Why Does Caring for Elderly Parents Make Me Mean?
0:00:04.0 Announcer: Caregiving can sometimes feel like an impossible struggle. Caregivers may be torn between taking care of loved ones and trying to maintain balance in life. The good news is that it doesn’t have to be that way. The Caring Generation, with host Pamela D. Wilson, is here to focus on the conversation of caring. You’re not alone. In fact, you’re in exactly the right place to share stories and learn tips and resources to help you and your loved ones. So now, please welcome the host of The Caring Generation, Pamela D. Wilson.
Why Does Being a Caregiver Make Me Feel Angry or Mean?
0:00:37:31 Pamela D Wilson: This is Pamela D. Wilson, caregiving expert, speaker, consultant, and guardian of The Caring Generation. The Caring Generation focuses on the conversation of caring. Giving us permission to talk about aging, the challenges of caregiving, and everything in between. It’s no surprise that needing care or becoming a caregiver changes everything. The Caring Generation is here to guide you along the journey to let you know that you’re not alone.
0:01:04:95 Pamela D Wilson: You’re in exactly the right place to share stories, learn about caregiving programs and resources to help you and your loved ones plan for what’s ahead. Invite your aging parents, spouses, family, and friends to listen to the show each week. If you have a question or an idea for a future show, share your idea with me by responding to my posts on Facebook, Instagram, Twitter, or Linked In. This week the I’ll share answers to the question asked by caregivers—why does caring for elderly parents make me mean?
0:01:42:35 Pamela D Wilson: We will discuss common reasons caregivers feel frustrated when trying to help aging parents, spouses, and others. The guest for this program addresses one of the safety concerns related to falls and talks about the CDC program called STEADI, which stands for Stopping Elderly Accidents, Deaths, and Injuries. If you want to read the published article, you will find the link in the show transcript.
0:02:11:78 Pamela D Wilson: One of the authors of this article joins us. Dr. Gwen Bergen serves as a senior behavioral scientist on the Safety Promotion Team in the Division of Injury Prevention at CDC’s Injury Center. Much of her work focuses on elderly fall prevention, including understanding older adult injury prevention attitudes, beliefs, and behaviors and designing evidence-based tools to encourage aging adults to adopt behaviors to reduce their injury risk.
0:02:47:25 Pamela D Wilson: Related to elderly falls and home safety, let’s discuss the first response to why does caring for elderly parents make me mean. The level of caregiver frustration with elderly parents who refuse to use a walker, cane, or wheelchair and who are a fall risk is significant. Care refusals by elderly parents have caregivers asking—why does caregiving make me mean—and understanding that it’s care refusals.
0:03:22:47 Pamela D Wilson: If you are a caregiver for an aging parent, you naturally worry about an elderly parent having another fall or serious injury after having a minor fall and injury. Concern about parents who have fractured a hip or watching a parent getting around but not very well because of painful knees or another body part makes you want to wrap parents up in bubble wrap to prevent a fall.
0:03:51:47 Pamela D Wilson: Because there is little discussion about the increase in falls and the associated injuries for persons over age 65, the consequences for the elderly and their caregivers are unknown —until it’s too late. When you are sitting in the hospital emergency room because of a hip fracture, having a doctor tell you that you or a parent that you need 24 7 care means you are in education catch-up mode. Based on my experience, it’s impossible to predict when or how a hip fracture might happen.
0:04:21:28 Pamela D Wilson: I had clients who rolled out of bed onto the floor and broke a hip. Others who stood up from bed or a chair lost their balance, fell, and broke a hip. Standing up or turning combined with poor balance can result in life-threatening injuries for the elderly. Let’s talk about the after-the-fact consequences. Specifically for hip fractures—one-year mortality, meaning the death rate—for persons over age 65 is 27%. Almost one in three.
0:4:53:11 Pamela D Wilson: Many elderly who have a serious fall or fracture can’t return to live at home independently. Unless you or a parent are physically active before and after age 65, physical injuries can result in no choice but to live in an assisted living community or a nursing home or moving in with your children for care. My answer and plan to avoid these injuries is to remain physically active aerobically and from a physical strength perspective.
0:05:22:72 Pamela D Wilson: Get out and exercise every day. Yes, it’s work—but it’s better than ending up in a nursing home. Separately if you are female—ask your doctor for a bone density test so that you know if you have osteoporosis or osteopenia. That’s the stage before osteoporosis. Osteoporosis happens when bones become weak and are more likely to break from a fall, even sneezing, or minor injuries.
0:05:48:99 Pamela D Wilson: According to the National Osteoporosis Foundation, one in two women, 50%, and one in four men, 25%, age 50 and older will break a bone due to osteoporosis. It negatively affects vertebrae, bones in the spine, and it can lead to stooped or hunched over posture. Also, be aware that there are many health problems and prescription drugs that increase the likelihood of osteoporosis. Remember when I say one diagnosis leads to another? This is a research-proven fact.
0:06:23:99 Pamela D Wilson: Becoming educated and learning how to stay healthy is the best investment you can make in yourself so that you don’t have to answer the question—why does caring for elderly parents make me mean? It’s time-consuming. If you fall at any age and are physically weak, you will have to put forth an effort to return to being physically active. The alternative is to become physically disabled and struggle with performing activities you used to take for granted.
