• Many of us have heard of or even experienced a family conflict at the bedside of a very sick loved one. Maybe you have read stories in the news about family members disagreeing about whether to continue Mom’s aggressive care or to let her have a natural ending without medical intervention. Neither side of the argument might be wrong, but the big question is: “What would Mom have wanted?”

    Such conflicts may be more easily managed or even minimized with a little planning and conversation ahead of time. In fact, according to a survey conducted by The Conversation Project, more than 90% of 2,073 Americans aged 18+ believe that having a conversation on end-of-life matters with loved ones is important. But only around 30% have actually done so.

    Discussing options, decisions, and wishes about end-of-life care can make a big difference during crises. The benefits to expressing wishes about end-of-life care include:

    • Giving loved ones a chance to understand important end-of-life care wishes for the future whether it is related to a progressive illness or older age
    • Removing the burden from caregivers and loved ones, who might not agree with one another when making certain end-of-life care decisions
    • Helping doctors and family members make vital healthcare decisions if a dying loved one becomes unable to make decisions for him or herself

    By having an end-of-life care conversation, you can establish comfort and trust with those in charge of your care. It may offer you and your loved ones more peace of mind than you might expect.

    Why It’s Important

    In a study published in the Journal of the American Medical Association, 126 participants—including 48 dialysis patients, 40 people with HIV, and 38 patients in long-term care facilities—answered a series of in-depth, open-ended questions about quality end-of-life care.

    Survey answers were analyzed and organized into the following 5 main categories representing what study participants cared about most:

    • Receiving adequate pain and symptom management
    • Avoiding inappropriate prolongation of dying
    • Achieving a sense of control
    • Relieving burden for caregivers, family members, and others
    • Strengthening relationships with loved ones

    How would you answer the question as to what quality end-of-life care is? What would matter most to you? It can help to jot some of your thoughts down.

    Having A Conversation with Loved Ones

    If you or your loved one is advanced in age or is managing a chronic, life-threatening or serious illness that will worsen over time, having on open and honest dialogue with loved ones, caregivers and family members is a good way to ensure that end-of-life wishes are known. Of course it can be difficult to discuss this topic—your loved ones may not want to face the sensitive topic of the uncertain future. Still, it’s important to talk about it.

    There is no right or wrong way to have the discussion—and there is never a wrong time to bring it up, as long as it’s done ahead of a crisis. Here are a few helpful tips to keep in mind:

    • Take the time to think about what’s important to you—don’t assume that loved ones will know exactly what you want. What are your thoughts on the type of medical care you would like to receive and the extent of life-saving efforts you would wish for (e.g., CPR, artificial breathing, artificial feeding, full life-support)?
    • Discuss your end-of-life concerns with the healthcare team to learn more about your options. If you are managing a condition, ask: How long will the end-of-life journey be? How much pain and suffering will there be? How will the condition affect your family?
    • Communicate your wishes to your family. Your loved ones may disagree about certain options but that’s okay. You may need several talks. It’s important to start the discussion before a crisis occurs
    • Ask yourself: What has to be done to get personal affairs in order (e.g., finances, home)? Do the wishes need to be put in writing, is a living will needed?
    • Think about who you would want to help you make decisions about your care, in the case that you are not able to do so yourself

    Remember that making end-of-life care decisions may be easier for you and your family with a little preparation and communication. So take the time now to ensure that your last wishes are known and that your quality of life during those moments will be supported.

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  • July 27, 2016 /  Difficult Conversations

    Facing the Difficult Subject of Living Choices Many families want to avoid talking about end-of-life matters. This is understandable, as it’s a weighty subject with a variety of emotions attached to it. Parents feel resistant to the idea that they are closer to facing this. Children and other relatives are saddened and worried by what the future holds for their loved one. However, it’s a conversation that can’t be sidestepped. Facing it head on with a frank attitude will help your family come to terms with it sooner.

    One of the first and most important items to address is living choices. You want to have clear plans before there’s a crisis. Consider whether your parent needs minimal assistance, or more intense care for issues like Alzheimer’s and dementia. Naturally, most older ones would still like to stay in their homes. But if they struggle with day-to-day activities and household duties, they might wonder how that will be possible. It’s important to assess the reality.

    Some questions that you will want to discuss with your parents would be, “What challenges do you face? Is it difficult to drive, walk up and down stairs, or access the bathroom? What’s the plan in an emergency?” It’s completely possible that they can continue to live at home. Mom or Dad might require part-time or full-time care to manage this. Sometimes simple changes or adaptations to the home can also make it feasible.

    For those who remain in their home, there’s an abundance of resources that will help. Options include home health aides, housekeeping, meal delivery service, and transportation services. Retirement communities offer many of these services while enabling residents to enjoy independent living.

    For some, living alone is no longer possible. Consider whether or not moving in with you is the right choice. It all depends on the circumstances. You might look into senior housing. Cost plays a primary role, so this needs to be factored in. You might not realize how much your parents value your input. Show care and empathy. Ask questions and genuinely listen to their answers. They absolutely need to be involved in the decision-making process if they’re going to be happy with the end result. Don’t rush this decision! Take your time and think wisely.

    Writing down a list of their wants and needs is helpful. What features would make them more comfortable? What’s essential to their care? This is valuable even if they continue to live at home or choose to live with family members. You’ll need to consider their financial and work situations, and the adjustments that might need to be made in those areas. Bringing on a part-time aide can maintain balance.

    This is a monumental time in both parent’s and children’s lives. Even with a well laid-out plan, nothing’s going to go perfectly. At times, emotions will run high. But through communication, empathy, and understanding, your family can make it through.

