Your Loved One is Getting Older... Now What?

All of us, if we are fortunate, will eventually grow old. Along with a great deal of wisdom and a lifetime of happy memories, old age presents a unique set of challenges. If you are trying to support a loved one who is aging – or if you identify as a senior, yourself – here are some of the issues that affect older adults: 

Falls:

Many older individuals are at increased risk of falling for a variety of reasons: decreased strength; poor balance; difficulty seeing or hearing; decreased cognitive ability; underlying medical conditions and/or the medications used to treat them. If your loved one allows, speak with their medical provider about potential side effects of medications (e.g., dizziness, fatigue) that may increase their risk of falling, and confirm that these medications are still necessary and appropriate for your loved one’s medical conditions. 

Evaluate (or hire a professional to evaluate) your loved one’s environment for common fall hazards such as area rugs, poor lighting, and uneven or slippery flooring or stairs. The bathroom can be a particularly dangerous place for older individuals; consider installing a shower chair, shower bars, and an elevated toilet seat with grip bars. If your loved one is frequently alone, they might consider using a medical alert system. Several smart watches are also equipped with fall detection technology, and these may be a better option for individuals who are resistant to the idea of using a traditional, free-standing medical alert system.

Consider giving an extra house key to a trusted neighbor or storing a spare key in a lockbox (similar to those used by realtors). The combination to the lockbox may be kept on file with emergency services and/or a medical alert system provider. This will make it easier to access your loved one's home in the event of an emergency. 

Social Isolation and Loneliness: 

Many older adults continue working or volunteering regularly, well into their 80s and 90s. Many working and retired individuals enjoy very active social lives, take up new hobbies, or return to the hobbies they were too busy to pursue when they were juggling family and career responsibilities. 

Some older adults, however, face increasing social isolation and loneliness. When my sister worked as a bank teller during college, she recognized that she was the only social connection some of her elderly customers enjoyed during a given day or week. Much to the dismay of her productivity-focused employers, she took the time to get to know these older customers and engage with them on a personal level. 

While I was writing this blog, the Surgeon General, Dr. Vivek Murthy, declared that the “impacts of social isolation and loneliness are a critical public health concern.” At the age of 18, long before Dr. Murthy’s declaration, my sister may not have realized the public health implications of her kindness, but she did understand how important these even brief interactions were to her customers (which to this day makes me immensely proud of her!). 

Some of the more concerning consequences of isolation and loneliness include: 
· Depression 
· Anxiety 
· Dementia 
· Cardiovascular disease
· Premature death

Community organizations are typically available to offer social activities, transportation, and companionship for older adults. If you are not sure where to start, your loved one’s medical provider, local house of worship (often even if they are not a member), or a health advocate can guide you.

Hearing Loss and Visual Impairment:

Hearing loss is very common as we age and contributes not only to social isolation and depression, but to cognitive decline and dementia. Imagine how frustrating it is when you can’t hear your friends on the phone or follow a conversation in a restaurant. It’s easy to understand why someone experiencing hearing loss might withdraw from their loved ones or their social activities, and in turn experience the consequences of isolation.

There are several reasons older adults experience decreased visual acuity including cataracts, glaucoma, macular degeneration, and complications of diabetes. Like hearing impairment, poor vision is associated with social isolation, depression, and cognitive decline, along with an increased risk of falling. Because many of the conditions that lead to vision loss can be treated or controlled, encourage your loved one to have regular screening exams and seek medical evaluation for any concerns. 

Driving Safety:

While many older adults continue to drive safely, increasing age is associated with higher rates of fatal motor vehicle collisions and overall collisions per mile driven. Slower reaction time, decreased visual or hearing acuity, underlying medical conditions, and cognitive decline may contribute to the risk of motor vehicle collisions. Because driving often represents freedom and self-sufficiency, many individuals are reluctant to give up this privilege, even if are no longer able to drive safely; this can be a source of tremendous conflict. If you are concerned about their ability to drive safely, reach out to your loved one’s medical provider to ensure the safety not only of your loved one, but also of those they may encounter on the roads.

End of Life Issues:

Many people feel uncomfortable talking about end-of-life issues, but it is crucial for your aging loved ones (for all of us, in fact) to clarify and document their wishes about the medical care and interventions they want to receive or avoid. Your loved one’s medical provider and/or an attorney can help to guide discussions about advance directives (“living wills”), health proxies, powers-of-attorney, and other important topics. The Institute for Healthcare Improvement provides free written and audio resources at www.theconversationproject.org. 

Final Thoughts:

Get to know (or at least identify) neighbors who can check on your loved one if you are concerned and/or unable to contact them yourself.

If you have concerns about your loved one, reach out to their medical providers. Privacy laws (i.e., HIPAA) prohibit medical providers from disclosing information about their patients; they do NOT prohibit you from sharing your observations and concerns with your loved one’s providers.

Keep in mind that your aging loved one has likely spent decades as a productive individual with family and/or career responsibilities and relative independence. Some older adults may be grieving the loss of independence, friends, and many aspects of their identity. While it is natural to want to help, it is important for your loved one to maintain as much independence as they desire and can safely enjoy.

This blog is for informational purposes only. In her role as an independent health advocate, Dr. Trend does not provide medical care or medical advice. Clients are advised to seek the advice of their personal physician(s).