0:06:51:93 Pamela D Wilson: Staying healthy takes work. Managing care for a sick parent or a sick spouse takes more work and effort. If you are a woman, ask your doctor about taking calcium and vitamin D. Weight-bearing exercises and taking calcium with vitamin D can prevent osteoporosis and potential fractures. Take care of yourself. Your body is your house. Now, let’s talk about healthcare costs—another factor that raises the question of why does caring for elderly parents make me mean?
0:07:27:52 Pamela D Wilson: You may have heard discussions in the news about healthcare transparency. Hospitals are now being required to disclose rates for items and services. Effective January 1, 2021, the Price Transparency Rule requires all hospitals within the United States to make a public list of their standard charges and make this available on the Internet. Even with this option, though, it can still be a little tricky to determine what is the financial responsibility of healthcare consumers.
0:07:58:93 Pamela D Wilson: Let’s look at hip fracture surgery since we’re talking about falls in the elderly. I will share research explaining why consumers struggle to make heads or tails of healthcare insurance costs, co-pays, or other rates. If you want to learn more and read the articles, visit my website, find the page for this show, you’ll find the links in the podcast transcript.
0:08:22:13 Pamela D Wilson: All fact-based – no hype, only education. A lack of understanding of healthcare costs is another answer to why does caring for elderly parents makes me mean? Uncertainty and fear about the costs of medical procedures is a big reason that some consumers still don’t have health insurance. Or, if you have insurance, you or your elderly parent may postpone seeing the doctor because you’re afraid you can’t afford the cost.
0:08:51:99 Pamela D Wilson: According to the 2014 Medicare LDS limited data set report, in an article by Dr. Ayoade Adeyemi called Intertrochanteric Fracture, the total annual direct medical costs associated with all hip fractures in the Medicare population was $50,508. That $50,508 rate is seven years old. Do you wonder what it is today? I’ll get to that in a minute. $50,000 for a hip replacement. That’s a crazy amount of money for medical care, right?
0:09:30:70 Pamela D Wilson: It’s more than most people earn from a job in a year. $50,000 is a 10% down payment to buy a $500,000 house. $50,000 is not an easy amount to save. Yet it’s the 2014 cost of a hip replacement, and no one is asking questions. Let me share recent figures from an article, Hospital and Surgeon Medicare Reimbursement Trends for Total Joint Arthroplasty, by corresponding author Dr. Venkat Boddapati from Columbia University in New York.
0:10:02:91 Pamela D Wilson: This article talks about the costs of over 1 million total joint replacements for Medicare patients. To define this, a total joint replacement can be a knee replacement, hip replacement, or replacement of other joints like the ankle, wrist, shoulder, and elbow. 2010 Research by Kremers confirms that total hip and total knee replacements are the most common type of joint replacement.
0:10:28:88 Pamela D Wilson: $62,094 is the cost in 2017 for a joint replacement. Add to this the surgeon’s cost of $6,737, and we have a total cost of $68,831. What consumer product has cost increase of almost $18,000 in three years? Why aren’t more consumers screaming? Part of the answer is this lack of price transparency and the ability to relate healthcare costs to everyday life, health, and spending.
0:11:05:42 Pamela D Wilson: Plus, if you are young and healthy, you don’t see these costs until you become a caregiver for a sick parent. It’s not like you pay for healthcare every week at the gas pump when you fill up your car. Healthcare expenses can be delayed expenses, especially if you are young and healthy. In the second half of the program, we will talk more about healthcare costs and other factors that address why does caring for elderly parents make me mean? We are off to a break. Up next, Dr. Gwen Bergen from the Centers for Disease Control offers education about reducing falls in the elderly.
0:11:44:17 Pamela D Wilson: Pamela D Wilson: The Caring Generation is not limited by time zone or location—caregivers worldwide can listen any time of day. The show and the transcript that you can read to find links to research and caregiver support tips mentioned during the program are on my website at pameladwilson.com. Click on the Media Tab and then The Caring Generation to find the show transcripts. This is Pamela Wilson, caregiving expert, author, and speaker on The Caring Generation. Stay with me; I’ll be right back.
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0:12:43:49 Pamela D Wilson: This is Pamela D Wilson, caregiving expert and eldercare consultant on The Caring Generation. We’re back with an interview and to talk about caregiving programs, support, and research. I’d like you to meet Dr. Gwen Bergen, a senior behavioral scientist on the Safety Promotion Team in the Division of Injury Prevention at the Center for Disease Control’s Injury Center, who is working to provide education about preventing falls in older adults.
0:13:12:76 Pamela D Wilson: Dr. Bergen, thank you so much for joining me.
0:13:15:92 Dr. Gwen Bergen: Thanks for inviting me to participate in this.
0:13:19:48 Pamela D Wilson: It’s my pleasure. So, in reading your research articles, I noticed that 30% of persons over the age of 65 experience falls, but interestingly only about one-third of those seek medical treatment. Why is it important for older adults to see their primary care physician about a fall?
0:13:39:48 Dr. Gwen Bergen: Older adult falls are preventable, and healthcare providers, especially the older adult’s primary care physician, have the knowledge to assess their older adult patients to find out what specific risk factors that person may have for a fall. Older adults can take steps to prevent their falls on their own. Such as, for example attending a tai chi class to improve strength and balance.
