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Caring for an Aging Family Member



Asresearch has given us advances in health care, people in most parts of theworld are living longer than ever. Although most people value long life, difficultchallenges await older men and women who develop disabling conditions and thosewho care for them.

Thisarticle addresses several key aspects of caregiving, including adopting apositive view of aging, knowing when it's time to step in, understanding howage-related diseases are diagnosed, and getting educated.

RejectingNegative Stereotypes and Embracing a Positive View of Aging

Westernculture today puts a premium on youth. The elderly, once respected and honored,are increasingly negatively stereotyped with ideas such as "old geezers,"  "setin their ways," and "senile." Those who care for aging loved ones should rejectthese dehumanizing stereotypes and embrace the idea that the elderly haveinherent value as human beings and can offer us precious gifts.

TheChallenges of Growing Older

Aspeople age, many medical conditions are more likely to develop that make itdifficult for a person to care for himself or herself. Some of the more commonconditions include heart disease, dementia, hypertension, osteoporosis, cancer,and depression.  

FamilyInvolvement:  When to Step In

Childrenand other family members often wait too long before they speak to a parentabout problems they're observing. Generally, earlier intervention is better.Some illnesses that are common in the elderly respond well to medication, andstarting medication earlier rather than later can prevent suffering.

It'simportant, therefore, to watch for symptoms of possible illness in your agingparents. Symptoms include difficulty with tasks such as driving, moving fromone room to another, preparing meals, eating, and keeping up with personalhygiene. If you observe these or other difficulties, it's important to helpyour parent make an appointment to visit a doctor for an assessment (Barlow& Durrand, 2005; AARP web, February 2006).

Assessmentand Diagnosis

Accordingto the website of the American Association for Retired Persons (AARP), anassessment should include "a full review of a person's mental,physical, environmental and financial condition to determine his or her abilityto remain safely independent. It identifies risks and helps determine optionsto reduce them."

Gettingan accurate assessment begins with the doctor asking for a detailed history,including education, employment, and past illnesses. The next step is a physicalexam and then a mental status exam, which includes things such as ability to learn,recall, pay attention, follow instructions, and read and write (Barlow &Durrand, 2005).

Afterreceiving a diagnosis, you and your loved one will have many decisions aheadabout what specialists to consult, what medications and other treatments to use,and where the loved one will live. If you educate yourself about your parent'scondition, these decisions will be easier.

TheBasics of Caregiving

Caringfor an aging family member is multi-dimensional. Many books have been writtento help caregivers (see the resources list at the end of this article). Wecover some of the basics here.

Determining severity.  Each illnessassociated with aging has different mental and physical symptoms. The severityof symptoms is often gauged by the loved one's ability to perform everyday tasks."Activities of daily living" (ADL's) are basic self-care tasks such as eating,dressing, reading, bathing, walking, and using the restroom. "Instrumental activitiesof daily living" (IADL's) are the more complex tasks of living, such as preparingmeals, shopping, driving, managing finances, using the telephone, and takingmedications.

Ifyour loved one is having trouble with IADL's, she might be able to liveindependently until the illness progresses. If, for example, you can preparemeals for her, she can eat them on her own. If she's having trouble with ADL's,however, she will need more intensive caregiving, including help with eatingrather than preparation alone.

Eating and meal preparation. Preparing food andeating it requires thought and physical movement. Physical disabilities that affectyour loved one's upper body will make eating and cooking more difficult. If theloved one has some form of dementia, the brain won't be able to tell the bodywhen, where, and how to eat. Preparing a meal might be impossible.

Personal hygiene. An aging loved onewith memory disabilities has trouble remembering when, where, and how to bathe,wash hands, comb hair, brush teeth, use the toilet, and shave. He will needhelp from a caregiver with all these activities.

Getting around. For some olderadults, walking from the bedroom to the bathroom becomes difficult. He mightneed a walker, wheelchair, cane, or crutches. You might need to modify yourhome or your loved one's home. For example, lower the bathroom sink, addrails to the walls, or replace thick carpet with a flatter surface.

Medication mishaps. Loved ones with a memorydisability can make medication mistakes that cause injury or accidental death. Youcan help your parent or spouse remember to take his or her medication bywriting notes, making phone calls, or dropping by when needed. You can preventoverdoses by putting medications in a lock-box.

Driving and transportation. Vision and reactiontime deteriorate with age. Older adults need your help to make sure they arenot a danger to themselves or others. Talk to them sensitively and lovingly butfirmly about driving concerns. In some cases, you might need to take actionthat angers your loved one, such as taking away keys or requiring them to takea driving test at the Department of Motor Vehicles. Stand firm in thisimportant responsibility.

Health care and finances. Personal pensionplans, investments, 401k plans, and Social Security are the main sources ofincome for the elderly, but they can be confusing. Understanding therights and benefits of each program takes time and patience. To ensure a lovedone receives the information and help he/she needs, be ready to become a legaladvocate if needed.

