This week by caregiver request, I am answering the question of when should elderly parents stop living alone? There are signs of frailty that family caregivers can notice, which indicate parents are getting weaker. Seeing these signs in elderly parents who may be struggling can help caregivers take better care of themselves.
How To Know When Aging Parents Need a Little More Help
Podcast episode 137, Caring for Elderly Parents What Matters, shares information about the 4Ms that combine coordinating care for aging parents with the healthcare system. Everyone can take action if you know about them and why they are essential to remaining healthy and active in your later years.
Is Your Immune System Healthy?
The guest for today’s program talks about staying healthy by supporting the immune system health to avoid or manage health conditions that affect caregivers and care receivers. Dr. Gary Kaplan, D.O., is a pioneer and leader in integrative medicine.
He is one of only 19 physicians to be board-certified in both Family Medicine and Pain Medicine. Founder and medical director of the Kaplan Center for Integrative Medicine, he and his staff offer patients suffering from chronic pain and illness a more effective model of medical care.
In 2015, he established the Foundation for Total Recovery to find a cure for all who suffer from chronic pain and depression by educating patients and partnering with leading researchers, academics, and innovators. Dr. Kaplan’s new book, Why You Are You Still Sick: How Infections Can Break Your Immune System & How You Can Recover, offers practical tips for anyone interested in a healthy immune system.
When Should Elderly Parents Stop Living Alone?
When should elderly parents stop living alone is a great question to ask. Many factors contribute to frailty, which is a medical speak term that the healthcare system uses.
What is frailty? In general terms, frailty means being weak and mainly applies to older adults. For example, frailty can mean that elderly parents are susceptible to more frequent colds or infections. Or if they do get some type of bug, it can take a long time to recover.
How Does Being Frail Affect Daily Life?
Physical or mental frailty relates to resilience and the ability to bounce back from illness. The elderly who are frail may generally be healthy with only minor health problems. Or you may have a weak parent diagnosed with multiple health conditions.
The outcome of frailty might be the experience of a urinary tract infection or pneumonia that leads to a downward spiral of more health issues negatively impacting impact health and well-being.
According to statistics from Age U.K., around 10% of people aged 65 and over live with frailty. The prevalence of frailty rises to between 25 and 50% for persons over 85.
Five Indicators of Frailty in Older Adults
To answer the question of when should elderly parents stop living alone, let’s look at five things you can look for if you are caring for aging parents.
1 Unintentional Weight Loss
Unintentional weight loss may be hard to identify, especially if you see a parent frequently. Baggy clothing can hide weight loss. The only way to measure weight is to place a parent on the scale and track the numbers.
Weight loss can relate to other conditions like depression, resulting in not being hungry. Parents sit all day and are physically inactive. They don’t work up an appetite, so you may hear them say, “I’m not hungry.”
Stomach problems like indigestion can result in not wanting to eat. Poor nutrition is a big concern in the elderly, many of whom are malnutritioned.
Poor nutrition can result in a long list of other health issues. Even if someone is overweight, many of these concerns still exist.
In the program’s second half, Dr. Kaplan addresses nutrition and stomach problems—like indigestion. Learn how stomach issues negatively affect the immune system.
2 Exhaustion
The number two frailty factor that contributes to asking when should elderly parents stop living alone is exhaustion. Are your parents tired all the time?
- Do loved ones sleep all day because of not getting restful sleep at night?
- Is the primary daily activity for a parent sitting in a chair and watching television all day?
- Does being physically active around the home or going out to get groceries result in a parent becoming out of breath?
Many family caregivers experience exhaustion. Caregivers tell me that they dream of being able to take a nap. Getting a good night’s sleep is vital for everyone involved in a caregiving relationship.
There are many reasons for feeling exhausted. Undiagnosed or poorly managed medical conditions, a lack of sleep for other reasons like restless leg syndrome, not getting proper exercise, or poor nutrition.
Many Conditions Contribute to Frailty for Older Adults
Aspects related to being frail contribute to safety risks for elderly parents who live alone. Frailty can lead to health events that need fast medical treatment.
If a parent isn’t proactive in seeing a doctor regularly to prevent health from worsening, mom or dad may hesitate to call 911—because of not realizing a severe condition. Then as the caregiver, you have a serious situation on your hands.
