Picture this: Dad is in front of the TV, as usual. He used to golf twice a week with his friends. Is there a problem here? This is a common and natural concern, and bridging the gap between what you hope an older adult does with their time and how they prefer to spend it can cause worry and friction. However, there are strategies to bridge this divide. Engaging an older loved one in conversation about their interests and values can lead to a more meaningful connection and an opportunity to learn more about each other. 

There is really no perfect formula for how much time an older adult should be active and engaged versus being more passive or solo. After all, preferences and limitations vary for individuals of all ages. Still, research supports that social engagement is vital for overall well being as it promotes cognitive stimulation and aids mental health (AARP). And of course, socializing can help prevent loneliness, a topic of growing interest due to its many negative impacts on quality of life. Likewise, physical activity is crucial for healthy aging as it promotes strength, balance, heart health, and prevention of chronic disease and falls. Harvard notes that “decades of solid science confirm that exercise improves health and can extend your life.” (Harvard Health).  With this in mind, the instinct to encourage an older adult to do more with their days makes perfect sense. Still, this conversation should be handled with care and the following tips will pave the way for a fruitful talk. 

Lead with Empathy

It is important to understand that your parent or loved one may have adopted a less active lifestyle for a variety of reasons. Research from Baylor University notes that physical ability can impact one’s social life;  “When an individual becomes less mobile, he or she may start to avoid activities and social events, leading to the feeling of isolation”. Indeed, many seniors are adapting to living with chronic pain, stiff joints and a need for more sleep and rest.  Additionally, while rewatching old movies or fiddling with the same gadgets may seem lackluster to you, these routines may be an enormous source of comfort to someone experiencing a season of loss and change. Be sure to consider how the individual’s unique history and circumstances influence their attitudes on adding more to their schedule.

Start Small

Knowing how many benefits there are to be found in increased activity, it might be easy to throw a lot of options out right away. Book clubs, senior centers, and walking groups are all ideas (potentially) worth exploring, but it may be too much, too soon. Focus on exploring interests and offer to help realize one new activity at a time. Be mindful that while you may love to see a packed schedule, your loved one may be satisfied with adding just a few elements of connection and engagement to their lives, or none at all. Also, be prepared to have this conversation over many weeks or months at a pace that feels sustainable. Be clear that your interest is in supporting a happy and well-rounded lifestyle and keep open to how your loved one defines those things, as well.

Exploring Interests Exercise:

Five Questions

The following questions are designed to generate meaningful conversation around activities, preferences and values. Take turns answering so that it becomes a free-flowing conversation. Look out for opportunities to find common ground and shared interests that you can do together.

1. What would a great day be for you? 

• What are 3-5 things that a fun day would include? 
• Consider simple pleasures and gratifying experiences of connection: is it time with the grandkids, being in nature, laughing with a friend?

2.  How do you feel about your current level of activity? 

• Rate your satisfaction on a scale of 1-10.  What could be done to get you closer to 10? What is something you would love to try?
• Dare to dream big!  If your great aunt used to love a beach day but has not been since she started using a wheelchair, know that this desire may not be out of reach. Adaptive tools, like a terrain-friendly wheelchair, can help individuals of varying abilities connect with the world again. 

3. Who do you like to spend time with these days? Is there anyone you wish you could see more often?

• What relationships feel most valuable and how can you make time to nurture these? What kinds of settings do you like to socialize in? 
• You can consider options like setting up a regular coffee date or teaching dad to use Facetime to connect with his brother who lives out of state. Though new technology can feel daunting to adopt, with a bit of patience it can provide a great source of connection. 

4. What are things you loved to do in the past?

• Reflecting on your past, what are some activities and interests you used to love? Are there any past hobbies you would like to try again?
• Reminiscing can help us remember parts of ourselves that have been long dormant. It can also be a way to engage with someone who is experiencing cognitive changes or dementia. Bringing out old pictures, videos or music can be a great way to prompt beloved memories and can stimulate conversation about dusting off the gardening tools, for example. 

5. How do you like to move? 

• What kinds of physical activities do you enjoy  or used to enjoy?

Be sure to consider changes related to mobility and health, along with individual preferences. Walking, tai-chi and swimming are all low-impact activities, and chair exercises can be adapted for a variety of abilities. Talk about ways to add more movement into everyday life that are fun and doable. If maintaining independence is a value to your loved one, you can  highlight that being physically active can support this goal. Check out this article to find seated and standing exercise options.

Modeling Self-Compassion and Mindfulness for our children

When it comes to teaching self-compassion to your kids, the place to start is with the one already on stage, you. Your kids are watching everything you do, including what you tell yourself when you forget something, lose something, burn something… are you saying out loud, “I’m such a clutz” or “I’m a disaster in the kitchen”? It’s just what you are saying to yourself, right?

It’s not like you would say to your child “you are stupid”, but because children learn how to talk to themselves by watching the way you talk to yourself, you could in fact unintentionally be teaching them to tell themselves things like “I’m stupid”. 

