There was a time, not so long ago, when most of the people caring for their senior parents were in their 40s or 50s. That was before the average life span skyrocketed. That was before today, when half of newborns are expected to live to 100.

Now the people caring for their truly elderly parents often are in their 60s, 70s, and even 80s (plenty of centenarians are looked after by "children" in their 80s). And for those senior-age caregivers, the challenges may be staggering.

The roots of the challenge are twofold: As our elders live vastly longer, they face more complex medical issues and a much greater frequency of dementia; and senior caregivers are not likely to have role models. We're out there blazing our own trails, figuring it out as we go, confused and overwhelmed.

A Best Times reader we'll call Stewart recently phoned to express his personal plight. At age 71, he's caring for his 93-year-old mother, who lives independently. But he's facing a mountain of issues daily, and he asked, "Where do I turn for help, and how do I know the right thing to do?"

To get at those questions, The Best Times and Stewart sat with Myra Hyatt, LSCSW, a social worker at the University of Kansas Landon Center on Aging. We got Hyatt's take on specific situations shared by other readers; learned about support groups and other resources; and became convinced that Best Times readers need to know about the Landon Center Geriatric Clinic's unique elder assessment program. We'll share all of that with you in this article.

Readers will notice that Hyatt has one consistent message: As senior caregivers—though we're wise and experienced—we're limited in our ability (or our right) to ask or demand that our elders change. What we can control is the way we perceive and cope with the situations in which we find ourselves as caregivers. Often that means finding support for ourselves, rather than our parents.

My dad has trouble with his stability but refuses to consider a walker. He says he'll become dependent on it and that will make him weak.

If he is able to understand, talk to him in no-nonsense terms about the consequences of falling. Tell him that a fall with broken bones almost always means time in a rehab facility and then nursing care—and the average life span after that is less than two years. Tell him that of course it's his choice, but ask him this: Is being stubborn about a walker worth the risk of having to leave home and increasing the risk of death?

My mom is 96 and still driving to the pharmacy and grocery store. She's a cautious driver, but her reflexes aren't good. What should I do?

There's a wonderful free Web-based tool called Roadwise Review Online that lets seniors perform a driving assessment in the comfort of home. It's very helpful if you can be there during the assessment. In as little as 30 minutes, you can identify and get further guidance on the physical and mental skills that need improvement. Visit www.seniordrivers.org. If the assessment indicates that your mom should not be driving, you can ask her physician to contact the Department of Motor Vehicles. The DMV will then send a letter, letting your mom know that her driving privileges have been rescinded.

The Hartford Insurance Agency has excellent publications about seniors and driving. Titles include "We Need to Talk: Family Conversations with Older Drivers"; "You and Your Car: A Guide to Driving Wellness"; "Your Road Ahead: A Guide to Comprehensive Driving Evaluations"; and "At the Crossroads: Family Conversations about Alzheimer's Disease, Dementia & Driving." Visit TheHartford.com.

Locally, the Shawnee Mission Medical Center and the MidAmerica Rehabilitation Hospital both offer driving assessments. These are somewhat costly and are private-pay only.

Let me close this with one suggested question to ask yourself: Would I let my grandchild ride in a car with my elder parent driving? If your answer is no, it's a no-brainer. The keys need to be taken away.

My mother's blood work shows that her kidneys are being stressed because she doesn't drink enough water. How can we get her to form that new habit, when she objects to having to urinate more often?

Explain to her why it's so important to drink water, and have a discussion about the consequences of not drinking, which can include kidney failure and dialysis.

If she doesn't like the taste of water, suggest she stir a lemon or lime slice into the water. Or have her try Crystal Light or another drink that's mostly water. Even sugar-free Jell-O is a great hydrator; it's just water in solid form! Frequently offer something to drink, and don't ask—just present the beverage. Enjoy a drink with her, too.

The only things your mom should not drink are coffee, other caffeinated beverages, and alcohol.

My elderly uncle is very lonely but will not socialize. All he does is watch trashy TV— no reading, no listening to music, no going for a walk in the park. But he complains of boredom.

The first thing I think of is depression, so please consider having him screened. His doctor can do that, as can the Landon Center. Also consider hooking up with some of the local "senior companion" programs or Shepherd's Center's Friendly Visitor program: 5200 Oak St., Kansas City, MO 64112; 816-444-1121.

Older adults are often isolated for a number of reasons, so helping them stay engaged with others is important.

My aunt has lost her sense of smell. When I open her refrigerator, I often smell rancid food. I'm concerned that she'll eat it and get sick.

