When gathering information from an older individual about his or her health status, in addition to asking about medical conditions, surgeries, hospitalizations, medications and their healthcare team, I also ask them to describe a typical day.
What time do you get up? Do you shower and get dressed on your own? What do you typically eat for breakfast? Then what do you do? How about lunch? Afternoon activities? Dinner? After dinner? How well do you sleep?
I find the answers to these questions to be so revealing. Not just about one’s ability to perform activities of daily living, such as bathing, dressing and eating; it also gives me an indication of the degree of engagement an individual may have with other people in their lives.
Red flags in conversations with baby-boomers
Much has been researched and written about older adults and the relationship between depression and sociability. And although depression can arise for anyone at any age from things like declining health, death of a spouse or lack of social support, I find this population, in particular, facing numerous changes that challenge their sense of self and their capacity to live happily.
Many older adults, as their worlds become less busy, continue to find great joy in a structured day that includes simple things that bring them pleasure and connection. It’s important for us to guard against projecting our own values about what these things may be.
What if mom gives up her license?
Consider this statement: “Mom shouldn’t be driving anymore.” Given my work, of course, I hear this frequently. And while it may or may not be true – and there are ways to assess capabilities that I’ll discuss later – what astounds me is the typical lack of sensitivity about what such a change would mean to the older adult. Although I know the adult child is motivated by safety concerns, children often fail to think about the impact that such a move would have on their parent.
A client of mine who was in her nineties, drove daily to visit her sister who lived in a nursing home; had her hair done once a week; and picked up some groceries on the way home. She also attended church on Sunday followed by a coffee hour with parishioners.
Overall, she struck me as a very content woman, spending significant time alone maintaining her home, reading and doing jigsaw puzzles. But her daily interaction with others, including her sister, was crucial to her emotional well-being. Taking away her ability to independently engage in such activities could be potentially devastating to her.
What if dad’s wishes don’t make as much sense now as they did then?
Another client of mine lives in a continuing care retirement community; he was diagnosed with mild cognitive impairment three years ago at the age of 90. With some in-home support from a private caregiver, he remained socially engaged in the community until fairly recently when we all began to notice a reluctance to participate in scheduled activities. When we asked him about this, he stated that at the age of 93, he’s slowing down and if he doesn’t want to get up in time to attend an exercise class, he has a right to make such a decision.
He’s been adamant with his family about his desire to remain in his independent apartment and that he would use his assets to pay for in-home support. As his professional advocate, I continue to fully appreciate and support his wishes and have worked tirelessly with his family to help execute them. However, based on his recent behaviors, I find myself wondering if the structured socialization of an assisted living environment might not be beneficial. I know that his children and the social worker in the community have thought about this too.
Some suggestions
The examples posed above are just two of numerous real-life dilemmas that require careful consideration and discussion with the individual, health care professionals, retirement community personnel and others. Everyone tends to focus on safety (so do I). But we can’t lose sight of the necessity of social connection.
Here then are some practical suggestions…
- Take a step back and assess the degree to which your loved one is socially engaged with others. How often does it happen in the course of a day or week?If you feel they are (or are becoming) socially isolated or experiencing depression, talk to your loved one about your concerns.
- Solicit the help of your loved one’s primary care physician so they can objectively assess for depression and make recommendations for treatment. If you are suggesting they no longer drive, talk to their physician as well; referrals may be made for neuro-psych testing and/or a formal driving assessment designed for older adults. (Here are some examples of available driving evaluation programs.)
- When making suggestions or helping to structure activities for a loved one, think about what is important to them and what brings them the greatest pleasure in life. If changes must be made, identify ways to maintain the independence they had before.For my driving client above, we hired a companion to drive her to see her sister every day, and included a stop for grocery shopping. We combined this with The Ride to get her to church every Sunday. Ultimately, she was willing to surrender her license because she knew she could maintain her previous schedule without placing undue burden on her children.
Conclusion
Having older adults in our lives is a wonderful privilege that carries with it major responsibilities. Social engagement is as important as physical health, so please be as conscious of the former as the latter. As always, there is no one, right, answer for everyone; be prepared to be thoughtful about dilemmas you encounter along the way.