Most older adults don’t need much help from others.
In fact, many of them are quite busy assisting others and otherwise contributing to their families, communities, and/or workplaces.
But of course, many older people eventually do need some help from others, especially if they live into their 80s, 90s, or beyond. After all, only a minority of people transition from being fully independent to deceased, with no intervening period of needing assistance.
(Wondering how to get an older person to accept help? That’s covered here: 6 Steps to Take When Aging Parents Need Help – Even if They’re Resisting.)
When an older person does start to need help, it tends to be close family members — assuming the person has family — that step in: spouses, adult children, siblings, nephews or nieces, grandchildren, and so forth. In fact, family members are by far the number one source of “long-term care supports and services” for older adults.
Sometimes providing this eldercare support can be fairly straightforward: a little help with transportation, or arranging for some assistance with shopping or household chores.
But in other cases, family members find themselves having to take on quite a lot. This is often due to health issues affecting the older person’s ability to remain independent and manage various aspects of life.
Some situations that commonly bring this on include:
- An older person starting to develop dementia, such as Alzheimer’s or a related condition
- Advanced chronic illnesses that limit daily function and/or cause frequent hospitalizations, such as advanced heart failure, advanced chronic pulmonary disease, or a progressive neurological condition
- Sudden disability after a fall, stroke, or other health emergency
- Difficulty recovering from a hospitalization, especially if the older person experienced delirium or other complications
- Advanced age, which can eventually bring on general frailty and loss of physical strength. Very advanced age also tends to bring on more noticeable age-related cognitive changes, and is a strong risk factor for developing dementia as well.
Most people are happy to be able to help an older parent or other loved one in need.
But it’s also common for people to find it…difficult. Especially when the older parent is reluctant to accept help or make changes. (Which is probably the norm rather than the exception.)
Trying to help an older parent tends to bring up lots of different issues that people haven’t prepared to address. And many people must continue to tend to their jobs, children, and other responsibilities, as they also start trying to figure their new caregiving role.
Over the past several years, both in my in-person doctoring work, and as an aging health expert writing online, I’ve seen countless people struggling to sort out just what their older parent might need help with, and how to help.
So in 2019, I created a Helping Older Parents online program to guide people through this.
As part of the related Helping Older Parents Course, I created a list of the key domains that family caregivers usually have to address at some point.
Since most of our members find the list really useful, I thought I’d share it below.
9 Domains to Consider When Helping Older Parents with Elder Care
Here are nine types of issues that tend to come up, when helping older parents.
- Helping with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs)
- These are key daily life tasks, which I describe in more detail here: What are Activities of Daily Living (ADLs) & Instrumental Activities of Daily Living (IADLs)?
- Older adults often first need help with IADLs, which include things like managing transportation, finances, shopping, home maintenance, and meal preparation.
- An older person’s need for assistance with ADLs and/or IADLs often determines what kind of care arrangements or housing arrangements a family might consider.
- Safety issues
- This includes addressing issues such as financial vulnerability (or even exploitation), falls, driving concerns, and more.
- Medical and health issues
- Medical concerns are fairly common in late-life. Many older adults have chronic conditions that require medications, monitoring, and other forms of ongoing management.
- Older adults may also develop new symptoms or health concerns, and may need their family’s assistance in getting evaluated. Family members often help bring up questions and concerns to the health providers.
- Most people will also need help when recovering from an illness.
- Serious illness or certain chronic conditions can cause older adults to lose the ability to make their health decisions or oversee their own medical care. Family members must often make decisions due to a health emergency or mental decline.
- Legal and financial issues
- Some older adults may lose the capacity to manage certain types of financial or legal affairs.
- Even cognitively-intact older adults are vulnerable to financial exploitation.
- Family members must often consider assisting with legal and financial issues.
- Planning ahead and completing the necessary legal paperwork can make it much easier for a family to assist, if/when it becomes necessary.
- Housing issues
- An older person’s housing situation often affects quality of life, safety concerns, the ability of others to provide assistance, and more.
- Families must often consider questions such as:
- Is the current housing situation a good fit for “aging in place”?
- Is a more supportive environment, such as moving in with a family member, potentially necessary?
- What other options (e.g. assisted living) would be financially viable, and could be considered?
- Quality of life and helping your older parent thrive
- Beyond meeting basic needs, most families are also concerned about their older loved one’s quality of life.
- This means considering issues such as social connectedness, purpose, autonomy, and dignity.