You may have to figure out how to find more time to care for parents, hire a caregiver agency, or consider moving parents to a care community. Unexpected health emergencies typically result in a need for time-sensitive decisions.
3 Low Energy
Low energy is different from being exhausted. Health conditions like heart disease, COPD, cancer, autoimmune diseases like lupus, multiple sclerosis, or anemia can cause low energy.
Low energy can be a sign of depression or anxiety and is sometimes a side effect of medications. Because elderly parents can take a lot of medicines, it is essential to monitor the impact of any type of change in medication.
4 Hand Grip Strength
The fourth contributor to frailty is handgrip strength. While this probably sounds like an odd measure of strength, weak hand strength can be a sign of overall physical weakness and loss of muscle mass.
Muscle mass and strength begin to decline beginning around age forty. A firm grip at an older age is an indicator of living longer.
In a research article by Joanna Dudzinska-Griszek and others published in Clinical Interventions in Aging, grip strength is influenced by multiple health factors. It is one of the top predictors of poor health outcomes, disability, and death in older patients who have chronic health conditions.
Other research by Diana Urbano and others confirms that handgrip strength may be an early indicator of the onset of frailty. In addition, a weak handgrip may be a warning sign that other conditions may be present, which can lead to elderly parents eventually requiring more care.
5 Slow Walking Speed
The fifth frailty factor is low walking speed or gait issues.
Difficulty walking or poor balance can be a sign of dementia, Alzheimer’s, or Parkinson’s disease if there are no other physical reasons like fractures, arthritis, or other functional concerns.
Poor gait or uneven steps when walking can contribute to serious injuries resulting from a fall.
Can you or your parents:
- Lift and carry ten pounds?
- Walk up a flight of stairs without becoming out of breath?
- Walk a block?
- Stand from a chair without holding on to its arms?
- Raise your arms high above your head?
- Independently perform activities of daily living that include bathing or showering, going to the bathroom, preparing and eating a meal, and dressing.
Signs of frailty, a lack of medical care if a person has multiple health conditions, and the ability to manage independently at home are indicators of potential safety risks. Separate from this, persons with dementia, Alzheimer’s, or cognitive issues have a higher risk of living alone as the memory loss progresses.
Participate in Medical Care
Take an interest in your parent’s health and medical care if they will allow it. This participation can decrease worry about when should elderly parents stop living alone. Attend a medical appointment to learn about their health conditions and their medications.
If you notice parents having difficulty with any of these activities, make a medical appointment to discuss options for physical therapy. Ask the doctor to complete a frailty assessment. Aging parents who commit to daily exercise and strength training exercises can avoid bodily injury and live in their homes longer.
Other health concerns relating to when should elderly parents stop living alone include multiple hospitalizations and recurring infections. Frequent illness means that the body’s resilience is low and that the immune system is struggling.
Have conversations about care with parents. For example, ask what type of care and to what extent parents want medical care or life-extending measures?
You may learn that mom or dad wants to stay in their home. They may choose hospice care over extensive medical treatment.
These choices are your parent’s, just as they will be your choices when you are the person who needs care.
Care Options for Frail Elderly Parents
Bringing care into the home can help with frailty issues like stopping weight loss through better nutrition, increasing walking speed with daily exercise, taking medications, and increased socialization.
Moving a parent to an assisted living community offers 24-hour care availability and supervision in a health emergency. In addition, the benefits of socialization, good nutrition, mental and physical activity, and having a doctor on-site at an assisted living community can support caregivers who are busy trying to manage their lives.
There are many steps caregivers can take to relieve worry about when should elderly parents stop living alone. As a caregiver for elderly parents, grandparents, or a spouse, there are a lot of considerations and things to pay attention to that are signs the health of a parent is declining.
Many elderly want to remain living in the comfort of their homes, but they don’t know what it takes to make this happen. When you begin talking about these concerns as a family, you can be more proactive in preventing falls, hospitalizations, or other events that require changing parents’ living arrangements.
Being proactive about health and self-care takes time, attention, dedication, and effort. There’s no way around doing things to stay healthy if being healthy is a goal. So this means that the answer to when should an elderly parent stop living alone is up to each individual.
Tips to Maintain a Strong Immune System
Let’s learn about the immune system and what you can do to support good health. If you have an autoimmune diagnosis, this interview will give you hope that you can improve your health.
