House Call: Tips on accompanying an aging parent at the doctor
Navigating health care, especially as we age, can be a big undertaking. Having an adult child or caregiver accompany an aging patient to appointments as a health care advocate can help make the most out of visits, whether an annual wellness exam or a trip to get a flu shot.
One in six Americans regularly helps with care for a parent or older adult, whether full-time caregiving or occasionally helping with daily activities. Participating in health care appointments can help track information and get questions answered. Here are a few tips to help you prepare and assist your parent while getting care.
Listen to your parent
Anytime you accompany a senior, or anyone else, to a health care visit, be clear with yourself and with them what your role is. Everyone – patient, provider and advocate – is there to help optimize and coordinate care. Clear information helps that happen.
Have an open and honest conversation with your parent about what’s going at home and what you both plan to discuss with the provider. What is your parent’s perfect day? Are there any medical issues that make that perfect day less achievable, safe or enjoyable? Some issues that come up frequently are memory concerns, unsteady gait and meal preparation.
It is not uncommon for older adults to minimize problems they are having. “I don’t want to be a bother,” is something I commonly hear. Sometimes people write off a concern as “normal aging” rather than a treatable problem. Reassure your parent that their concerns matter and share your concerns with them.
These topics can be sensitive – this is about the parent or family member getting the best care and not being judgmental or assuming a diagnosis. Right now, you are just both gathering information to work through with the provider. At the appointment, be respectful of your parent and offer additional details if there are information gaps.
Sometimes an advocate would like to bring up concerns about memory but runs into resistance from the patient. Sometimes, they don’t want to embarrass mom or dad by bringing incidents like getting lost or being confused. Discuss these concerns honestly in advance if you can, so you can clarify what you will bring up with the provider.
Get organized
If your parent gets most care through one provider or has coordinated care through an HMO or other health care system, the provider may have all the patient’s medical records at their fingertips. On occasion, people get care elsewhere, whether a shot at a flu clinic or a doctor visit while out of town. Most pharmacies and providers will send in information about vaccines or other services. That’s why they ask for primary care provider info, but it’s still worth double-checking.
A patient of mine recently cut their foot on a piece of glass requiring stitches and a tetanus booster while traveling out of state. (A good reminder to be up to date on Tdap and other vaccinations.) They hadn’t thought to let us know, but we were able to get their vaccination record updated at the wellness check.
Talk with your parent about any new concerns or escalation of existing issues. Write them down so you have a list at the appointment. It can be helpful to fill out paperwork ahead of time, especially if the patient has trouble downloading online forms or difficultly writing due to arthritis.
Bring your meds
Go beyond a list of what has been prescribed: Grab a bag and gather all the medications the patient takes. This includes nonprescription medications and supplements. By looking at all the medications together, your provider can confirm that medications are being taken as intended.
This is a good time for your parent or you to ask any questions about dosage, taking medications correctly and interactions with over-the-counter medications.
Many patients aren’t aware that medications are a key contributor to falls. Kaiser Permanente and the University of Washington researchers started a new program to increase awareness among patients that drugs such as sleeping pills, anti-anxiety medications and pain relievers can increase the risk for falls among older adults with dementia.
Close gaps in care
At the visit, there is an opportunity to close gaps in care and to cover general aging issues. Does the patient need to start using a quad cane to avoid falls? Would physical therapy help them keep up exercising? Are they having trouble with personal hygiene? Are their vaccines and screenings up to date?
A senior patient recently complained about weight gain in her annual exam. Her daughter pointed out she had stopped exercising altogether due to pain in her knee. We worked through her limitations and got her into water aerobics to get her back on track.
Health care visits are also a place to cover other issues that can affect senior health. Financial struggles might cause some to skip care or medications. Mom or dad might be getting into fender benders due to poor eyesight or arthritis, and it might be time to consider alternatives to driving.
As fall and winter loom, flu is lurking around the corner. Flu is a serious illness with serious consequences for some seniors. Flu shots offer good protection. It’s a good time to check on flu shots, shingles vaccinations and COVID-19 boosters. Vaccinations are the best chance to protect yourself and those around you for serious preventable illness.
Cover memory issues
The thought of memory issues or Alzheimer’s is an enormous fear for many older adults. People often brush off single incidents or don’t want to acknowledge the difference between minor forgetfulness and more serious cognitive issues. As a health care advocate, you may be able to provide an extra perspective on how often an older adult has trouble remembering familiar faces or travel routes, struggles with language and word finding, or has difficulty with routine tasks such as tying a shoe or following a recipe.
If your loved one is showing repeated signs of these cognitive issues, it’s time to get evaluated with a more comprehensive cognitive assessment. This will facilitate advanced care planning for the future or getting a baseline for comparison should symptoms worsen. Having an advocate in the room at a visit can sometimes help give the provider independent confirmation that the parent may not be able to give or may not be able to recall.
Future and ongoing care
A comprehensive wellness exam every year is useful for reviewing health concerns and ongoing issues as people age. Patients can get started on coordinating care between providers for conditions from asthma to balance to high blood pressure. It’s also an opportunity to get up to date on routine labs, screenings and vaccinations.
Having a family member or advocate familiar with the situation at home who sees the patient regularly can make the visit even more productive by clarifying information, filling in gaps, and keeping an eye on future needs.
Dr. Jeff Markin is a family medicine physician practicing at Kaiser Permanente’s Veradale Medical Center.