0:14:06:78 Dr. Gwen Bergen: But they may have other risk factors such as the medications they’re taking, a chronic disease they have that are also increasing their fall risk. And their primary care physician is the person best positioned to assess the patient to see what his or her specific modifiable risk factors are and to recommend evidence-based interventions that the patient can use to reduce their fall risk for those modifiable risk factors.
0:14:37:24 Dr. Gwen Bergen: And to give you two examples, the primary care provider might find out that the older has strength and balance issues. And then the provider can give that person a referral to physical therapy to help them out. The older adult may be taking medications that have side effects that increase their fall risk and again, the provider can help that patient by adjusting their medication dosage or possibly suggesting a better medication.
0:15:09:54 Dr. Gwen Bergen: So when an older adult falls, even if he or she is not injured, it’s still very important to discuss this fall with their primary care physician to reduce their chances of a future fall that might end up injuring that person. The CDC is working with the CDC Foundation to create an interactive online screening tool that older adults and their caregivers can use to screen for fall risk and in addition to telling the older adult what their fall risk is. The screening tool should provide them with information about how to discuss their specific risk factors and how to follow up with their primary care physician.
0:15:51:40 Pamela D Wilson: Of older adults who have an accident and they seek treatment through the emergency room for a fall, what are the top three to five injuries that they sustain?
0:16:00:01 Dr. Gwen Bergen: CDC actually just did an analysis of emergency room data and found that fractures and dislocations were the most common injury. With just over a third of all older adult ED visits for a fall requiring treatment for a fracture or dislocation. About—when we looked at it by body part—about half of arm, leg, spine, and pelvis fall injuries were fractures or dislocations, and three-quarters of hip injuries from falls were for fractures or dislocation. We also found the body area most likely to be injured was the head which was about a quarter or a one-fourth of all ED visits.
0:16:44:56 Dr. Gwen Bergen: And the majority of these head injuries were internal, which are commonly described as traumatic brain injuries. The arms and the legs were the next two body parts most likely to be injured. But of particular concern is that falls are the leading cause for hip fractures and traumatic brain injuries. These are two potentially very serious injuries that can have long-term consequences for older adults in terms of limiting their independence and causing serious injury and high medical costs.
0:17:18:54 Pamela D Wilson: Poor gait, I call it the ability to put one foot in front of the other, is a reason for falls. Do the statistics show an increased likelihood of falls among people who have dementia, Alzheimer’s, Parkinson’s, or other chronic diseases?
0:17:33:48 Dr. Gwen Bergen: We do know that many chronic diseases are associated with an increased risk of falls. The data sources I’ve personally analyzed show an increased risk of falls for people who also report depression, a stroke, arthritis, or diabetes. While my data sets have not had information on cognitive conditions such as Alzheimer’s and diseases such as Parkinson’s that affect movement, they have also been associated with increased fall risk in the literature.
0:18:05:85 Dr. Gwen Bergen: There are many reasons that fall risk may increase with chronic diseases. And these include the results of the disease that increase the fall risk. So, for example, you mentioned poor gait associated with certain diseases such as Parkinson’s, which is a risk factor for falls. And another example is diabetes. In diabetes, you can lose feeling in your feet, and this can increase your likelihood of falling. Another reason chronic conditions may increase your fall risk is because of the medications being taken for the disease.
0:18:41:72 Dr. Gwen Bergen: So, for example, some depression medicines are associated with an increased risk of falls. So, with depression, it might be the depression or the results from the depression that are increasing the fall risk, or it might be the depression medications being taken to treat the disease that are increasing the fall risk. Chronic diseases may also result in less physical activity. Which can lead to reduced muscle strength and balance, which also increases your fall risk. And in the case of some diseases, again, I’ll use the example of depression.
0:19:17:45 Dr. Gwen Bergen: We know that it’s associated with an increased fall risk, but we don’t know what comes first. So, it might be that you are depressed, and because of that, you are less active, and you increase your fall risk. Or it might be the case that you have a bad fall, and that leads you to being depressed. What we do know now is more research is needed on chronic disease and falls to understand the pathways and the sequence among the disease, the medications used to treat the disease, and falls so that we can better understand why these chronic diseases are related to increased fall risk. And so that we can develop better methods of preventing the increased fall risk associated with these chronic diseases.
0:20:05:50 Pamela D Wilson: As you mentioned, some of these falls are medication-related. So is it best for older adults to consult their pharmacist about medications and to ask which might cause a fall risk?
0:20:17:38 Dr. Gwen Bergen: Pharmacists can work with physicians to manage older adult medications and help identify the most appropriate medication and recommend the right dose to minimize side effects. While pharmacists do have a deep knowledge of medications, it’s important to include primary care providers. Because the primary care provider probably has the best in-depth knowledge of the particular patient’s chronic conditions and is maybe more aware of all of the factors that went into recommending specific medications.
0:20:51:24 Dr. Gwen Bergen: Older adults are more prone to adverse side effects from medicines due to changes that come with aging. And it’s important for older adults to discuss their medicines with their pharmacist and their primary care provider to see which ones might increase their fall risk either through the medication itself or through interactions with other medications they’re taking. The CDC provides resources to help older adults and caregivers with understanding the injury risk for medications.