Recreation. Recreationalactivities renew the spirit and help your loved one avoid isolation and stayconnected to others. They also promote mental and physical health and provideopportunities for self-expression, exploration, and relaxation. Depending on yourloved one's mental and physical condition, he or she might enjoy activities suchas drawing, painting, dancing, Tai Chi, water aerobics, board games, and card games.

Change of residence. When a parent canno longer live independently, moving may be necessary. Search out the options,such as living with a family member, moving to an assisted living facility ornursing home, or hiring someone to live with the loved one. If possible, includeyour loved one in your discussions. If your loved one is developing hostile orcombative behaviors, you might need to consult a social worker (available atmost facilities) to help you make the transition as smooth as possible.

FindingOut and Honoring a Loved One's Wishes for Later Life

Itis vital that families discuss the financial and health care issues of agingparents and spouses sooner rather than later. If decisions are made before aloved one is diagnosed with a disabling condition, the loved one can moreeasily make his or her preferences clearly known.

AnAdvance Directive document spells out a person's wishes should they become tooill to make medical decisions. Without this document, which must be signedwhile a person is competent, family members are left to their best guess aboutwhat the loved one would want. Other legal documents you should considerinclude a financial Power of Attorney, a medical Power of Attorney, and aLiving Will. Because situations and preferences vary, some of the documents mayor may not be necessary. Families should investigate the options together.

Creatinga Family Caregiving Plan

Caregivingusually works best if it is shared among several family members. If one personvolunteers to be the main caregiver, other family members should still considerthemselves part of the caregiving team and make sure the main caregiver getsplenty of rest and breaks.

Belowis a summary of some of the more common caregiver stresses that families shouldconsider as they develop a family caregiving plan for their loved one (Lague,2000; Schmall & Stiehl, 2005).

  • Part-time or full-time supervision. The hours needed for caregiving can range from a few hours a day to 24-hours a day.
  • Supervising others who provide direct care. Arranging, coordinating, and monitoring services provided by family members, friends, and medical professionals can be time-consuming and stressful.
  • Income loss. Family members who provide care often can no longer work their normal hours. Income thus goes down. In some cases families find they need to finance the needs of the loved one, from remodeling costs to medical copayments.
  • Listening, talking, and providing emotional support. This dimension of caregiving can be emotionally rewarding but also emotionally draining. Some people are better than others at the nurturing approach that aging people need.

Ifa family finds itself in conflict about the caregiving plan, family membersshould consider consulting with a professional who can help them sort out ofthe options and make sound decisions.

Caringfor the Caregiver  

Takingcare of a loved one can bring many rewards, but it is not easy. Many caregiversexperience sadness, depression, or anger. When these symptoms progress, caregiverburnout can result. Below are several strategies for reducing the risk ofcaregiver burnout (Lang, as cited by Lague, 2000; Schmall & Stiehl, 2005).

Express your feelings by writing in ajournal, talking to a trustworthy person, attending a caregiver support group,or getting counseling.

Sustain your health by eatinghealthfully, exercising, getting enough sleep whenever possible, and takingtime out for your own doctor, dentist, and other health-related appointments.

Fill your well by taking breakswhenever you can, scheduling activities that are renewing for you, keeping upyour friendships, and letting others do things for you

Benefitsof Taking Care of a Loved One

Caringfor your parent or spouse may appear to be a relationship where one persongives and the other receives. However, research shows that the relationshipactually goes both ways. Adult children caregivers experience moments of"warmth," "comfort," "pleasure," "feeling appreciated," and "greatsatisfaction" (Walker, Shin, & Bird, 1990, pp.1-2).

Caregivingoffers the opportunity for a uniquely intimate relationship. Caregivers providecompanionship, warmth, comfort, and peace of mind. This gift enhances therelationship on both sides, and important memories are created.

Whenthe person being cared for passes away, many caregivers take comfort in knowingthey spent extra time with their loved one (Boerner et al., 2004). Caregiversmay also feel an extra sense of relief that the loved one's suffering is over.And they can take advantage of the greater knowledge and experience they nowhave to share with others and to help them prepare for their own older years.