How to shift self talk for the whole family

If you find yourself berating yourself out loud, try to model self-compassion by changing your message to something like, “Oh, I shouldn’t talk that way. I know everyone makes mistakes, it’s just part of being human” or “Oops I messed that up. I know how to do better next time”.

Dr. Neff, the leading researcher of the self-compassion concept, shares that self-criticism is a threat to how we perceive ourselves since we become both the “attacker” and the “attacked.”

When we are self-compassionate, we reframe our language by learning to be kind, supportive and understanding when we make mistakes. It’s a tool that will serve our kids well with how they speak to themselves and to others. 

Resources for you and your children

There are lots of resources out there that can help build healthy self-compassion and mindfulness habits in children. We found a few we thought you’d enjoy…

For ages 3-7:

This book, titled “Listening With My Heart” by Gabi Garcia, “reminds us of the other golden rule– to treat ourselves with the same understanding and compassion we give to others.”

The Emotion Motion podcast has 12-17 min. pods featuring Megan the Mermaid’s underwater adventures designed to teach social-emotional learning through tools such as song, dance, deep breathing and stretching. Warning: we cannot promise that you won’t walk into work singing “Emotion motion, emotion motion….” 

For ages 4-10:

The Like You: Mindfulness for Kids podcast introduces a variety of mindfulness exercises about:

• Breathing
• Affirmations
• Music
• Imagination

These activities can help explore their feelings, relieve anxiety, encourage self-esteem, and grow empathy.

breathing, affirmations, music, and imagination to explore feelings, relieve anxiety, encourage self-esteem, and grow empathy. With a voice like Mr. Rogers, he’ll have you wanting to listen. Each pod is 10-18 min. 

Beautiful, busy, tired parent: you’ve got this! You are doing your best and are so precious to those around you! 

Now it’s your turn: “I’m doing my best and am precious to those around me!”

To read about more tips to show self-compassion to yourself to better model it for your children, read more here!

Start with kindness—to yourself.

We all want to spend time with people who care.

If you spend time
tending to someone who needs help in day-to-day life…
you are a caregiver.
You may not give yourself that title.
Wear it proudly—it’s a beautiful thing to be.

However, sometimes helping an older adult can overwhelm an already stress-filled life and caregivers often don’t have all the support they need or enough hours in the day. Caring can come at a cost, including to our mental wellbeing. Additionally, caregivers are often terribly hard on themselves.

A caring mental health response:
Self-compassion

The practice of offering internal kindness and grace—self-compassion—can help process caregiver stress, burnout, and mental health struggles.

Caregivers tend to compound the already challenging moments of life with their own harsh inner critic. The Cleveland Clinic notes that caregivers are overly burdened with feelings of guilt and unrealistic expectations of themselves. Self-critical statements might sound like, “I am such a jerk for snapping at mom when we were driving,” or, “I haven’t been to the gym in weeks; I am so lazy.” The brain thinks it is doing us a favor by motivating us to work hard or live up to our personal standards. Instead, negative self-talk leads to feelings of defeat and exhaustion. Some caregivers are great at offering patience, kindness and forgiveness to just about everyone but themselves.

What is self-compassion?

If compassion is about seeing the suffering in others and feeling compelled to help, then self-compassion is turning this instinct inward. A leading researcher of the concept, Dr Kristen Neff, thinks of self-compassion as “a healthy attitude towards oneself during times of struggle.” Or, as Christopher Germer succinctly puts it, “Self compassion is simply giving the same kindness to ourselves that we would give to others.” Self-compassion helps us to understand that suffering is a universal, shared experience and that we can best manage it with warmth instead of shame.

Honing the skill of self-compassion can take time and patience.

Three exercises to develop self-compassion

• Get mindful and flip the script
  Notice when you are in a moment of difficulty and offer yourself a kinder assessment of the situation.
  In fact, research from McGill University says that treating ourselves more kindly “has been shown to be related to increased psychological well-being.”
  
  Compassionate self-statements will sound more like, “I have been under a lot of stress. I am going to ask my sister to help with driving mom.” Or, “I haven’t been exercising and I feel best when I do. How can I make space for this in my life?” Noticing negative self-talk and consciously reframing these thoughts will help this practice to become more automatic going forward. This shift can work wonders!

• Talk to yourself like you would a dear friend
  Imagine you are sitting with a beloved friend who is struggling with her many responsibilities. Would you really tell her to get a grip and snap out of it or that she is a bad daughter for forgetting about dad’s 4th appointment this month, or call her a jerk for losing her patience with her kids?
  
  You would be more likely to remind her she is doing her best and that you love and accept her. You might then offer her a cup of tea and thank her for sharing her struggles with you. The next time you are beating yourself up, try to apply the same compassion to yourself that you would with someone else you love.

• Write it out
  Writing about stressful events has been shown to improve our physical and emotional health. Practice self-compassion through journaling or by writing a letter with prompts. Writing out your stressful thoughts will help you to get them aligned with a kinder view of a difficult situation. The Center for Clinical Intervention has a Compassionate Letter Writing template (page 8) for how to write a compassionate letter to yourself. Or, you may want to make your own version.
  
