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.

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?”

Combating Helplessness – One Weed at a Time

I recently read the chapter on weeds in Michael Pollan’s book Second Nature and it seemed to me that there are some parallels between weeds and hopelessness, especially for those who live in the country’s nursing homes. I have been counseling nursing home residents for the past 12 years and in that time I have worked with people who have had such a profound sense of hopelessness that it seemed almost tangible. When I first started working with people in this state I would often leave the room feeling exhausted and like some of my own hope had been drained from me.

These experiences got me thinking a lot about hope and about why it is important to keep the flame of hope lit – even if it is just the pilot light. It seems to me that hope is what keeps us going even when we can see no ostensible reason to do so. So we must be vigilant and combat threats as they arise.

This is where the analogy to weeds comes in – if we have one or two weeds in our garden they are easy to ignore and they may even blend in with the other plants so as to be unnoticeable. However, as more weeds appear, they can no longer be ignored and if not dealt with they can easily take control of the garden. So it is with hopelessness – with losses and disappointments comes threats to our hope for the future. For many of us this is a normal part of life - we experience some feelings of hopelessness which we may ignore expecting that they will resolve without much special effort from us. However, if the situational factors support the spread of hopelessness and we continue to do nothing the insidious effect of hopelessness can take over our lives.

The sooner you begin to tackle the weed problem the better the chances of success, so it is with hopelessness. Nevertheless, it is always possible to make progress in the fight, and even when all seems lost improvement can be made. Most gardeners have their preferred tools for tackling a job and psychologists are no different. The choice of tools has a lot to do with how they have worked in the past and how comfortable we using them.

One of the most effective tools I have found in combating hopelessness is to change the subject. How I go out doing this varies based on the person I am working with and my relationship with them. Sometimes I will explain what tool I am using and what I expect it to do, and at other times I will subtly introduce the tool with no mention of its presence.

In nursing homes it is common to hear complaints about everything from family not visiting to the food that is served. I find that these complaints, while usually justified, serve to nourish hopelessness, so I will work to refocus the person to more positive themes. One of my favorite positive themes is gratitude and I will ask the person to tell me about the things that they are grateful for. I have found most people responsive to this intervention, but I have had a few people say that they could not think of anything that they were grateful for. When this happens I encourage them to think about things from the past that they are grateful for and I have not yet come across a person who has failed to find something they are grateful for. The wonderful thing about gratitude is that it is incompatible with hopelessness. You cannot in the same moment feel gratitude and hopelessness, and so in that moment it provides a person with respite and nourishes the seeds of hope (the stuff we want growing in our garden).

There are other great tools to fight hopelessness and so if, like me, you encounter hopelessness in your interactions with those you care for weed assiduously and do not let hope die.

Is My Dad Depressed?

The question of depression comes up frequently in my conversations with the children of aging parents – especially when there has been a recent significant loss. In answering this question it is important that we understand what depression is, how it is manifested differently among seniors and what are the things that mimic, or look like depression.

I think of depression as an impairment of mood that usually results in subjective distress and interferes with social and/or occupational functioning. It can result from internal factors or a response to external situations. Depression is not a normal part of the aging process. It occurs in 5-9% of women and 2-3% of men in the population at large and in about 5% of healthy elderly people. The prevalence of depression increases dramatically among those who are chronically ill and those living in residential care settings.

The symptoms of depression include: depressed mood (feelings of sadness sometimes accompanied by tearfulness), anhedonia (loss of interest in things that used to be enjoyable), weight loss/gain, insomnia/hypersomnia, fatigue, feelings of worthlessness and/or hopelessness, excessive guilt, problems with attention and decision making, and when severe can include persistent thoughts about death and suicidal ideation and/or intent.

Among seniors anhedonia is usually the primary symptom and depressed mood (the subjective feeling of being depressed) may be denied. The older depressed person is more likely to present with somatic symptoms (physical complaints for which there is no identified illness, or that are in excess of what would be expected for an illness). Cognitive symptoms may also be prominent particularly short-term memory loss and mental slowing.

If you think that your aging loved one may be depressed ask yourself – has there been a notable change in their involvement in the things that used to be enjoyable to them? Are they sleeping and eating well? Does there appear to have been a significant change in their mental capacity or short-term memory? If you answered yes to any of these questions then there your loved one should be evaluated for depression. I recommend starting the evaluation process with a physician who specializes in the treatment of older adults because he/she will know the medical conditions to assess that may be responsible for the symptoms. There are many systemic, neurologic and iatrogenic (caused by treatments – for example medication side-effects) that can cause or exacerbate depressive symptoms.

If the physician believes the person is depressed she/he can prescribe various treatments including counseling and/or medications. Both counseling and the newer anti-depressant medications have been found to be effective in the treatment of depression in older adults.

To Blog or Not to Blog

To Blog or not to Blog – that was my question. At 47 (I know - where have the years gone – it seems like only yesterday I was 29) I am among the last of the boomers and, like many of my peers, have an uneasy relationship with advancing technologies. However, the convenience and the expediency of the web and mobile devices have largely won me over, and while I am not ready to tweet (still not sure what that means) I am finally ready to Blog.

To Blog then - allow me to introduce myself - I am Tony Morrison a psychologist who specializes in working with seniors and the founder of http://www.helpwithmyparents.com/ . While my interests are largely around issues of aging and caring for older adults, I will be Blogging about a wide range of topics and events. I plan to Blog on the areas where I have experience including: depression, anxiety, the effect of aging on other mental health conditions, neuropsychological assessment as a tool for the diagnosis of dementia, the management of difficult behaviors and improving the quality of life for older adults and their families. I will also Blog about my observations of the senior care industry – where I see strengths and where I see problems. I will plan to comment on what I read in the news and on other Blogs. If I can summon the nerve, I may even Blog about my own experience of aging and, with children in grade school and parents in their 70’s, about being a part of the Sandwich Generation. I hope that some of you will join me, for at least part of this journey, and that together we learn how to better care for our aging family members and friends.