When my mother was 83, she troubled me with the way she used — or rather misused — her pillbox. I set it up for her each Sunday evening, carefully placing mounds of tablets of different hues and sizes in the appropriate daily slots. But I'd often return later in the week to find she had somehow taken the wrong pills from the wrong slots. It worried me that she might not be getting the medicine she needed for her high blood pressure, mild dementia and pain. Worse, I was concerned she was taking too much medication at times and could suffer adverse effects.
It should have been clear to me that my mother could no longer safely take her pills on her own. And yet I hesitated for months to completely take over the task. In my mind, she was still the most compulsively organized woman I'd ever known. During her working years, she had been a teacher, an accountant, an insurance broker and a condo board president. (The "Condo Queen," we had called her teasingly.) Would she feel angry at me if I spoon-fed medicine to her as if she were an unruly child?
When I finally went ahead and told her that from now on, I or someone else would literally hand her the right pills (and then observe to make sure she swallowed them), she winced but hardly protested. I worried less for having ensured her safety, but I felt guiltier for having hurt her pride.
Few adult children relish taking over. It takes more hands-on work and emotional duress. No one wants to be known as the power-mad usurper of an aging parent's dignity. As a consequence, many of us watch and wait — and wait and wait. But while a parent is declining physically or cognitively, we have constant fears about medication errors, frequent falls, poor hygiene, financial mismanagement, errant driving and other threats to their well-being. Ultimately, it is not a question of if they need more help, but what type and when.
Timing is everything. If we act too soon, we risk babying a parent and fostering unhappy dependence. If we act too late, we risk a catastrophic event that we could have prevented. Here are some ideas for finding the right balance.
Safety is paramount but not always decisive
As physician and author Atul Gawande points out in his best-selling bookBeing Mortal, keeping our parents safe is crucial but shouldn't negate every other consideration. We must take into account a parent's preferences and needs for independence before we swathe them in bubble wrap and order 24-hour supervision. Most of us weigh the risks and benefits of any given activity. If Mom still wants to cook, then we ask ourselves if she can safely use the oven, perhaps with some prompting. If she wants to go to the bathroom on her own, then we ponder if she can physically manage with a commode seat and grab bars. We exercise reasonable caution but are also prepared to tolerate some degree of risk.
Talk early and often
Adult children and their parents should start talking about developing contingency plans for adapting to aging-induced changes long before an older adult is absentminded or tottering. (See AARP's The Other Talk by Tim Prosch.) That's not being negative or disrespectful; it's being realistic and proactive. If a parent shies away from such a discussion, then back off for the time being but gently return to the topic when opportune — on a parent's yearly physical or birthday, for example. Promote a spirit of partnership, common goals and shared decision-making: "I want you to live as independently and fully as possible, with my help at various times."
Take over incrementally
Unless they experience some untoward medical event, aging parents usually change slowly. Closely gauge their functioning and help them out incrementally. In other words, don't take over all at once. Tailor what you do to only provide as much support as they clearly need, but no more. For example, a parent with dimming eyesight may need to be driven by others after dark but not during the day.
Overrule, if necessary
When a parent's judgment is impaired by dementia or blinded by pride, then the most loving thing a child can do is to speak up firmly and make prudent decisions on his or her behalf. That parent may fume or pout. You have to calmly respond with empathy and understanding, but do what you know is right for all involved.