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How to Care for Aging Parents or Loved Ones [Podcast]

Posted April 24, 2023 by Gabrielle Ruff, M.D., MPH

Listen to this episode of the Healthy Vitals Podcast.

In this episode, Dr. Gabrielle Ruff leads a discussion focusing on advice for caregivers of aging parents/relatives.


Featured Guest:

Gabrielle Ruff, M.D., MPH

Dr. Ruff's information includes:
Special interests: Geriatric/Senior Health Medicine
Medical School: The Ohio State University, Columbus, OH
Residency & Fellowship: Summa Health System
Board Certifications: Internal Medicine, Geriatric Medicine

Transcription:

Scott Webb: Caring for an aging parent can be challenging for caregivers trying to navigate the growing needs of their loved ones. And joining us today is Summa Health Geriatric Medicine Specialist, Dr. Gabrielle Ruff. She's here to answer some of the most commonly asked questions that she gets from caregivers who are seeking support for health and social needs for their aging loved ones. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Gabrielle, it's so great to have your time. We're going to talk about senior healthcare and when we should possibly consider moving to higher levels of care and supervision and so on. So we've got a lot to cover today. Just as we get rolling here though, how do we know when it's time to seek senior healthcare and is that different than other types of care?

 

When should you seek senior healthcare? Is it different than other types of care?


Dr. Gabrielle Ruff: I'm gonna actually answer that by saying there really is no wrong time to seek senior care. We have patients that come in because they have a specific issue, like memory loss or concern about their medications. But we also have patients that come in because they just want to get a comprehensive senior assessment and establish a baseline level of either cognitive or physical status, as well as just figure out how they can age well. And that's why I say there's really no wrong time to seek senior healthcare because there are a lot of reasons people come to us and they are all appropriate. We work really closely with a lot of primary care providers in the area, so primary care and senior healthcare are not mutually exclusive. We co-manage with these primary care providers for a variety of senior health needs.

Scott Webb: Yeah. And so when seniors and or their families come in for that baseline, what types of health assessments do you provide?

 

What type of health assessments are provided?


Dr. Gabrielle Ruff: We provide what I like to call a multi-domain assessment. Senior healthcare is at its core, a very collaborative practice, so we are working with a multidisciplinary team of social workers, advanced practice providers and pharmacists. We actually tend to have longer appointment slots, and this additional time allows us to provide a more in-depth assessment of patients that we're working with.

And we know that the environment surrounding the patient is just as important as the physiologic processes happening inside, and we know it takes time to delve into that. That's a little bit of difference that you may see between our practice and maybe a primary care practice. But that multi-domain assessment we provide includes looking at not just the medical components, but the mental, physical, environmental, and spiritual components as well.

We may look at things like weight and nutrition, making sure that someone is maintaining a healthy weight. We look at medications and ensure that the medications a senior patient is on are actually appropriate for their age and the changes in physiology that happen as we all get older. We look at cognitive status.

Sometimes we're just again looking at someone's cognitive status for a baseline that we can later compare to if we need to, or sometimes we're actually diagnosing a change in cognition and giving our patients and their caregivers tips on how to navigate those changes. We also look at emotional status, mood, functional status, fall risks, living environment, and most importantly, what matters to the patient when it comes to quality of life.

So goals of care conversations are also a type of assessment that we do in our practice.

Scott Webb: Yeah, there's some buzzwords in medicine over the last few years, multidisciplinary being one of them. So I love hearing that and just love of hearing that you really listen to prospective patients and their families. And my wife is sort of confronting this with her dad. He wants to stay home, right?

He's not interested in going someplace else, which I'm sure is a common theme, but I think she's a little bit concerned about his safety, and I'm sure others have those same concerns. So what can we do, you know, if we've got those seniors in our lives that we care for and we love, and we want to keep them safe, what can we do to keep them safe?

 

How can we keep our senior loved ones safe?


Dr. Gabrielle Ruff: This is a discussion that is never going to go away and it is an appropriate conversation. Again, I'm sure your wife wants the best for her, for her father, and I think comes, sometimes that struggle comes because we try to balance autonomy and dignity with safety, and that's not always easy. Trying to respect an individual's right to live in the environment that makes them the happiest, but to also make sure that environment is safe.

