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In grief circles, the holidays are most often the hardest to face.  With people no longer there, how can we celebrate?  Holidays can also be a time of emotional stress for families as parents age.  The NYT blog New Old Age discusses a common occurrence, the children come home to find the aging parents frailer and needing of more help than they realize.  The importance of a piece like this is to prepare people for the additional reality about the challenges during the holidays.  While many are “prepared” for the experiences of grief during the holidays, especially considering the amount of material written on the subject, many cannot say the same when parents are still alive. When parents are still alive, we don’t consider the reality of their getting old and dying.  So when confronting the realities of life, people get frightened and act hastily.  If we plan and talk, something I advocate in lectures and in writing, we can begin to avoid the holiday scrambles.  Would it not be better to prepare gradually and actually enjoy the visit? 

The Holiday Reality Check


I spoke to a couple of veteran geriatric care managers in the Boston area earlier this week. They were braced for ringing phones today, their own sort of Black Friday surge.

“I get these S.O.S. calls” from adult children visiting family at Thanksgiving, said Emily Saltz, who operates a practice called Elder Resources in Newton, Mass. “They’ve been talking with their parents all year, being told everything is fine. Then they get there, and it’s not fine. And the kids freak out.”

Suzanne Modigliani, who practices in Brookline, Mass., expects to hear the same stories. “The kids come home, they see rotting food in the refrigerator, clothes not washed, bills not paid,” she told me. “And subtler things, like increased frailties. They’re concerned, they sometimes dash around trying to do things — but then they have to leave.”

This jolt is more likely to hit adult children who are distant, who can’t regularly look in on aging family members. They’ve been reassured for months by parents who are trying not to burden them, or who don’t want to confront their own diminished capabilities, or who may not be fully aware themselves that they’re losing ground.

Then their children arrive, look in the medicine cabinet or get into a car a parent is driving and see that all is not well.

Some organizations urge families to use these holiday gatherings to raise the issue of advance directives, giving parents a chance to express their preferences for future care decisions before a real crisis hits. It’s a fine idea to initiate these conversations in person, when older relatives can hear and see their children and when siblings may also be on the scene.

The evidence suggests that it doesn’t happen terribly often (perhaps it seems insufficiently celebratory?) given that most people, even very old and sick people, don’t have advance directives. But, as Ms. Saltz urged, “even if Mom sends you packing, give it a try.” These are seldom one-shot conversations anyway.

(On a less charged subject, The Atlantic magazine has suggested that today should be Update Your Parents’ Browser Day, another idea I can endorse.)

But say we accept that a lot of families are going to duck this dialogue for now. The holiday reality check nevertheless can lead to some pragmatic steps that can help older people maintain their independence, at least for a while.

“It could be a small change,” Ms. Modigliani pointed out: engaging a bill-paying service or a chore service, a transportation program, a few hours a week of a home helper to handle laundry and shopping and help with bathing. “Small things can produce large differences,” Ms. Modigliani said.

“A lot of times the fix is not so traumatic,” Ms. Saltz agreed. “Not everybody has to be uprooted. If transportation is the issue, what’s the least we can do to protect their ability to function?”

Trying to figure out even small fixes can be difficult from a distance. That’s why geriatric care managers — who can assess the situation, come up with a plan and supervise its execution — will be getting phone calls, at least from families able to pay for professional guidance. Others will be calling area agencies on aging, centers for independent living, or aging and disability resource centers to see what help is available.

I sometimes think this unwelcome surprise is related to increasing life spans. Our older relatives keep chugging along, past 70 and past 75 and then past 80; we can be forgiven for thinking that with a few meds and a hearing aid, they will function well forever. But most older Americans do need some sort of hands-on assistance eventually, and the holidays are often when their families recognize that “eventually” has arrived.