- It’s also essential to learn more about what matters most to the older person, and what kinds of things they consider less important or would be willing to trade-off.
- Planning ahead
- Things to plan ahead for include future declines, emergencies, and end-of-life care.
- Planning ahead tends to reduce later stress, hassles, and sometimes expenses.
- Managing relationships and family dynamics
- Trying to help an older parent often brings on relationship challenges and difficult emotions.
- Well-intentioned people often inadvertently treat older relatives in ways that threaten their autonomy or dignity, or otherwise strain the relationship.
- It’s also common for family caregivers to experience relationship challenges with siblings, a caregiving parent, or others who are involved.
- Most people benefit from learning and practicing better communication skills, to better manage these relationship dynamics.
- Self-care
- Helping an older parent is rewarding but can easily become a source of chronic stress.
- Because family caregivers are often busy, they can easily neglect their own needs and wellbeing, which can jeopardize their own health, and also affect their ability to care for and connect with their older parent.
- Family caregivers can use a variety of self-care strategies to keep their caregiving strain manageable. These include joining a support group, asking for help, setting boundaries, allotting time to tend to one’s own health and other needs, and more.
- I’ve also found that family caregivers can benefit from learning strategies to organize and prioritize what they are working on.
As you can see — and as many of you already know from personal experience — helping an older parent in late life can be a pretty complicated endeavor.
This is in part because all the above domains tend to interact and overlap with each other. Some examples:
- An older person’s medical situation often affects their ability to manage ADLs and IADLs, and their caregiving needs.
- The intensity of the medical situation also affects how much time an older person and their family spend with health professionals, which affects everyone’s quality of life.
- A family’s legal permissions to assist determine how easily they can help with medical issues, housing issues, financial issues, and more.
- Relationship dynamics — and a family caregiver’s self-care — affect caregiving stress, which then affects one’s ability to help a parent, and the type of energy and patience one is able to muster when communicating with others.
- Sorting through decisions — whether about safety, medical, housing, or anything else — should always involve considering the older person’s quality of life and what matters most to them.
And so forth.
Are you currently trying to help older parents?
If so, I hope you’ll find this list useful.
There is a lot on it, but with some persistence, you’ll eventually sort your way through it all. Just don’t forget to address your self-care, ok?
And if you’re having trouble getting a parent with memory loss to accept help: be sure to check out my free online training posted below!
In it, I teach a simple but effective method that will reduce conflicts and make it easier for you to help your aging parent.
Thank you for doing what you do for your older parent!
This article was first published in 2018, and was last updated in December 2023.
Leanne L. says
My mother lives with me and my family. My husband is now not happy, supportive or empathetic. I however, feel differently. What can/should I do?
Nicole Didyk, MD says
Having an aging parent live with your family can be a wonderful gift, but adds stress to the household. I’m not a family counsellor, but communication is usually the key to sorting out these types of tensions.
Before an in-law moves in it’s best to discuss issues like:
1. What are the ground rules about privacy and “alone time”?
2. Do you need to set boundaries about things like cooking and housekeeping?
3. How will finances be shared (or not)?
4. Are there any health issues that could progress, and what would be the next step if staying at home isn’t an option?
5. Are there other family members (siblings for example) who need to be involved?
Every situation is different but a spouse who isn’t supportive could be a big roadblock to family harmony. I would suggest having a calm, rational talk to explore what his concerns are and how you can address them as a family.
Dr. K has recently published a book called: “When Your Aging Parent Needs Help: a geriatrician’s step-by-step guide to memory loss, resistance, safety worries, and more”. This is a practical guide to how to help an aging parent, even when you don’t have full family support. You can learn more here: /education-and-support/when-your-aging-parent-needs-help/
susan douglas says
I am dealing with an 85 yr old mom that lives alone and has severe back pain but refuses to use a walker as advised but her PT. As the primary caregiver, I have to deal with 4 siblings that are not there for Mom but love to be doctors from afar. I dont work because I am retired. My husband who still works and I go to our 2nd home every other weekend. My siblings feel that since I don’t work and go away every other weekend I should be the only caregiver when I am home. They are never there to take my Mom to any of her numerous doctor’s appointments (because they all work and I don’t). My mom calls me and my husband for everything, although my brothers are within 30 minutes of her. It has gotten so overwhelming that as of today I have blocked all my family members. All I want is to help my Mom without dealing with all this drama (one sister is an alcoholic ). I am so stressed. Any suggestions??
