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5 Dec. 1997 - 8 Jan. 1998

Vol. I, No. 14

Feature Article

Making Life Work

The parent trap

By Cliff Bernard

An only child with a 90-year-old mother asks how she can help her mother cope with the death of her friends.

An adult child in a family of five still lives with her parents and wants to know about the problems she might face as her parents grow weaker.

A daughter worries that her parents are both failing. The parents are distressed by the changes they are experiencing and by their diminishing independence They are resisting their daughter's efforts to help them.

These three children with elderly parents are University employees taking advantage of the expertise of Elizabeth Markson, associate director of the BU Gerontology Center and professor of sociomedical sciences and community medicine. Markson addressed a recent brown-bag luncheon workshop, part of the Making Life Work series.

Markson told the participants that children need to understand that although in some ways the roles of parent and child reverse as parents gets older, in other ways the roles are immutable. The mother can never forget that she once tucked her little girl into bed, brushed her hair, and packed her lunches. Appreciating this, she said, might help us to understand the irascibility and stubbornness of ailing parents who seem to resent our efforts to help them.

Nor should we be overly concerned about problems like memory loss. Markson pointed out that some changes are inevitable and normal.

"As we grow older, it becomes harder to retrieve information," said Markson. "This is what we call the 'tip-of-the-tongue' phenomenon."

Markson likened memory retrieval to a computer's hard drive. "The more information stored on the hard drive, the longer the access time. This doesn't mean the information is lost to us. Later, when we are relaxed &emdash; in bed perhaps &emdash; the memory will come back to us."

Behavioral problems, Markson said, do not necessarily indicate permanent physical problems. What may seem to be alarming personality changes in our elders may just be a long-repressed expression of their true character. "As we grow older," she said, "we become more like we always were. We may get depressed, we may get paranoid, but basic personality structures don't change. If we were entitled and needy as children, we get more so when old."

And when our elders express their personalities in ways we find intolerable, what should we do? "Develop self-control," answered Markson, "and failing that, walk away."

When our elders show alarming symptoms such as severe memory loss, confusion, or inability to recognize familiar things, the first thing we fear is Alzheimer's disease. According to Markson, these symptoms may be caused by more benign, and usually reversible, factors. (See sidebar.)

Causes of reversible memory loss and confusion:

  • Vitamin B deficiency
  • Toxic confusion caused by underlying infection, the physical symptoms of which may not immediately appear
  • Any severe illness
  • Sensory deprivation, such as might occur in the sterile environment of an intensive care ward
  • Depression
  • Drug interactions
  • Malnutrition

"Despite all the media attention," Markson said, "only 4 percent of the population has severe symptoms of Alzheimer's or similar disorders. It's easy to think it's inevitable. It isn't."

Markson said that the medical community doesn't fully understand Alzheimer's. "There are many theories," she said, "but we don't really know. Diagnosis is a rule-out procedure."

"If your elder relative shows signs of forgetfulness, irascibility, moodiness, or obstinacy," Markson advised, "you should not assume the worst. The first step is to get him a careful medical workup. There are a number of common medical problems caused by drug interaction."

Even drugs as seemingly benign as over-the-counter cold tablets, according to Markson, can cause alarming symptoms when combined with other prescription and nonprescription drugs. Markson cited the example of a 92-year-old-man who showed symptoms of advanced dementia shortly after he began taking a common brand of cold tablets. As soon as he stopped taking the tablets, his symptoms disappeared.

"Unless you have a doctor who really understands elder care," said Markson, "the medical workup should be done by a geriatrician." She stressed that when you and the patient visit the doctor, it is important to take along all the older person's medicines.

Another possible cause of Alzheimer's-like symptoms, according to Markson, is depression. "Depression is common among elders," she said. "The condition is treatable and the symptoms reversible."

Markson said that most of us are overly protective of our elderly relatives. We are naturally concerned when behavioral changes or memory loss occur. We want to know what to do and when to intervene. In our concern, we may draw unnecessarily alarming conclusions based on behaviors that disturb us.

"You should look at what actually happens," Markson said, "and separate that from what you're worrying about."

In the next workshop in the Making Life Work series, Monday, December 8, in the Office of Personnel, Karen Freund will address the health challenges of midlife for women. Freund is associate professor of medicine at the Boston University School of Medicine and director of the Women's Health Unit and Breast Health Center at the Boston Medical Center. The series is sponsored by the Faculty/Staff Assistance Program, directed by Bonnie Teitleman, and the Office of Family Resources and Boston University Children's Center, directed by Nikki Sibley.