• Mental health needs minding
  While self-compassion is a great framework for coping with distress, sometimes we need more. If you are dealing with changes to your mental health at a level that is disrupting your life, read through the symptoms of depression below. This is not a comprehensive list, but show some of the most common symptoms of depression, one of the largest mental health challenges facing caregivers.

Common symptoms of depression*

• Are you spending less time doing things you used to enjoy? Do you have less interest in activities you used to love?
• Are you experiencing persistent feelings of sadness, hopelessness, or numbness?
• What about feelings of irritability, restlessness or having difficulty concentrating?
• Have you noticed changes to your sleep or appetite levels?
• Are you feeling less energetic, fatigued and slowed-down?
• Do you often feel a sense of guilt?
• Do you experience thoughts about death or suicide?

*If you notice these symptoms for more than 2 weeks, it is important to be evaluated for clinical depression. Additionally, this list is not intended to make a diagnosis. If you think you may be suffering from depression, it’s important to reach out to a medical professional who can diagnose and support you.

If you are suffering, you are not alone

Caregivers deal with depression and other mental health disorders at higher rates than their peers. According to the Family Caregiver Alliance, “40% to 70% of family caregivers have clinically significant symptoms of depression, and about a quarter to half of these caregivers meet the diagnostic criteria for major depression.” In fact, the American Psychological Association recommends caregivers be screened for mental health conditions due to their elevated prevalence. This is startling but, maybe not surprising. Afterall, caregiving, while deeply rewarding, can also be tiring, confusing and isolating.

Mental health conditions, including clinical depression, are treatable

The good news is that most individuals will find relief from depression with effective treatment, according to Mental Health America. The most common and effective treatments for depression are psychotherapy and medication, or a combination of the two. A good place to start would be to talk to your primary care doctor and ask for referrals or to initiate treatment. In addition to formal treatment, doing things like eating a balanced diet, getting exercise, and spending time with loved ones are all helpful. These are great examples of self-care practices we can engage in to help bolster our mood. As caregivers, it is especially important to avoid isolation and reach out for support

Practical Books & Other Resources

If you want to dive deeper into books, podcasts and workbooks here are some recommendations:

• Books: 
• Self-Compassion by Kristen Neff, PhD.
• The Conscious Caregiver: A Mindful Approach to Caring for Your Loved One Without Losing Yourself by Linda Abbit 
• The Gifts of Imperfection by Brene Brown, PhD

Podcasts: 

• Ten Percent Happier with Dan Harris: The Scientific Case for Self-Compassion with Chris Germer
• Daughterhood The Podcast: For Caregivers

Workbook:

• Australia’s Center for Clinical Interventions published a Building Self-Compassion workbook with step-by-step modules on building self-compassion.

If you’re in crisis, there are options available to help you cope. You can call the Lifeline at any time to speak to someone and get support. For confidential support available 24/7 for everyone in the United States, call 988.

You already know how to love well; that’s why you are a caregiver. But if caregiving or other life stressors have impacted your mental health, it is important to seek support from a professional.

Engaging social supports and asking for help from our loved ones is an important step. And if you can practice self-compassion and give yourself grace through the ups and downs of your caregiving and mental health journeys, it will be that much easier to manage. You deserve to care for yourself just as well as you care for others!

Review these tax credits

Disclaimer: We are not accountants, tax advisors or lawyers. Please consult professionals as you manage your finances and taxes.

Whether you have a child or are helping an older adult or both, you’ll want to make sure you are leveraging all relevant tax credits, deductions and employer-sponsored programs.

When it comes to children, ask your tax advisor about the following:

• Child Tax Credit
• Child Dependent Care Credit
• Earned Income Tax Credit
• Leveraging a Dependent Care Flexible Spending Account (DCFSA)

Child Tax Credit

The Child Tax Credit helps families with qualifying children get a tax break. You qualify for the full amount of the 2023 Child Tax Credit for each qualifying child if you meet all eligibility factors and your annual income is not more than $200,000 ($400,000 if filing a joint return). Parents and guardians with higher incomes may be eligible to claim a partial credit.

This IRS Interactive Tax Assistant tool helps clarify the question of, “Does My Child/Dependent Qualify for the Child Tax Credit or the Credit for Other Dependents?”

Child and Dependent Care Credit

According to the IRS, “You may be able to claim the child and dependent care credit if you paid expenses for the care of a qualifying individual to enable you (and your spouse, if filing a joint return) to work or actively look for work. The amount of the credit is a percentage of the amount of work-related expenses you paid to a care provider for the care of a qualifying individual. The percentage depends on your adjusted gross income. The total expenses that you may use to calculate the credit may not be more than $3,000 (for one qualifying individual) or $6,000 (for two or more qualifying individuals).”

This IRS Interactive Tax Assistant tool helps clarify the question of, “Am I Eligible to Claim the Child and Dependent Care Credit?”

