The Critical Incident – Are you Prepared?

Most of us who have aging parents go about our daily lives without much thought about what our parents might need if they suddenly became incapacitated or severely ill. Our parents are relatively healthy and self-sufficient, but as they continue to age the likelihood that a critical incident will create a sudden need for us to intervene increases. At HelpWithMyParents.com we think of a critical incident as any event that rapidly changes the circumstances of an older adult, or couple, requiring rapid intervention by family or other concerned persons. Some common critical incidents include: a fall that results in significant injury, a death that exposes significant vulnerabilities in the surviving spouse, the onset of an acute illness (especially if it leads to a delirium). The critical incident may also result from an unexpected reaction to an elective surgery.

When these critical incidents occur, the need for action on the part of the adult children, and other caregivers, is often immediate and significant. The time and resource demands placed on loved ones can be very disruptive to their daily lives leaving them feeling overwhelmed. HelpWithMyParents.com was started as a response to the unmet need for a place that the adult children of aging parents could go to get all of their needs met when they are called to action.


There are several things that can be done to mitigate the impact of these critical incidents before they occur. The first thing is to make sure that there is a current set of advance directives. Beyond advance directives, it is also helpful to have a plan for who in the family (and non-family support system) will take on specific responsibilities. This type of planning may seem like a low priority when everything is going well, but a plan can be put together fairly quickly and the benefits down the road are significant for all involved.


If you would like to put together a plan to prepare for a critical incident but feel like you need help to do so contact us at helpformyparents.com and we will assist you.

When Good Parents Make Bad Decisions

When you see your aging parent making decisions that you disagree with how do you decide if, when and how to intervene? I’ve encountered this question many times and in a wide variety of situations. I have seen children struggle with how to confront a parent who has demonstrated that he should no longer be driving. I have seen children struggle with a parent who is living in a nursing home and has started a new romantic relationship (that may include sexual contact). There are also the many situations in which seniors are enticed to part with their money (including their home equity through a reverse mortgage).

As we observe our parents making decisions that we don’t agree with we may be tempted, or feel obligated, to get involved. I would argue that in some situations we do have an obligation to our parents and, sometimes to society at large, to get involved. For example, if a parent has dementia that interferes with his decision making, his reaction time, or other faculties that are required for driving, we have an obligation to help prevent him from continuing to drive. However, in other situations it may best to do nothing.

Before getting involved in your parent’s decision making, it may be useful to ask yourself some questions. The first question I would suggest asking is “what is my motivation for getting involved?” If you can truly say to yourself that you have your parent’s, and society’s best interests in mind then you are in a good place to start thinking about getting involved. However, because most of us are good at rationalizing our decisions to ourselves, it may be useful to explain to someone else what you think you should do and why. If you find yourself fumbling over a weak argument or if the person looks askance at you, then you may want to rethink your decision.

Once you are pretty sure your intentions are good, the next question might be “does my parent have a condition that is known to impair decision making abilities?” Some of these conditions, like Alzheimer’s disease, have a permanent and progressive effect on decision making abilities. While others, including delirium, may only temporarily impact decision making. The presence of these conditions, although significant, is sometimes not enough by itself to obviate a person’s ability to make a decision. I have seen situations in residential settings where people with moderate dementia experience an increase in their quality of life through a relationship with another resident that leaves their children shaking their heads. However, I have also seen family members move a person to different facility to get them out of such a relationship.
The next question I would suggest asking is “what are the consequences of intervening versus doing nothing?” Even if the decision made by your parent appears to you as an adult child to be a bad one, ask yourself “what is the harm that will come if I do nothing?” You might also consider the question “what consequences will the decision have on my parent’s life?” It is of course important to think of both the short and long-term when asking these questions.

Consider this example: A woman in her early seventies is talking about taking out a reverse mortgage so she can travel the world with a new companion. For her adult children there is a lot to consider. After they have established that their own motives are “pure” they next consider the conditions that may impact their mother’s decision making ability. Let’s suppose the doctor reports that she has mild dementia, probably Alzheimer’s disease. According to a neuropsychological evaluation, she is believed to have some cognitive impairment, but she can still demonstrate the ability to consider the consequences of her decisions, at least as posed to her in the abstract. The questions that she has a harder time answering involve what happens to her if she lives longer than the money from the reverse mortgage lasts. When it is suggested to her (by the neuropsychologist) that she will likely have to live in a subsidized apartment or, if her health does not hold, go into a nursing home under Medicaid, she does not appear willing, or able, to appreciate the significance of this possibility.

This example illustrates some of the complicated factors that should be considered by adult children as they think about trying to influence, or take over, their aging parent’s decision making.

It is not my intention that this post be a comprehensive treatment of the topic, but only to provide some questions to think about as this very sensitive topic is broached.

If you decide to intervene after diligently considering all other options, the next question is how to go about doing so. In the next few days I will post some ideas on how to go about trying to influence your parent’s decision making, while preserving your relationship with them.

Could it be Delirium?

I can’t tell you how many unfortunate situations I have seen that could have been avoided if someone had asked “could it be delirium?” I have seen people committed to psychiatric facilities where they were treated for psychosis and I have seen people assigned long-term guardians because of what was a temporary alteration in consciousness caused by an episode of delirium. If you have ever seen people during a delirium it is not hard to understand how this can happen – they are often highly agitated, they may make outlandish statements with no basis in reality and they may even hallucinate. The symptoms may also fluctuate over a relatively short period of time which can add to the confusion. The problem is that a delirium is often a short-term situation resulting from a reversible condition like an infection, dehydration or an unintended response to a medication. There are three basic clues to look for if you think the person is suffering from delirium.

The first clue that it might be delirium is that the onset of the symptoms is fairly rapid. If a person over 55 years with no history of hallucinations starts talking about seeing bugs crawling on the wall it is appropriate to ask “could this be delirium?”

The second clue that it might be a delirium is that the person is not oriented to person, place and/or time – They can’t they tell you basic things about who they are, where they are or they can’t tell you the day, the month and/or the year? During a delirium a person will also have difficulty focusing their attention for sustained periods and will often have to have questions repeated for them – if they can respond at all.

The third clue that it might be delirium is the presence of significant changes in the person’s life. For example, recent onset of physical symptoms (especially those consistent with a Urinary Tract Infection), changes in medications, recent surgeries (deliriums are common after anesthesia), or changes in eating, drinking or sleeping patterns?

It is also important to understand that delirium is not mutually exclusive with any other condition – i.e. a person with any other condition (e.g., dementia, bipolar illness) can still experience delirium. A person with dementia who develops a delirium as the result of a Urinary Tract Infection (UTI) may be overlooked because the symptoms are assumed to be part of the progression of the dementia. The key is the timeframe for the onset of the worsening of symptoms. If there is any question, consult a physician – a test for a UTI is simple and it is usually treatable.

It is not wise, or helpful, to try to diagnose delirium and its primary cause on your own. The diagnosis of delirium is tricky, even for doctors, and that is why so many get overlooked. If the clues mentioned above are present, it is advisable to get the person to a doctor as soon as possible and to ask the doctor “could this be delirium?”