Our parents will become our children

What Are We Going to Do with Dad by Jerald Winakur in the Washington Post.  A sobering piece.

My only sibling, an architect, asks me every time we are together....."What are we going to do with Dad?" As if there must be a definitive answer, some fix -- say, putting a grab bar in the bathroom or increasing the width of the doorways.

He asks me this question not just out of fear and frustration, but because he figures that his older brother, the physician, should know the answer. I do not know the answer. I do not have a pat solution for my father or yours -- neither as a son, a man past middle age with grown children of his own, nor as a specialist in geriatrics who is also a credentialed long-term care medical director.

In the United States today there are 35 million geriatric patients -- defined as over the age of 65. Of these, 4.5 million are older than 85, now characterized as the "old old." Yet the American Medical Directors Association, which credentials physicians in long-term care, has certified only 1,900 such doctors in the entire country; only 2 percent of physicians in training say they want to go into geriatric care. As we baby boomers go about our lives, frozen into our routines of work and family responsibilities, a vast inland sea of elders is building. By 2020 there will be an estimated 53 million Americans older than 65, 6.5 million of whom will be "old old." Many of you will be among them. America will be inundated with old folks, each with a unique set of circumstances, medical and financial.
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It's rarely talked about, but hospitalizations are the most dangerous times for the elderly. Even if they have never manifested any signs of disorientation, it is in the hospital -- in a strange and threatening environment, under the influence of anesthetics, pain pills, anti-emetics and soporifics -- that many elderly will meet their match. Add to this the treatment mishaps (caused by the "normally expected" side effects and complications of standard medical procedures) and the human errors (mistakes in drug dosing, the right medication given to the wrong patient), now multiplying in our modern hospitals like germs in a Petri dish, and it is almost a miracle that any elderly patient gets out relatively unscathed.

Every night, I slept in the reclining chair by my father's bed. I got up when he did; ran interference with bedrails, side tables and IV poles; guarded his every move to the bathroom; looked at every medication and every fluid-filled bag plugged into his arm. Yet each day, my father descended deeper into paranoid confusion. He was restless, and intermittently unsure of who I was. At first I could calm him with my voice, talking about the old days, reminding him of our fishing trips on the Chesapeake Bay when I was young. Then he needed the physical reassurance of my hand on his arm or shoulder at all times. Finally, so that he could get some rest, I got in the bed and held him, comforting him as he once -- in a long-ago life -- did me.
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At first, my mother didn't believe that my father was demented. Most of us do not recognize the reduction in the mental capacities of our spouses or parents unless something unexpected happens. My mother continued to see his stubbornness and withdrawal as purposeful acts of belligerence against her -- until the day she realized he could no longer figure out how to unlock the front door by himself..

From my years as a geriatrician and now as the son of an "old old" man, I recognize that there is one inescapable truth: Our parents will become our children if they live long enough. Perhaps if we looked on our elderly in this way, we would be kinder to them.