Earned Income Tax Credit

The Earned Income Tax Credit (EITC), sometimes called EIC, is a tax credit for workers with low to moderate income. Eligibility for the tax credit is based on various factors including family size, filing status and income. You can start with an eligibility test at the bottom of this page. 

FSA or Dependent Care Credit

You may be wondering if you can use both your employer provided Dependent Care Flexible Spending Account (DCFSA) and the Dependent Care Tax Credit. The answer is maybe.

According to the FSAFEDS, “You are not permitted to claim the same expenses on both your federal income taxes and Dependent Care FSA (DCFSA), although in certain situations you may be able to take advantage of both the DCFSA and the Child and Dependent Care Tax Credit. If you have two or more qualifying individuals as dependents, the IRS allows you to apply up to $6,000 of dependent care expenses to your taxes. The maximum allowable under a DCFSA is $5,000, so you may apply the $1,000 incremental difference between the DCFSA maximum and the Child and Dependent Care Tax Credit if you have two or more dependents and your expenses exceed $5,000.”

If you have a DCFSA, you can use it to pay for a variety of child and adult care services. The IRS determines which expenses can be reimbursed by a DCFSA. This list from the FSAFEDS shows the eligibility of some of the most common dependent care expenses, but it’s not meant to be comprehensive.

Ask your tax professional to advise you on what is best for your situation.

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When it comes to older adults, ask your tax advisor about the following:

• Claiming an older adult as a dependent
• Medical expense deductions for an older (dependent) adult
• Head of household status

Claiming an older adult as a dependent

According to the IRS, you can claim your parent as a dependent if:

• You (and your spouse if filing jointly) are not a dependent of another taxpayer.
• Your parent, if married, doesn’t file a joint return, unless your parent and his or her spouse file a joint return only to claim a refund of income tax withheld or estimated tax paid.
• Your parent is a U.S. citizen, U.S. national, U.S. resident alien, or a resident of Canada or Mexico.
• You paid more than half of your parent’s support for the calendar year.
• Your parent’s gross income for the calendar year was less than $4,400.
• Your parent isn’t a qualifying child of another taxpayer.
• If your parent is your foster parent, they must have lived with you all year in your main home and as a member of your household.

Two tips related to claiming an older adult as a dependent

If you are supporting more than 50% of their living expenses, medical care, and other care, you may be able to claim them as a dependent.To be claimed as a dependent, the family member doesn’t need to live in your home for the entire year as long as they meet other guidelines.

Medical expense deductions

According to the IRS’s guidelines for which medical expenses you can approve are defined here: “You can generally include medical expenses you pay for yourself, as well as those you pay for someone who was your spouse or your dependent either when the services were provided or when you paid for them.”

According to the IRS (with some exceptions) “If you itemize your deductions and your parent was your dependent either at the time the medical services were provided or at the time you paid the expenses, you may claim a deduction for the portion of their expenses that you paid during the taxable year, not compensated for by insurance or otherwise.

Your medical expense deduction is limited to the amount of medical expenses that exceeds 7.5% of your adjusted gross income.”

The IRS has a list of eligible medical expenses which includes things like dentures, hearing aids and medically necessary home modifications like ramps and handrails. 

Head of household status

The IRS’s ‘special rule for parent’: “If your qualifying person is your parent, you may be eligible to file as head of household even if your parent doesn’t live with you. However, you must be able to claim your parent as a dependent. Also, you must pay more than half the cost of keeping up a home that was the main home for the entire year for your parent. If you pay more than half the cost of keeping your parent in a rest home or home for the elderly, that counts as paying more than half the cost of keeping up your parent’s main home.”

If you are unmarried at the end of the year and can claim an older adult as your dependent, consider filing under ‘head of household’ instead of ‘single.’ If you are married but live apart from your spouse, ask your tax advisor if you can file as ‘head of household’.

TIP from the IRS:

Are you 50+ years old and need help filing for this year? 

AARP has a free tax filing program aimed at taxpayers who are 50 years and older. AARP Foundation Tax-Aide is the nation’s largest free filing program. It’s available across the country and staffed by volunteers who are trained and certified by the Internal Revenue Service. You don’t have to be an AARP member to use this service. An online site locator can help you find one near you. Even if you’ve already filed this year, keep this in mind for next year.

Common mistakes and best practices

How involved are you in your parents’ or in-laws’ finances?
How involved do they want you to be?
How involved do you think you should be?

You may not have talked in detail about managing your parent’s finances yet. The top two reasons (out of the 37) are:
1) it’s uncomfortable to talk about and;
2) you aren’t sure exactly what the next steps are.
The other 37 reasons include things like “I don’t want to talk to my siblings about it”, “I have a kid’s soccer game to go to” and “I’d rather have a colonoscopy than dive into this.” We cannot save you from the colonoscopy, but we’ll give you a brief “financial companion” overview to get started.

The Conversation

We’ll assume the older adult in your scope of care is currently managing their own finances (even if they are no longer doing it well.) Step One: Engage them in a conversation about their wishes. There are many ways to approach the conversation. One playful way is to use this “mad lib” as a springboard to a more serious conversation.

