Ep 94 Geriatrician Dr. Leslie Kernisan

“Practice a certain acceptance”: Dr. Leslie Kernisan, MD, MPH and founder of the Better Health While Aging website and podcast, on how adult children can ask better questions and accept suboptimal choices with grace when caring for aging relatives.

The post Ep 94 Geriatrician Dr. Leslie Kernisan appeared first on Midlife Mixtape .

“Practice a certain acceptance”: Dr. Leslie Kernisan, MD, MPH and founder of the Better Health While Aging website and podcast, on how adult children can ask better questions and accept suboptimal choices with grace when caring for aging relatives.

Find Dr. Leslie online:

Website: BetterHealthWhileAging.net

Podcast: Better Health While Aging

Book: When Your Aging Parent Needs Help

Recommended reads and other resources:

How to Care for Aging Parents by Virginia Morris
Being Mortal by Atul Gawande
Geriatrician Dr. Rebecca Sudore’s website, Prepare For Your Care
Difficult Conversations: How to Discuss What Matters Most by Douglas Stone et al
We Need to Talk: Family Conversations with Older Drivers from The Hartford (free download)
Dementia and Driving: resources from The Hartford (free download)
Ep 84 Therapist Mazi Robinson – on the importance of giving yourself permission to feel ALL the feelings

A-b-b-bye bye, b-b-b-b-bye

Thanks as always to M. The Heir Apparent, who provides the music behind the podcast – check him out here! ***This is a rough transcription of Episode 94 of the Midlife Mixtape Podcast. It originally aired on March 30, 2021. Transcripts are created using a combination of speech recognition software and human transcribers, and there may be errors in this transcription, but we hope that it provides helpful insight into the conversation. If you have any questions or need clarification, please email [email protected] ***

Dr. Leslie Kernisan 00:00

There’s really this whole other aspect which is how are you going to transition into this change in your relationship?

Nancy Davis Kho 00:09

Welcome to Midlife Mixtape, The Podcast. I’m Nancy Davis Kho and we’re here to talk about the years between being hip and breaking one.

[THEME MUSIC – “Be Free” by M. The Heir Apparent]

Nancy Davis Kho 00:34

Hey, listeners. Before we get into today’s episode, I want to acknowledge that the past few weeks have been particularly hard on people in the Asian American/Pacific Islander (AAPI) community. I know from hosting this show how critical it is to listen to diverse stories and voices as a means of building empathy, connection, and understanding. If you follow @midlifemixtape on Instagram, you know that last week I participated in boosting the signal for AAPI writers and musicians in my posts. So just to balance out the three-legged stool, I wanted to take a moment to shout out a few AAPI-hosted podcasts you might also want to check out.

I love “By the Book.” It’s half reality show, half self-help podcast, and one wild social experiment hosted by comedian Jolenta Greenberg and culture critic Kristen Meinzer as they live by the rules of a different self-help book each episode to figure out which ones might actually be life changing. Another one to check out is “Self Evident,” a podcast hosted by Cathy Erway that tells Asian America’s stories across generation, across cultures, and across class, to explore what it really means to claim America today. And finally – a brand new one to check out called “Anywhere is Home”, hosted by Julia Relova, that explores the complexities of home through interviews on the who, what, where and when of home. She’s a newbie podcaster. Let’s help her find her groove!

#DiversifyYourPodcasts and Stand Up Against AAPI Hate!

[MUSIC]

Hi Midlife Mixtapers, it’s me, Nancy Davis Kho, creator and host of the Midlife Mixtape Podcast and author of The Thank-You Project: Cultivating Happiness One Letter of Gratitude at a Time. Did you ever own a comb that you bought at the mall because it had a really rad saying on it that you could display on your backside when you walked down the hall at school? Mine said DyNoMite. And did you use it to feather your hair? You are very welcome here.

This is one of those episodes that I call Hack Your Midlife – guests who can help us navigate the harder aspects of what we around here refer to as years between being hip and breaking one.

One of the hardest things many of us grapple with at midlife is the switch to being in a caregiver role for our parents, and that’s why I invited today’s guest on the show.

Dr. Leslie Kernisan, MD, MPH, is a practicing geriatrician and the founder of the popular aging health website and podcast Better Health While Aging, created to help families and older adults learn better ways to manage aging health challenges. Now a Clinical Instructor at the University of California, San Francisco, Division of Geriatrics, she was previously the site medical director of the Over 60 Health Clinic in Berkeley and founder of the GeriTech blog.

Together with award-winning writer health and aging Paula Spencer Scott, Dr. Leslie is the author of When Your Aging Parent Needs Help: A Geriatrician’s Step-by-Step Guide to Memory Loss, Resistance, Safety Worries, & More.

I asked listeners to send in questions and I had a bunch of my own. During the episode, you’ll hear a lot of book recommendations as follow up – no worries, I have included links to each of those in the show notes. If for some reasons the show notes for episode 94, don’t show up where you’re listening or they are not easy to read there, remember you can always go to midlifemixtape.com to see them in all their glory.

Ok, put in your ear horn. We’re gonna talk aging with Dr. Leslie.

[MUSIC]

I’m joined today by Dr. Leslie Kernisan. Dr. Leslie, thank you so much for joining me today.

Dr. Leslie 04:06

Thank you so much, Nancy for inviting me.

Nancy 04:08

We have a lot to get into. You’re a geriatrician, and I have an audience that is full of questions for a geriatrician! Their first question that they’re going to want to know from you is: what was your first concert and what were the circumstances?

