It happened again last week. I received a call from a close friend concerned about an aging parent.
In truth, I work with clients of all ages, but since half of them fall into the “older adult” category (80 years old and above), I tend to be the “go to” person for questions regarding health care in this stage of life.
My friend, Jen, had noticed a few unsettling things about her dad in recent weeks: problems with short term memory; an unreasonable and angry disposition; a growing inability to hold back from saying whatever came to mind, no matter how hurtful it may have been.
She felt that a crisis was looming.
To make matters worse, Jen lives here in the Northeast, while her dad resides in Florida. She felt helpless because her father was resisting any assistance or suggestions about his health (or anything else, for that matter).
I was alarmed as well. I know her dad well and the major change in mental status she described suggested that an immediate trip to his primary care physician was necessary, to begin the process of identifying what might be going on.
Maybe her dad had a masked urinary tract infection (in older adults, one of the first manifestations is a change in mental status). Maybe he was beginning to experience signs of Dementia. Or maybe he was experiencing mini-strokes, low blood sugar, anemia, or any one of many, many possible medical issues.
No matter what, it was appropriate for his primary care physician to know, to evaluate him and to begin to rule out causes of this change.
Develop the relationship before you need it
In my last Newsletter, I suggested that you develop a relationship with your parents’ primary care physician.
If you live close by, this is fairly straightforward. Plan to attend an upcoming physician appointment, then meet the doctor face-to-face and describe how interested and motivated you are to be a member of the support team. Let him/her know that you are only a phone call away and have your parent(s) sign a release form giving you permission to speak directly with the doctors.
When your parents live at a distance, on the other hand, it is not quite so easy, particularly when you are dealing with a resistant parent.
Even so, it is manageable. Some thoughts about what you can do:
- Call the primary care physician practice and identify yourself as Mr. Smith’s daughter.
- Explain that you live far away but would like to open up lines of communication with the physician to describe observations and share concerns.
- Try to set up a pre-arranged phone appointment with the physician and offer to pay for his/her time (physicians are not often compensated for time spent on the phone or answering emails so they are sometimes reluctant to communicate in ways other than a face-to-face visit).
- Suggest that you could articulate your request and concerns in writing. Send it via fax so that you can have a productive discussion with the physician.
- If the physician is unwilling/unable to talk directly, ask if there is another key clinical person orcare/case manager in the practice who might be familiar with your parent and his/her health. It could be a nurse, nurse practitioner, physician’s assistant or social worker. One of these might be a starting point.
- Once you have the meeting set up, prepare a concise document – an agenda for your meeting – that you can share beforehand and that clearly describes observations and articulates your concerns and specific questions. (If your parent has not granted permission for the physician to share information, he/she may not be able to tell you much about clinical issues. Still, the physician will appreciate the concern and the input and hopefully you can come up with a plan together.)
Above all, the thing to remember when noticing changes in an older adult is that it’s not always simply the result of “natural aging.” An explanation is needed and the primary care physician is the key player and the best starting point.
The relationship that you develop today with that physician – whether face-to-face or through a combination of other, long distance means – will play a critical role in ensuring that all members of your parents’ extended team are working together!
P.S. We were able to isolate the medical cause of Jen’s Dad’s change in mental status and he is doing great!