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  • June 21, 2016 /  Basics, Difficult Conversations

    sensitive subjectsThis is a continuing series using information from the booklet written by the National Institute on Aging working with the National Institutes of Health called: Talking with Your Doctor. (U.S. Department of Health and Human Services, NIH Publication No. 05-3452 August 2005. Reprinted April 2010.)

    For many, it’s hard to discuss topics like depression, grief, family issues, incontinence, and alcohol use with their doctor. It may feel awkward to bring up such personal matters. The fact is, though, that doctors are used to talking about these things with their patients. After all, the very nature of the doctor-patient relationship is personal. Let’s take a look at some of the subjects you may hesitate to bring up.

    Depression and Grief

    One of the most difficult aspects of growing older is facing the loss of your spouse, friends, and other important people in your life. This would be tough at any age, but can be even more significant at an older age when the losses are compounded.

    Mourning is normal, but clinical depression is not. Take note when feelings of sadness are constant, last more than a few weeks, are accompanied by poor or increased appetite, and lack of energy. If this applies to you, it’s time to talk to your doctor. As the booklet says, “A doctor who knows about your losses is better able to understand how you are feeling. He or she can make suggestions that may be helpful to you.”

    Problems with Family

    Another issue that can cause emotional distress is difficulty with your family. Age and illness can bring severe stress to any family, even those who are normally very loving. You may feel that family issues should be kept private. Remember, though, that your doctor is trained to offer you valuable assistance in these areas. If you feel you’re being abused emotionally, physically, verbally, or even financially – speak up!

    Falling, Incontinence, and Memory Problems

    Since falling can be very serious for an older person, many develop a real fear of it. It could prevent them from doing the things they usually enjoy, or from trying new activities. However, you can become weaker and frailer through this, hence increasing your chances of actually falling! Gentle and specific exercises can help, and your doctor can advise you about these.

    Incontinence is an embarrassing subject for many. You may be surprised to learn that there are many useful exercises and medications to assist you in controlling your bladder. Don’t hesitate to ask your doctor for help because of fear of embarrassment. It’s worth it to improve your quality of life!

    It’s not uncommon to experience some issues with memory as you age. That doesn’t make it any less distressing, however. The booklet assures you, “For most older adults, thinking and memory remain relatively intact in later years.” If you or your family members do notice a change in function, be specific when talking to you doctor about it. Tell them which parts of your life it’s affecting. There’s no reason you should suffer in silence.

    Alcohol and Sexuality

    These two matters are especially sensitive for many. Alcohol moderation is important, though, because the effects on a person may change or increase in later years. Depression and loss, discussed earlier, can even contribute to one misusing alcohol as a coping mechanism. One way to bring this up, the booklet suggests, is by saying something like, “Lately I’ve been wanting to have a drink earlier and earlier in the afternoon and I find it’s getting harder to stop after just one or two. What kind of treatments could help with this?”

    Some assume that aging means sexuality will decrease or worsen. This doesn’t need to be the case! Many have a healthy sex life long into their later years. Most doctors recognize this. If you aren’t satisfied with your sex life, it could be because of a medication or disability. Don’t be shy bringing this up. Let them know you have a personal question to lead into the topic. Be assured they’ll be very understanding.

    It’s important to have a doctor you can discuss these sensitive topics with. What if you’re uncomfortable with yours? Try being direct with them. Tell them your issue and how it makes you feel. Misunderstandings happen, and communication fosters trust. If you truly don’t feel satisfied, though, it may be time to look for a new one. Your comfort matters, and you need support while coping with these changes.

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  • December 10, 2013 /  Difficult Conversations

    Each of the 5 tips listed below are shared with us courtesy of Help Guide.org about effective tips when having this type of conversation with an aging loved one about driver safety, or possible confiscation of car keys. 

    • Be respectful. For many seniors, driving is an integral part of independence. Many older adults have fond memories of getting a driver’s license. At the same time, don’t be intimidated or back down if you have a true concern.

    • Give specific examples. It’s easier to tune out generalizations like “You just can’t drive safely anymore.” Outline concerns that you have noticed, such as “You have a harder time turning your head than you used to,” or “You braked suddenly at stop signs three times the last time we drove.”

    • Find strength in numbers. If more than one family member or close friend has noticed, it’s less likely to be taken as nagging. A loved one may also listen to a more impartial party, such as a doctor or driving specialist.

    • Help find alternatives. The person may be so used to driving that they have never considered alternatives. You can offer concrete help, such as researching transportation options or offering rides when possible. If your family member is reluctant to ask for help, it can lead to isolation and depression.

    • Understand the difficulty of the transition. Your loved one may experience a profound sense of loss having given up driving. Don’t dismiss their feelings but try to help with the transition as much as possible. If it is safe, try slowly transitioning the senior out of driving to give them time to adjust. For example, your loved one may begin the transition by no longer driving at night or on the freeways, or by using a shuttle service to specific appointments, such as the doctor’s. ~ Source: Help Guide.org

    This can be a difficult conversation for several reasons including sensitivity some aging loved ones might feel, or head strong aging relatives like Uncle Oscar who are used to having everything their way.

    Join our conversation and share with us any helpful tips and suggestions on what can make this sometimes dreaded conversation end with a favorable result.

    A friendly reminder is the week of December 2nd is National Older Driver Safety Awareness Week, so these helpful tips are ideal for future reference information.


    I serve the counties of El Dorado, Placer, Sacramento, Solano, Sutter, Yolo, and Yuba, as well as cities like Auburn, Lincoln, Rocklin, Roseville, Sacramento, Placerville, and Woodland.

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