Dr. Leslie 04:20

I think my first concert was when I was 16 or 17 and it was Paula Abdul in Phoenix. I grew up in Tucson, but all the concerts were in Phoenix and I went with a friend.

Nancy 04:32

Was it one of those drive up and back same day kind of odysseys that teenage girls used to be able to go on without fear?

Dr. Leslie 04:40

Yes, something like that. And especially in Arizona, where everybody was driving by age 16! It was fun.

Nancy 04:45

Isn’t that ironic, because that actually ties into the story today. Because I saw an ad yesterday – it’s an old, old Paula Abdul video, and then it’s current Paula Abdul dancing with her old self, looking fantastic but talking about how now, she’s dancing with arthritis. We of Gen X used to watch videos on MTV, and now we’re worried about calcium supplements.

So thank you so much for joining me on the show today. This is one of those topics that I think those of us “in the years between being hip and breaking one” are grappling with. We want to know that we’re doing the right things and I think maybe there are no right answers, but there are better answers. So I really appreciate you coming on the show and bringing your expertise.

I mean, it is really shocking, that moment when you realize that your parent is the one who needs caregiving now. I think we all have had that moment, everybody can probably point to a conversation or an incident or, I hope not a fall, where you suddenly think, “Oh, my God, I’m in charge.” It can be really terrifying. But together with your co-author, Paula Spencer Scott, you’ve written this really practical, helpful guide for helping people assist their aging parents and other relatives. Because oftentimes, it’s not just the parents we’re caring for, I’m really looking out for an aunt of mine, personally. And the book is called When Your Aging Parent Needs Help: A Geriatrician’s Step-by-Step Guide to Memory Loss, Resistance, Safety Worries, & More.

I’m going to call you Dr. Leslie, if that’s okay.

Dr. Leslie 06:19

Yeah.

Nancy 06:20

I want to start by asking you why you wrote this book. What were the gaps that you were trying to fill?

Dr. Leslie 06:24

First of all, I started Better Health While Aging many years ago, because I got really interested in the fact that people had questions for all these common age-related challenges. They were looking online or googling, and often were finding information that was not written by us as geriatricians and that was not what we would tell people. I felt like well, here’s really an opportunity to support people.

Nancy 06:44

This is betterhealthwhileaging.net.

Dr. Leslie 06:48

Betterhealthwhileaging.net. Actually, initially, it was called Geriatrics for Caregivers, because I was really trying to help those people who were worried about an older parent or older relative, but we had a lot of older adults arrive interested in their own aging health challenges as well.

In running the site, I have always written articles specifically for people worried about aging parents, or an older relative. But we do get a certain type of question over and over again, which is: “I’ve noticed these declines in my parents,” – often they sound memory related, but sometimes they’re not. Sometimes it’s recurrent falls, or sometimes it’s just, “I just don’t feel like it’s safe for her to be living at home. But I’ve brought it up, and she’s ignoring me or she gets mad, or he gets mad” (there are like older fathers or male relatives, of course, too) “and won’t do anything and what do I do? Help!”

We’ve gotten a variation of that question over and over and over again and although we do have articles that address some angle of it, I felt like there was a need to sort of put it all together into something that would be kind of step by step and helpful to people.

We’ve actually had on the site, for many years, this free download The Quick Start Guide to Checking your Aging Parents, which started with that question. “My mom is getting old and still lives in this big house, should I worry or can she live at home?” That used to be the question and the answer is “Well, it depends.” And I thought, “Well, I have this whole process of what I look at and think about when I’m considering what’s happening with an older person who might be declining and lives at home, let me kind of lay it out.” Not that I can make people geriatricians, but here are the specific things that you would look for, and that you could ask a doctor about or a social worker about. So that was the first one.

This book was kind of the follow up to that, a little bit more about how to step in, especially if you’ve noticed memory problems.

But the other thing I really have noticed over the past few years is that people want to know, it’s not only like, what’s a sign they need help or what would be the intervention? But there was also this whole aspect of how to step in, how to talk to your parents, how to sort of think about your role. Initially on Better Health While Aging, I just gave a lot of the geriatric medical information like, “These are the important things to consider if somebody has been falling.” Then I would have people write and say, “But how do I get my mom to do this?”

I thought, “Oh, there’s really this whole other aspect, which is how are you going to transition into this change in your relationship?” Because most of us, if we’re lucky enough to grow old, will eventually experience some declines. And if we are lucky enough, we will have family members and people who care about us who will want to help. I feel like a lot of people, older adults, are going to go through this stage in life where their family is first concerned, and then often providing some assistance and even though this is really common, we don’t provide anybody with a roadmap of how to get started on that.

The book was meant to fill that gap. It does presume that – because there are so many variants on how people can get started on this journey with their parent –  it was written with the idea in mind that you have a parent who has been living independently and maybe they’ve had some health problems, maybe you’ve been involved a little bit but they’ve mostly been okay and now you’re noticing things. How do you figure out whether there’s really something to worry about? How do you approach your parent about it? If there are really worrisome signs, what could you do next, should you do next, and then some strategies on how to actually step forward in a way that is empathetic and compassionate and respects your parents’ dignity and autonomy as much as possible? So that was the genesis of the book.

Nancy 10:26

All in one small book, to get ALL your answers.

