Monday, April 15, 2013

Caregiver Series VI: Sandwich Generation. What is right for your aging parents.

In the poem, Stop all the clocks, cut off the telephone, poet W.H. Auden anguishes about the loss of a love one: “My North, my South, my East and West; My working week and my Sunday rest”. Sometimes this loss occurs before death, as a familiar loved person fades in their ability to function as they used to.  Auden’s expression of pain about how his loved one could be swept away can serve as a reflection of the feelings of an adult child when their aging parent---their compass in many times past—begins to fail and is no longer capable of independently managing home and activities of daily living.

The loss of a parent’s independence often sets off deep feelings of sadness, betrayal, foreboding or even relief.  But no matter the range of feelings, the dynamic between parent and adult child changes. The child must assert and make decisions for the parent that are often difficult for everyone. Roles are often reversed. Dr. Nancy Giles, a therapist in Boston sees a parallel at opposite ends of the age spectrum: “It is rather the reverse of the independence dynamics with a toddler or even a teen. In that context the struggle can be to gain and define self. This adult child/aging parent scenario is about the surrender of one’s self." 

The Mayo Clinic suggests seven questions to help evaluate parental ability to maintain independent function:

- Are your aging parents taking care of themselves, such as their physical appearance?
- Are your aging parents experiencing memory loss?
- Are your parents safe in their home?
- Are your aging parents safe on the road?
- Have your aging parents lost weight?
- Are your aging parents in good spirits?
- Are your aging parents able to get around?

For some people the decisions of how to help an aging parent may be clear and agreeable. For others a parent may be independent in some ways, but no longer in others.  Resistance and defensiveness may be at high levels.

There are many resources to assist in making the decisions of what modifications of environment may be best for your mother or father. A good starting place for guidance may be a trusted and familiar physician. On line resources are abundant to help sort through questions to ask in choosing a home health service or live-in facility. Many resources are available to help you consider the financial decisions.  Here is a sampling:

In our next blog, we will investigate a variety of the resources available to make helpful changes, such as simple, but critical modifications to a parent’s home.  If you make the decision that the best solution is to remain in the home, we will explore effective ways to bring care to them.

If you have suggestions on this topic, please enter the conversation and let us hear your ideas and experiences. 

Wednesday, April 3, 2013

Caregiver Series V: Managing chronic illness with your diet.

Have you ever imagined a time when people no longer have to take drugs like Insulin, or daily doses of Lipitor to manage diabetes, high blood pressure and heart disease?  Would you believe that day is already here?  

Dr. M. Emin Donat, a Detroit-area gastroenterologist, says “it is possible for someone to reverse a diagnosis of type-2 diabetes, high blood pressure, even heart disease.” Donat sees success in his busy metro-Detroit practice, but he adds that success “often takes a year, and happens if people are willing to make a commitment and make tough choices.”   But for every one successful patient, “dozens more would rather take medicine, which is a patchwork approach, that doesn’t get at underlying problems.” 

These problems make heart disease the leading cause of death in the United States.  According to the American Dietetic Association, about 81 million Americans have some type of heart or cardiovascular disease.  That’s 35 percent of the population and doesn’t include the millions with diabetes.

Diabetes, high blood pressure, and heart disease are often related conditions and can be controlled making tough changes starting with losing weight.  

Controlling the fat and sugar content, plus eating smaller portions is the key combination for consistent and safe weight loss.  Switching to a vegetarian or vegan diet can also have a dramatic impact on weight loss and disease management goals.  Many people are put off by the thought of less or no more meat.  The following information comes from Colorado State University and explains types of vegetarian diets. 

Vegans, or total vegetarians, eat only plant foods; including fruits, vegetables, legumes (dried beans, peas, and lentils), grains, seeds and nuts.
Lacto vegetarians eat plant foods as well as dairy products, such as milk and cheese.
Lacto-ovo vegetarians eat plant foods, dairy products and eggs. Most vegetarians in the U.S. fit into this category.
Semi-vegetarians don’t eat red meat but may include chicken or seafood with plant foods, dairy products and eggs.
If you willing to try to reduce the amount of meat in your diet, it is a good idea to get some help. Check on-line resources with recipes, or buy a vegetarian cookbook.  Because if you make uninformed choices, you can hurt yourself.  “Vegetables are what you should be adding. Not eating less of something,” says Dawn Jackson Blatner, RD, LD, a spokesperson for the American Dietetic Association. “The same goes for carbs and eggs. Go overboard, and you can put yourself at risk for weight gain, heart disease, and out-of-control blood glucose. Replace carbs with beans and nuts. And limit yourself to two eggs a week; the rest of the time, get the same protein—minus the cholesterol—from egg substitutes, tofu, yogurt, or soy milk.”
Once you decide to make a diet change the resources with helpful recipes, and suggestions are almost unlimited.  The American Diabetes Association and the American Diabetic Association, as well as hospitals like the Mayo Clinic are good places to start.    And remember Dr. Donat’s suggestion that it can take up to a year to really notice the benefits of a radical change of diet.   But think how great you will feel when you realize you are actually more in control of your destiny than you thought.

American Diabetes Association
America Dietetic Association

If you have any success stories or suggestions to share with us, we would love to hear from you.