Who will manage their finances if/when they are no longer able to do it themselves? If you want a deeper dive into suggestions for how to start complex conversations like this, download the conversation guide.

Be open to the fact that, for whatever reason, the older adult may have a strong opinion about who will play this role—and it might not be you. If you are not the one chosen, don’t take it personally. Alternative possibilities include other family members or a professional financial planner.

Common financial “companion” strategies

There are a number of different ways to help older adults manage their finances. The following information outlines the drawbacks and risks of certain approaches and suggestions for successful structures

“Borrow” their log-in credentials
If you are helping the older adult by accessing their account using their credentials you could find yourself in a sticky situation. There may come a point when the older adult is not able to confirm that they’ve given you permission to do so.

Sign paperwork on the older adult’s behalf

If you do not have the legal documents in place (like the power of attorney), signing paperwork as the “responsible party, guarantor, or cosigner” means that you may be personally liable for the expense. If you are unsure of the financial obligations you could personally face by signing an agreement, seek legal counsel and don’t rush into signing something before you are certain how you could be personally liable.

Create a joint account
Setting up a joint account with an older adult or adding your name to their current account could seem like an easy solution, but there are clear drawbacks.

Let’s examine the pros and cons of the joint account structure.

Pros:

• It is easy to monitor transactions and account balances which helps to protect against fraud.
• It’s convenient to make deposits or withdrawals of cash to pay for the older adult’s expenses. There is immediate access to the funds in the account at the time of the older adult’s passing. Those funds could be used to pay for final expenses.

Cons:

• Money in the account when either person dies belongs to the surviving account holder. This can create conflicts among siblings or other potential heirs.
• If you have your own financial problems, creditors can take funds from the joint account to settle your debts which means the older adult’s funds are at risk.
• If you have children seeking financial aid for college, assets in the joint account could affect their eligibility for aid.
• The older adult’s eligibility for Medicaid could be impacted if you are making withdrawals from the account since those withdrawals could be considered a transfer of assets to you. The result could result in the older adult becoming ineligible for Medicaid for a certain period of time.
• There could be tax implications of having a joint account. If the account earns interest, you’ll have to report the interest earned on your own federal income tax return, as well as the older adult’s tax return. Joint accounts also can have gift tax implications if the co-owners aren’t spouses.

What is the best way to set up account permissions?

There are structures that offer protection for all involved. Yes, they are also more complicated to set up. But as you’ve read, a purposeful account permission strategy can prevent long-lasting negative impacts both financially and relationally.

This table from the Consumer Financial Protection Bureau outlines the various structures for financial caregiving.

Legal permission to manage finances

A durable power of attorney is a legal document in which one person assigns another the power to make financial decisions on their behalf should they become unable to make sound decisions. The person assigned power of attorney is called an “agent” or “attorney-in-fact.” (This power of attorney is different from a healthcare power of attorney which appoints someone to make medical decisions on someone else’s behalf should they become incapacita

A financial power of attorney document makes you a fiduciary which separates your own personal finances from financial actions and decisions you make on behalf of the older adult. It’s important to note that the older adult must be of sound mind to grant and revoke the power of attorney.

If the older adult does not have a completed financial POA, an attorney isn’t required to get this completed, except if the older adult already has cognitive impairment. If they are already cognitively impaired they can’t legally sign the documents required to set up a power of attorney. (This is one reason why it’s a great idea to set up a POA early.)

The laws vary by state with some states requiring two witnesses and others a notarization. It’s wise to use an attorney for this process, but a notary at a minimum. If you want to hire an attorney to put together a POA, we recommend searching for one through the National Academy of Elder Law Attorneys where you can do a state-specific search.

What happens if a power of attorney is not in place?

Without power of attorney or a trust, the family is at risk of having to go to court later to file for guardianship if the older adult becomes incapacitated—a process that can be expensive, time-consuming and potentially divisive.

Using the power of attorney to manage accounts

Institutions have different guidelines for how to allow access to account information. It’s wise to contact the financial institution to ask what is required so you can easily put things in place outside of an emergency situation. For example, at a BECU bank in Seattle, once the Durable Power of Attorney is presented at the branch, the one designated as holding the DPA completes a form which is then signed and notarized at the branch.

Understanding your responsibility

If you are responsible for helping an older adult manage their finances, you must use that permission and money properly. Failing to do so is considered a form of abuse and caregivers are bound by the laws protecting older adults.

To help manage this responsibility, use these four tips to help handle funds in a transparent manner.

1. Keep detailed notes with dates and details about how funds were used. Keep a written record of expenses paid from the joint account, including noting reasons in the checkbook register’s memo field. This record-keeping is actually required by law.
2. Never borrow from the account.
3. Consider putting an app in place that offers remote monitoring of financial transactions and provides alerts like unpaid bills or unusual activity. Email notifications can also be set up via the bank of choice.
4. Share financial updates and decisions with siblings and other relevant family members even if they don’t ask. Doing so will help keep possible incriminations and disputes at bay. Consider setting up quarterly family meetings to review financials.

