Ask the Expert
Ask the Expert

R. Sean Morrison, MD, on Caring for Aging Parents


R. Sean Morrison

R. Sean Morrison, MD
Director, National Palliative Care Research Center
Vice Chair for Research
Professor, Departments of Geriatrics and Palliative Medicine, and Internal Medicine
The Mount Sinai Hospital

A survey conducted by the National Alliance for Caregiving estimates that more than one third of adult children are caring for an older parent.  As life expectancy increases -- and people 85 and older are the largest growing group in America -- adult children may spend more years caring for their parents than their children.  Dr. Sean Morrison, a renowned expert in the care of older adults, offers advice on how caregivers can ease the strain and seek supportive services. Dr. Morrison is a recipient of the 2000 Paul B. Beeson Career Development Award in Aging Research.

Infoaging: What are the challenges facing adult children of aging parents? 

Dr. Morrison: The challenges are dramatically different than they were a generation ago.  People are living much longer - long enough to develop multiple chronic diseases and disabilities.

Fifty years ago families tended to be larger and relatives lived close by so there were more people to share the care-giving responsibilities.  Often only one person worked outside the home. Disease progression was much more rapid.  If a person developed heart failure, for example, death would generally occur in one to two years.  Today, with advances in diagnostics, drug treatments, and safer surgical procedures, heart disease can be managed as a chronic condition and people can expect to live a normal life span. The same is true with other common age-related diseases and conditions such as diabetes, hypertension, and some forms of cancer.

Added to the mix - and this is one of the biggest emotional and financial strains on families - is that with the increase in longevity comes the greater likelihood of developing cognitive decline ranging from mild cognitive impairment to Alzheimer's disease.  So now you may have a 75-year-old man with hypertension, diabetes, and dementia, who may live another 20 years. As his dementia advances, who will care for him?

Our healthcare system was not designed to take care of the large number of patients that need long-term care.  The challenges we face as a society are to bring together needed support and the personal and financial resources to help people function well in their environment.

I'm in California, Mom's in New York. What should I be thinking about?

I see this more and more with the children of my patients. In addition to the normal anxiety and worry they feel about the health and well-being of their parents, there is an added feeling of guilt and helplessness at not being able to visit them at home and accompany them to doctor's visits.

Try not to feel this way. You can assemble a team of health professionals, use state and city services, and seek support from the community.

First, seek out the care of a geriatrician, ideally one who is part of a geriatrics care program comprised of an interdisciplinary team of nurses, social workers, and other health care specialists trained in geriatrics care. They can help coordinate your parent's health and social service needs and serve as a resource about community and state aging programs such as home care and meal delivery and transportation services.

Other recommendations:

  • • Have frequent conversations with the healthcare team. Many of them will communicate with you via email.
  • • Make sure that your parent's home environment is safe.  Are area rugs secure? You can do this by hiring an occupational therapist to evaluate your parent's ability to function safely and independently in the home.
  • • Establish a lifeline.  There are many new technologies such as the wearing of electronic medical alert type pendants so that your parents can call for help in an emergency.
  • • Establish a regular timeline with parents.  Call them at the same time every day.
  • • Make sure someone - a trusted neighbor or an aide visits your parent on a regular basis to ensure that their home environment is clean and that they are taking care of their personal hygiene.
  • • Let your parent do as much as they are able to.  It is easy to take over the decision-making but it is understandably unsettling for them to lose their independence. With professional input, determine the activities of daily living (ADL) they are able to do and help as necessary. ADLs are the ability to cook and shop, feed oneself, bathe, take medications as prescribed, etc.

What is palliative care? When can it help? How can I get it?

Palliative care should not be confused with end of life or hospice care. Palliative care is used along with disease specific treatment to help relieve the pain and suffering caused by illness. It is employed for people at all stages of disease not just the terminally ill. A team of palliative care specialists that include doctors, nurses, social workers, chaplains, pharmacists, and psychologists work with patients and other doctors to provide an extra layer of support to address the physical, emotional, and spiritual concerns of coping with illness. More than 80% of hospitals with more than 300 beds offer a palliative care program. GetPalliativeCare.org is a good source for hospitals with palliative care programs.

Whether we are caregivers or not, what are the best things we can do to keep ourselves healthy as we age?

The advice you have been hearing bears repeating. Good eating habits, regular exercise, maintaining a normal weight, not smoking, reducing stress, and building social networks will do remarkable things in slowing the rates of aging and helping you to live healthier longer.  As mentioned earlier, while people are living longer, many of them are living longer with a host of preventable conditions like diabetes and hypertension.

While we can't change the genes we are born with (at least for now) and the predisposition to diseases that come with them, it's not inevitable that you will develop the conditions and diseases that your relatives did.

03/14/12





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