Aging Adult Care with Anita Beckerman (cont.)

Dr. Beckerman: One of the things is to try to have open communication between family members, and sharing of responsibility. What happens is that one person in the family is designated the caregiver, and others will lend support, but not as the ultimate caregiver. Open communication is important, and to include the person like your father in the discussion. Who will visit the person in the nursing home? Know that what you do, if you do it with love and caring, is the best you can, and don't feel guilty. More guilt comes about when children are involved with older-aged parents, when the family members don't sit down and discuss what the older person needs and wants, and the resources to provide this. The discussion can be opened up, and ask "can we share?" and "who's best at this and that?" Family members often don't have good communication. We suggest trying to have family meetings. It can be done by the phone. Sometimes with technology now, you're in California and he's in Canada. There can be conference calls.

Moderator: Isn't it difficult to accept the role of caregiver? For so long there was a parent-child relationship, and now it begins to change. How does this affect the family dynamic?

Dr. Beckerman: There is a growing and change in roles. You want the person receiving the care to maintain as much independence as possible. One way is to include them in discussions concerning them. It's very difficult when the roles change. Parents take care of the children, then the children take care of the parents, and it's very hard. Including them in the decision-making is important. One chapter in the book is about protecting your own health and not feeling guilty about it.

Moderator: Do you feel that enough attention is paid to the psychological impact of aging, both on the receiver of care and the caregiver?

Dr. Beckerman: I would say probably not, because many times it's like the person is getting old, so we write it off as emotional. When somebody is in their eighties or nineties, and tired and discouraged because they can't do things for themselves -- if it suggests signs of depression, there is medication that can be given for that. One of the things that society doesn't deal with is death. We are born to die, and death should be made as pleasant an experience as when someone is born, with family members around, allowing the person to talk about it. Most of the time, we don't want to talk about it. When talking about signs and symptoms of depression, changes in sleep pattern, weight loss or gain, restlessness or irritability, feelings of worthlessness or self-reproach, or just losing interest in other things, sometimes those are signs and symptoms of depression. For that, you need an assessment from the health care provider. If the person wants to talk about the end of life, you need to allow the person to do that too. Usually, the caregiver can't deal with the end of someone's life. It's often very difficult, stressful, and straining, and we tend not to talk about these things very much.

Moderator: How can you tell if an older person is experiencing the onset of dementia?

Dr. Beckerman: Dementia is usually something ? Alzheimer?s being the most common. It's decreased blood flow to areas of the brain, and it's usually progressive. Somebody is forgetful, but if somebody becomes more forgetful, and mental aspects aren't working appropriately -- the major thing is that it progresses, and not something that just acutely happens. There is delirium, and that's different than dementia, because that's caused by medication. That can cause you to seem to be forgetful, or you seem to be confused. Dementia is usually progressing over time.

Moderator: In your experience, what do older adults fear the most?

Dr. Beckerman: They fear not death, but the pain of dying. Many associate dying with pain, and the study I did on hope a number of years ago -- that was the constant comment of participants. It wasn't death itself, and they didn't have any regrets, but they fear any pain that can be associated with the process of dying. This is something health care professionals are able to address.

Moderator: What can we, as caregivers, do to alleviate those concerns?

Dr. Beckerman: Forcing the topic out into the open, and if the person has a particular illness like cancer, and there's pain associated with that, to make sure appropriate pain medication is prescribed, and to work with the health care provider. To make sure that the person knows that they will not have pain -- this is not doing a Kevorkian, or helping someone to die, but making sure that the end of their life is pain-free.

Moderator: A very uncomfortable topic we sometimes hear about is elder abuse. How common is this?

Dr. Beckerman: It is there, and most of the time it'll be there because of frustration from the caregiver, if the caregiver has a lot of stress. One chapter of the book goes into the resources available. That person, in getting stressed out, can react physically, mental abuse, they can handle the person roughly, or talk to the person very coarsely. That can happen, and usually will happen when the caregiver is very stressed. It may be because there isn't enough staff available in the institution. This is where the caregiver needs not to just say "okay, this is the particular place I brought mom or dad here to live, and they seem to be fine", and then just walk away from the situation. You always need to be involved. Constantly ask questions. Observe if they seem to be bruised, or do not seem to be eating, or refusing care. There are reasons why people refuse care. They're not used to the shower because they always took a bath. Older people do bruise more easily. You need to be the eyes and ears of the person while that person is in an institution. In home, stress needs to be reduced by looking and asking for help. In the book, we give the resources you need to go find help. Most caregivers tend not to ask for help. My husband had a stroke six weeks ago, so now I'm the caregiver, when last year he was the caregiver. When I need help, I don't hesitate to ask my children for help.