I have quite a few elderly patients in my practice—compared to my training period as a resident, when I saw exactly 1 patient over the age of 75. I often find their care difficult and even frustrating, likely because my past experience with the elderly is so limited. Chronic diseases affecting the elderly—memory loss, incontinence, and heart and kidney disease—can make their medical care very challenging, never mind their daily care.

I also sense the frustration in the adult children of these elderly patients nearly every time I meet with them. The "kids" and I spend a lot of time trying to decide on treatment plans for each of their parent's concerns, treatments that won't cause the patient too much distress. Both the adult children and I feel defeated when an elderly patient is unable to offer his or her preferences, and so ends up telling us, "Just do what you think best." And, 180 degrees in the other direction, we also find it immensely frustrating when the patient refuses simple but important tests, such as the mammogram.

What suggestions do I have for grown children who are in this position?

1. Talk with your parents early on about what they expect. Try to get some idea about what your parents expect to happen, not only during their next visit to the doctor's office but also more generally, in their future medical care. Ask them whether they would want surgery or a hospital stay if either of those became necessary due to an illness. If they would never, under any circumstances, want to undergo aggressive measures--like the treatment given in an intensive-care unit (ICU)--then consider talking to the doctor about a Do Not Resuscitate (DNR) order. (Note: A DNR order does not imply that the patient wishes to receive no medical care, just no CPR.)
   
2. Ask your parent who they would want making their medical decisions in the event they become unable to make them for themselves. Would it be their spouse, or one of their children, or a friend? If they offer a preference, complete a "health care proxy" form.
   
3. Encourage your parents to get the basics. This includes proven, worthwhile health care such as immunizations and appropriate cancer screenings. The U.S. Preventive Services Task Force (USPSTF) has set very conservative guidelines for the health care they recommend; the American Geriatric Society is another resource.
   
4. Review your parent's medications and supplements with the doctor, to verify that all are safe, appropriately dosed, and worth taking. The elderly are at greatest risk for suffering adverse effects from medications, especially when they're on 3 or more drugs at the same time.
   
5. Get assistance. Call on the whole family for support and supervision. Consider hiring a home health aide, who can sometimes be paid through Medicare. Look around for municipal and elder services in your community. through. Likely, the info is right in your phone book!