So the first thing I would recommend for anyone facing this dilemma is have that conversation with your loved one about what your specific concerns are. I think you will find you will get much further in making a plan for safety if you start with that. Because when you start with a conversation, you're letting that individual know that you love them, you respect them and you realize that they have a part in this discussion and they are part of this decision process.

After you have the conversation and share what your specific concerns are, it really depends then on what the safety concerns might be. For some of our patients, just fall hazards are the biggest concerns. So looking through the home, looking for fall hazards. Throw rugs are lovely for decor.

Scott Webb: I thought you might say, uh, yeah, I thought you might say throw rugs. That'd be at the top of my list, right?

 

What are some safety measures you can take?


Dr. Gabrielle Ruff: Yes, yes. Horrible fall risk. The throw rugs. So looking for things like that and removing them. That is definitely gonna be already improving the safety environment of your loved one. A medical alert device is another great way to increase the safety of someone at home. Sometimes individuals may fall on their home, they're not near a phone or a, a device that allows them to call out for help. Having a medical alert device on their person, gives them the opportunity to push the button or even just have the device detect a fall and have help contacted. In some unique situations, some of our patients families have actually placed cameras in the home.

That is not something I recommend for everybody. Again, that is for very unique situations. Other things include using a pill box. It's a great way to make sure that you took a medication and you're able to see if you missed a medication. Your loved one can actually show that to you when you come over and you can make sure that they are indeed getting all of the doses of their medications appropriately each day.

Also, something that we don't talk about a lot, but is weapons. Some people have guns in their homes. Making sure that those are stored appropriately. That's also a way to increase safety in the home. And lastly, I'd like to say driving. If you are in a position where you live near your loved one and you're able to just occasionally, ride along with them to the store or a doctor's appointment, to just kind of keep an eye on how they're doing with the rules of the road, and if you feel that their driving is still safe and that it's something that they should continue.

Scott Webb: Yeah. There's a lot of layers here. You know, it's like sometimes we're dealing with folks, you know, uh, seniors in our lives who were the ones who taught us to drive, right? And so who are we to criticize their driving? Uh, there's a yeah, there's a lot to unpack here. And just great suggestions. And you know, I think that one of the difficulties is how do do we know?


So you say there's no bad time to come in, but you were mentioning like, you know, pill boxes. I'm 54 and I use a pill box because I sometimes go, wait, did I take my medication or did I just think about taking my medication? You know? And so I go to the pill box and I go, oh. Okay. I took it good. So pill boxes, uh, you know, all great suggestions, but how do we know when it's time to transition to a higher level of care and supervision and how, this is the million dollar question, how do we convince our, the seniors whom we love that it's time?

 

How do you convince your senior loved one that it's time for help?


Dr. Gabrielle Ruff: Well, let me just say, I've been doing this for a long time, Scott, and I don't know that I, I am able to convince people all of the time. But, uh, we do the best that we can with that. I would like to answer that question by saying something that we talk to our patients about is the five M's. The five M's stand for money, mobility, meals, medication and medical care. And we've touched on a little bit of those throughout this conversation, but when we're looking at money, we're looking at someone being able to manage their bank account, pay their bills successfully, not get behind on bills, not be scammed out of money that they need to care for themselves as they get older. Meals. We want to make sure that someone consistently has food in the refrigerator. Someone is eating on a regular basis. That their weight is not unintentionally dropping. Mobility. We want to make sure in addition to driving, like we mentioned earlier, that someone is not having lots of falls in their home and we're not aware of that.

Medications, we talked about the pill box. We talked about making sure that we use that so we can know when we took a med, when we didn't and medical care. Making sure that a loved one is getting to doctor's appointments, making sure that they remember what's being said in those doctor's appointments and that someone is aware of any changes to medications or tests that have been ordered.

We kind of summarize those by calling them the five M's. And I would say that the answer to when you should transition to a higher level of care or supervision is when someone can no longer safely maintain the five M's in their current environment. I think that's the most simple answer to that question.

There's a lot of nuance to that, but when someone is no longer able to maintain a safe level of function in their current environment, that's when it's time to consider the next level of care or supervision.

