remember, don't necessarily assume, oh my gosh, they're falling apart, their house is messy. That may not be true. It may be that they're facing some pain and it's harder to get up and do housework. They may have a little more fatigue than before from medical illness. They may just be motivated by different things. Maybe once upon a time it really mattered that the house looked beautiful and perfect and decorated for Christmas, and maybe now they're prioritizing reading books and sitting outside and playing with the dog. You don't know. So don't necessarily be concerned if the house seems a little messy or if they didn't decorate in the big way for the holidays like they used to do. It's something to note, but it is not necessarily something to be concerned about. Now, of course, if it's unsafe, like the exits are blocked or there's really a hoarding situation, that is of concern. But if it's just cluttered or not decorated like you remember, I wouldn't necessarily be concerned about that. The second thing that may seem concerning, but isn't necessarily concerning, so you don't have to get freaked out about this one, is word-finding difficulties like tip of the tongue, pauses, can't find the word, or slightly slower processing of ideas. This is not necessarily a red flag. So slightly slower thinking or word-finding problems, not necessarily a red flag. Being disoriented, though, that is a red flag. So not knowing what's happening or where they are, that obviously is of concern. But if they just are having trouble, like, oh, I can't think of the word, don't freak out about that. That is probably fine. Now, what about if they're irritable or short-tempered? Sometimes that can be associated with pain, with early dementia, but not necessarily. So that's not something that you necessarily have to feel like, oh my gosh, he's irritable, therefore he's getting dementia and everything is falling apart. Sometimes it can be from pain or fatigue, from illness. Sometimes it can be from hearing loss. And people don't always realize that they're having hearing loss. It seems like you would know, but they don't always know. They just may feel annoyed that they can't figure out what everybody's talking about, and that can make people short-tempered. The biggest thing to watch for, though, if someone is more irritable or short-tempered, is could they be depressed? So sometimes depression does not show up with crying or feeling sad. Sometimes it shows up with irritability. So that is the one thing I if you if you see that your loved one, your parent is more short-tempered or irritable, ask them about pain or other symptoms, but be alert, could it be depression? If not, it's not necessarily something that you need to be concerned about. You could check in with them, of course, but it doesn't necessarily mean, oh my gosh, they're having cognitive dysfunction. Now, what are some things that do really deserve your attention and should perhaps make you feel concerned and need to take some kind of action? Probably the most important one is functional changes of various kinds. So that can mean functional problems in terms of mobility, meaning falls or near falls. So if they have scratches on their knees or on their elbows or their bruises on their hands, you might check in, have you fallen? If they're having difficulty getting up from a chair, that's concerning. Another functional change that's important to keep an eye on is driving. So often people, as they age, don't notice that their driving skills have declined and they may not say, I don't think it's safe for me to drive anymore. They may, but they may not. And so you want to look for things like have they had accidents or near accidents? Have they gotten lost when they were driving in a place where they shouldn't be lost, where they should know where they are? Have they made mistakes like they tried to turn on the lights and they turn on the wipers instead? Now, I do that too sometimes. So one time doesn't matter. But if recurrent you're watching them drive and you're feeling like you just don't seem as smooth as before, that's of concern because of course it's such high risk to drive when your functional abilities have decreased is not safe for the person themselves and it's not safe for the other people around them. The next functional change that you want to look for is medication management. So what can you look for? You can look for do they seem confused about what medicines they take or when? Are they missing doses? Are they taking the morning medicines at night? Are they no longer able to fill up their pillbox appropriately? So look, keep an eye on medication management and how is that going? Another functional change that you can look for is nutrition. So what's up with the fridge? Is it empty? Is it filled with spoiled food? Has your parent been losing weight for no particular reason? So keep an eye on nutritional well-being. Are they able to recognize the people, family and friends, that they should know well? If they're not, that is a reduced function that's of concern. And then also keep an eye on functional changes around finances. Are they missing bills? So they're paying their bills late. Are they making strange purchases, like spending a ton of money on things they shouldn't be spending money on? Are they giving money to other people who might be scamming them? So those are the functional changes that I want you to look for: mobility, driving, medication management, nutrition, recognizing loved ones, and finances. Sometimes you can just ask if one parent is doing better than the other, you can ask, you know, how's he doing? Is he able to manage his medicines? But sometimes you're just going to observe. So you can look for things, as I said, expired food in the fridge, seeming to get lost if you go to the market, not being able to find the door to get out. You can look for burn marks on the pots, suggesting that maybe food has been burnt on the stove. You can look for scratches and bruises, which might suggest that they've fallen or had minor accidents. You can look at the med medicine bottles and see are there too many or too few left in the bottle compared to what you would expect. And then let's talk about cognitive changes that you might keep an eye out for. Very often in people who have early dementia, their older memories are very preserved. Even in late dementia, their older memories are very preserved. So they might remember something from their childhood, but not remember what you said 20 minutes ago. When you're looking to assess someone's cognitive function, you want to make sure not only do they remember things from a long time ago, but also do they