Difficult discussions around aging and senior care

Three important things to discuss when planning care for an aging loved one

Helping parents or loved ones as they age can be difficult when it comes to senior care. There are sometimes hard decisions: How aggressively should we treat an illness? Does someone need additional care? In the home, or is a facility required?

These decisions not only cause stress for the family, but the patient as well.

Carmel J. Person, M.D., medical director of Norton Community Medial Associates – Geriatrics, has lived it, experienced it as a nurse and seen it as a physician.

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“Having a conversation about these issues is difficult, but necessary in order to advocate for that senior when the time presents. Those conversations need to focus on quality of life and maintaining dignity,” Dr. Person said. “Our aging community needs access to medical care consistent with their individual goals, education about futility of treatment options, and resources that optimize health and lifestyle. Ultimately, it’s the element of the human spirit that must be preserved as we all learn how we accommodate the needs of our ‘silver tsunami’ generation,” or wave of aging baby boomers.

When you have the conversation, Dr. Person suggests focusing on three things:

Where does your loved one want to live?

“It’s very important to look at living arrangements, how to thrive and how to finance that vision,” Dr. Person said.

There are people who want to remain in their homes no matter what, and there are people who are open to other care options. What options are there for care if your elderly loved one is no longer able to care for herself in her own home? Or what if he falls and an injury requires long-term care?

What kind of continuing medical care does your loved one want?

“Many times seniors undergo aggressive medical procedures that require complex medical management,” Dr. Person said. “Is this what they really want? There is often a difference in medical treatment that impacts quality of life versus quantity of existence.”

As people age, chronic conditions usually progress and more management is often required. This can include more physician office visits, increased medications, disruptive and even painful diagnostic tests though worsening of the symptoms persist. Therefore, as the chronic disease progresses, it’s important to review and possibly reconsider goals of care. Chronic disease progression can subtly and insidiously disrupt daily activities and slowly compromise one’s quality of life.

Talk about what kind of life your loved one wants to live. Is he or she willing to sacrifice quality of life for potentially extending life?

Who makes the decisions?

Your discussion around medical care should include advance directives as well as who will be in charge should your loved one no longer be able to make decisions.

Dr. Person also suggests having a health care surrogate who is not a family member.

“This is someone who can help in a crisis and make sure any wishes are fulfilled,” Dr. Person said. “Family members, especially children, often struggle with hard decisions that can go along with a loved one’s goals.”

Having a plan can help you look for resources to help a loved one transition, whether it’s moving to assisted living, a nursing home or bringing care into the home. Talking with your primary care provider also can help.


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