What’s next?

Once you have the right paperwork permissions in place, you are ready to gather and confirm an updated inventory of accounts and assets. Without this list, it’s just a “best of luck treasure hunt”. This Account Permissions Checklist shows where and what the power of attorney’s name needs to be added to. Additionally, your Ways & Wane GoKit Medical Planner has a place where all of this can be filled in.

While this may seem daunting, it’s worth it to carve out time to put things in place in order to show up as your best self for the older adult for whom you care. It’s what you can hope someone will do for you someday. You can do this and will be proud you did!

Now schedule that colonoscopy.

Elizabeth Dameron-Drew is President of Ways & Wane.

We are not accountants or lawyers. Please consult professionals as you manage your financial situation.

Recipe for Gatherings with Older Adults

Take 12 pounds of holidays, toss in 6 tablespoons of dementia, a couple of hard-of-hearing ears, 2 creaky knee joints, a side of grumpy teenager and top with a lifetime of family history and you’ve found yourself with a multigenerational holiday that is sure to be memorable. It’s a special time. Not necessarily an easy time, but precious because of those who are present. In the spirit of wishing you the best version of a holiday recipe for success with the older adults in your life, we have ideas for activities, practical suggestions, safety tips and things to avoid.

Ideas for fun activities:

• Go on a drive to see the holiday lights. If possible, drive through a neighborhood where the older adult used to live.
• Listen to their favorite holiday songs and or watch a classic holiday movie together
• Reminiscing about past holidays is a way to help keep older adults connected to their legacy. Talking about traditions and reminding them of your appreciation for what they have done over the years can be a sweet way of honoring them.
• Decorate for the holiday together, either at their residence or yours. Unpacking decorations or setting out decorations on a table top can both be done from a seated position. For their room, even just a pre-lit tree or a string of hanukkah lights can make a big difference.
• Host a gingerbread house decorating contest and divide your group into teams. Maybe the winners get something funny like these fuzzy flamingo slipper shoes. If a Hanukkah House is more relevant, this one is a fun choice.
• Offer to create and help them mail holiday cards to their friends. A card with a photo of them with a silly filter could be fun. Maybe you address the envelopes and the older adult licks and seals them shut. Hopefully they’ll receive some in return. 
• Play a new game as a family. The game, “Do you really know your family?” can be played across many generations and can mix up the conversation. Just be sure to make sure the older adult can clearly hear the questions/answers. 
• If you are geographically far apart, arrange a video call and decorate together virtually or just have a cup of tea or cocoa.

Tips to remember:

• If possible, schedule events for the older adult’s best time of day
• Offer healthy options like pre-cut vegetables and fruits
• Generally older adults have trouble staying hydrated. Make sure to have water available to them before, during and after the meal. A straw and stable glass can make things even simpler. 
• If there are parts of the meal that are hard to cut, pre-cut the older adult’s portions beforehand so that it’s accessible once it’s on their plate.
• Set up a quiet area for the older adult to be able to spend time if the excitement of the event becomes too overwhelming
• Provide a place to sit that isn’t difficult to get out of like a chair with arm supports

Safety tips:

• If prescription drugs are usually taken at meals, make sure they day’s events don’t throw off their medicine schedule. 
• Arrange in advance who is available to help the older adult use the bathroom (should they need it). If the event is at your home, consider temporarily adding a raised toilet seat or spring mounted support pole to give the older adult independence and keep them safe in the bathroom.
• Ensure that there are clear walking paths and remove trip hazards like throw rugs or extension cords.

What to avoid:

• Activities that require a lot of fine motor coordination. Between arthritis and diminished eyesight these could just be frustrating for an older adult.
• Activities that require standing or walking for extended periods of time.
• Low and soft couches or chairs that are hard to get out of
• Additional background noise (like music) that can make it difficult to hear and participate in conversations
• Too many fatty or salty foods and ‘over doing it’ can be challenging for an older adult with a pre-existing health condition. 
• An event that’s too long/tiring.

Lastly, remember that children (young or not so young) who are part of holiday events are watching how you love and honor the older adults who are present. Someday they may be loving and honoring you in those same ways. You are showing them how.

Availability, Style & Denial

“M-O-U-T-H”

“Thank you John, but you don’t have to spell the word, just say the word you’ve heard.”

The very patient audiologist, my father and I were sitting together in a cramped, sound-proof room. I admit I had to chuckle at my dad spelling out the words instead of just repeating them. He always had been a good speller, but in this case spelling back the words was a reflection of his dementia.

He was also a surprisingly stubborn man which he applied to resisting hearing aids despite the fact that he knew he couldn’t hear clearly. 

We were lucky he eventually consented. 

His wife thanked me. 

Hearing Loss Increases Dementia Risk

One surprising aspect of hearing loss is the connection to dementia. In a study that tracked 639 adults for nearly 12 years, Johns Hopkins expert Frank Lin, M.D., Ph.D., found that mild hearing loss doubled dementia risk. Moderate loss tripled risk and people with a severe hearing impairment were five times more likely to develop dementia.