AdditionalInternet Resources

    Caregiving in General

  • Administration on Aging

http://www.aoa.gov/

  • Care Pathways

http://www.carepathways.com/

  • National Family Caregivers Association (NFCA)

http://www.nfcacares.org/

  • United States Department of Health & Human Services

http://www.hhs.gov/

  • American Association of Retired Persons (AARP)

http://www.aarp.org/learntech/family_care/

  • Elder Care

http://www.eldercarelink.com/what.html

  • Caregiving.com

http://www.caregiving.com/

     Social Security & Health Insurance

  • American Association of Retired Persons (AARP)

http://www.aarp.org/money/

  • United States Social Security Official Website

http://www.ssa.gov/

  • Medicare Official Website

http://www.medicare.gov/

     Financial & Legal Information

  • AARP

http://www.aarp.org/families/legal_issues/

  • Elder Law Answers

http://www.elderlawanswers.com/

http://www.elderlawanswers.com/elder_info/elder_article.asp?id=2742

  • Aging with Dignity.org: a preview of the 5 Wishes

http://www.agingwithdignity.org/

SuggestedBooks about Caregiving

  • The 36-Hour Day: A Family Guide to Caring for Persons with Alzheimer Disease, Related Dementing Illnesses, and Memory Loss in Later Life (3rd ed.) (1999), by N. L. Mace and P. V. Rabbins. (John's Hopkins University Press).

Baltimore: John's Hopkins University Press.

  • The Complete Eldercare Planner: Where to Start, Which Questions to

      Ask, and How to Find Help (2nd ed.)(2000), by J. Loverde (Random House)

  • How to Care for Aging Parents (2004), by V. Morris, (Workman Publishing)

Writtenby Matthew G. Mellinger, Research Assistant, and edited by Richard B. Miller,Jeremy Yorgason, and Stephen F. Duncan, Professors in the School of Family Life, Brigham Young University. Fall 2007.

References

AARP(2006). My parents: How do I know if they need help? Retrieved February 22, 2006 from
http://www.aarp.org/families/caregiving/caring_parents/a2003-10-27-caregiving-needhelp.html

Alder, E. R. (1987, June). Growing older. Ensign, 44. Retrieved March10, 2006.

Barlow,D. H., & Durrand, V. M. (2005). Abnormal psychology: An integrativeapproach (4th ed.). Belmont, MA: Thomson Wadsworth.

Barney,K. W. (2006, Winter semester). RMYL 307: Accessible Recreation course notes, Brigham Young University, Provo, Utah.

Bee,H. L., & Bjorkland, B.R. (2004). The journey of adulthood (5thed.). Upper Saddle River, NJ: Pearson Prentice Hall.

Benson,E. T. (1989, November). To the elderly in the church. Ensign. RetrievedMarch 10, 2006.

Boerner,K., Schulz, R., & Horowitz, A. (2004). Positive aspects of caregiving andadaptation to bereavement. Psychology and Aging, 19,668-675.

Bookwala,J., & Schulz, R. (2000). A comparison of primary stressors, secondarystressors, and
depressivesymptoms between elderly caregiving husbands and wives: The caregiver healtheffects study. Psychology and Aging, 15, 607-616.

Connidis, I. A. (2001). Family ties and aging. Thousand Oaks, CA: SagePublications.

Dittmann,M. (2003, May). Fighting ageism. Monitor on Psychology, 50-52.

Harrington-Meyer,M., Wolf, D. A., & Himes, C. L. (2006). Declining eligibility for SocialSecurity spouse andwidow benefits in the United States? Research on Aging, 28,240-260.

Hopfe,L. M. (2001). Chinese religions.  In M. R. Woodward (Ed.), Religions of theworld (8th ed.). Upper Saddle River, NJ: Prentice-Hall.

Lague,L. (2000, September/October). Start the conversation. AARP ModernMaturity.

Mace,N. L., & Rabins, P.V. (1999). The 36-hour day: A family guide to caringfor persons with Alzheimer disease, related dementing illnesses, and memoryloss in later life (3rd ed.). Baltimore: John's HopkinsUniversity Press.

Malley,P. (2005). Finding peace of mind through practical Five Wishes document.Retrieved March 28, 2006 from http://www.agingwithdignity.org/Article1.html

Miller,R. B. (2005, Winter semester). MFHD 334|Adult Development & Aging coursenotes,
Brigham Young University, Provo, Utah.

Plummer,L. (2001, September). The zen of Alzheimers: Part 3. Retrieved March 10, 2006from http://deseretbook.com/mormon-life/news/story?story_id=923

Sanders, S. (2005). Is the glasshalf empty or half full?: Reflections on strain and gain in caregivers of individuals withAlzheimer's disease. Social Work in Health Care, 40, 57-73.

Schmall,V. L., & Stiehl, R. E. (2005). Coping with caregiving: How to manage stress whencaring for older relatives. A Pacific Northwest ExtensionPublication.

Smith,R. W., Austin, D. R., Kennedy, D. W., Youngkhill, L., & Hutchison, P.(2005). Inclusive and special recreation: Opportunities for persons withdisabilities (5th ed.). New York: McGraw-Hill. 

Walker, A. J., Shin, H. Y.,& Bird, D. N. (1990). Perceptions of relationship change and caregiversatisfaction. Family Relations, 39, 147-152.

Vance,B. (1995, September). Taking care of mom and dad. Ensign. Retrieved March 10, 2006.