Scott Webb: Yeah. One of the things that drives my wife crazy about her dad is that he doesn't have a home phone. He only has a cell phone, and the cell phone is often not where he is. So he doesn't know that she's trying to reach him. He doesn't know that he has messages to call her back. And as you say, there's a lot of nuance to this. And I know there's a lot of nuance when we think about memory loss as well, and it can be a very difficult thing dealing with seniors as they begin to lose their memory a little bit, whether that's a natural part of aging or something else that's going on. So how do we have those conversations?

How do we communicate with a parent or a loved one who's clearly suffering from some memory loss?

 

How do you communicate with a senior loved one who is suffering from memory loss?


Dr. Gabrielle Ruff: Well again, these are all great questions. The first key that I would say for communicating with someone who has memory loss, is patience. We live in a society that you know, patience is not always at the top of our list of virtues. But when it comes to dealing with someone who has memory loss, patience has to be at the top of the list of virtues, because not being patient with someone who may already be aware of the fact that they are not remembering things like they used to or like they would like to, is going to cause frustration.

So it may seem that it makes sense to say, oh, you just said that, if someone's repetitive. Well remember I already asked that, you answered that question. But the truth is that's just going to frustrate the individual. So sometimes just answering the question again and not acting like you heard it, you know, the second time or the third time or the fourth time that day, is the best way to approach someone who is dealing with memory loss.

And I think that will go back to that concept we talked about of protecting dignity in someone who may have a process that they cannot control when it comes to their memory decline. You also mentioned Scott, that there's this question of is it normal to have memory loss or not? I like to say that I have a job because it's difficult to tell sometimes whether memory loss is just normal aging or it's something else.

And I encourage anyone listening to this to never assume that memory loss is just normal aging. If you are noticing memory loss, you should definitely speak with your primary care provider who can do an assessment or even point you in the direction of a senior healthcare specialist like myself who can do the assessment that will let you know one way or the other.

Scott Webb: All great advice today and as we get close to wrapping up here, how do we help our parents, our seniors, our loved ones, really prepare for the future; whether we're thinking about financial exploitation or other concerns, how do we best prepare them for, you know, the twilight years if you will.

 

How can we prepare our senior loved ones for the future?


Dr. Gabrielle Ruff: I like to say that one of the things about my job that I enjoy, is the ability to give people the tools to do just what you asked, control the future. We have so little control over the future. Looking, ahead, I would recommend that any family working with an aging parent, decide who the decision maker is going to be in the event that parent has either a medical reason or some other reason why they are unable to make decisions.

Best case scenario is that never happens. But in the event that it does, you do want to be prepared for that. So making sure that you have filled out a healthcare power of attorney form is crucial. Making sure that you've filled out a financial power of attorney form is also crucial. And what this does is, it doesn't take decision making power away from the parent. It only kicks in when that individual does not have the ability to make those decisions for finances or healthcare. I would also recommend talking to an elder law attorney. Oftentimes, those attorneys can help families get all of the things together that they need to be prepared for the eventualities of the future.

Again, best case scenario is we never have to use these things, but it's better to be prepared than unprepared.

Scott Webb: Yeah, it's difficult to have these conversations because you start talking about end of life care or hospice care, or power of attorney, and, you know, those conversations can be uncomfortable and you're just trying to do the best thing you can for our loved ones and prepare for the future so that we don't butt heads later or there's indecision later.

But it's difficult because mortality is not something that most people are really comfortable talking about. So glad we had this conversation today. Just hearing your compassionate approach, and encouraging all of us to have these conversations and while we're doing it and having those conversations to be patient, right?

To be proactive, and that everybody just needs to know that we're just trying to do the best for our loved ones, and hopefully we can convince them of that as well. So thank you so much for your time today, and you stay well.

Dr. Gabrielle Ruff: Thank you. You too, Scott.

Scott Webb: And to make an appointment with a Summa Health Senior Health Specialist, call 330.375.4100 or visit summahealth.org/seniors to learn more. And if you found this podcast to be helpful and informative, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Stay well, and we'll talk again next time.

About the Author

Gabrielle Ruff, MD

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Maternal Health in the Black Community [Podcast]

Dr. Cheryl Johnson leads a discussion focusing on empowerment in the African American community, especially maternal health.

Testicular Cancer: An Overview from Prevention to Treatment [Podcast]

Dr. Dankoff provides an overview of testicular cancer. Learn about symptoms, prevention, and treatment options.

