Managing What Feels Unmanageable: Caregiver Support Through the Unpredictable Aging Process

In my last post on this issue, I focused on why it is so hard to approach and prepare for the aging process. In this post, we'll talk about minimizing fear of the unknown in our seniors and ease caregiver stress, too. Aging is a long and challenging process and there isn't a one size fits all approach to managing it as a whole. Breaking down aging into distinct stages rather than one long stage helps. Here are four roughed-out stages, based on what I see with my patients and what I saw with my parents:

I’m not on-the-go or traveling as much but I can still run my own errands and pay my own bills without help. At this stage, seniors are still making their own social plans and enjoying their hobbies. They may reach out for help now and then, and are most likely staying closer to home. They may or may not be working.

My judgment is slipping; I’m struggling to solve problems that I used to handle myself. At this stage, when problems arise, they are aware of them, but may not be able to fix it themselves as they once could. Your dad no longer feels comfortable troubleshooting when the furnace isn't working. Your mom hires a gardener because she is afraid she might get hurt doing it herself. Neither of them remembers how to update their computer software.

Forgetting/ignoring elements of self care: medicine, banking, bill paying. In this stage your senior needs reminders, check-ins. They may not realize there are problems. You might find more expired food in the fridge, medicine bottles are full when they should be close to empty. You might notice unpaid bills; they're late filing tax returns. They can still go to the store or make plans with friends but some of the nitty gritty details are being missed. 

Needing help for most daily tasks. People in this stage might need reminders about eating or drinking enough. They may need reminders to bathe or change clothes. At this stage, they'll need someone else to get them to their doctor's appointments or take them to the store.

End of life- I can’t survive without someone else’s help. You can’t miss this stage. You’ll know it when you are in it. 

These are by no means absolute but can help plan. It will feel hard, but talking about these stages with your senior are important. A good time to broach the subject might be when you're talking to them about advanced directives. Your senior might get upset and not want to talk about it which is ok. You may need to keep at it. And build a community of caregiver

support. Exchange numbers with neighbors, friends and relatives with whom your senior interacts. That way if anyone notices anything unusual going on with your senior, they can call or text you about it.

Focus on Guiding Principles not Concrete Plans

Very little about growing older is set in stone. Think of the aging process as a marathon, not a sprint. And like with running a marathon, you need to plan, train and prepare for obstacles along the way. Above all, though, know that there will be times when you have more questions than answers. And sometimes the answer will be that there is no solution, only ways to cope with crappy situations.

I know you’re thinking, “Thanks for this uplifting post, Nancy.” But you can help manage the fear of the unknown, both for you and your senior. Talk with your senior about their goals and expectations early and often. To make sure everyone is on the same page, be sure to include your siblings in these discussions. Questions you should ask your seniors: 

Do they want to stay at home for as long as possible? What would make this feasible? Can caregivers and seniors agree about how to decide when living at home is no longer the best choice?

How important are friends and outside relationships to your senior? Sometimes people worry no one will come visit them if they are in a nursing home. They may want assurance that someone will still take them to the places they want to go if they can't drive themselves.

What does happiness look like to your senior now vs later on? How will they find joy when they can’t drive or when they need more help managing their day-to-day life?

When interacting with Healthcare Providers

I will cut my fellow medical providers some slack here. The current healthcare environment forces providers to see a lot of patients in a short amount of time. They can be forgetful or provide suboptimal care in this rushed situation. When it comes to ensuring they are meeting caregivers’ needs, you must prepare and be direct. Don’t assume they will tell you what is coming next, what is normal or what you should do. Go in ready to ask some version of the following questions:

• Is this something that is common with this condition?

• What should we do if this plan doesn't work out?

• What red flags should I be on the lookout for?

• When should I worry?

• When should we come back to see you for an appointment?

• Are we moving into a new normal or do you think this is just a blip?

• What is the bes-and-worst-case scenario here?

These might seem generic but they fit for a surprising amount of situations.

Above all else, remember that this is difficult for everyone, across the board. Aging comes for us all, no matter our gender, race, socio-economic background. We all have to face tough situations. Have patience and empathy; be pragmatic and prepared. Be kind to each other, and take it one day at a time. Or one minute at a time on hard days.