0:21:14:68 Dr. Gwen Bergen: We provide a medicine risk fact sheet that informs older adults on what medicines have side effects that might increase their risk of a fall or a car crash. And in association with that, we provide a personal medicines list that lets an older adult track the medicines they’re taking along with some important information about the medicines. And then, probably, more importantly, we provide a personal action plan to help older adults, to guide older adults through conversations with their pharmacist and physician by giving them several questions that they can ask to understand their medicine or medications.
0:22:07:78 Dr. Gwen Bergen: And these questions are, what is this medicine used for. Does this medicine interact with others I am taking? Could this medicine have side effects that might change my ability to drive safely or increase my risk of falling? Is there another medicine or dose I should try? And finally, if I stop or change this medicine, what side effects should I expect? And we’re hopeful that by asking these questions, the patient can start a good conversation with their pharmacist or physician to optimize their medicines and the doses that they’re taking.
0:22:46:68 Pamela D Wilson: Dr. Bergen, those are great questions. I have had clients who have had falls happen because of issues like urinary tract infections, dehydration, delirium, and blood pressure changes. So let’s assume that these patients are talking to their doctors about that. In addition to that though if an older adult participates in strength and balance training, does exercise become a protective factor to reduce falls?
0:23:14:18 Dr. Gwen Bergen: As we age, we tend to have reduced muscle strength and balance impairment. And additionally, older adults may be less likely to exercise compared to younger adults or may reduce the exercise they did when younger for many reasons. So this also results, in addition to the natural changes that come with age, if you are getting less exercise, this results in reduced muscle strength and balance impairments which are leading risk factors for a fall.
0:23:45:47 Dr. Gwen Bergen: So, yes, exercise to increase your muscle strength, especially in your legs and core, and to improve your balance is very important and can protect yourself against falls. In fact, exercise is something you can do even if you’re not at risk for a fall, it’s very important to maintain your muscle strength and your balance so you will prevent falls as you grow, as you age even more. Tai chi is a form of exercise that has been shown to be very effective in reducing fall risk as it does increase muscle strength and improve balance.
0:24:23:62 Dr. Gwen Bergen: And this is, tai chi is something you can do on your own without a referral or a prescription from your primary care provider, as is the case with any general strength and balance exercises you may do at the gym or at home. Physical therapists also play an important role in assessing older adults for strength and balance issues. And then teaching them specific exercises they can do to help reduce fall risk. And again, I do want to emphasize strength and balance training are very important. In one clinical trial that looked at falls prevention screened older adults for fall risk and then assessed their risk factors. They found that almost all older adults at risk for a fall did have strength and balance issues.
0:25:12:15 Pamela D Wilson: Increasing awareness of these concerns about falls, it’s important so that we can get consumers interested and medical providers talking. You mentioned a lot of resources that the CDC has. Can you talk a little bit more about how the CDC is supporting this effort to communicate this to everyone?
0:25:30:17 Dr. Gwen Bergen: First of all, CDC developed the STEADI. That’s S-T-E-A-D-I which stands for Stopping Elderly Accidents, Deaths and Injuries initiative to help reduce older adult falls. STEADI is based on the American and British Geriatric Society’s Guidelines for Older Adult Fall Prevention and on feedback from healthcare providers. STEADI was designed to provide medical providers with education and resources. Mainly an algorithm that they can follow to screen their older adult patients to determine which are at risk for a fall.
0:26:10:21 Dr. Gwen Bergen: Assess those patients who are at risk to determine what their modifiable risk factors are. And then to intervene by recommending evidence-based interventions to reduce fall risk. CDC has developed training videos, fact sheets, instructional brochures, and implementation guidance aimed mostly at medical providers to help them implement older adult fall prevention into their office visits with their older adults. There are some materials for older adults also as a part of this initiative, and these are available at www.cdc.gov/STEADI, and again that’s S-T-E-A-D-I. Along with older adults, these materials are also very good for caregivers.
0:27:02:12 Pamela D Wilson: Dr. Bergen, I thank you so much for sharing all of this information and for joining me today.
0:27:07:21 Dr. Gwen Bergen: Thank you for inviting me to talk about falls.
0:27:10:81 Pamela D Wilson: It’s my pleasure. Up next, more on why does caring for elderly parents make me mean. If you are looking for help with decision-making about care for elderly parents or making a care plan for yourself, I can help. Visit my website PamelaDWilson.com to schedule an eldercare consultation. Click on How I Help, then Family Caregivers, and then Eldercare Consultation. Stay with me. I’ll be right back.
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0:28:06:13 Pamela D Wilson: This is Pamela D Wilson, caregiving expert, eldercare consultant, and speaker on The Caring Generation. Helpful information for caregivers and aging adults are in my book: The Caregiving Trap: Solutions for Life’s Unexpected Changes, available on my website www.PamelaDWilson.com where you can also check out my caregiver course online, Taking Care of Elderly Parents: Stay at Home and Beyond,
0:28:30:26 Pamela D Wilson: with 30 hours of webinars and other information featuring practical steps for how to take care of elderly parents and make a plan for aging and health. It’s never too early to make a plan to live the best life possible today and in your later years.
0:28:49:73 Pamela D Wilson: Living your best life is made possible by taking care of your health. Let’s return to talking about healthcare costs and answering the question, why does caring for elderly parents make me mean. I want to talk about the importance of having and using health insurance. Now you might think, why would I want to use my health insurance? I don’t want to be sick. Using your health insurance for annual check-ups and preventative care is the way to stay healthy.