Dr. Leslie 10:31

Well, it is actually pretty short. And the reason is because we didn’t write the comprehensive encyclopedia guide of “here’s what to know about every single thing that might come up when you help your parent.” There are some books out there. There’s one I really like called How to Care for Aging Parents by Virginia Morris. This was more meant to address a few specific things like what people worry about early on. I even thought about calling it When Your Parent First Starts to Need Help. It’s really a bigger focus on communication, and how to navigate the role change and then really outlining a process that you could use.

Nancy 11:04

It’s written and organized so practically because it’s full of cheat sheets and checklists, and real life examples. You could never write the comprehensive book because everybody goes through this so individually, but you have it organized into Taking Stock, Taking Aim, Taking Action and Taking the Long View.

I mentioned this to you, when we were talking about setting up this interview: I lost my dad in 2016 very suddenly. We only had six weeks from diagnosis to funeral. I lost my mom to dementia in December over years. So I felt like, as I was flipping through the book, “Oh, yeah, we went through that. Oh, yeah, I should have asked that question. Oh, I did ask that question.” Some of the questions I’m asking today are because there were times I felt my siblings and I handled it ourselves GREAT, we were really on top of it. And then there was some stuff we NEVER figured out how to do right. When I saw the questions coming in from listeners, I was like, “Oh, yeah, I had that question, too.”

I think one of the challenges is even figuring out who should be on your team. I have to be honest, we could not find a geriatrician in my mom’s situation, there was so much demand. So good for you on picking a field where you will have the Full Employment Act your whole life, because we need really good geriatricians. Part of the challenge is even finding one who can do a consult with you and so I think Dr. Leslie’s book, while you’re waiting for that medical professional to be on your team, is a really good way to kind of position yourself and get prepared for what may be ahead.

Dr. Leslie 12:39

Yeah, we do try to give people a sense of not just what would happen ideally, but what to expect and what often happens. Because often, this unrolls kind of un-ideally, and that was actually part of the genesis for Better Health While Aging. Also I have a background in quality improvement and the quality of health care is often in general not as good as we wish it were, especially so for older adults who come in with more vulnerabilities. We do have this field of geriatrics, the art and science of modifying healthcare for older people, but there are not a lot of geriatricians there.

So I have an interest in, how do you leverage geriatrics? It can’t be that every older person frail or vulnerable or in need older person who needs us is going to be able to see us personally. Also, one of my goals has been to provide people with the information so that they can ask better questions of their usual providers and maybe elicit more of that geriatric approach, or at least have more of a sense of like, “Wow, I think my mom is really not getting what is recommended, so I need to either ask more or look for another provider.” The terrible thing is that people already have so much to do and the fact that they have to learn to be proactive and advocate is unfair and it makes me sad. But that is the reality right now. If you want better care and better health from the healthcare system, the more you know about it and go in prepared to ask for more productive things, the better off you are.

Nancy 14:06

I feel like this is one of those areas where we as Americans want everything to be perfect. You want there to be a right answer. I think it’s kind of a cultural thing that you can take a pill and everything’s gonna be fine or you can follow a stretching regimen or whatever it is, and things will be fine. I think it is one of the great life lessons that we have to learn that things may be suboptimal. They need to be good enough, but they may never be perfect. You mentioned another book that was helpful, but I wondered if you had ever read Being Mortal by Atul Gawande. I’m sure you’ve read that.

Dr. Leslie 14:41

Yes, I did. You know that was part of the impetus for this book too, because I mean, that’s a beautifully written book. He’s an amazing writer, a very knowledgeable clinician, and he is not particularly knowledgeable about geriatrics. He’s actually more knowledgeable about end of life and palliative care.

I was really struck reading his book how at one point, he tells the story of how, I think it was his mother in law, started having some memory and thinking problems and how she parked the car in the wrong driveway.  He sort of says how this was like “a moment” for them, but then he doesn’t tell people what to do about it.

I was like, “You didn’t give the information about what people could and should do!” He gave more specific information on how to address end of life situations but less on that situation that does come up for people all the time, which is, “My parents seems to be having difficulties, how do I get help for them and really, crucially, what do I do if they’re resisting and not accepting the help?”

Nancy 15:43

We needed you to write this book to put in concert with his. Bcause where his was helpful to me, and I’ll include links of course, to Dr. Leslie’s book, but I’ll put a link into this one, too…

Dr. Leslie 15:52

It is a great book. I want to say I think it is a great book!

Nancy 15:56

No, it was just helpful to me because he talks so much about thinking in terms of how each individual person defines quality of life. So you make your choices through the lens of, “Does that improve my parents, my older relatives quality of life as they define it?” Somebody recommended Being Mortal to me right when my dad got diagnosed, and I was like, “Are you kidding me now? I’m not going to read a book called Being Mortal when my dad’s about to die,” She said, “No, you really should read it. This is the time to read it.”

I was really grateful that she encouraged me because with that book under my belt, I was able to say to my siblings, “We need to figure out what are the things Dad wants to be able to continue to do,” and we came up with driving, and golf. Those were two things that animated my father. Every time there was a treatment decision, we would say to the doctors, “Will this prevent him from driving? Yes?” We’re like, “Not going to work for us.” I just wanted to mention that book. It’s kind of about the philosophy of end of life, whereas yours is about making everything as good as possible until you get to that point, in a really practical way.

Dr. Leslie 17:02

Yes, that idea of like what matters to someone is foundational to geriatrics. We share a…there’s a lot of overlap at times between geriatrics and palliative care and it’s really crucial in having these conversations and negotiations with an aging parent about how you can support them.

Nancy 17:20

Right.

