It is human nature to avoid difficult discussions, especially when they involve the health and future of our loved ones. However, delaying these talks can inadvertently put your family at risk. Procrastination often leads to making high-stakes decisions during a crisis, when time is short and emotions run high, rather than in a calm environment.
Engaging with aging parents about their future is a profound way to show love and respect. While every family dynamic is different, reaching a consensus on essential aging issues is vital. Asking the right questions now ensures you can honor their wishes before an emergency limits your options.
This highly insightful article by Simar Bajaj in the New York Times highlights this urgency. Bajaj identifies five critical questions that adult children should ask their parents. While most are practical, one in particular offers a unique perspective on quality of life that every family should consider.
(Please note that a subscription may be required to access the New York Times article online.)
Adult Children Are Often Unaware of a Parent’s Health Changes
“Americans are living longer, often juggling multiple chronic conditions,” writes Bajaj, but this can often go unnoticed by adult children until a fall, ambulance ride, or hospital stay reveals what’s going on with their parents’ health.
Dr. Louise Aronson, a University of California geriatrician and author, says that this lack of communication hurts everyone involved: children are at a loss, siblings clash, and parents feel like their desires are not heard. Emergency situations are already challenging enough without misunderstandings, conflict, and the stress of guessing and guilt adding to the mix.
Bajaj and the experts he consulted offer the following topics to broach with your aging parents before a crisis. The conversations may be difficult, but experts agree: they prevent more problems than they create.
As Dr. Aronson says: “It feels like you’re putting them through something hard, but it’s avoiding something that is far, far worse.”
Establishing a Baseline for Daily Functioning
Bajaj writes, “In an emergency, doctors only have a snapshot of your parent’s health, so getting a sense of daily functioning can help them diagnose and treat your parents effectively.”
First step: ask your parents about their routines. Then, suggests Dr. Sabrina Taldone, you can ease into more specific questions regarding their mobility and cognition.
Because these topics are often sensitive, ask for permission and explain why you want to know. Dr. Taldone, who is the chief of general internal medicine at University of Miami Health, suggests phrasing it this way: I’m asking “because I care about you and want to make sure I can support you in case of an emergency.”
Using Empathy to Approach Sensitive Topics
With certain difficult topics, talking around the issue can be useful, says Bajaj: “Instead of directly asking if they’ve fallen or are having memory problems, try asking if there are any situations they avoid (like stairs, long walks or driving at night) or if there’s anything that used to feel easy that now takes more effort (like managing bills or keeping track of appointments).”
It’s also useful to revisit these questions occasionally, Dr. Taldone tells us, especially if you don’t live nearby or aren’t around to witness gradual changes in health or behavior. Once a year is ideal, or after any major health event, like a hospitalization or surgery.
Organizing and Documenting Medical History
In a crisis, you would much rather have too much information at your fingertips than too little.
Dr. Namita Seth Mohta, an assistant professor of medicine at Harvard Medical School, suggests starting by making a list of medications your parents are taking, as well as their physicians’ names and contact information. If possible, add a note about any supplements and which of their medications, if any, your parent might not be taking as regularly as they should (because of cost, side effects, or even forgetfulness).
If your parents prefer not to share their medication list with you, you can also jot down their pharmacy name and number. In an emergency, a doctor can use this information to call and find out which prescriptions have been picked up.
This information can tell a doctor what underlying condition your parent might have, whether a drug might be contributing to the problem, and which medications to continue or avoid in the hospital, says Dr. Mohta.
“You can keep all of this information as a file or photo on your phone, but it’s also worth tucking a copy in your wallet in case your battery dies,” Bajaj suggests.
Identifying Core Values and Life Goals
Aside from the more pragmatic information, experts say that getting a grasp of your parents’ individual preferences is key as well.
“During a health crisis, there are countless choices that parents or adult children might need to make,” Bajaj writes. “While you can’t anticipate every single one, discussing goals and values in advance can help parents feel more prepared for an emergency and keep adult children on the same page.”
Dr. Mohta adds, “It’s not just about what you want at the end of your life, it’s about what you want your life to be like” as you age.
Defining Preferences for Long-Term Care
What kind of topics should you ask about? Bajaj suggests getting a grasp on what brings your parents joy, what makes them feel fulfilled, what worries them most, and what their priorities are for medical treatment. “For example,” he writes, “a parent might say that they want to maximize their time spent at home, that they want to do everything possible to survive or that they don’t want to be kept alive by machines in the intensive care unit.”
Dr. Mohta agrees: “In an emergency, you’re rushing through the decisions — it’s emotional. This is a chance to reflect ahead of time.”
This recent Blog article may also be a helpful reference.
Family Discussions as a Group Activity
If you don’t want your parents to feel singled out, says Dr. Mohta, you could treat this conversation as a group activity for a family gathering, asking everyone to share what matters to them. This also gives your parents time to prepare an answer and feels less like an ambush.
(The New York Times article includes this helpful link to a workbook called What Matters to Me, published by the Conversation Project.)
Assessing Safety and Housing Needs
Dr. Aronson notes that a major reason people end up hospitalized or in care facilities is that there is a “mismatch” between their daily abilities and the home they live in.
“So, talk to your parents about making changes around the house to extend their independence,” Bajaj suggests. “For example, as vision and balance worsen, it might help to remove loose rugs and clutter — and to install better lighting, a shower chair and handrails. A fall can lead to a hospitalization, a stint in rehab and even a move to a nursing home, so frame these adjustments as a way to help your parents stay in control of their daily lives.”
Exploring Long-Term Housing Options
This conversation is the ideal lead-in to discussing where your parents see themselves living long-term, says Dr. Aronson. Remember not to frame this as a nudge to move, but as a way to understand their preferences: Are they open to downsizing? Would they ever consider bringing in care helpers, or moving in with family? Do they have any interest in assisted living?
“Having these conversations early can help maximize your parents’ options, since facility wait-lists can be long and some places can’t accommodate more serious illness,” Bajaj adds.
Dr. Aronson asks us to remember that this could end up being an ongoing negotiation, especially if adult children prioritize safety and parents prioritize independence.
“The idea is to find something that offers a little bit of each,” she says.
Choosing a Family Decision-Maker
Sometimes, despite it all, a parent is too sick to speak for themselves and the loved ones have to step in, says Dr. Aronson. How do you make sure that the parent’s wishes don’t get lost, especially if the family isn’t fully aligned?
Dr. Taldone tells us that, bare minimum, this is why adult children should explicitly ask their parents to elect who will be in charge of medical decision-making. Formalizing this with a living will and health care proxy form will make this crystal clear to anyone who needs to know, especially in the chaos of an emergency situation.
Identifying the Best Representative
It’s vital to remember that this is not about picking a favorite family member, says Dr. Taldone. It’s about choosing the person best positioned to carry out the responsibility. She suggests selecting someone who lives nearby, is closely involved, understands the parents’ desires, and can carry out those desires even when there’s pushback from other family members. This could be an adult child, the parent’s partner, close friend, or even their sibling.
“Oftentimes, a family makes the decisions together, but there’s one person at the end of the day who’s responsible,” Dr. Taldone says.
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