Nicole Didyk, MD says
I can understand your feelings of frustration and isolation. It sounds like your siblings are assuming a lot about your capacity to do all of the caregiving for your aging mom.
Often, family members would be willing to help but they need specific instructions. In my practice, I find that when caregivers make specific requests of siblings, it can often go better than expected. There is a way to ask for help that’s more likely to be accepted, which Dr. K has outlined in her new book: “When Your Aging Parent Needs Help: a geriatrician’s step-by-step guide to memory loss, resistance, safety worries, and more”.
The book has some practical advice for how to talk to family members about pitching in with the caregiving. I highly recommend it, and you can find out more here.
Katrina Barber Johnson says
I am taking care of my Mother. I have a curved spine. She refused to get me some help. What should I do.?
Nicole Didyk, MD says
Hi Katrina. It sounds like you’re a care partner for your mom but have some medical needs yourself. It can be hard for aging parents to recognize the importance of a care partner looking after themselves, so that they can keep caring. Sometimes the care partner has a hard time with this too.
It can take some time to figure out the best way to get the help you need while respecting your mom’s perspective. IN Dr. K’s new book, “When Your Aging Parent Starts Needing Help: a geriatrician’s step by step guide to memory loss, resistance , safety worries and more” which is an excellent resource for someone in your position. You can find out more about it here.
Your own family doctor or medical care provider would be a good resource to help you advocate for the help you need. I would suggest starting there.
Milton Brown says
Thank you for your interesting articles, but you may want to consider putting more emphasis on actually “Asking” the Senior Person about the kind of assistance that THEY would like offered, during the initial assessment. [This could avoid some of the unnecessary emotional strain that could tax the relationship.] Secondly, I think that a cautionary approach to your kind advice should be acknowledged in order to avoid ‘over-zealous’, yet loving, adult children from operating on false presumptions [that oftimes cause conflicts created by ‘self-medication’ solutions.
Nicole Didyk, MD says
Thanks for the reminder to be “person-centered” when we open a dialogue about how to help an aging parent.
Dr. K really goes into more detail about how to take stock of the situation and decide on the best way to meaningfully help in her new book “When Your Aging Parent Needs Help: a geriatrician’s step-by-step guide to memory loss, resistance, safety worries, and more”. You can find out more, here. I read this book cover to cover! It goes through the steps of how to learn about what matters most to an aging parent and how to respectfully help them with the most accurate information.
Jenni says
Good Day Leslie, thank you for sharing, albeit 2018, a few yrs ago, and do not know if u will still reply in 2021.
I am resident in South Africa and have not been able to find anything that addresses an ageing parent (mine) who has been diagnosed with dementia and is married to his second wife and trying to make decisions for him going fwd, and trying to include us siblings. What are our legal and social rights in terms of final decisions for our father, does she have final say? Or, if you could refer me to a an association, group, etc in SA that I could talk to.
Please let me know, if yoy can, would be greatly appreciated
Jenni
Nicole Didyk, MD says
Hi Jenni and thanks for your comment!
I don’t know too much about the legislation capacity and power of attorney in your region, but I found some links that may be helpful:
Alzheimer’s South Africa is dedicated to supporting those living with dementia and their families: https://alzheimers.org.za/
Dementia SA is a resource for those with limited access to private health care: https://www.dementiasa.org/
You might find this article helpful, although it’s written from an American perspective.
I hope that helps and thanks again for visiting the blog!
john says
thanks
Lynelle D Johnson says
I really appreciate your article and expertise. Unfortunately we (my two bothers and I) are in a difficult and complex situation with our step mother, and I didn’t find the resources to be helpful in our situation. We are still quite confused on what to do with and about our step mother. (Let’s just call her “Ruby”, not her real name, for our purpose here and to protect her identity). Our father died 6 years ago. “Ruby” never came to the hospital or rehab or even his funeral service! After dad passed we did our best to reach out to “Ruby’s” natural children (she has 4 children). We were only able to reach one daughter on the east coast. She expressly said she wanted nothing to do with her mother.
Ruby’s last rent check bounced. She pays us and we pay the rent. (A mobile home in a park). The home belongs to dad’s estate. She lives in the Bay Area–housing is crazy expensive! Clearly she can’t afford to live anywhere else. Her rent now is $1200 per month. She gets meals on wheels weekly. No one wants her. She doesn’t shower or bathe. She never leaves the house. Basically we’ve been told “she’s not a danger to herself or anyone else” so there really isn’t anything we can do. We’d like her out of the house so we can sell it, but we can’t just kick her to the curb. None of us live close by. My brothers both live over 300 mile away, and I live 700 miles away.