What Makes a Great Doctor - Personal Insights, Advice, and Why they Chose Medicine [Podcast]

Dr. Shanu Agarwal and resident Kortnie Broschinsky discuss their journey into healthcare.

Feeling the pressure? 8 ways to live a heart-healthy lifestyle

Are you feeling the pressure to live a heart-healthy lifestyle? You’re not alone.

Heart disease is the leading cause of death for men and women in the United States, according to the American Heart Association (AHA). What’s more, nearly half of all adults in this country are living with some type of cardiovascular disease.

The good news is you don’t have to be a statistic. While genetics do play a role in heart disease, there are several risk factors that can…

Occupational Therapy: What Is It, How Does It Help, Who Should See An OT [Podcast]

Craig Wood leads a discussion focusing on occupational therapy, its benefits, and why he got into the field.

Our Commitment to Creating a Healthier Community [Podcast]

Iriel Hopkins and Marlo Schmidt discuss ways in which Summa Health System contributes to a healthier community.

Sudden Infant Death Syndrome – What You Need to Know [Podcast]

Karen Frantz DeSeptis and Ericka Malone lead a discussion on SIDS, and important information you need to know.

An Overview of Osteoporosis: Prevention to Treatment [Podcast]

Natalie Hiltbrand, an Osteoporosis Specialist at Summa Health, leads a discussion on osteoporosis treatment, as well as prevention.

10 Early Signs of Diabetes That Shouldn't Be Ignored

FsoHigh blood sugar can cause gradual, unassuming symptoms that can sneak up on you. Frequent urination and excessive thirst — the telltale signs of type 2 diabetes — are often mild and can easily be attributed to other factors.

In fact, most people don’t even know they have high blood sugar until they’re diagnosed with type 2 diabetes.

Diabetesis a chronic condition that causes glucose (or sugar) levels in the body to rise. The problem is ignoring or writing off the symptoms…

Addressing Common Pelvic Health Issues [Podcast]

Dr. Megan Cesta and senior physical therapist Amy Senn discuss common pelvic health issues women may experience.

Why is it so important to get your flu shot this year?

Last winter, the community took several precautions to help stop the spread of COVID-19. From masks and social distancing to virtual work and school to cancelled events, an unforeseen positive side effect was a less intense flu season.  

Flu cases documented during last year’s flu season were historically low by a wide margin. Medical professionals haven’t seen anything like it.  

So with many precautions still in place amidst an ongoing pandemic, you may be…

African-Americans More at Risk for Heart Disease

February is Black History Month, when we recognize African-Americans and those of color who have played major roles in shaping our present culture. February is also American Heart Health month – a time to raise awareness of heart disease. While these two events are different, they are linked in healthcare. Heart disease remains the number one killer of Americans, and African-Americans are 20 percent more likely to die from heart disease than non-Hispanic whites.

We do not…

Is working from home a pain in the neck — literally?

Many agree one positive that has come out of the COVID-19 pandemic is the work-from-home order to prevent further spread. No more long commutes and fighting traffic, more time spent with family and less interruption from chitchat around the water cooler.
 
In the United States, it’s estimated nearly 50 percent of the working population is now working at home. But as more and more companies embrace remote working for the long haul, one negative has emerged: new or…

Thyroid disease 101: Early diagnosis and treatment are key to preventing serious complications

The thyroid gland has an important job to do in the body. It produces thyroid hormones that help regulate metabolism and the body’s overall temperature. Metabolism is a process that turns food into energy, which is vital to keeping all of our body systems working correctly. This small, but mighty gland impacts just about every area of the body, including heart function, digestive function, muscle control, mood and brain development.
 
The thyroid gland is a small,…

Urologic cancers 101: Be in the know so you can catch it early

Bladder cancer is the most common urologic cancer in both men and women. Each year, about 57,000 men and 18,000 women are diagnosed with the disease, according to the Centers for Disease Control and Prevention (CDC).

But, urologic cancers don’t only affect the bladder. They also can affect the kidneys, ureter (tubes that carry urine from the kidneys to the bladder), urethra, and specifically in men, the penis, prostate and testicles.

In fact, the CDC states prostate…

All About Sleep Apnea [Podcast]

Dr. James Bavis & Dr. Ketan Deoras explain sleep apnea as well as signs, symptoms, and what to expect.

