Each day, questions come to HealthLeader from readers who are now responsible—literally or emotionally—for their elder parents. No surprise when you look at the statistics:

• Persons 65 years and older now represent over 12 percent of the population, about one in every eight of us.
• The number of Americans 45-64 who will reach 65 over the next 20 years increased almost 40 percent in this decade.
• The 85+ group is estimated to increase by 40 percent in the next two years.

Our parents (and ourselves) are living longer, not necessarily better. We adult children may have 20 years ahead of us of elder care, even as we’re raising our own children (or grandchildren.)

You have questions; we have answers.

As part of our new ASK THE EXPERTS! section, we have added Elder Care and Geriatric Medicine experts to help you make healthier choices.

This week’s questions have been answered by Dr. Nasiya Ahmed, assistant professor of internal medicine, Division of Geriatric and Palliative Medicine at The University of Texas Medical School at Houston.

 

Q. My grandfather was recently diagnosed with colon cancer. His oncologist would like to try chemotherapy, but his primary care physician feels that he should go to hospice. I would like to help my grandfather make this decision, but I am not sure what the right choice is myself. When should a person go to hospice?

A. I can understand the difficulty of the position you’re in. Hopefully, this will help: Hospice is for patients who no longer wish to actively treat their medical illness. If your grandfather were to enter hospice, he would no longer be allowed to have chemotherapy or surgery to help treat his cancer. He would be allowed to have any treatment that would help alleviate the symptoms his cancer might cause, such as abdominal pain or constipation. He could also continue to take medications for his other illnesses. Hospices will also treat infections that might occur, but are not related to your grandfather’s cancer. It is important to know that hospice neither hastens nor postpones the process of dying.

It is very difficult to decide when a patient should enter a hospice program. Medically speaking, patients should enter a hospice program when they have approximately six months to live. However, this is not easy for physicians to assess. Many patients choose hospice when they are tired of undergoing treatment or when the symptoms of their illness become too complicated or painful to bear.

Hospice provides a comfortable and caring environment for the end of one’s life. It also can lift the round-the-clock worry and burden of family caregivers, giving them a measure of peace. Once in hospice, a patient can always change his or her mind and decide to resume active therapy.

I hope this helps with your decision. If you have any other questions you can visit www.nhpco.org for more information.

 

Q. My father passed a little more than a year ago. Since then, my mother’s memory has gotten progressively worse. She did not have any memory problems before my father died. She currently lives alone, but lives only a mile from my house and I visit her every day. She forgets what day it is and forgot her own birthday last week (she turned 79). She has stopped socializing with her friends. Could this be dementia?

A. While at her age it is possible that your mother could have dementia, it is more likely that she is still grieving the loss of her husband and is suffering from depression. There are questions that your physician can ask to help differentiate whether your mother is suffering from dementia or depression. There are medications available to help alleviate the symptoms of both these illnesses. I would recommend that your mother see her physician for a better assessment of her symptoms.

 

Q. My father is 85 years old. Is it okay for him to continue driving?

A. Older drivers are at increased risk for accidents. However, like all adults, they enjoy the independence that driving gives them. Without the ability to drive, many senior citizens are unable to perform day to day activities, such as grocery shopping.

Loss of vision (from cataracts, macular degeneration, glaucoma or other eye-related illnesses) and hearing loss can result in making driving more difficult. Elderly can have physical disabilities from arthritis, Parkinson’s disease, peripheral neuropathy, or just generalized weakness that can decrease their reaction times in traffic. Medications can also cause dizziness or confusion.

Many elderly recognize their own limitations and will stop driving on their own. If your father has any of the above conditions, you might discuss your concerns with his physician. Occupational and physical therapy can improve strength and coordination and may help individuals drive more safely as well.

Finally, the Department of Motor Vehicles also has a driver evaluation program to help determine if your father is safe to drive.

 

Q. As my mother has aged (83), she has developed arthritis, with moderate to severe pain. Since she can't tolerate NSAIDS (non-steroidal anti-inflammatories such as ibuprofen or aspirin), she has been drinking increasing amounts of wine at “cocktail hour.” She is very active physically and mentally, surrounded by a close family and happily married. She won’t stop drinking because she says it's the only time she doesn't hurt. I'm concerned!

A. Drinking alcohol is an increasingly dangerous and often overlooked problem in the elderly population. As the body ages, the amount of total body water decreases, so each drink is more potent than it is in a younger person. Furthermore, the older patient is physically less able to compensate for the unstable gait and slowed reflexes that often result from drinking large amounts of alcohol. Lastly, the rate at which the body breaks down alcohol decreases with age. Alcohol has been shown to result in an increased incidence of falls and can interact with medications.

If your mother drinks wine only to lessen her pain due to arthritis, then she should discuss this with her physician as there are other ways to manage arthritic pain. However, studies show that older patients who drink are more likely to be depressed as well; this should also be discussed with your mother and her physician.

 

Q. My dad, 78, a recent widower, is the catch of the town—he's handsome, articulate, financially secure—and can still drive at night. He has started dating lately and is sexually active. Should we be worried about sexually transmitted infections? And how do we approach the subject? We joked about his needing condoms and he thought that was hilarious—he doesn't use them.

A. Sexually transmitted diseases (STDs) are becoming increasingly common in the older population. While the incidence of HIV is decreasing in the population under 30, it is steadily increasing in those over 60.

Aging itself increases the risk of sexually transmitted diseases. After menopause, a woman's vaginal tissue thins and natural lubrication decreases. This can increase the risk of micro-tears and of sexual transmission of certain diseases. The immune system also becomes weaker as we age. Treatment for concurrent conditions can make treating STDs more difficult in the elderly.

Physicians rarely perform STD screens for the older population and many of these diseases are asymptomatic. Older adults should be counseled about safe sex practices just like adolescents; they should try to maintain monogamous relationships and use protection at all times. You should discuss this information with your father and recommend that if he has additional questions he discuss it with his physician.

 

Q. My mother is 86. Should she still get pap smears and mammograms?

A. The US Preventive Task Force along with The American Geriatric Society recommend that women who are healthy (absence of signs of dementia or more than three other medical illnesses) should get screening mammograms. Women who have had three normal PAP smears or have had a hysterectomy for a reason other than cancer do not need to continue PAP smears after age 65, unless they have multiple sex partners. You should discuss this matter further with your mother and her physician.

 

Last Updated: 3-04-2008

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