Pamela D Wilson: Dr. Kaplan, thank you so much for joining me.
Dr. Gary Kaplan: My pleasure. Thank you for being here. Delighted to be on the show.
How Does the Immune System Work?
Pamela D Wilson: Can you talk about how the body’s immune system works?
Dr. Gary Kaplan: Absolutely. So the immune system’s job is to protect us from the other. From bacteria, from viruses, from parasites. And so that’s the job. The immune system has to recognize things that are not us and stop them from hurting us. And so, there are two big components of the immune system. The first which is the innate responders, and then the acquired, which are all the antibodies that we built up for things.
So you build antibodies, for example, when you get immunizations. So the immune system, its whole job is to prevent us from getting sick or, if we do get sick, to fix it so that we repair and heal.
What Causes Autoimmune Disorders?
Pamela D Wilson: And then there’s this terminology called autoimmune disorders. What causes those?
Dr. Gary Kaplan: That’s when the immune system gets a bit confused, and it fails to recognize us from the other. And so what happens now is that our own immune system starts thinking that our tissues, particularly the brain of the conditions we are talking about here, but it can also be the intestines. We talk about Chron’s disease.
But what happens is that the immune system gets confused, and it thinks that our own tissues are the problem. That we are the other. So it starts to attack it. The end result of which we get very sick.
Types of Autoimmune Disorders
Pamela D Wilson: And so if I’m a person and I’m thinking do I have an autoimmune disorder, what would that be called?
Dr. Gary Kaplan: So there’s a lot of ways a lot of things that we call autoimmune disease. The classic autoimmune disease is things like rheumatoid arthritis or things like lupus, Chron’s disease, and multiple sclerosis, but there’s a whole new group of diseases that actually are autoimmune diseases. And they include things like chronic fatigue syndrome, problems with chronic pain syndromes, post-COVID.
It’s a problem where the immune system is broken, it’s no longer the virus. Problems with chronic Lyme disease and things like anxiety disorders can all actually be problems where the immune system has mistakenly attacked ourselves and is now inflaming our brain, and we’re getting all of these symptoms—pain, sleep disturbances, focus, and concentration issues.
And, when it really gets inflamed, you get things like Alzheimer’s. You get things like Parkinson’s disease. So this is, keeping the immune system happy is absolutely crucial for us to be healthy and happy.
How to Keep the Immune System Healthy
Pamela D Wilson: And so how do we do that? How do we keep the immune system healthy?
Dr. Gary Kaplan: Well, there’s a lot of things that are kind of the basics. One of which is sleep. We need to make sure we’re getting not just enough sleep but the right kind of sleep. So we need to make sure we’re getting, and a study just came out yesterday, as a matter of fact, that looked at what is the right amount of sleep, and the answer is seven hours. And maybe eight to nine on either side of that. But seven hours is kind of the sweet spot for ideal, optimal immune functioning.
So you want to make sure you are going to bed at the same time every night. You’re getting up at the same time of day every day, and that you’re sleeping solidly through the night. You also want to make sure that you’re breathing throughout the night. About five percent of people have a condition called sleep apnea, where they stop breathing at night. They have very loud snores, typically. And about eighty-five percent of the people who have sleep apnea don’t know it.
The end result is that they wake up exhausted no matter how much sleep they get. They’re dozing off during the day. They’re falling asleep watching movies or even in conversations with people they could be falling asleep. And worse, they could be falling asleep at the wheel of a car. And their brains are not functioning as well because they’re not sleeping.
So if you are suspicious that you’ve got sleep apnea. You need to talk to your doctor about it. Because it’s easy to fix. And may save your life. For example, it can prevent the occurrence of hypertension. It can prevent the occurrence of cognitive problems and prevent car accidents. So sleep is really, really important, not just for the older person who people may be caring for but for the caregivers themselves.
Because if the caregivers themselves are not getting adequate sleep, their judgment is impaired. And they’re going to make decisions that they’re going to regret later. So having adequate sleep is important for everyone involved.
The next thing would be diet. You want to make sure that you’re eating a good clean diet. You want to make sure that you’re eating foods that support you and not eating junk foods and packaged foods. You want to eat as much fresh food as possible. So that’s going to keep you healthy.
