GUEST COLUMN: What’s really going on with mom and dad?

By Kathleen Zura

As we all know, our parents are living longer, healthier, and therefore more independent lives than ever before. And gone is the extended family under one roof and the small neighborhoods where we all looked after one another.

Currently, one in every eight individuals in the United States is over age 65. The elderly population will more than double between 2000 and 2030. By 2030, one in every four individuals will be over age 65.

These population projections are indeed dramatic. The percentage of people over age 85 is expected to increase by 54 percent between the years 2000 and 2015. As many as 40 percent of those over age 65 will have nutrition-related health problems requiring treatment or management, with 10 percent of people over the age of 65 developing Alzheimer’s disease. And 50 percent of those over the age of 85 will develop this disease.

In 2010, in Vermont alone, 14.6 percent of the total population was over age 65. More than 50 percent of our rural residents are over 65. And of these individuals, a third live alone, and the numbers in residential care are declining.

Over the last 12 years, 600 Vermont nursing facility beds have closed, shifting care into the home and community-based system. Although nursing homes still contribute significantly to the state’s long-term care system, they house only 3.3 percent of Vermonters age 65 and older and 12.5 percent of those age 85 and older.

Yet the demographics of Vermont’s aging population indicate that Vermont’s older adult population is growing at a rapid pace. By 2020, 21 percent of the Vermont population is projected to be over the age of 65. But the fastest growing segment of the population is now 85 years and older, with 12,000 residents, and projections for 2030 showing a 149 percent increase over 2000 census number in that age group.

Recent AARP surveys have shown that the vast majority of all seniors want to age in place, to grow old as vital members of their communities living in their own homes.

So, with mom or dad still living in the family home, or in their own apartment in an assisted living facility, and myself either out of the area, or not always having the time to check on them, how can I be certain that he or she is really doing all right? Through regular phone calls and visits, I attempt to gauge just that.

But, when I ask…. did you eat today and she says yes, but can’t remember what… that normal? If he is more quiet than usual, is he just having a bad day or is he depressed?

Always, she assures me that everything is fine, and quickly changes the subject to my family, my job, the grandkids, and me. She asks, “Are you eating well, taking your vitamins?” He asks, “ How’s that new promotion?” The role of parent-as-caretaker never ceases.

I try not to get too frustrated or too worried—everyone forgets things (heck, I can’t remember why I went into the kitchen after I get there sometimes).

But how do I know that’s all it is? And how do I know that he or she is not forgetting something more important—like taking medication, locking the front door, eating breakfast, going to the doctor?

The truth is, that while most of our older parents are fine living alone, there comes a time when some type of assistance is needed.

In this day and age of overbooked physicians and complicated insurance procedures, our elderly loved ones are often not able to access the full cognitive screenings required to determine when this time is.  And when in the doctor’s office, they tend to put their best foot forward and not complain too much.

This is, after all, the generation that learned not to complain, to be independent, and to take care of themselves and their families – by themselves.  It is their way of life.  It can be difficult and even demeaning to ask for help.  And, they fear that admitting they may not be ‘okay’ can compromise, if not shatter their dignity and their independence.

As a result, many behavioral health conditions go undetected and untreated.  Untreated, they have the potential to progress unnecessarily, and lead to, or result in physical conditions that compromise the health and safety of our parents.

Some areas of concern cannot be diagnosed that easily.  These often cannot be uncovered in a single doctor’s office with time-limited observation.  They cannot be truly explored from a distance or over the telephone by loved ones.  They can only be truly assessed in the home.  Here are a few of these areas of concern, and the questions to ponder.

Loneliness. How many hours a day, how many days a week are they really alone?

Depression. are they simply “down” due to a disappointment, or has this been going on for a period of time?  Is their mood affecting their daily living skills?

Confusion. Is it caused by something simple and treatable like a common urinary tract infection, or is it the early stages of dementia?

Forgetfulness. Is it the normal aging process, or is something more serious going on that I don’t know about?

How do I know what is normal, if they are truly safe, and where to look for help, especially from a distance?  In-home screenings and treatment can be provided.  Initial in-home assessments can be followed by regular weekly sessions. Professional on-call staff can check on the individual when you have a concern or suspect there may be a problem.  Services can be provided in-home, in a facility such as assisted living, or in office.

Remember, the key is to make sure your older parents or other relatives get the assistance, support and treatment they need.  The good news is that we can help many older people continue to live independent lives.  But intervention is most effective when issues or symptoms are recognized and addressed as early as possible.

Kathleen Zura, LICSW, is a licensed clinical social worker affiliated with Otter Creek Associates in Burlington.