Not only can hearing loss dramatically increase the risk of dementia, but if an older adult cannot understand those around them they may avoid conversations and social gatherings. This dynamic can then lead to social isolation which could then lead to depression and further withdrawal from activities. All that can add up to a pretty good argument for using hearing aids. 

NEW! Hearing Aids Available
Over-the-Counter (OTC)

Starting mid-October 2022, the U.S. Food and Drug Administration is allowing some hearing aids to be purchased over the counter. The cost and required prescription for hearing aids has been an obstacle in the past. The FDA change establishes a new category of over-the-counter (OTC) hearing aids, enabling consumers with perceived mild to moderate hearing impairment to purchase hearing aids directly from stores or online retailers without the need for a medical exam, prescription or a fitting adjustment by an audiologist.

With OTC hearing aids available, there are essentially three different kinds of hearing enhancement product categories. 

1. Personal Sound Amplification Products (PSAPs)
   1. Intended for people with normal hearing to amplify sounds in certain situations, such as recreational activities like birdwatching or hunting. 
2. Over the Counter (OTC) Hearing Aids
   1. For mild to moderate hearing loss
   2. Sold in retail stores and online
   3. No prescription needed
3. Standard prescription hearing aids
   1. For all levels of hearing loss, including severe
   2. Prescription is needed

OTC Purchases Can Be Online or Retail

You can purchase OTC hearing aids from either a brick and mortar retail store or through an online retailer. There are pros and cons to both.

When purchasing OTC hearing aids from a retail store, you can immediately have the product, but you won’t be able to customize the fit and the quality may not meet your expectations. You are also on your own in determining the level of hearing loss and selecting the kind of aid. When shopping, you’ll want to keep the following features in mind:

• battery life
• warranty
• size and weight
• volume control

When purchasing an OTC hearing aid from an online retailer you will have to wait for it to be shipped, but you have the benefit of the fact that online hearing aids are registered with the FDA. Even though they don’t require a visit to the doctor or a prescription to purchase online hearing aids, these aids are dispensed through audiologists. When purchasing online hearing aids, you’ll receive services like:

• an online hearing test
• personalized programming based on test results
• telehealth support with an audiology team
• remote adjustments
• financing options

For OTC hearing aids sold by online retailers, we found four highly recommended brands: Lively, MDHearing, Eargo (which offers a 20% discount for Veterans on a specific model) and Lexie. They are different price points and have different features, but they all come with at least a 45-day risk-free trial (which on a side note is way more generous than what I got with my 70lb rescue dog). 

Hearing Aid Style Options

There are a range of options when it comes to hearing aid designs as they are no longer the bulky, highly visible kind that your grandpa had. The graphic below from the FDA shows the various styles.

How to Approach the “Hearing Aid Conversation” with an Older Adult

Among adults aged 70 and older with hearing loss who could benefit from hearing aids, 30 percent have never used them. If you have an older adult in your life who really needs hearing aids, but is resistant here are four tips for how to approach the topic: 

1. Encourage dialogue. Let them know what you’ve observed about them not hearing or understanding conversations. Maybe point this out: Michelle Matyko, Au.D., an audiologist in New York says “You can explain that hearing aids are just like glasses, and if someone can’t see well, wouldn’t you suggest they try glasses to help them?” If they are concerned about how hearing aid will look it may help to point out that hearing loss is more obvious than a hearing aid. 
2. Provide literature on hearing loss or give them this quiz to determine if seeing an audiologist would be helpful. You could mention the fact that nearly 30 million U.S. adults could benefit from using hearing aids. 
3. Encourage them to talk to their doctor. Sometimes a recommendation from a medical provider makes the need legitimate.
4. Be patient. This may be something that they need to decide to do (or not) and on their own timetable. It’s very possible that the best thing you can do is respect their decision.

If you want a deep dive into all things hearing aids, this article from the National Council on Aging is very comprehensive. 

1 in 4 older adults report
having depression or anxiety.

May is National Mental Health Awareness Month (MHAM). People don’t talk about the mental health of older adults much.

Discover the ten signs that indicate an older adult is depressed, common causes for depression and how you—as an involved family member or friend—can help.

“I’m not sad, my body just hurts.”

Depression in older adults is not a normal part of aging, but it is a common experience. Identifying and treating depression in an older adult can be complicated since the older adult may have a stigma attached to depression, seeing it as a taboo topic, a sign of mental illness or weakness. Additionally, the signs of depression in an older adult may not look like the signs that show up in other age groups. 

According to the National Institute of Mental Health, depression in an older adult may look like: 

1. Persistent sad, anxious, or “empty” mood
2. Being grumpy or irritable
3. Feel confused or struggling to pay attention
4. Loss of interest or pleasure in hobbies and activities
5. Moving or talking more slowly
6. Having a change in weight or appetite
7. Feelings of guilt, worthlessness, or helplessness
8. Difficulty sleeping, early-morning awakening, or oversleeping
9. Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment
10. Having suicidal thoughts

According to the NIMH, if these signs and symptoms show up most of the day, nearly every day, for at least two weeks it may be a sign of depression.