And then you want to make sure that you’re getting adequate exercise. Exercise is probably the single most anti-inflammatory for the brain that we have. So exercise is important. And exercise doesn’t have to be running a mile or two miles. It just may be walking. And it may be walking 3,000, 5,000 steps a day. Whatever you can do. We want to keep you moving. So those are the big things.
And meditation, we also know, is also an excellent anti-inflammatory for the body. It helps calm down the immune system. So diet, sleep, exercise, and meditation are things you’ve all heard before. But the reality is that the science is there, and it’s extremely important to take care of yourself.
Unintended Effects on the Immune System
Pamela D Wilson: So caregivers are some of the most stressed-out people I know. And they get headaches and take Aleve and Advil and maybe some of those over-the-counter stomach things. So what effect does that have on the body and the immune system?
Dr. Gary Kaplan: So, an excellent question and a very important one. Because the reality is taking anti-inflammatory medications on a regular basis like Advil or Aleve causes ulcerations not just in the stomach really if you’re taking it on a regular basis, seventy-five percent of people end up with ulcerations in their small intestines.
That then is going to cause problems with being able to absorb proper nutrients. It’s going to cause problems with diarrhea or constipation, bloating, and gas. And also, the fact is without a healthy gut, you do not have a healthy brain. And so you have to make sure that you’re not taking things that are doing damage to the gut. So Aleve and Advil, once in a while is one thing. On a regular basis, it’s probably doing a lot of damage.
The other major medication that we need to be very careful about is the medications that suppress our stomach acid. Taking those on a regular basis has been shown to have a link to the development of Alzheimer’s. And so again, we have this thing that’s disrupting the health of the gut, and that’s not helping the brain.
And so it’s important to be careful about what medications we’re taking and what amounts of it we’re taking in order to protect the gut. Taking things like a good probiotic can be a nice way to help keep the gut healthy and keep you regular. Taking magnesium which almost everybody is deficient.
Magnesium taurate, in particular, can be helpful in terms of revitalizing the brain. Magnesium glycinate can be helpful in terms of if you’re having problems with constipation. You just have to be careful how much you take; otherwise, you will experience diarrhea. So those are two supplements. And another basic supplement, by the way, that you can take that will help reduce some of the inflammation in the brain, is melatonin. But you have to make sure you get a good quality product.
Do Options Exist for Healing the Immune System?
Pamela D Wilson: And so caregivers—they’re stressed, right? And so they probably have upset stomachs a lot. And to your point, if you don’t have a healthy gut, then you’re going to have all kinds of problems. So, and I know you mentioned some of these supplements. But if somebody has gone to the doctor and the doctor says, “oh, just take this stomach acid thing.” And they’ve been taking it for years, and the minute they stop taking it, they have an upset stomach. What’s the solution to that, or are there solutions?
Dr. Gary Kaplan: Oh, there are great solutions for that. One of which is simple stuff. Ginger tea. Get fresh ginger root. Carve the bark off. Take about a one-inch square of it. Put it in a garlic press. Squeeze that into hot water, and you can sip that. Ginger is lovely in quieting down mucosal inflammation—that’s the stomach inflammation.
Another thing you can do is aloe vera juice. Four ounces three times a day. Also great for healing the stomach and the mucosa. Deglycyrrhized licorice is another thing you can take to help with heartburn and stomach acid. You want to make sure you’re not taking real licorice because real licorice can cause high blood pressure. So deglycyrrhized licorice (DGL) is really important to be able to help with heartburn.
So those are not quick solutions because it does take a while for everything to come back into balance if you’ve been on these antacids—these acid suppressants—for years. It’s going to take a little bit to balance everything out. I’ll tell you another way that I do it is I’ll have people take something like Pepcid, which is a neutralizing substance as opposed to a total acid suppressor.
And then, what you can do is a transition to that from a proton pump inhibitor. And taking Pepcid on a regular basis then allows you to transition off that into something like the aloe vera juice or the DGL or the ginger tea. So all of those things can help get you off those things. So we really want to get you off those things if at all possible.
Are There Alternatives to Prescription Medicines?
Pamela D Wilson: Earlier, you mentioned depression and anxiety being kind of like an autoimmune disorder. And I know a lot of people will take anti-depressants or things like that. Is there an alternative to those types of medications?
