Aging Well in the Upstate
Helpful tips for family caregivers

"Promise you won't …"

The request every adult child dreads: “Promise you won’t put me in a nursing home.” Your natural response is to provide a soothing answer: “Of course. Never.” That is instinctual, and comforting. But that quick response now may prove problematic later. Take time to think things through so you are prepared to give a loving, fail-safe reply.

You can’t predict the future—your parent’s needs or your own health and abilities. It may be that 24/7 care is exactly what your relative eventually needs. For example, they may lose mobility and need to be lifted in and out of bed. Or become unable to care for themselves at the toilet, bath, and kitchen table.

In the case of advanced dementia, your parent may need full-time supervision, including throughout the night. Is that something you can promise to do?

Keep in mind that the root of such a request is typically fear—fear of being alone in an institution, of lingering in pain, of potential indignities, and of overall loss of independence.

A promise of “never” is a setup for you to feel guilty—even when you’re responding realistically to the demands of the situation. Instead, consider how you can address their fears without making a commitment you may not be able to keep. To reassure your relative, say something like

• “I will do everything I can to help you stay at home. If it turns out you need other care, I will make sure you are comfortable and respected.”
• “Let’s talk about your priorities and wishes later, when we know more about what you actually need for your health and well-being. I want to ensure that things go to your liking in every way that I can.”

If you’ve already made a promise, take a deep, settling breath and reach out to your loved one. It’s not too late to talk things through. And it’s better than feeling guilty later. Choose a quiet time, perhaps shortly after a doctor’s visit. Acknowledge the potential for the unforeseen. Then restate your commitment to ensuring their care and comfort regardless of the circumstances.

Preventing aspiration pneumonia

Many people hear of aspiration pneumonia when it’s already too late: their loved one has the diagnosis. This doesn’t have to be you. Aspiration pneumonia is preventable. It occurs when foreign matter, such as food or saliva, is breathed (aspirated) into the lungs, introducing bacteria.

People who have swallowing problems due to stroke, advanced dementia, Parkinson’s or other neurological disorder, are highly prone to aspiration pneumonia. And there’s no vaccine for this pneumonia.

With dysphagia, the flap that covers the airway does not reliably close. This allows inhalation of particles of food, drink, saliva, or gastric acid. Supporting good swallowing is key to helping your loved one stay clear of this diagnosis.

Tips for mealtime

• Provide rest for thirty minutes beforehand. Weakness, fatigue, and sedation promote trouble with swallowing.
• Position sitting up to eat. Make sure your loved one is sitting up as close to 90 degrees as possible. Preferably at a table.
• Ensure calm, leisurely meals. Rushed eating is more likely to result in food going down the wrong pipe.
• Reduce distractions. Present one food at a time. Smile encouragingly but minimize conversation. Talking is distracting. It increases the risk of aspiration.
• Encourage small bites and sips of water. Food goes down more easily when cut into small pieces, especially if alternated with sips of water.
• Try a tucked chin position for swallowing. Lowering the chin toward the chest may help line up the throat in a favorable angle. Ask a speech therapist for instruction.

Regular oral care is essential. Brushing teeth twice a day removes food particles and bacteria. Using a nonalcohol mouthwash can help. Also, routine cleaning by a hygienist. 

Thickened liquids can reduce swallowing problems for some people. Others dislike the texture and reject fluids altogether. That can lead to dehydration, which can present other problems, such as bladder infections. Instead, try high-liquid foods such as Jello, watermelon, and sorbet.

Getting them ready to fly?

Is air travel coming up for your older relative? These tips can make it an easier, less stressful experience for both of you.

Preflight planning

• Check with their doctor. Get an “okay” for travel by air. Ask for a note to support any special assistance needed.
• Book wisely. Look for nonstop flights midday or midweek. Get a seat with easy access to the lavatory. Follow airline instructions to request help with check-in, security, boarding, and for wheelchairs at both airports, if needed. If your loved one uses oxygen, check for the airline’s specific rules.
• Prepare carry-on items. Put nametags on all carry-on items, including a cane or walker. Don’t forget dignity items such as briefs, wipes, or a change of undergarments. Compile information: health insurance card, doctor contact, emergency contacts, and a current list of medications. Put all medications in a one-quart baggie. Label or use original bottles, if possible.
• Contact TSA. Call the Transportation Security Administration’s hotline (855-787-2227) at least seventy-two hours ahead of travel if you have questions or want to request extra support through security.

Day-of-travel assistance

• Facilitate check-in and security screening. If you’re not traveling, get a gate pass at the airline’s ticket counter so you can escort your relative to the gate. You’ll need your government-issued identification for this. At security, jackets must come off but shoes can stay on.
• Ensure comfort in the air. A head pillow, layered clothing, and gum for takeoff and landing are helpful. Have your loved one hydrate well before and during the flight.
• Support arrival. Ask your relative to wait to deplane after other passengers. That makes it easier for airline staff to help. Have whomever will meet them at the gate arrive an hour early to obtain a gate pass and get through security (bring their ID!).