remember things recently, a conversation you just had. And the other thing to be aware of is that politeness is preserved for a very long time. So if you're just having small talk kind of conversations, oh, how's it going? Oh, pretty good. How are the guys at the bar? Pretty great. Those kinds of conversations, they can be preserved in someone even who has very advanced dementia. So be alert that just because you can have that kind of small talk conversation doesn't necessarily mean that their cognition is fine. But sometimes people focus a little too much on memory lapses and get really upset about that, concerned, oh my gosh, he was having dementia because he didn't remember that thing. Keep an eye on memory, of course, but it's probably not the most important thing. More important is judgment and managing complexity in instructions and language. So judgment. Are they being scammed by somebody? Are they giving their money to someone that they shouldn't be giving their money to? Have they signed up for a bunch of things that they don't need? Are they spending way too much money compared to what they have or what they used to do? Are they able to follow multi-step instructions? Like, Dad, could you go downstairs and look in that closet and get the green hat? If if he can't follow several steps like that, that's of concern. So keep an eye on memory, of course, but it's not the only thing to look for. And a little memory lapse is not necessarily concerning. I would be more concerned about poor judgment or the inability to follow a complicated instruction. And a few things that can be missed are number one, social withdrawal that's new. So for a super introverted person who's always been introverted, don't worry about that. But if they used to be fairly interested in social connections and now they aren't, that can be depression, but it also can be cognitive dysfunction, early dementia. So that's just something to keep in mind. Like, oh, dad used to love to go to the club and he never wants to do that anymore. Why is that? You can check in, is it, are you not feeling well? Are you tired? Do you have pain? Do you just not want to, which would make you worried a little bit about either depression or cognitive dysfunction, like dementia? So that if you notice that, that's probably worth talking to their doctor about. Also, neglecting hygiene is something that you can look at. On the one hand, people may not be motivated to, you know, blow dry their hair and spend all this time on makeup, and that's perfectly fine. But if they're unable to keep themselves clean and you can smell them, for example, that and that's different, that's something to keep an eye on. And another thing to keep in mind is that people can sometimes have increased dependence that they disguise as a preference. Like, oh, I just love it when she brings me breakfast. Maybe, and that's fine, unless they're saying that because they're no longer able to make breakfast for themselves. So just keep an eye on if something seems like the you're like your loved one is being more dependent and they say, Oh, I just like it this way. Just keep an eye on is it really that they just like it that way, or are they no longer able to do it on their own? So keep an eye on independence that is decreasing and and check that everybody in the family isn't just like, oh, this is how we do it now. Oh, this is what he likes. Make sure that that's really true and it's not just that everyone's sort of covering for the fact that he's not able to do what he was able to do before. So when you're there, you also want to look for hazards, safety hazards like throw rugs, for example, which people can trip on and fall, cords that running across the room that people can trip on, or complicated furniture arrangements where the person has to make zigzags to get from the couch to the bathroom. So those are all things that you might want to fix because falls are one of the fastest ways to reduce quality of life and maybe even lifespan in an older person. So preventing falls is one of the most important things that you can do to keep an older person healthy. And then definitely keep an eye out for caregiver burnout. It is so hard to be a caregiver. And just because your parent who's doing better says they're quote, fine, doesn't mean they're thriving. And it doesn't even mean they're fine. People really have a hard time saying, this is too much, or I'm really struggling. They're much more likely to say, I'm fine, we're fine. We don't, you know, they don't want to burden their children often. But I wouldn't take the first fine and assume that that's real if you're getting like a spidey sense that something's not going well. Big picture, people should get more help than they think they need sooner than they think they need it. If you have one parent who's not doing so well and one parent who's doing better, they probably should be getting hired help if they can possibly do it. And they may say, I don't need it, but they really probably should have it. And one conversation that you can have around that is to ask your parent who's doing better, the caregiver parent, what percent are they as a caregiver, like in a in a day per day, and what percent are they the spouse? What percent are they a caregiver, and what percent are they a spouse? And your goal is to shoot for them being about 75 to 85% spouse and 15 to 25% caregiver. Probably they're reversed. They're probably 75 to 85% caregiver and 15 to 25% spouse, and that is not what you want. So that's sometimes a way to have a conversation around getting help. It's not that you're failing or you can't do it. It's that if our goal is for you to be mostly their spouse, so that you can connect the way you've connected with this person for probably decades. You can only be 75 to 85% spouse if someone else is doing some of the caregiving. And that is often a hired caregiver or someone else in the family who can do some caregiving. So that's just a tip for you, a way to have this conversation with your loved one, your parent. And then don't forget to talk with the caregiver about nighttime. How's nighttime going? Because caregivers need to sleep. It's really hard to be a caregiver. And if you're not sleeping well, it is extraordinarily hard to be a caregiver. So it may be a great idea to hire help at night if the the parent who's doing better is not getting good sleep. Okay, so when do you act versus when do you just watch and wait? If the changes are mild, if it doesn't seem like there are safety issues, and if you're not sure if maybe this is just a moment in time, you're not sure that this is really a pattern, it's perfectly fine to wait