“Mr. Jacob, I regret, not taking your advice, Had I been acting according to your suggestion, my parents would have been in a better state now. I wouldn’t have traded your advise for the world. I can’t explain in words the suffering my parents going through today and I sort of helpless. I want you to help me” During one of these lockdown days in the wee hours, Mr. Jacob, our Social Gerontologist, receives a frantic call from the USA. Mrs. Vandana Gowda, lives in Monmouth, NJ. Both elderly parents live in Bangalore with inadequate support. Being the only child she was the sole primary care giver and like may NRI’s she was doing long distance care giving for her parents.

Vandana met Jacob 6 months back at his office, a casual inquiry visit, with ‘no serious plans yet!’, the typical mistake by NRI children. Vandana’s father 78 years old suffering with Parkinson’s Disease (PD) last three years, though risky, he manages his daily chores but he is developing gait problems and a recent history of fall.  Jacob, recollects his conversation with Vandana, “my father recently fell down twice but my mother lifts him and puts him back to bed, there are no major issues with fall only thing and only one time had a minor cut on the forehead, which my mother fixed it with first aid at home”.  It was indeed a rude shock for anyone to even imagine how on the earth a  70 year old severely arthritic, needing assistance for her own chores can help her 78 year old husband who is a PD patient. In that trip when she stayed with her parents she found her mom is forgetful losing her immediate past memory, she could not recollect if she took medication and gave medicines to her husband, she would forget she had kept milk on the stove for boiling, she feels unsure about the front door locked or not. Enough signs for intervention, still Vandana glossed over.

There are two types of people we see in our practice, the ones who don’t want to accept the problem, saying, ‘age related minor issues’, thus trying to gloss over. Exactly like Vandana because she never felt anything serious or abnormal. Here, Vandana is closing the eyes to the real issues though she’s has been warned and told about the consequences. Second type of people are totally ignorant about the condition and never tried to find out or never has a proper counselling about the nuances of aged care. Either of these mindsets, will make a dent on their parents’ health. 

Vandana was told about the inadequacy of hiring a care giver because in the changed scenario, a home nurse cannot manage alone.  Considering the fact that having no immediate or extended family to monitor even if home care arrangements were made, we could clearly foresee, living at home and getting cared is going to be a failing scenario. There was no assessment, no care plan, no preventive care and no crisis intervention strategy. In short, Vandana never made any timely intervention thus leaving the elderly parents to fate. Since a health crisis in the elderly can escalate quickly and catch everyone involved off guard, it’s important not to ignore signs that something may be wrong. Ideally, families will have to go for professional help like ‘assessment and care plan’, getting their affairs in order and set a well defined long term care plan in motion.

With more and more families dispersed geographically like Vandana living in New Jersey, adult children who live far away from their elderly parents face ongoing worry about their health and safety. But the million dollar question is are you able to intervene at the appropriate time. As ageing parents, particularly those who live alone, face medical and mobility issues, questions relating to their physical, social and psychological well-being arise. Children should be constantly on the lookout for any changes in their parents’ attitudes or behavior— changes which are often undetectable over the telephone call. This is best done by a social gerontologist often having a review of functional, psychological, nutritional and social aspects.

Like Vandana, more and more people wait for something to go wrong, till then not willing to intervene.  How do you know when the time has come to involve and support your parent?   Following indicators are signs that your intervention is required.

Let’s start with housekeeping. Of late, if you see the house is cluttered and unkempt, it shows the inability or lack of interest, especially in the early days, your parent was a stickler to cleanliness. Similarly if the food kept in the fridge is uneaten or spoiled, you can doubt he or she is not eating properly. Shopping, cooking, and cleaning become too much trouble so either he skips or might eat just enough to get by, but suffer nutritionally. Losing weight can be another sign that a parent is not eating a nutritious diet.

If you notice a decline in personal hygiene as indicated by unkempt hair, dirty or lengthy nails, poor oral hygiene, body or urine odour, unshaven, and wearing same clothes over and over then you may find the underlying reason. Few may be avoiding bath for fear of falling in the tub or shower or it can be sheer inability or laziness.

Another sign is not going for regular doctor consultation and it can be months or years together. Sometimes this is simply a product of not having

transportation and simply forgot to do so, in turn have a very unpleasant outcome. Forgetting to take medication, is very common in the elderly. It can be a  sign of short-term memory loss or depression and this is  not just a quality of life issue, but a real risk factor.

Once adult children determine their elderly parent may need help or assistance the next step is determining what kind? Since the health decline can grow into a crisis, you may have to act immediately. Timely intervention  can save the situation. Resistance to any kind of change is common especially among the senior population. That’s where having a third party involved can be helpful. Social gerontologist like us can make this time of transition easier for everyone. Even if the adult children live far away, a care consultant can be your eyes and ears so a parent’s everyday well-being is less of a worry.