Sports injuries of the knee: ACL and meniscus tears

You’ve seen it on the soccer field or basketball court: a player plants a foot, twists and goes down grabbing a knee. The problem is most likely tearing of the meniscus (cartilage) or ACL (anterior cruciate ligament). Both can be extremely painful and sideline an athlete for months of recovery.

A tear usually requires more intervention than a strain or sprain.

A knee strain is a stretch or partial tear of a tendon or muscle, while a sprain is a stretch or tear of a…

Breast Cancer: The Importance of Knowing Your Risk [Podcast]

Dr. Keristen Brantley & Dr. Victoria Van Fossen discuss Breast Cancer Prevention and Treatment.

Alzheimer’s Awareness: Symptoms, Stages, and Support [Podcast]

Amanda Harvan sheds light on the symptoms, stages and support of Alzheimer's.

Men’s Well-Being: All About Prostate Health [Podcast]

Dr. Kevin Spear discusses men's health and different risk factors and how to ensure optimal well-being.

The Latest Updates on COVID-19 [Podcast]

Dr. Thomas File shares the latest updates on COVID-19.

Can Obesity be Considered a Disease [Podcast]

Dr. Adrian Dan discusses obesity as a metabolic disease.

Breaking the Stigma of Mental Illness [Podcast]

Emily Hionides-Horner discusses 7 ways to overcome mental health stigma.

The Modern Guide to Heart Health [Podcast]

Dr. Peter Bittenbender shares his insight on the modern guide to heart health.

Tips on Maintaining Fitness and Physical Health During the Pandemic [Podcast]

Dr. Cipriani discusses tips on maintaining physician health during the pandemic.

Tips for Managing Anxiety [Podcast]

Dr. Leslie Zaynor discusses tips for managing anxiety.

5 health numbers you should know by heart

As we grow older, wrinkles, fine lines and gray hairs aren’t the only aging factors we need to be concerned about. The real health indicators we should be tracking can’t be found in any mirror — and they affect our heart and other vital organs. 

These are critical heart health numbers that should not be ignored and include blood pressure, resting heart rate, cholesterol, blood sugar and body mass index. Heart disease is the leading cause of death for…

Early Warning Signs and Symptoms of Alzheimer's

As our loved ones get older, it’s normal for them to lose a little bit of their mental sharpness, and it’s easy to rationalize and gloss over strange behavior. After all – we all forget things once in a while. When memory and mental issues start affecting daily life, it could be a sign of something more serious. While a qualified physician is needed to diagnose someone with Alzheimer’s disease, there are some signs and symptoms that can suggest a…

Alzheimer's Research Showing Promise for Future

Billions of dollars have been spent on researching Alzheimer’s, but it stubbornly continues to affect 1 in 10 Americans over the age of 65. While we are still waiting for a cure, there have been significant advances that have made an impact on the treatment of Alzheimer's and related diseases:

New treatments and positive trials on the horizon
Currently, the medications on the market for Alzheimer’s only relieve symptoms of the disease. None stop the progression.…

Palliative Care 101

Palliative Care is specialized treatment tailored to those who are suffering from chronic or life limiting illnesses. Some of these illnesses may include cancer, kidney disease, heart failure, dementia, lung disease and many others. Palliative care is a specialized team of doctors, nurses, chaplains, social workers and others who work together with a patient’s primary physician and care team. The goal of the team is to improve the quality of life for a patient (and sometimes their caregivers) who has a serious illness or disease. It is appropriate for all ages and stages in a patient’s severe illness.

Should you get a wearable sleep tracker?

Deep, consistent, quality sleep can not only make you feel great during the day; it can also improve your health. Sleep can boost your mood, help you maintain a healthy body weight and help your heart and mind function at tip-top levels.

But, for some of us, a solid night's sleep may seem like a dream. Lack of sleep can affect our brain's ability to react properly; so much so, that our body’s overall health can be at risk.

Alzheimer's Awareness Month: Seven Tips For Caregivers

Did you know 5.7 million Americans are living with Alzheimer's disease? Every 65 seconds, someone in the US develops this disease. It is the most common form of dementia and affects women at almost double the rate of men. Dementia diseases relate to the brain’s ability to regulate memory and cognitive skills. Other forms of dementia include Parkinson’s and Huntington's disease and vascular dementia, dementia with Lewy bodies and mixed dementia.
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