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Nextavenue.org: By Laura Mosqueda
Recently I saw an 84-year-old woman whom we diagnosed, at the Keck School of Medicine, with moderately
advanced Alzheimer’s disease. “I would love to have my mother move into my home,” my patient’s daughter said
upon hearing the diagnosis. Her mother was no longer safe to be living alone.
I have heard this said by many well-meaning adult children wanting to care for their aging parents. While this is a
lovely reaction to hear, I have learned that there are questions to ask of both a practical and emotional nature in order
to help my patients and families make a decision that is best for them.
In this particular case, we organized a family conference to discuss the options. Often we have months, if not years,
to plan for an eventual change in a living situation, but this was not one of those times.
Once I sat down with the entire family, I learned that the mother and daughter had a history of a contentious
relationship. It was the 20-year-old granddaughter who pointed out that her mother and grandmother continue to have
bad feelings towards each other over a private family incident that occurred decades before. These feelings have
remained close to the surface and reappear with minimal prodding.
This approach of “person-centered care” means the patient’s values and preferences are elicited and used to guide all
aspects of care.
Clearly, caregiving for her mother who was now exhibiting problematic behavior was going to be difficult for the
daughter to do without losing control of her emotions. The risk of abuse was evident and we recommended against a
shared living arrangement.
In this case, we were able to find an alternative living situation that was satisfactory for all involved and the daughter
could continue to visit regularly without taking on the role of daily caregiver. It is possible that we prevented the
evolution of an abusive situation.
Unfortunately, not every family has alternatives. This may be due to lack of finances, lack of good quality options or
challenging family dynamics.
Our society has a looming crisis: The percentage of the population older than 85 is growing at an exponential rate and
we cannot meet their needs with the small number of adequately trained professionals.
Even those in the health professions have much to learn in the area of geriatrics, and it is my goal to help usher in a
new generation of health professionals, including physicians, physician assistants, nurses, pharmacists, social
workers and others who will know how to provide excellent care to older adults and understand that, in a sense, the
family becomes our patient as well.
Instead of thinking of our patients as a collection of ailing body parts, we must embrace a more holistic philosophy of
care. In a team-based care model, providers from many disciplines work together to create a comprehensive health
care strategy that is based on the patient’s goals and wishes.
This approach of “person-centered care” means that the patient’s values and preferences are elicited and then used to
guide all aspects of his or her health care. It is a dynamic process, since someone’s goals may develop and a
treatment that may support that person’s values at one period of time may no longer do so at a later point.
For example, a 75-year-old person with brain cancer may want a trial of aggressive treatment for a while and then
decide the treatment is no longer warranted. Utilizing this approach empowers the patient to be the team leader and
helps the health care team tailor a plan that is congruent with the patient’s values and preferences.
Asking tough questions, wholeheartedly listening to the answers and involving families in a thoughtful way are
hallmarks of person-centered care that will help avoid abusive situations, as well as promote better quality of life.
Teaching the next generation of health care professionals these principles and techniques, along with a move toward
interdisciplinary education at early stages in our careers, should help us do a better job in caring for those who cared
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