Dr. Leslie 17:21

That’s part of why in the first section, Taking Stock, the first part of it is like, “Here are some specific cheat sheets and things you can look for, signs that yes, you should really be worried or maybe not so much.”

But the second part is getting your parents’ take. Because I have seen over the years that people so badly want to jump in and help their parents. But it’s really important to step back and be curious and better understand, how are they seeing the situation? What are they most concerned about when it comes to this situation? What do they really want? What are they afraid of?

Then also, at a larger level for their life, what are their most important priorities? Because later we can use that as a compass, as you and your siblings we’re doing. When we face specific decisions, we can think of it in terms of like, how does it fit in with what my parent has said is most important to them? Or what we’re aiming for? So yes, I mean, the more people can hear this message in various books and sites, the better.

Nancy 18:15

We got a ton of listener questions and there’s no way I’m going to get to all of them, but I’m going to get to as many as I can. If I don’t get to yours, make sure you check out Dr. Leslie’s book, When Your Aging Parent Needs Help and the website which is…

Dr. Leslie 18:31

betterhealthwhileaging.net. We have lots of articles and you can post a comment on most of our articles, and either me, or I have a geriatrician colleague in Canada, who helps me answer them.

Nancy 18:42

Right. Okay.

The first question I’m picking came from Esther, and it is a three-part question, but I’m gonna let Esther have three questions because a lot of what she was asking encompassed what other people were asking. So the first one was, “What tips do you have for starting challenging conversations about the individual’s desires for the future, whether it’s healthcare, long term care, etc and making a plan before your options are limited?”

Dr. Leslie 19:08

Okay. Should I start with that one or do you want to tell the other ones?

Nancy 19:10

Yeah, let’s start with that. Oh, God, I’m not going to hit you with all three. We’ll never remember them.

Dr. Leslie 19:13

We do have like a communication cheat sheet that is part of the book where we just list lots of good opening phrases or if it hasn’t gone well.

My general tips for challenging questions is first of all, stepping back, like, how have the conversations gone in the past, one? Two, have you had any concerns about memory or thinking? I bring that up just because if you have, I recommend approaching the conversation sort of slightly differently.

I mean, in particular, it’s harder for older adults to kind of make decisions or clarify what they want sometimes if they are having memory or thinking problems. It kind of depends on questioning yourself, like, what is it that you’re worried about, and that you’re hoping to know? Without knowing more specifics about the situation… if it’s how do I get them started generally on advanced planning, one of my geriatrician colleagues, Rebecca Sudori, has a really great website called prepareforyourcare.org that addresses conversations to prepare for the healthcare side of planning.

In healthcare, we’ve actually emphasized a lot the advanced planning for health care decisions, and not the other part, which is really relevant for every older adult, which is, “What would you like your life to be like later on? If you weren’t able to do everything you can do now, what would be most important? How could we support you? What were you thinking that might look like? If you had to make tradeoffs between some safety and autonomy or independence, what would you be willing to trade off?” Because, as you were saying, as Americans, we want everything to be perfect, and for there to always be solutions.

And aging often gets a little messier and involves adapting to changes. We often don’t give older adults enough credit for how much they do in getting through these adaptations. But then also, often it involves some tradeoffs, right? You can stay in the place where you’ve lived your whole life with three stories and lots of stairs and all the rest and there are some safety risks there. If it’s on the suburbs, you might end up further away from things, which can create some issues. Or you can make a change. But helping people think through their tradeoffs or understanding what goes into them, those are some of the things that I think about.

Nancy 21:30

I think it’s comforting to know that there are going to be tradeoffs. It’s not you, you’re not a bad kid, I think it’s really important to recognize that there are suboptimal choices, and you do the best you can. You try to keep the relationship cordial and not be the kid who’s yelling at your parent and not be the parent who’s yelling at your kid. Honestly, it reminds me of the toddler years. You have to be the bad guy sometimes but it’s okay to let them lead the way a little bit. Or a lot.

Dr. Leslie 22:05

Well, initially, you want to be letting them lead a lot, unless you’ve had reason to believe that they really are losing their mental faculties, in which case you might have to step in.

But you know another thing we address in the book is, again, framing people’s roles. Because initially, people really want their parent to be safe and healthy and they’re quite frustrated if they feel like their parent isn’t doing these things. They see it as their role to help them be safe and healthy. We saw this a lot, actually, when COVID hit, as people were very upset about their parents not following enough safety precautions.

One of the things that we try to do in the book is reframe as you’re not going to be able to control everything that happens to your parent. Yes, you can help them by bringing up things that might help them be safer or healthier, or things that fit in with their goals because if you ask them, most people would like to be safe and healthy enough to continue to live independently, and have all these things that matter to them.

But your goal is really to show up and accompany them on this journey and be there for them. That does start by being attentive and listening to them and learning more about what matters. And then I think there is a really important role for family to play in one, researching what could and should be done. And then trying to find respectful ways to bring it up and encourage or facilitate that for their parent, recognizing that it’s often not going to be up to you whether your parent does it or whether it works out.

Now, if it is looking like your parent really is losing their mental capabilities…and we do cover that in the book too actually, the question of capacity. Not that I think I can write a book and people can now determine their mental capacity, but it is important to start thinking about that a little bit that if it looks like they really can’t understand the implications of this choice that they’re making, then it becomes ethically and sometimes legally more permissible to intervene a little bit and do things that maybe you wouldn’t do otherwise. Say, “Well, should I maybe still let their doctor know even though they’re telling me no.” How much insight they seem to have into what’s going on is really relevant.