You (or a friend, a neighbor, or a home health agency) can go in at least once a week and toss any stale food. You can also add "Cleaning the Frig" to your grandmother's to-do list, with a step-by-step process that includes labeling every left-over container with the food in it and the date. She should throw out any food more than four days old.

My 100-year-old mom gets frequent urinary tract infections and needs a urine analysis every three to six months, but she's homebound and it's almost impossible to get her to a lab. How can we get her tested?

You can collect a urine sample yourself in her home, then take it as quickly as you can to a lab. If you can take it in a cooler, even better. The doctor ordering the analysis or the lab can explain how to get a clean sample for testing. (And if she will, have her see a urologist.)

But there's a bigger issue to address, and that's the fact that frequent urinary tract infections (UTIs) may cause cognitive changes or cognitive impairments, which can mimic dementia. UTIs can be treated with medication, but encouraging adequate fluid intake and cleaning after elimination can help minimize the occurrence of UTIs.

My dad, who's 90, has diabetes and is also supposed to be on a restricted-salt diet. But sweet and salty foods are just about all he enjoys. Do we really need to force him into a bland diet?

My gut instinct is to say, let him eat what tastes good to him. As we age, we lose taste buds, and some elders can only taste deeply salty, sweet, spicy, or fatty foods. Ice cream is something a lot of elders love. Be sure to ask his doctor, but I believe that eating foods that have previously been discouraged is better than not eating at all—and weight loss is a real concern for elders.

A couple of other tips: make "power pudding" for him (you can find the recipe online by simply searching for "power pudding"); put butter, brown sugar, and raisins in his oatmeal; or mix a pint of Haagen Dazs ice cream into his daily Ensure!

When we visit my husband's mom, the conversation is an endless loop of the same old stories. We know it's important to let her talk, but how can we keep from being impatient?

It's important to remember that for elders like your mother-in-law, it's always a new conversation! For you it's numbingly boring, but for her it's fresh every time she tells it. You can't change her conversational patterns, but you can change the way you perceive them. Think up new ways to say "Is that so?" "How fascinating," etc.

You can also try distracting her. Crazy comments like "Hey, Mom, is that Elvis outside the window?" or "What do you say we go outside and take a walk?" can pull her out of her loops. They can also keep you from going crazy.

Remember, this repetitive behavior is often not purposeful or intentional. She truly will not remember that she has told you a particular story dozens of times.

My mom asked me to get a sweater from her closet. There I found nine pairs of identical red, elastic-waist pants and 36 pairs of white socks. She has a tight budget, but she's obviously been on buying binges. What should we do?

Elders can become addicts of the QVC channel and of clothing distributors like Buck & Buck, Haband, or Silvert's. But if she is binge-shopping and can't afford to, it may be time to talk about power of attorney for her finances. Her geriatrician can support that step.

We also hear about elders who start giving out their banking information to scammers who call on the phone, or entering contests. If you can see that an elder isn't competent to manage her financial affairs, you have a right to seek durable power of attorney. Talk to her doctor about your concerns; the doctor can help determine if your mom should no longer make financial decisions for herself.

Be aware, also, that difficulty managing finances can be one of the early markers of Alzheimer's disease.

You mentioned a geriatrician. How important is it for elders to have a gerontologist for their primary care doctor?

I think it's hugely important. Many primary care doctors will look at the problems of elders and say they're a "normal part of aging." But often that is not true at all. Geriatric specialists know what's normal and what isn't.

Geriatric specialists also are much better versed in medication management. "Polypharmacy" is a real problem. That's the use of multiple medications by a patient, especially when too many forms of medication are used, when more drugs are prescribed than is clinically warranted, or when all prescribed medications are clinically indicated but there are too many pills to take (a "pill burden"). Gerontologists usually prescribe with a motto of "go low and go slow"—starting with the lowest possible dosage and very slowly increasing it. They're also good at determining which medication may be causing undesirable side effects.

We don't have a template for aging like we do for children. We know that normal development tells us that children should walk by age 1 and talk by age 2. We don't have such a framework for older adults. Each is unique, and a geriatrician understands that.

So I highly recommend finding a board-certified geriatrician to be your elder's primary care doctor. Ask your friends and neighbors for recommendations or call us at the Landon Center.

My mom falls and falls, getting stitches and wounds that can take a long time to heal. We know she's hiding some falls from us. She thinks it's fine to keep calling Johnson County Med-Act. Is there a time when it's irresponsible to let a parent remain at home?

Many elders will "push back" when their children suggest changes, especially change as major as leaving home. If your mother is still mentally competent or has reasonable "capacity" (meaning she's capable of making good, safe choices for herself and understands the consequences of her choices), then she has rights, and she deserves as much self-determination as possible.