Depression can also be an early sign of dementia. To make things more complicated, dementia can cause some of the same symptoms as depression. It is also common for people with Alzheimers and related dementias to suffer from depression. So in short, depression may be a sign of the onset of dementia or dementia may be causing some symptoms that look like depression.

For those who love and care for older adults, these issues are particularly important to pay attention to since older adults have one of the highest suicide rates in the nation. In fact, white males 85+ years old complete suicide at 4 times the rate of the general population. We highlight this because we don’t believe it’s common knowledge, but important to know.

Three reasons why an older adult may be depressed

1. People who are isolated or lonely are more likely to experience depression, cognitive decline, dementia and Alzheimer’s disease. In fact, prolonged isolation can be as bad for your health as smoking 15 cigarettes a day!

2. Older adults frequently find themselves in a season of loss. It may be loss of independence, mobility, health, a long-time career, or someone they love. 

3. Dealing with chronic medical conditions like: Parkinson’s disease, Stroke, Heart disease, Cancer, Diabetes, Dementia and Alzheimer’s disease, Multiple sclerosis (MS) among others, particularly when painful, disabling, or life-threatening, can lead to depression or make depression symptoms worse.

In a season marked by loss, it can be difficult to tell the difference between someone who is grieving and someone who is depressed. This article from helpguide.org provides some valuable information about grief vs depression, depression vs dementia as well as detailed self-help suggestions. 

What you can do if you think the older adult may be depressed or at risk of becoming depressed

• Enlist the help of the older adult’s primary care physician and specifically ask them to do a screening for depression.

• Explore the topic with them. Dawn Carr, PhD, an associate professor of sociology at Florida State University’s Pepper Institute for Aging and Public Policy says, “The most important thing is to be able to develop a relationship where you can talk through and normalize the depression symptoms”. 

Carr suggests asking about the person’s social interactions. “Essentially, speaking about the symptoms of depression is more accessible than simply saying, ‘You seem depressed,’ because that can be confrontational for some people,” says Carr. You might ask:

• “Are you enjoying spending time with others?”
• “What activities do you look forward to lately?”
• “You don’t seem like yourself today. What’s on your mind?”

There are many reasons for hope.

Depression, even the most severe cases, can be treated. The earlier that treatment can begin, the more effective it is. Depression is usually treated with medications, psychotherapy, or a combination of the two.

Treatment is usually covered by private insurance and Medicare. Also, some community mental health centers may offer treatment based on a person’s ability to pay.

Equally important is to remember to care for your own mental health. You must care first for YOU so that you can even begin to show up well for the people you love in your family circle.

Can I just say, “Good work!” to you? Here you are loving the older adults in your family circles, not only through a pandemic, but through the bumps and turns in your own life. Through it, you are paying thoughtful attention, caring and advocating well. 

This is dedicated to my Uncle Howard, whose huge heart matched his huge smile.

If you or someone you care about is in crisis, please seek help immediately.

• Call 911
• Visit a nearby emergency department or your health care provider’s office
• Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889) to talk to a trained counselor
• Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.
• Also visit the online treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.

A heart-forward Mother’s Day

It’s my day.
It’s my own mother’s day. 
It’s my wife’s day.
It’s my partner’s day. 
It’s my grandmother’s day.
Basically, it can be a complex day. 

Emotions come with all those relationships, past and present. It’s easy to get stuck in those complex emotions. 

Wade through the emotion and bring the honor.

Our vision at Ways & Wane is to bring honor and respect to older adults. 

Which of these ideas inspires your perspective for Sunday, May 8th? 

1. Acknowledge the emotion—the joy, the grief, the regret, the love.
2. Know that you cannot change the past, you can only control how you show up in the present.
3. Remember that it’s possible that you may not get a second chance to do this.
4. Make a plan for the day ahead of time so you can be purposeful. 
5. Keep your expectations low and your heart big. 

We also have some sweet ideas for you, to acknowledge your own mom, whether she is still with you or not.

If your mom is with you, honor her in the manner she feels most loved. What is her  “love language”: words, gifts, time, service, touch? If you don’t know, ask her. Then do your best to give her a gift that matches her love language. 

If your mom is with you (but not entirely), try these ideas:

• Share happy memories about her from the past, reminding everyone who she is.
• Celebrate all her senses with her favorite music and scents. 
• Include the grandchildren – maybe they can do nails for you & grandma!
• Take an easy trip to a park or a beautiful drive. Just get out of the house.

If your mom has passed away, remember her in one of these ways:

• Try out a hobby she loved. Maybe doing so will provide new insight into her.
• Make a donation in her honor.
• Frame her handwriting (maybe it’s a recipe card or a note).
• Celebrate another mother in your life.

Whatever the day looks like for you, may you honor and love well!