Nancy 24:17

Oh my God, Dr. Leslie, get out of my head.

That was, I think, maybe the hardest thing with my mom, is we did not feel her physician was taking it seriously that she was clearly slipping. So we tried every ruse, oh my goodness. I would call ahead and say, “I’m bringing my mom in for an appointment. Can I please come in with her because we think she’s slipping” and he’d say, “No, no, HIPAA can’t bring you in.” I would write notes… I mean, we tried everything and we didn’t feel like he really even clocked the loss of mental acuity until she’d had dementia at that point for maybe seven years. It’s super frustrating.

Dr. Leslie 24:59

It’s definitely been shown in a lot of research that normally trained primary providers are often very slow to notice. And then yeah, in terms of trying things – part of what the book does is layout, “Here are lots of things that you can try, here’s how we recommend trying them.” Sometimes people try these things, and they make headway. Other times they try all the things we suggest and give it a few tries and bring their best communication skills, and it still doesn’t work out. That was another message for the book is that if you feel like this is hard? It’s not you. It’s not your parents.

Nancy 25:33

It’s because it is hard.

Dr. Leslie 25:35

They are difficult situations. We have not set up our healthcare system and social service system right now to optimally step in and provide assistance. It often does take multiple tries: multiple tries talking to your parent, multiple tries talking to the doctor. We wanted not to discourage people by saying, “Listen, this is often going to be very hard,” but to reassure them that it doesn’t mean that you failed, or that you’re doing it wrong. It’s just the nature of this, and we wanted to especially try to help people give themselves some grace. Because I think, as you probably know, people often take on a lot of guilt, and put a lot of pressure on themselves.

Nancy 26:15

Guilt, and frustration too. Because you just think, “Oh, if they could only just do what I’m telling them to do, go to the memory care clinic or do this thing that is so obvious to me, but if they’re perceiving it as a loss of control,” and it can be really hurtful. We talk on the show a lot about normalizing things, sharing your story so you can normalize it for other people. That’s part of my goal for this episode today is just to recognize anybody who’s listening who feels like you screwed up, or your parents are mad at you, or you don’t know what to do. Same. I mean, SO same.

Dr. Leslie 26:54

Nobody has the skills to do this. I felt a little bit that way when I became a parent too, but I think we generally have more support for helping parents step into that role. It partly helps that it’s more predictable, the way people step into the parenting: the woman is pregnant, you have a due date, and all the babies start off usually mostly the same.

Whereas it’s exponentially harder to manage this transition where you start noticing things about your older parents, and you start trying to figure out how to step in because if your parent hasn’t been used to you being involved, and you haven’t been used to it, there’s a huge learning curve.

Nancy 27:34

Right. We’ve covered Esther’s second question. I’m not even gonna get through Esther’s questions before its time but we did cover the second one. Here’s another one. She wondered what was the best way to get all parties, meaning siblings, on board with your plan.

Dr. Leslie 27:50

We do mention this in the book that early on, in the Taking Stock part, it’s getting your parents take, but also getting the take of other people who are closely involved. Could be your other parent if you have two parents living together and you’re more worried about one than the other, could be the other siblings, other people who are close.

Another book that I really like – I don’t think it’s great as a guide for talking to your aging parent, but it’s great for talking to other people – is called Difficult Conversations: How to Discuss What Matters Most by the team from the Harvard Negotiation Project.

Nancy 28:22

Okay.

Dr. Leslie 28:23

It’s a book, I think, from the late 90s. It’s really good.

Nancy 28:26

Are you saying that caring for our aging parents is similar to negotiating a hostage crisis? Because it sure feels that way sometimes.

Dr. Leslie 28:32

Well, you are going to negotiate with your parents. However, what’s in that book, I don’t think is great [for that].

But it is great for negotiating with siblings, and others who are involved. In a way, they’re kind of relationship communication basics, which is that our tendency is to start off by trying to convince somebody else of something and to make our point.  We want to feel heard. But what is often more effective is for us to start with what they call in Difficult Conversations a “learning stance,” where we start off by being curious and saying to ourselves, “Let me first better understand how this person sees the situation and how they feel about it. Can we articulate a shared goal and then can we work together to figure out how to work towards that?”

That’s a really useful framework, I think, for addressing a lot of the things that come up with siblings. Sometimes one sibling will have – and it might be the sibling who’s closest who has seen lots of things – who is like, “Well, I think we should do this and when older parents start needing help.” All the existing sibling tensions and dysfunctions…

Nancy 29:37

Bubble right back up to the surface. Oh, yeah.

Dr. Leslie 29:39

…get to be more. They’re starting off with checking in with your sibling on like,”Have you noticed anything? How do you think things have been going? What were you thinking?” might be some next steps. Often when people feel like their input has been solicited and they’ve had a chance to be heard, they’re more receptive than to a proposal of, “I was thinking we should try this next.”

Nancy 30:03

By the way, if you are the sibling who does not live close, because that’s me… I think there is a really important role that those siblings can play. I was pretty good at charting the progression of my mom’s disease over time, because I wasn’t seeing her as much as they were.

One of the ways that it’s helpful to think about this is that everybody can play a role. What are your strengths? My brother was always super close to my dad in a way that my sister and I weren’t, just because they were both guys. So there were certain things, with my dad, that my brother was the better messenger for. It can be fraught, obviously. But also, if you think about it as, “What do we each bring to it?” maybe that’s a way to approach it from a more positive framework as you’re trying to get everybody working in the same direction, But stuff always bubbles to the surface. I think having that shared goal is really important.