Would you please send some information or resources? We desperately need help for both her and ourselves.
Nicole Didyk, MD says
Hi Lynelle and sorry for the delay in replying (I will blame technology for that!). What a difficult situation you describe, and it sounds like you are at a bit of an impasse as long as “Ruby” is not in imminent danger. It sounds like the three of you stepchildren need to come to a consensus about how to move forward, and unfortunately, it is most likely to be some version of “kicking her to the curb”, or tolerating the situation until something changes and there is no option but for her to move to a more supportive setting. A Geriatric Care Manager could be the professional to help you navigate the system and find a way to make some progress. This podcast may also be helpful. Best of luck.
Debra Williams says
Hi Lesley
Both my sister and I were told in our late 40’s that we have extensive SVD. There was initially interest from one Neurologist, but that has came after a year.
I am 57 now and my sister is 49. Apart from myself having worsening major depression and my cognitive score being 26 we are not recieving any treatment or advice to protect us from things like stroke, we are not belng checked for progression. Basicly we do not know what to expect or what we and family members should be doing to help ourselves.
My husband has recently had a minor stroke and is receiving lifelong treatment so the risk of another stroke is monitored. Am I correct in thinking that my sister and I should be treated in a similar way. Should we be concerned and be looking for a specialist to monitor us going forward?
Any advice would be greatly appreciated.
Regards
Debra
Nicole Didyk, MD says
Hi Debra. It’s understandable that you’re concerned about the diagnosis of “extensive SVD” in you and your sister. The BHWA website has some excellent resources about SVD, or cerebral small vessel disease, including this podcast. In general, controlling risk factors for stroke, like high blood pressure, diabetes, high cholesterol, smoking, and sedentary lifestyle, can help to prevent progression of the small vessel changes.
It’s important to talk to your doctors about what your risk factors are, and the best way to deal with them. In terms of “monitoring” most family doctors take the lead with checking in on those risk factors that I mentioned as part of a preventive health screening program. The treatment that your husband is on may not be right for you, so check with your health team before making any drastic changes.
Debbie Williams says
Thank you so much Nicole. I think you have helped me to put some questions on paper to take along with me on my next visit to my GP
Nicole Didyk, MD says
I’m so glad you found the suggestion helpful!
Gloria Hansoon says
Thank you so much for this opportunity to receive this information! I am 82 yrs.; lost my husband 6 yrs. ago, no family & dr. told me I have Alzheimers !
I appreciate to learn more about aging! Thank you!
Leslie Kernisan, MD MPH says
Thank you for your comment. I’m glad if the information here is useful.
If you have been told you have Alzheimer’s, I want to encourage you to find a support group for people diagnosed with dementia. Getting moral support is helpful and also a group can help you do some planning ahead. Especially if you are widowed and have no family, it will be important for you to figure out who might be able to step in and help you make decisions when your Alzheimer’s progresses. Sometimes people realize they have distant family; other times, people turn to friends. In some states you can also hire a professional fiduciary.
Good luck and take care!
Kate says
Elders can also get help from neighbours and friends not only from family members.
Leslie Kernisan, MD MPH says
Very true! Many older adults are benefiting from the help of neighbors, friends, and other “non-relatives”.
That said, certain forms of commonly needed care are really difficult for anyone other than family to provide. (And, family tend to find it difficult too, but they persist due to a sense of obligation, love, or some other relationship-based motive.)
Winifred says
Do they, my family helpful when my elderly mother has been home if she goes into hospital I am left with washing, cleaning etc & I work full time they never think to make me a meal or offer to do the washing or put the vac thru if they do it either doesn’t happen or they take washing home & don’t return it I WOULD RATHER PAY someone to do this thats not family & know they would come when they say & if u want a meal u have to ask yourself to go to their place surely they could do so.e meals & put in freezer neighbours are hopeless
Leslie Kernisan, MD MPH says
Sorry for delayed reply, we had a glitch in our system that we have just resolved.
It sounds like you would like more help from your family when your mother goes into the hospital. It might help if you request a meeting to talk about how things are going and what you would like to request from them. It’s important to frame these requests constructively; you may be thinking “that’s not family” but it’s probably not going to help to say that out loud.
I quite like the book “Difficult Conversations: How to discuss what matters most” as a resource to prepare for a better conversation with family. Good luck!