We discussed eldercare & aging issues—including powers of attorney, how participants are coping with the pandemic, challenges of caring for a frail parent with dementia, affordable psychiatric care and deprescribing medicines for frail elders.  

Aging & Elder Care

Based on questions posed by a DLM Eldercare Group member prior to this meeting, we discussed circumstances when it was advisable to get powers of attorney (POA) for a loved one’s health care and/or finances—particularly for those who had dementia that was impairing their ability to make sound judgments in these matters. 

A few of our participants had some knowledge or experience with POAs and offered to provide direct advice to those who were considering doing them.  It was advised that—if other siblings or family members were affected—they be included in the POA to share responsibilities or serve as a designated backup when appropriate.  However, our participants agreed that it was best to speak with or hire a lawyer who specialized in elder law.  A couple of suggested lawyers were named.   

We discussed a situation where a parent who had always very giving and generous when younger was now acting very self-focused and demanding her daughter’s attention—in spite of now living in a potentially supportive senior living community.  It was noted by another experienced caregiver that frail older adults and those who are losing their cognitive abilities are often concerned about their lack of control.  Depending on their personalities and beliefs, they will either take the path to peace or the path to struggle.

Another participant observed that some mother-daughter care relationships could be challenging due to the mother’s fear about having enough resources to avoid a nursing home and her strong desire to have her daughter remain as her main source of support.  Another partner added it was common for a frail parent to reverse roles with their son or daughter and act like a child.  These problems were seen as especially common when the loved one has some dementia, which becomes increasingly likely with age—even if not diagnosed.

Another participant noted that the loved one might actually be getting more help and social support from others in their senior residence community than they report to their care partners.  Communicating with the social worker or equivalent staff person at a senior residence can help to assure a care partner that their loved one is getting adequate support and can help to alert the staff to the loved one’s needs and stimulate staff efforts to help.

Another experienced care partner said that it was important to be honest with your loved one about your own physical, mental, financial and emotional limitations and vulnerability in caring for them.  This straight talk was seen as important for their relationship and getting the understanding, respect and cooperation of the loved one.  Another caregiver remarked that a tearful conversation with her loved one shattered the super-caregiver image that she had previously established and led to the much-needed, less-demanding expectations of her loved one.

It was noted that the Alzheimers Association offered  valuable support to care partners through its support groups and educational programs.  See Alzheimers Association Help & Support https://www.alz.org/help-support.

We discussed how participants were coping with aging and eldercare during the pandemic.  As in past recent months, those with caregiver responsibilities reported challenges in delivering care due to cost and safety concerns. 

Describing symptoms of caregiver stress and social isolation, one participant described the relief and joy of a two-week nature cure at the beach with a friend.  Another reported some relief at having a loved one with a serious chronic condition recently move from an isolated rural environment to a city with better access to medical care and family support.  Another was taking advantage of the social restrictions to develop her spiritual practice.

Other caregivers expressed concern about the recent rise of pandemic fatigue (the general public’s impatience for public health restrictions to end), the conflicting (and too often political) public prevention messages, and the predicted Fall surge of coronavirus infections as the weather cools and more activities are moved indoors.

One care partner expressed anxiety about the challenges of assessing the health status and COVID risk environment of her loved ones—including everything about their medical and specialty care, the incidence of positive coronavirus cases and the testing protocols at their senior residence.   Other participants suggested working with their primary care doctor or the health care professionals that provide services to the residents as a conduit rather than attempting to coordinate all of their health-related needs and issues.

One experienced care partner described difficulty in finding a geriatric psychiatrist who accepts Medicare or Medicaid reimbursement for a loved one.  Due to increased demands, she noted that Emory Health Systems is currently not accepting new clients for psychiatric care…and she was told to try again in 3-4 months.  Participants made recommendations for other possible psychiatrists who might be able to take new Medicare or Medicaid patients.

We discussed the unexpected health problems of many older adults who are overmedicated—especially those taking multiple prescribed medications.  It was noted that there was a new trend in geriatric care to gradually wean older adults with co-morbid conditions off their multiple medications.  This was especially true for those aged 75 and older, due to their often-changing weight, physiology and vital signs as well as the unknown effects and unintended consequences of drug-drug interactions at any age.  One participant recommended a National Public Radio (NPR) article on this subject that appeared last year.  

Luisa Torres.  Do You Need All Those Meds?  How To Talk To Your Doctor About Cutting Back. 

National Public Radio — August 15, 2019   https://www.npr.org/sections/health-shots/2019/08/15/751272016/do-you-need-all-those-meds-how-to-talk-to-your-doctor-about-cutting-back  

Many seniors take multiple drugs, which can lead to side effects like confusion, lightheadedness and difficulty sleeping.  Doctors who specialize in the care of the elderly often recommend carefully reducing the medication load….

See also:  Deprescribing.org, a project and Website developed and supported by Dr. Barbara Farrell and Dr. Cara Tannenbaum—a pharmacist and physician who work with older people and are concerned about the risks associated with medications in this population—and their research teams at the Bruyère Research Institute (Ottawa) and Université de Montréal (https://deprescribing.org/about/).   Per the Website:

Our vision for this website is to share and exchange information about deprescribing approaches and deprescribing research with the public, health care providers and researchers.                    

Our mission is to offer:

1)  Tools to help patients and providers participate in deprescribing

2)  Information about ongoing and completed deprescribing initiatives and research projects in Canada.

3)  Links to people around the world who are interested in deprescribing.

Other Matters

Although we can all breathe a sigh of relief that most 2020 election results have been determined, Georgia has now become the national focus of January 5, 2021 Runoff Elections for the two Georgia U.S. Senate seats that will determine the party control of the Senate.  The statewide Public Service Commissioner Runoff (previously scheduled for December 1) will also now be on all voters’ January 5th ballots.  See the Runoff Explainer page of the continually-updated non-partisan Georgia Voter Guide:  https://faq.georgiavoter.guide/en/article/georgias-2020-runoff-elections-explained

 For those few who are not yet registered to vote in Georgia, the voter registration deadline for the Runoff is December 7.  Early in-person voting will start on December 14.  You can apply for your absentee ballots NOW for this race by going to: https://ballotrequest.sos.ga.gov.  NOTE: If you have a disability or are 65 years old AND have applied for an absentee ballot for an earlier 2020 election and checked the box to receive absentee ballots for all remaining 2020-cycle elections, you should get your ballot in the mail by mid-December.  However, to be sure all who plan to vote by absentee paper ballot should regularly check the Georgia My Voter Page for your absentee ballot status.  https://www.mvp.sos.ga.gov

   To make sure your vote counts, here are some helpful resources….

VOTING RESOURCES

*  ESSENTIAL–My Voter Page (MVP) https://www.mvp.sos.ga.gov official Georgia Voting Info

*  BEST GUIDE– GA Voting Guide https://www.GeorgiaVoter.guide  updated continuously***

*  Georgia Voter Protection Hotline (888-730-5816) Voter Registration Help & Voter Problems

*  Excellent U.S. Voting Resource https://www.vote.org links to all states’ Voting Info & Help

*  National Voter Protection Hotline (866-687-8683) Help with U.S. Voting in 10 languages***

DeKalb County Voting Info

*  DeKalb Votes http://www.dekalbvotes.com links to official DeKalb County Voting Info & Forms

*  DeKalb County Voter Registrations & Elections Office (404-298-4020)  call for help

*  NextDoor – Voting in DeKalb https://nextdoor.com/g/4r4lwiz9k/ has several Voting Experts