Do you address sensitive issues with older adults as well?

Once a year, I try to do a mental evaluation of memory and cognition. If I see that those scores are sliding, I might say, “We did some testing today and, looking over it, I see that the scores are starting to slide. Have you noticed anything related to memory, such as not remembering appointments or having trouble paying bills?”

It will often emerge that the patient is already aware of these issues, which have been growing over time, and other family members are already stepping in to help with appointments, bills, or other tasks.

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Children of older people see me because they are worried about their parent or grandparent. In that case, we may need to have a family appointment. If the elderly parent is living alone and becoming increasingly frail or cognitively impaired, I suggest services, such as home health aides, home nursing, or community help so the parent can remain at home, and I point out concerning signs to look for.

The hardest conversation to have is when I think the patient is no longer safe to remain at home. This is an ongoing discussion that will not necessarily be resolved in a single visit.

I explain that I think they need more help than they are receiving and initiate a conversation either about a rehabilitation facility, if the condition is reversible, or about other options. We discuss whether everyone’s goals are reasonable and viable, and work with the children and patient, always trying to keep the best interest of the patient at heart and follow his or her wishes if it is safe and prudent.

If elderly patients trust you, they will understand that you are not trying to convince them to go to a facility for any reason other than their safety, and that every effort will be made to find a facility that is appropriate for their needs.