0:29:19:26 Pamela D Wilson: You can avoid worrying about health diagnosis, medical care, taking prescriptions, and all associated costs if you identify health issues early and take preventative actions. Learning about health and staying healthy can save you a lot of money. If you are caring for aging parents or paying for your care so that you can stay living in your home, you may already realize how expensive aging is.
0:29:44:52 Pamela D Wilson: Depending on where you live in the United States, in-home care rates are $20 to $40 per hour. Assisted living $5,000 to $10,000 a month, nursing homes $8,000 a month, and more. If you are not saving for the cost of aging and taking steps to stay healthy today, like using your health insurance for preventative care, this is something to think about. If you had to privately pay $62,000 for joint replacement surgery, would then not participate and work at physical therapy exercises after surgery to return to being physically active?
0:30:27:83 Pamela D Wilson: Amazingly this is precisely what many healthcare consumers do because the $62,000 isn’t real. It never hits their bank account directly. Consumers have surgery and don’t have the commitment to exercise. As a result, the elderly become more physically disabled and experience more health problems than before the accident for the rest of their lives. Caregivers are more burdened with their care. Let me share why having health insurance is a must.
0:31:04:82 Pamela D Wilson: You may or may not know, but there is a difference between billed hospital and surgeon rates and negotiated insurance rates. In the article, of the $62,094 billed by the hospital, Medicare paid the hospital $13,254. Under Medicare, the surgeon performing the surgery in a large metro area charged $6737 and was paid $1105. So after the insurance review, a payment of about 20% of the total cost. The hospital received almost 13 times the surgeon’s reimbursement.
0:31:45:19 Pamela D Wilson: Why is talking about this important? Number one, doctors are beginning to close their practices to accepting new Medicare patients because they can’t pay their operating expenses. You might think that doctors make a lot of money. Not anymore UNLESS they are part of a more extensive healthcare or hospital group. Hospitals, imaging centers, and labs continue to raise prices and make more money than the doctors who take care of us.
0:32:15:54 Pamela D Wilson: Is it any wonder why there aren’t enough geriatricians, doctors who specialize in treating the elderly, available to treat the elderly? Medical school is expensive, and reimbursement rates and dealing with insurance companies is problematic. Second, what do you think happens to healthcare consumers who don’t have healthcare insurance? Who negotiates the costs for people who don’t have health insurance? No one, including patients. An uninsured consumer gets the bill for $62,094 for joint replacement surgery that they will never be able to pay off.
0:32:54:21 Pamela D Wilson: their credit rating is ruined. Medical collection agencies that call your house are threatening. Collection agencies don’t tell you that they will negotiate or settle for less. What happens then? Healthcare providers raise their rates to pay for costs billed to the uninsured, and healthcare costs continue to rise and rise and rise. This is a very simple example of a complex problem that answers the question, why does caring for elderly parents make me mean? Part of it is paying for healthcare.
0:33:29:50 Pamela D Wilson: If you are looking for a comparison that may be a little easier to understand. Look at your car insurance. In some states like Colorado, where I live, uninsured motorist coverage costs more than regular automobile coverage. It basically doubles the cost of your coverage. People who have insurance pay for people who don’t have insurance. Now you might say, well, this is okay because people who can afford insurance have the money to pay for insurance.
0:33:58:63 Pamela D Wilson: While this may be factually accurate, as, yourself—what are the additional costs to the uninsured? Whether you lack healthcare insurance or automobile insurance, when you are in an accident, and you become injured? Is it bankruptcy? Is it losing your house because you can’t work anymore due to health issues because you’ve lost your income? Is it being unable to afford the medical care you need because you don’t have insurance that would negotiate your costs to be lower and possibly more affordable?
0:34:38:17 Pamela D Wilson: While you may think not having insurance saves you money—being uninsured costs you more money in the long run when you are older and need care. If you have insurance, dealing with the healthcare system, insurance companies, receiving crazy bills, and being unable to understand the importance of being healthy, is frustrating. It does make caregivers and older adults mean and angry.
0:35:05:22 Pamela D Wilson: Let’s talk about a related topic for why does caring for elderly parents make me mean. Elderly parents and adults refuse to take prescription medications because you don’t think you need to take them. I understand your concerns. The question to ask yourself is if you are refusing to take medications because of the cost or because you don’t fully understand your medical condition, what are the short- and long-term effects of not taking that medication? Have you asked your doctor enough questions?
0:35:41:77 Pamela D Wilson: If you want to learn more, listen to The Caring Generation podcast and my interview with Dr. Neha Jain, a geriatric psychiatrist from the University of Connecticut Health System. She talks about Medication Issues in the Elderly. In my opinion, if you can make healthy changes so that you don’t have to take medications, that’s the ideal situation. However, if you haven’t been proactive about taking care of your health and you are just now learning—it may be too late, and that medication may be necessary.
0:36:14:22 Pamela D Wilson: So ask yourself, what’s better? Doing nothing today to protect my health, refusing to take medications, and being miserably sick in 5 or 10 years? Taking medications and learning about a health diagnosis is prevention and having health insurance allows you to get the care you need today so that you are not sicker and need more care when you’re older. Adult parents, spouses, and others who refuse to take medications does answer that question, why does caring for elderly parents make me mean and frustrated.