I wanted to definitely ask this one. Matthew asked, “What is the time and how to broach the subject of taking the car keys?”

Before I let you respond, I want to tell you the terrible, terrible plan that I executed that didn’t work because you guys will know you have to get creative.

My mom was an excellent driver. Even when we had got her to stop driving, she still directed us wherever we went in Rochester because she’d lived there her whole life – Rochester, New York, where I grew up. She could barely talk. But she could point to the right and point to the left, and you’d be like, “Why are you directing me through the Burger King parking lot?” You’d pop out, you’d be like, “Oh my God, we’re at Betty’s house. How did you know that was the shortcut to Betty’s?” My mom was just a very good driver so for her, it was excruciating to try to get the car keys away.

So I came up with this plan. I’m like, “I’m going to issue a fake recall notice on her car, and then she won’t be able to drive anymore because she won’t know that it’s not a real recall notice, because she doesn’t have the ability to figure that out.” I went to the trouble of finding the dealer’s logo online. I made up this fancy letterhead paper, I wrote this letter.

If my mother got that letter, she round binned it IMMEDIATELY because we never heard. So my brother and sister were like, “Oh, yeah, the recall? Yeah, that worked really well, Nancy. Nice plan.” It did not work. So what should I have done?

Dr. Leslie 32:23

This is in the context of dementia of an older parent?

Nancy 32:29

Or maybe even if not. I mean, part of the thing with older drivers that I worry about is reflexes, even if they don’t have dementia.

Dr. Leslie 32:38

That’s true. Well, it’s definitely not your job as the adult child to intervene if their reflexes are getting slow.

I would say it’s really only your job to think about taking the keys away if you think your parent has a diagnosis – but sometimes it’s hard to get a diagnosis – of dementia, such as Alzheimer’s. By dementia, we mean a decline in their memory and thinking functions that seems to be permanent, that’s slowly getting worse and that’s affecting their ability to do daily life tasks, like drive reasonably well. If that’s the case, I’m actually working on a course that’s a bit of a follow up to the book right now. It’s going to be for people who are helping an aging parent with early memory loss or who’s early in the dementia journey.

Nancy 33:20

Oh, wow. Great.

Dr. Leslie 33:21

We have a whole lesson in there about dementia and driving so I was reviewing this. But there is a great resource online, it’s from the Hartford Center. They’re run by gerontologists. They create resources and they partnered with the MIT AgeLab to create a really good PDF resource on being at the crossroads for driving in dementia that has a worksheet of what to look for, ideas on how to bring it up. I mean, it’s great. So I highly recommend that resource.

Nancy 33:50

Where will people go to take the class that you’re talking about, because I’m sure people are gonna be interested in that?

Dr. Leslie 33:55

We’re gonna be starting the first version of it later this spring. But if they come to Better Health While Aging and just sign up for our email list, in general, we will definitely send out a notice.

Nancy 34:05

I want to take that class. Here’s what not to do: don’t do a fake recall notice. That’s not going to get you anywhere.

Dr. Leslie 34:10

Actually, what I was gonna say is a fake recall notice is not necessarily a bad idea.

One of the things we teach in the book is a process. For this problem, if you are worried about the driving of your parent with memory and thinking problems, we would recommend that first you  research what’s considered the expert recommended approach to doing this. The book doesn’t cover that in depth, although we have links to a few resources that cover it.

Generally, if you were to research, what people would say is, “Well, you should first see how your parent perceives it.” That’s what I would tell you, but you should make sure their doctor is aware of it. See if the doctor is wanting to make a recommendation that they stop driving; depending on the state, the doctor may in some states – I think where I am in California, you’re actually required to report dementia, although it’s not enforced at all.

But as a family, you could ask the doctor to report them to the DMV. In many states, you’re allowed to report an unsafe driver to the DMV, so the DMV calls them in. You’re supposed to take these various steps to see if you can get them to give it up and if those things aren’t working and they are impaired, then you start potentially coming up with “fiblets” or approaches like hiding the keys, disabling the car, telling a story about the car. In part of the book, we have a worksheet for coming up with a plan, and one of them is to like brainstorm things you could try. So I think what you did is fine: you brainstormed an idea that you could try. Not every idea is going to work.

Nancy 35:35

Yeah, if anybody needs letterhead from Dorschel Toyota in Rochester, New York, I’ve got it on my computer. Hit me up.

Dr. Leslie 35:42

It could have worked. I mean, in the end, the nitty gritty does involve brainstorming something that you think might work for your particular situation.

We want those for people to do that from an informed place, where they’ve already learned about the various approaches. The Alzheimer’s Association has covered it that ideally, we work with people with dementia so that they willingly give up driving, but in reality, a lot of them don’t and so sometimes family members do have to do something. I think what you did is fine.

We say at one point that no plan survives contact with reality. You’re gonna make a plan to try something with your parents, and you should be prepared for it to not work the way you expected the first time around. Then either you have to try a few times, because that’s really common. You just bring it up a few times in slightly different ways. You ask yourself, “Did I bring my best communication skills to it? Was that the best person to bring it up?” You also look, and sometimes you’re like, “Well, I think we could try that, again, just a slightly different way.”

Other times, you’re like, “Oh, nope, that didn’t work at all.” That’s part of the process, going back and being like, “Well, what’s a different little ‘fiblet’?” It is, unfortunately, sometimes necessary to kind of stretch the truth to get a person with dementia to stop driving, if they don’t willingly do it. Sometimes people take the car, it’s under repair, they just keep repeating the same story for a year. There are lots of different.

