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Involving the Family and Others
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Contrary to the common belief
that families warehouse older relatives in nursing homes, the vast
majority of older people have family members who care deeply about
them and are active in promoting their well-being. Many older people
also have close ties with friends, partners, neighbors, landlords,
clergy, and others. Communicating effectively with these individuals
and involving them in the older person's care can help your patient
and make efficient use of medical resources. |
Respecting the Patient
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Maintaining the patient's privacy
and autonomy, and yet involving others, can be a difficult balance.
Here are some suggestions you may want to try:
 If
possible, first see the patient alone. Have others join you, or
meet separately with them, only after obtaining the patient's permission.
If meeting with the patient first is not feasible, be sure to spend
some time talking with the patient alone, perhaps during the physical
examination.
Be
aware that three-party interactions tend to degenerate into "two
against one." Avoid the tendency to "gang up" on the patient..
When
both the patient and others are present, address primarily the patient,
if possible.
Especially
when a patient is very frail or has dementia, beware of a tendency
to discuss him or her in the third person in his or her presence-or
to act as if he or she was not present at all.
If
others want to shield an older patient from potentially painful
information, explain to them the problems inherent in doing so.
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Working With the Family and Others
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To aid the family and others
in working with the patient:
Realize
that some people want to help but are unsure how. Offer specific
suggestions.
Try
to understand the group context. Learn about other demands on family
members. Consider how to help integrate care of the patient.
Foster
a sense of collaboration. Make family members and others part of
the older person's health care team.
Ask
the patient about other health care professionals he or she may
be seeing. Remember to communicate sufficiently with the other health
care providers or counselors seeing the patient.
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Supporting Caregivers
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Day-to-day care of a frail
older person can be stressful, exhausting, and demoralizing. Through
measures such as those listed below, you can support caregivers and
contribute to your patient's well-being.
Ask
caregivers to identify the problems they find most distressing or
disruptive, and work to address those problems..
Remember
that praise and encouragement from a physician can help sustain
a caregiver.
To
help keep stress from building up, encourage ongoing involvement
of people other than the main caregivers.
Recognize
that a caregiver may need respite but feels guilty taking it. Recommending
a vacation, or indicating that nursing home care may be the best
option for all, can give the caregiver the permission needed to
proceed.
The Administration on Aging
supports a toll-free information line that can help family members
or other caregivers identify local organizations for assistance.
Call the Eldercare Locator at 1-800-677-1116 (880 instead of 800
if you are calling from outside the US).
Information about caregiving
is also available from:
Children of Aging Parents
1609 Woodbourne Road, Suite 302-A
Levittown, PA 19057
1-215-945-6900
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