As hard as this may be for adult children to hear, sometimes it's best to leave an elder at home until or unless a crisis happens that forces a change. Sadly, sometimes things have to get worse before they get better. That's a difficult situation, and it's nothing to look forward to, but it can be worth the risk in order to give her the independence she craves.

In that case, the best thing you can do is to seek care for yourself through caregiver support groups or other avenues.
That said, most families have some benchmark that they consider a "deal-breaker" as far as letting an elder parent remain at home. Family A will not diaper or give perineal care to an elder parent, Family B will not let a parent stay home after just one fall, Family C says Mom gets to stay at home until she sets the house on fire. And there is no reason you can't be exploring other options or services even if your loved one isn't ready to make a change.

Dad's apartment has a safe shower with grab bars and all the rest, but he has to be nagged to bathe. I don't like taking him on errands, because he smells. It's embarrassing, and other residents of his apartment building have started to avoid him.

First, consider hiring a home health aide who can come a couple of times a week to help your dad bathe. That can make all the difference. There are many home health agencies in the metro region. You can also compare home health agencies in your area by going to www.Medicare.gov.

But if your dad is becoming neglectful of personal hygiene, that can also be a sign that he's dealing with depression or has dementia. Please consider having him screened. Depression doesn't always manifest in the typical ways, like being mournful or withdrawn. It can manifest in irritability, aggression, lack of self-care, and a loss of interest in doing things one once enjoyed. Dementia can make the person literally unable to remember how to perform grooming tasks.

My mother needs orthotics. We bought her a $250 pair of the best shoes and found them in the trash. She'd rather walk around in the rubber-tread socks she got at the hospital!

This is an example of learning how to choose your battles. If these socks keep her from slipping and she's happy in them, you might let well enough alone. Other "choose-your-battle" situations include elders who need but will not use hearing aids, and elders who live off of peanuts and French fries.

Our daughter, a nurse, used to provide advice and back-up for my husband and me with my elderly mother. She's moving out of state and we're going to be on our own soon. How will we ever be able to leave town again?

I'd recommend that you try out a couple of home health agencies now, before you need them. Find one you're comfortable with, and find one or two of their employees your mom is comfortable with. Have them visit and just go through the motions a time or two. Then you, your wife, and your mom will feel familiar with this source of assistance when you want or need some time away.

Tell your mother that she will be involved in choosing the caregiver, and if she is unhappy, another one can be chosen. Making her feel that she has some say in the decision will increase the likelihood that she will be agreeable to getting help.

Assessment
Many senior caregivers are not aware that the Landon Center on Aging offers a comprehensive elder assessment that is unparalleled in the region.

During an approximately two-hour visit to the Landon Center, the elder will visit with a social worker, a pharmacist, a geriatric resident doctor, and a geriatric preceptor. The elder will receive a holistic appraisal of his health and well-being and recommendations for follow-up or treatment.

At the end of the assessment, center staff can also recommend a geriatrician who will become the elder's primary care doctor. Such physicians are available at the Landon Center on Aging and at other facilities throughout the metro, including in Johnson County.

To schedule an assessment, which is covered by Medicare, call the Landon Center's Geriatric Clinic at 913-588-1204 or 913-588-1571, or call Myra Hyatt at 913-588-2365.

Support groups & resources

Caring for yourself
Dealing daily with an elder family member can be an over-whelming and challenging task for caregivers. Support groups and other resources provide information about patient care; promote the self-care and health of caregivers; and allow caregivers to receive support from other caregivers.

Remember, you don't have to do this alone. Even the Lone Ranger had Tonto!

Alzheimer's Disease and Memory Disorder Caregiver Support Group
Second Thursday of each month
2:00-3:30 p.m.
Landon Center on Aging, Room 145
3599 Rainbow Blvd.
Kansas City, KS 66160
No reservations are required.
Call Phyllis, 913-588-6981, for more information.

Family Caregivers Support Group
Fourth Thursday of each month
Noon-1:00 p.m.
Landon Center on Aging, Room 270
3599 Rainbow Blvd.
Kansas City, KS 66160
To register or for more information, call Myra Hyatt, 913-588-2365.

The Internet
Many Web sites provide excellent information and advice. They have the added benefit of allowing you to ask difficult questions anonymously. Some good sites:

Family Caregiver Alliance: www.caregiver.org

National Family Caregivers Association: www.nfcacares.org

Today's Caregiver: www.caregiver.com

Johnson County Area Agency on Aging
Call the Johnson County Aging Information Line, 913-715-8861, to access a host of resources for you as a caregiver, including support groups and a newsletter, as well as assessment for your elder and development of a care plan.