and gather more information. You're going to check back in, you're going to watch over time, maybe you have another visit, maybe you have a Zoom meeting, but you at least have an idea of what to keep an eye on. On the other hand, if safety is at risk, if the person's function has clearly declined, if you're kind of compensating or your other parent is sort of compensating without realizing it, like pretending everything's fine, but covering by doing more for the person who's doing not as well. And even if your gut just says something doesn't feel right, that's the time to act. That's not the time to say, oh, it'll probably be fine. We'll talk about it in six months. That's the time to take some action. Even if that action is just calling your parents' primary care doctor and saying, this is what I've seen, and I'm very concerned. Can you see my parent and check all these things out? So there are a couple things that might surprise you or you might miss that I just want to point out. The first one is that sometimes the most concerning changes are the least dramatic. So we're kind of trained to look for big, obvious red flags, but particularly in a person who's aging and perhaps is developing dementia, the changes are more subtle and often have to do with a loss of initiative, as in they don't cook anymore, they don't shower on their own anymore, they could go out, but they don't anymore. Those are signs that you want to take a look at. Not so much like, can you remember what we ate yesterday evening, but more just, gosh, they're not doing the things that they used to do. Because that can be about cognitive load, like maybe it's just too complicated because their cognition is reducing and they have some early executive function changes, for example. So don't think of it as, oh, he's just lazy or oh, that's just aging. If your loved one, your parent, isn't doing the things they used to do, it can be very subtle, but that can be an important clue. The other thing that can be missed, I alluded to it before, but it's important enough that I'm going to say it again, is that families can unconsciously adapt to their loved ones' decline long before they see it or name it. Maybe one person now always does the medicines for the other, or one parent now always drives when that wasn't true before. Or one parent just kind of quietly takes over the finances or the scheduling and nobody really talks about it. So it can look like the family's still working, but it's still working because other people are accommodating the person who's not able to do as much as they were before. So just keep an eye on that. Just have a look. Is everything still functioning fine because one parent is overcompensating for the other? That's an important thing to notice. It's important because it can mask the loved one's decline. It can mask the other parents' decline. Another thing to keep an eye on is that hearing loss can masquerade as cognitive decline. So you may think, oh no, my dad or my mom, it looks like they may have dementia, but it may actually be hearing loss. Maybe they don't even realize they have hearing loss or they realize it and they had hearing aids, but they're not wearing them. That can cause people to withdraw. It can cause people to be irritable. It can cause them to look confused because they just didn't hear what everybody was talking about, but they may not have admitted that. So then when you ask them, well, don't you remember what he said yesterday? Maybe he doesn't remember because he never heard it the first time. They can obviously have trouble tracking a conversation which can look like executive dysfunction, but maybe it's just that they can't hear. It can make people definitely feel more isolated, which can lead to depression. So it's tremendously important to check hearing and if somebody has hearing loss, to give them high-quality hearing aids. And hearing aids used to be kind of big and ugly and bulky and people didn't like them. They're much, much, much, much better now. So if your parent is resistant because they remember when their parent wore hearing aids, reassure them that they're completely different now, very small, very high quality. And there's really no reason for somebody with hearing loss not to use a hearing aid. And also be aware that if someone has hearing loss, they're going to do worse in a room that's noisy, in a room where there's multiple conversations or where people Talking over each other, they may just be completely unable to follow conversations and just kind of remove themselves psychologically from the conversation. And it can look like they don't care, they're depressed, they have dementia, et cetera. It may just be hearing. And then in addition to all the specific things we just talked about, pay attention to your own intuition. Sometimes we just have a vibe that something feels off and we can't exactly pinpoint what it is. But I wouldn't blow that off because you know your parents, you know your loved one. And if something doesn't seem right, don't automatically discount your own feelings. Even if you're not sure what it is exactly, maybe that's even enough just to check in a little more frequently, just because maybe you're perceiving something under your cognitive awareness that you can't even label, but maybe really important. So overall, my invitation to you, if you're seeing your aging parents over the holidays, is to just practice noticing. Be the observer of the situation, not with a stressful energy, but just with a curious energy. What do I see? Is there anything that feels different than normal? What is my intuition telling me here? So just notice. And then if after you notice, if you want some help thinking all of this through, making sense of what you're seeing, this kind of support exists, you can reach out to me or others. And of course, make sure that your parent has an advanced directive that names a healthcare power attorney. Make sure that you know where the copies are kept. And then be in the moment and enjoy this special time with your loved ones. Thanks for being here. I so appreciate that you listen. If you know somebody who has aging parents and you think this might be helpful for them, please send it along. You can reach out to me anytime through my website, drdelia.com. Have a wonderful holiday. Thanks for being here. Bye-bye. Thanks for listening. You can learn more from my book, Coping Courageously A Heart Centered Guide for Navigating a Loved One's Illness Without Losing Yourself, or from my website, drdelia.com. And if you liked what you heard, please share this podcast with a friend, write a review, or subscribe so you don't miss the next episode.