0:36:59:07 Pamela D Wilson: The answer is because a loved one doesn’t care enough about him or herself or isn’t educated enough about the risks of poor health. This refusal of self-care will be more work for the caregiver in the future. It all seems unfair, doesn’t it? Next on the list of why does caring for elderly parents make me mean is a lack of basic hygiene. Refusals to bathe or shower, brush teeth, wash hair, trim finger and toenails, or take care of the skin are common.
0:37:28:21 Pamela D Wilson: These are all things that most of us do regularly. Why does hygiene become an issue for aging parents? We’ll talk more about hygiene after this break. This is Pamela D Wilson, caregiving expert, caregiving speaker, and eldercare consultant with you on The Caring Generation. Please share this week’s show and all of our shows with your family, friends, and colleagues.
0:37:50:18 Pamela D Wilson: You can find the Caring Generation on all of your favorite podcast and music apps: Apple, Google, I Heart Radio, JioSaavn, Spreaker, Amazon Music, Breaker, Deezer, Listen Notes, Pandora, Player FM, Pocket Casts, Podcast Addict, Podchaser, Stitcher, Spotify, Tune In, and Vurbl. Also, if you are looking for information and tips about caregiving, check out my Caring for Aging Parents blog. It’s on my website. this is Pamela D Wilson, stay with me I’ll be right back.
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0:38:45:32 Pamela D Wilson: This is Pamela D Wilson, caregiving speaker, expert, and advocate on The Caring Generation program for caregivers and aging adults. Whether you are twenty or 100 years old, you’re in exactly the right place to learn about caregiver support programs to help you and your loved ones plan for what’s ahead. If you’re not sure how to talk to your children about caregiving issues or if you’ve tried to talk to your aging parents. Let me start the conversation for you.
0:39:13:89 Pamela D Wilson: Why does caring for elderly parents make me mean? Refusals for what caregivers see as appropriate hygiene can make us frustrated. One way to put hygiene into perspective that almost everyone might be able to understand is looking at COVID, self-isolation, and for some, the ability to work remotely from home. How has this unexpected shift changed your daily appearance? Are you walking around in your pajamas or sweats until noon?
0:39:49:30 Pamela D Wilson: Has showering changed from an everyday event to every other day event or even longer? What about your hair or if you are a woman, putting on makeup, brushing your teeth, doing your hair, nails? If any of this sounds familiar, the idea of living in isolation may help bring insight into why elderly parents who no longer work do not have a daily or weekly hygiene routine or any self-perceived reason to maintain a good appearance. They let themselves go.
0:40:24:73 Pamela D Wilson: People who live alone or in isolation lose their sense of self-esteem. Having poor hygiene negatively affects mood and interactions with others. Just the opposite, good hygiene boosts self-confidence and creates more positive interactions with others. Add to isolation a parent not feeling well, which results in less activity. Less activity results in balance problems and physical weakness that leads back to falls.
0:40:55:52 Pamela D Wilson: Being sick means that the effort to participate in hygiene care: showering, bathing, trimming nails, brushing teeth, hair, makeup, skincare, incontinence care is a lot of work for your parent. Hygiene is a behavior that parents model for their children. Good personal hygiene habits have a direct correlation with health. Body odor, oily or dirty skin, dirt under the fingernails, poor dental care—all these contribute to being sick.
0:41:26:75 Pamela D Wilson: Frustration about good hygiene when caring for aging parents is an issue that can frustrate and anger caregivers. Instead of scolding a parent for refusing to practice good hygiene, focus on the positive health aspects of being clean and wearing clean clothing. If a parent has dementia or Alzheimer’s, bathing can turn into an ongoing battle. If this is the case, consider different bathing options. Like, dry shampoo or shampoo caps.
0:41:57:97 Pamela D Wilson: Washing different body parts every day. Taking the initiative to trim finger and toenails weekly. Helping a parent brush teeth if necessary or at a minimum establishing a morning and bedtime routine if you are caring for a parent that includes regular care. Consistency of behaviors is part of establishing hygiene routines to minimize that frustration about why does caring for elderly parents who refuse to bathe make me so mean.
0:42:29:03 Pamela D Wilson: Another alternative, have a home care aid visit the home regularly to take the time to bathe, dress, and complete all routine hygiene tasks with your parent. Part of why does caring for an elderly parent make me mean is the time that working children have to devote to the care of a parent. If parents are slow because of mobility issues, arthritis, fear of falling, dementia—assisting with personal care can be very time-consuming.
0:43:02:23 Pamela D Wilson: A bath, shower, associated care, plus dressing, it can take one or two hours. As a caregiver, decide where best to spend your time and where you might be able to hire or enlist the care of others. Time pressure is a factor answering why does caring for elderly parents make me mean. Another factor leading to caregiver frustration is parents who won’t listen.
0:43:32:70 Pamela D Wilson: Caregiver frustration can increase the unwillingness of parents to listen to suggestions. Suggestions may include any or all of the areas we’ve discussed – attending regular medical appointments, taking medications, being proactive to prevent health and safety concerns like falls, bathing, hygiene, physical activity. As a caregiver, are you aware of how your communication style may reflect upon the answer to why does caring for elderly parents make me mean when I make suggestions?
0:44:10:35 Pamela D Wilson: Do your parents say, “stop telling me what to do.” Or do they ignore recommendations by putting you off or delaying the conversation? Part of the reason elderly parents may not listen can be the way the caregiver approaches conversations. To make this a little easier to understand, let’s put this in a workplace perspective. How would you describe your relationship with your supervisors—current or past?