Dr. Gary Kaplan: There are, and I want to clarify that a bit. I look at depression and anxiety as neuroinflammatory diseases. That is the brain on fire. Now the cause of that may be an autoimmune process, but it can be other things that create the problem. Because the innate immune system may be the problem here. So that inflammatory process can be reduced again by taking something like melatonin.
Resveratol is a supplement also something that may help. Again we get back to proper sleep and exercise in order to reduce that inflammation in the brain. And doing that on a regular basis, relaxation techniques. You’ve got to take care of yourself. If you don’t take care of yourself, you’re not going to be good to anyone else. And that’s the most important thing of all because if you collapse, who is going to be there to pick the problems up?
Pamela D Wilson: That is so true.
Dr. Gary Kaplan: Yes.
Resources For Autoimmune Diseases and Healing
Pamela D Wilson: Earlier, I mentioned your book, so now I want to talk about where people can go if they are searching for information. There’s the website called the Foundation for Total Recovery. Can you talk about that?
Website Link: https://www.brainonfire.org/
Dr. Gary Kaplan: That was the foundation that I created after I wrote my first book. It’s an education and research foundation. We recently held an international conference, if you’ll excuse the expression Autoimmune Encephalopathopy and Infectious Epidemiology. The scientific meeting was sponsored by Georgetown University. We had over 900 attendees.
That conference is available on the website on the Foundation for Total Recovery. There’s a small fee involved for the two and a half days of the conference. But it’s an excellent place to get top-notch education from some of the leading thought leaders in the profession talking about this stuff. Some of it is a little too much, but a lot of it is acceptable to the general public.
And in fact, we probably have about three hundred or four hundred of the general public in attendance at that meeting and got rave reviews on it. So that conference which was held in February of this year, is available on the foundation website, a great place to get resources.
Additionally, within the book, I’ve got a lot of resources in terms of different labs that you can look at. And go to their websites. They have a lot of information on stuff. There’s a lot of information and ways to educate yourself. Our own website has a lot of free information, lectures we’ve given over the years to get you well educated and to help you help yourself.
How to Find Integrative Medicine Providers
Pamela D Wilson: And so your center for integrative medicine, you’re on the East Coast. If someone is in Los Angeles or Texas or somewhere else and they’re looking for somebody like you, how do they find somebody like you.
Dr. Gary Kaplan: So they can look at the Institute for Functional Medicine might be a group of people that have access because they’re a group of people that can help them. ILADS, the International Association for Lyme-related Diseases. ILADS is a great physician referral list, and there’s a number of good physicians there.
The American Alternative Medical Association has a number of physicians, referrals within your area. So there’s—you have to go look. You have to ask questions. You have to interview. The thing you need to keep in mind is that, as physicians, we work for you. You hire us. You fire us. And if we’re not working for you, if we’re not paying attention to you, fire us and go find somebody who listens.
Because you should not just be locked into a physician because you went to this one doctor. And, you know, we all have different specialties and strengths. And so I really want people to be their own advocates and make sure that they’re being listened to.
There are people that we see from around the country. So to a certain extent, we can sometimes be that physician. But there are really only a couple of us here, so we really need to connect with other physicians around the country and around the world, for that matter, who can do this kind of medicine. And we’re also geared toward educating those physicians.
Pamela D Wilson: Dr. Kaplan, I thank you for joining me. Is there anything else that you’d like to share before we sign off?
Dr. Gary Kaplan: I want people to understand that they can get better. I want people to understand that there is hope, and we’re only getting better at what we do. Take care of yourself so that we get better, we get better answers for you in the immediate future, and that there is better for you and your loved ones.
Pamela D Wison: Thank you so much.
Dr. Gary Kaplan: Pamela, pleasure. Thank you for having me on the show.
Being Proactive is the Best Medicine
Being proactive to learn about health and well-being and when should an elderly parent stop living alone. When families make health a priority, many of the issues associated with aging can be better managed.
Older adults who are healthy are more physically and socially active. They participate in annual medical appointments but need less care overall. Many take fewer medications.
Being old and sick is a choice, but only if you learn about options that positively impact your health early enough to have an impact on avoiding health diagnoses.
Even when information is learned in middle age or later, there are many steps you can take to reduce frailty and support good immune system functioning.
Here’s to staying healthy and happy well into the later years of life.
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