Nancy 37:05

That was exactly what happened. It went into “the shop”. “The shop” was my sister’s driveway and if somebody was driving her to my sister’s, we would move the car, so she didn’t get the visual cue. Eventually, she stopped asking about it.

Dr. Leslie 37:18

Exactly. You always want to sort of see if there’s a way to engage them and get them to agree. You also sometimes have to just nudge them and accept that they might not be entirely happy with it and then you’re kind of working your way to more sort of things that work around them after you’ve tried other things.

That process of trying other things is, I think, an important part of the process. It’s how we clarify to ourselves why we’re doing this: “Because I tried the alternatives. I gave it a good try. It didn’t work and now I’m moving on to this.”

Nancy 37:50

So I can’t even get to half the questions that I was going to, which was already a pared down list. I’m gonna read you one. You don’t have to answer because I think we already have, but it just made me laugh so hard.

Baruch Hernandez, who is a writer and stand-up comedian in San Francisco, sent this one in, “Do I have to tie up my dad to a chair to keep him from working? At this point, I feel like he’s a teenager, and I’m some old bag going, ‘You’re 70 with a ton of health problems, stop doing yard work!’ and he’s like, ‘Of course, you’re right! I’m just gonna chill, son. Don’t worry!’ A week later: ‘Hi, Dad. You what? You broke everything because you were trying to build a fence tried to lift some shit? No more pot gummies for you!’” I don’t think you have to answer that one, but I just love that question.

Dr. Leslie 38:26

My usual thing is “Well, do you think his memory and thinking is okay?” because we do address this in the book. If it is, then some of your role as a concerned adult child is to check yourself a little bit and be like, “Somebody I love is going to have different priorities when it comes to safety versus doing stuff.” And as a concerned family member, we totally got to try to influence each other. That’s what families do.

You want to be thoughtful about how far you’re going to take it. Sometimes a way to really show love is to tolerate our parents making us uncomfortable and accept that they’re going to make some choices that aren’t what we wish they would have chosen for themselves. I want to remind everybody listening that you’re quite likely to be making a similar choice when you’re the one who’s older and changing. We’ll see.

But that’s what tends to play out, is that we prioritize safety a lot when it’s for somebody else and when it’s us, we really want to live our lives and do things that bring us satisfaction, even if it puts us at some risk.

Nancy 39:28

The last question I’ll ask that a reader sent in, I thought was really important. Kristen asks, “How do we mentally let go and enjoy who our aging parents are becoming?”

I really love that because I think again, this goes to this quality-of-life question not just for them, but for you. It’s important – as your parent diminishes, they’re still something there. For me, it was so meaningful to just remind myself that my mom had a great sense of humor all the way to the end. She could barely talk, But her slapstick went up three notches because she couldn’t talk anymore. And I was so grateful for that.

So this idea of reminding yourself, there’s still a person that you love inside whatever is happening to your parent. The love can still be there – even with who they are now, you can find things to appreciate.

Dr. Leslie 40:21

Again, it’s going to be different if we’re talking about dementia than other forms of age-related decline. But yes, dementia in particular tends to really change a person in a way that’s really hard for family members.

I think a huge part of this journey, whether or not there’s dementia is, you’re learning to practice a certain acceptance and giving space to along with learning to focus on what they still can do, what they still have. They’re always lots of positive things that we can turn our attention to, and that are often going to help us and them.

I think it’s also really important to acknowledge and give space to the grief, the sadness, also often frustration, resentment. I mean, this journey brings up lots and lots of feelings and I think sometimes people can have trouble finding the balance between both seeing the positives, and also allowing space for the negatives. But they need an outlet, because otherwise, they really kind of poison you.

So it’s really important to find support groups, and forms of support, where you can connect with other people who know what you’re going through and can be a space to let you let that out and share it with you. Because that’s part of what’s gonna enable you to release it a bit and then turn back towards the many beautiful things that are often still there. I mean, this can be a time of incredible richness and growth for families, but also we shouldn’t sugarcoat it. I mean, often, it’s hard because people often have it happening at a time when they already have lots of other things going on in their lives.

Nancy 41:55

Absolutely. Their midlife mixtape is stacked.

Dr. Lesley 42:01

Yeah, exactly.

Nancy 42:03

I’m gonna link everybody to the Mazi Robinson interview that I did last year where she talked about, in the pandemic, feel all the feelings. Feel all the feelings. It’s okay, you need to do that.

Dr. Leslie 16:54

Yeah, you do.

Nancy 16:55

We have not just run out of time, but run way over. There’s so much to talk about, but I do want to ask you this: what one piece of advice do you have for people younger than you or do you wish you could go back and tell yourself?

Dr. Leslie 42:27

I do find that in doing this, people then start thinking a lot about their own aging.

So maybe if I can speak to that for a bit, I would say that this time in midlife is first of all, a great time to think about practicing those relationship and communication skills with anyone, practicing that art of – especially if someone’s not doing something you think they should do – let me like think more about how they see it, and what matters to them. Practicing those skills now is great. Anything to address long running conflicts with your parents or your siblings, anything you do towards that now is going to pay off.

Nancy 43:09

Get them handled now.

Dr. Leslie 43:11

Then I think learning better ways to manage one’s anxiety and stress and worry.