0:44:42:33 Pamela D Wilson: Was the relationship dictatorial—you do what you are told and don’t ask questions? Did the relationships support balanced discussions where the supervisor asks your opinion, and you agreed about moving forward? How does your supervisor bring out the best in you? Motivate you? Compare a positive supervisory relationship to the relationship you have with a parent.
0:45:08:07 Pamela D Wilson: Assuming that there are positives in some supervisory relationships that you’ve had, what positive aspects can you transfer into encouraging a parent to take action? If you are a caregiver, also consider the mind-body connection. If your parents feels sick all the time, motivating mom or dad may be a little more challenging. Also, an elderly parent may not realize that they respond negatively to all of your suggestions or even that they may lack of motivation. These could be lifelong patterns that may not be changeable.
0:45:42:04 Pamela D Wilson: Another aspect to consider is the family pattern of talking about issues. Did your family talk about issues as a group and arrive at solutions, or were there things that you didn’t openly discuss? Lifelong patterns of interaction in families have a profound effect on the relationships children have with elderly parents. For more on this topic, listen to the Caring Generation podcast Resentment Towards Parents and my interview with Dr. Christian Heim about childhood templates and what you can do.
0:46:23:84 Pamela D Wilson: Consider that aging parents may be hesitant to discuss uncomfortable topics because of feeling shame, anger, embarrassment, sadness, or regret about their health. The way that they planned or didn’t plan for all of the current issues they might be experiencing. Feeling regret about things we should have done can cloud the ability for all of us to accept the current situation.
0:46:52:61 Pamela D Wilson: While none of us can change the past, we can change the present and the future. Focusing on the future with parents may open the door to conversations that get stalled when a parent won’t listen or have practical and necessary thoughts about making decisions. Fear of making decisions is another item on that list for why does caring for elderly parents make me mean.
0:47:17:70 Pamela D Wilson: As a caregiver, if you have been helping a parent for years, you may be ready to move on with your life and leave care responsibilities behind. On the other hand, your parent may be stuck living with health issues and not feeling that there are many good options. In many cases, this may feel true. The option is for all of us to decide how we will respond and to make and own the decision. We’ll continue the topic of why does caring for elderly parents make me mean, specific to decision-making, after this break.
0:47:53:39 Pamela D Wilson: Caregivers seek information about caregiving programs and support in meaningful ways. If you’re here listening—podcasts may be your go-to source for information. For others, videos, reading articles or blog posts, giving opinions by participating in caregiver surveys like my website survey, reading a book, watching a webinar, taking an online caregiver course, or joining an online support group may be your go-to solution. No caregiving situation is the same. In whatever way you prefer to receive information—you’ll find a variety of options on my website at pameladwilson.com. This is Pamela D Wilson. Stay with me. I’ll be right back.
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0:49:07:45 Pamela D Wilson: This is Pamela D. Wilson, caregiving expert, speaker, and consultant on The Caring Generation. If you are an aging adult or a caregiver not sure what to do or how to plan for care, my website PamelaDWilson.com offers resources for caregivers. Check out my caregiving library, my Caring for Aging Parents blog, listen to all of The Caring Generation podcasts, read the show transcripts, watch videos, and check out caregiver courses online. Introduce your parents, siblings, friends, and family to my YouTube Channel, featuring hundreds of caregiver videos.
0:49:39:40 Pamela D Wilson: There’s something for everyone at PamelaDWilson.com. Hesitance to make decisions directly correlates to answers for why does caring for an elderly parent make me mean. Think about a time when you had to make a decision, and you hesitated. Why did this happen? No time-pressure? Not important enough? Not having enough information? Not motivated to do what making the decision required?
0:50:04:99 Pamela D Wilson: Now turn this around. Why does caring for elderly parents make me mean when elderly parents refuse or delay making a decision? As a caregiver, how much of your caregiving time depends on an aging parent making decisions? Have you discussed how not making a particular decision or any decision affects you, your family, your career, your children, or your life?
0:50:29:19 Pamela D Wilson: While the caregiving relationship is often between two spouses or an elderly parent and one primary caregiver, decisions made have a much broader impact. Think about everything we’ve discussed in this program. Being narrow minded, thinking only of our needs, or being involved with a spouse or a parent who lacks insight into the bigger picture and effects of short- and long-term decision making can be a problem. Caregivers face the same struggles when losing themselves in the role or act of caring for a spouse or a parent.
0:51:01:88 Pamela D Wilson: Losing your identity as a caregiver is discussed is in The Caring Generation podcast When You Can No Longer Care for An Elderly Parent. Caregivers can delay making important decisions because of experiencing the same feelings as an aging parent. In thinking about why does caring for an elderly parent make me mean, have you considered how many of the same feelings you and an aging parent might be experiencing that lead to frustration?
0:51:28:31 Pamela D Wilson: Worry over making a decision that might negatively affect the other person—or making decisions that disregard the needs of the caregiver or the parent. It’s almost like being in a marriage trying to maintain a loving and positive relationship and balancing everything else in life except that this relationship is with a parent that you may not have chosen if you were marrying a spouse. Caregiving relationships represent a fine balance between meeting the needs of the caregiver and the care receiver while not being insensitive to the fact that it may not be possible for everybody to get what they want.