I think midlife is a great time to do that. I mean, the pandemic has given us all reason to practice, but I think first of all, it’s gonna be really helpful for when problems with an aging someone or anybody come up, but also with our own aging, right? Many of us right now have an achy joint here or there that doesn’t heal as quickly as we wanted to. Learning to balance that, “Well, I’m going to try to make it better and I’m also learning to not be so intensely frustrated when it doesn’t get better as quickly as we wish.”

But also, those skills also matter because one of the things that comes up for people when they’re in the 60s is vulnerability to medications that affect memory and thinking. A lot of times in my work when we see people in their late 80s who are developing memory and thinking problems, we’d like to get them off these medications so that their brains can function at their best level. It’s really hard to do it at that stage if somebody is already declining. So I would say midlife is a great time to do the work, because often it takes work to learn to manage things without medications. Things like anxiety, sleep problems, the rest, because those skills that you learn in terms of managing stress, anxiety are going to pay off later.

Nancy 44:26

We Gen Xers hate to know it, but we are going to be those aging parents someday. So anything we can do to take steps now to make it easier for our kids and yet still, like you said, maintain the independence that we are all going to want to cling to the very last minute. Maybe that’s a good way to think about it. You’re gonna be the same way. Try to have a little grace for your parents who for whatever reason also want to be independent.

Dr. Leslie 44:55

The independence front is interesting.

I would say generally, you want to be preventing bad stuff now, building skills now that are going to serve you later or help maintain your health later. But there is also a very real need, which most people do very little on, to plan for unpleasant possibilities. Because if you’re lucky enough to get old, a lucky minority of those people are totally functional until they die relatively suddenly, or quite suddenly due to an accent or some illness.

But what most of us are going to experience is some health declines, some health crises, and needing assistance from other people and a significant number of people are going to need that assistance for even a few years if not longer. In a way, it’s sort of like succession planning, right? “Who could I start grooming to get to know a little bit my health, my finances, so that first, if there were a crisis, if I suddenly got sick, or was in a car accident, who could oversee this for me, short term?” Then later, it’s “Who could actually like be a collaborator with me?”

Then we’re going to keep our fingers crossed. I always tell people to hope for the best but plan for the possible. I am the type of person who feels like, “Well, I’m gonna take an umbrella and plan for the rain on a cloudy day, because every time I take it and never rains.” That’s my approach, right? So if you do all this planning, probably you’ll find it was never necessary. But that’s better than the opposite, which is finding that it was necessary. If I were to start becoming forgetful, what would I want my family to do? Who could start helping me out? What would that look like? The ideal is to start doing that, but it’s hard. It’s hard to get started and most people tend to just put it off until it’s kind of too late.

Nancy 46:36

Well, maybe after you’ve gone through it with your parents, you’ll understand why it’s so important.

Dr. Leslie 46:40

We’ve had so many people ask us about it that if I get around to it, in another year or two, we’ll do the follow up, “In Case I Need Help.” That’s for all the people who come to our site and first help an aging parent and then are like, “How do I prepare so this doesn’t happen to my children?”

Nancy 46:56

Title it: “Don’t Let It Happen to Me.”

Dr. Leslie 46:57

Exactly.

Nancy 46:58

Alright, Dr. Leslie Kernisan, thank you so much for being on the show. The book is called When Your Aging Parent Needs Help: A Geriatrician’s Step-by-Step Guide to Memory Loss, Resistance, Safety Worries, & More. You can find it at betterhealthwhileaging.net. I’ll include links. You’ll find it there. But thank you so much, Dr. Leslie, I really enjoyed talking with you.

Dr. Leslie 47:18

Thank you so much, Nancy.

[MUSIC]

Nancy 47:23

Throughout that interview, I had one critical question that kept bugging me: what IS the Paula Abdul video that got made into an ad where she’s dancing with herself?! It’s “Straight Up”, duh, and I put it into the show notes. Crisis averted.

I hope you found Dr. Leslie’s insights helpful – it’s a big topic but luckily, between her book and the others we mentioned in the episode, there are a lot of resources available to you, including me, who has a template for a fake car recall if you need it.

My takeaway is that I’m going to document all of our banking/insurance/household stuff for our kids this weekend. My dad used to send his three kids an updated list like that every January, showing where their accounts were held, what bills were paid automatically, all that, and my siblings and I used to roll our eyes. What do you think was the BIBLE after Dad died and we had to take over household management for my mom? That instruction manual saved our bacon. I figure I owe at least that much prep work to my kids.

We’re gearing up for another listener-contributed episode at the end of April and I want to know from you what YOU’D like to talk about – we’ve done first concerts, we’ve done GenX summer memories, we’ve done advice to our younger selves…what do you want to talk about – and hear about from other Midlife Mixtape listeners – next? Drop me a line at [email protected], or send me a message via Facebook, Twitter, and Instagram @midlifemixtape.

I also wanted to let you know that I’ve been doing a TON of virtual events around the topic of gratitude letters in my book, The Thank-You Project – for school groups, community organizations, libraries, and workplaces. If that sounds like something you’d be interested in learning more about, or if you know of a conference or organization that might be interested in learning more, please let me know at [email protected]! If I book an event thanks to you, I’ll send you a signed copy of The Thank-You Project! I really appreciate the support.

Take care, all of you, and get those vaccines as soon as you’re eligible, so we can all get together and hang out soon! Straight up!

[THEME MUSIC – “Be Free” by M. The Heir Apparent]

The post Ep 94 Geriatrician Dr. Leslie Kernisan appeared first on Midlife Mixtape .