0:52:04:64 Pamela D Wilson: Not getting what we want is another answer to why does caring for elderly parents make me mean. As the caregiver of a spouse or parent, we may want a loved one to do what we see as right or best for the situation. While the care receiver may not buy into the caregiver’s ideas for what is right or best, being okay with having different opinions and disagreeing can be a learned behavior for the caregiver and the care receiver.
0:52:30:31 Pamela D Wilson: Sometimes, it is impossible to agree with a spouse or parent or even agree to make a plan. There may be times when a parent wants to seek information on their own to validate information provided by the caregiver. If you are married, how many times has your spouse ever said, “I’m looking into this because I want to hear it from someone else, not my husband or wife.”
0:52:52:65 Pamela D Wilson: There are times when elderly parents look at adult children as if you are still 12 years old, even though you may be 52, 62, or 72, or 32. Ongoing differences may result in a point in the relationship of wondering why does caring for elderly parents make me mean that the caregiver decides to take a step back. Is it possible that you have taken over a parent’s life too much? Have you done too much without mom or dad specifically asking?
0:53:25:23 Pamela D Wilson: Have you become too controlling in your desire to be helpful and efficient? How do you give a parent that you care and worry about space and time? Having a conversation about reluctance to cooperate, make decisions, or whatever the subject at hand is—is your starting point. It’s okay to express frustration or even resentment about the situation and tell a parent that you need a little bit of time away. Make it clear that this is decision is about you and not the actions of your parent—even if it is the actions of your parent that are driving you away.
0:54:02:35 Pamela D Wilson: Is it possible that a little time apart may bring emotional balance to the situation? Allow you to think more clearly? Stop pressuring your elderly parents to do things that you think are right or best for the situation. Start making decisions for yourself that don’t depend on your parents making the first move. Focus on yourself and your needs and allow your parents to make decisions or take more responsibility for their care. Don’t obsess or worry about what will happen to your parent if you are not around all of the time.
0:54:36:93 Pamela D Wilson: Your job isn’t to rescue a parent who makes poor decisions or refuses care unless you are the legally responsible party for a parent with Alzheimer’s or dementia. That is a very different situation from the situation we are talking about here. Offer options for mom or dad to investigate and hire a paid caregiver or look at assisted living communities. Sometimes caregivers can smother a spouse or parent so much that the care receiver feels unable to make their own decisions.
0:55:10:65 Pamela D Wilson: As you create a little bit of space between you and caring for a parent, commit to spending time with some of your friends. Set self-care goals for yourself. Act to do those things you’ve always dreamed about doing that you put on the back burner because of care responsibilities. I realize this may feel like you are abandoning or walking away from caring for a parent. You are not. You are setting a healthy boundary to minimize the effects of caregiving to think about why being a caregiver is making you mean.
0:55:41:42 Pamela D Wilson: By taking time away, you may gain some unexpected insights. Being too close to a caregiving situation can lead to exhaustion and impaired decision-making for caregivers. You may think you are doing a great job caring for a parent when your anger or mood is having a more significant effect than you think. You may not be doing your best which can be difficult to admit. Being angry doesn’t solve anything. Instead, direct anger and frustration into something productive to solve problems.
0:56:14:53 Pamela D Wilson: Talk to elderly parents about finding answers, doing research instead of making excuses for why something won’t work or isn’t possible. Feelings of stress, anger, frustration, and anxiety negatively affect health and the immune system. If your caregiving relationship with a parent is equally stressful, the emotions you experience are harmful to your health, and the emotions your parents experience are harmful to their health. Instead of your efforts having positive effects, the emotional disruptions from everything you’re doing may be causing more harm.
0:56:54:78 Pamela D Wilson: While it may be easy to think of many reasons that respond to that question, why does caring for elderly parents make me mean. The opportunity for caregivers to investigate, learn and model healthy behaviors for aging parents exists. Think about “do as I do.” That means acting upon the recommendations you make for elderly parents about daily activities and future planning for yourself so that you don’t place your children in a similar situation. Understand what you are asking your parents to do—instead of expecting parents to do the impossible to improve caregiving and health.
0:57:34:94 Pamela D Wilson: Pamela D Wilson: This is Pamela D Wilson, caregiving expert, speaker, and eldercare consultant. If you’d like to learn more about the experiences and interests of other caregivers, follow me on social media. My posts respond to caregivers who complete the caregiver survey on my website and post on social media. On Facebook, follow me at @pameladwilsoncaregivingexpert where you can join my online caregiver support group, The Caregiving Trap. Follow me on Twitter @caregivingspeak, Instagram at @wilsonpamelad, and Linked In pameladwilsoncaregiverexpert.
0:58:07:17 Pamela D Wilson: Pamela D Wilson: Thank you for joining me on The Caring Generation – the only program of its kind connecting caregivers and aging adults worldwide to talk about caregiving, well-being, health, and everything in between. Invite your family and friends to listen each week. This is Pamela D. Wilson, caregiving expert, advocate, and speaker. I look forward to being with you again soon. God bless you all. Sleep well tonight. Have a fabulous day tomorrow and a great week until we are here together again.
0:58:36:58 Announcer: Tune in each week for The Caring Generation with host Pamela D Wilson. Come join the conversation and see how Pamela can provide solutions and peace of mind for everyone here on Pamela D Wilson’s The Caring Generation.
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