Talking to Aging Parents About End-of-Life Care

Knowing how to talk to aging parents about end-of-life care can help families make important medical decisions with less stress and more confidence. Starting the conversation early gives everyone a chance to understand wishes, plan ahead and avoid making difficult choices in a crisis.

Topics To Cover When Talking to Aging Parents About End-of-Life Care

Knowing medical history: If an elderly parent falls ill and becomes confused or nonresponsive, doctors will turn to family members for information to guide treatment. Having the facts helps ensure the most appropriate care. It's also important for you to know of any diseases that run in your family to guide your own screening and preventive care.

Designating a health care proxy: If someone is so ill that they can't participate in their own medical care, doctors turn to their health care proxy, someone who is officially designated to make care decisions on the ill person's behalf. It's important for all of us as caregivers, elderly or not, to have a health care proxy who can make health care decisions on our behalf if we're unable to do so on our own.

Having an advanced directive: This document spells out someone's wishes about end-of-life care. This includes if they want CPR resuscitation, to have a feeding tube, to be put on a breathing machine or dialysis, particularly if they're not able to voice their wishes themselves. These 'what-if' scenarios may be difficult to broach with a loved one, but it's necessary to understand what they want before you're faced with a crisis.

If your loved one is having memory issues: In this situation, the best first step is for your loved one to have what's called a neuropsychiatric evaluation. This evaluation, performed by a psychologist or psychiatrist, assesses a person's cognitive abilities. It's particularly helpful when your loved one denies having memory issues because it provides objective results to justify your concerns and get help.

When it's no longer safe for an elderly parent to drive: This is a tough issue because giving up driving has a huge impact on someone's independence. As doctors, we're obligated to notify the Department of Motor Vehicles (DMV) if we know it's not safe for a patient to drive. The DMV will then require them to take a driving test, and, if appropriate, revoke their license. If you have concerns about your loved one driving, talk to their doctor. This way, it's not up to you and the family, and the DMV can be the 'bad guy.'

How To Start the Conversation and Get Support

I understand that older parents often resist taking advice from their children, even when those children are adults themselves. That's why I often advise adult children to enlist the aid of their parent's doctor, who usually has more authority and sway. You can go to a doctor's appointment with your parent, write a note or email the doctor before they see your parent, or make a separate appointment to talk to the doctor without your parent to express your concerns. 

Finally, I encourage anyone who is struggling with how to have a conversation with a loved one about end-of-life care to check out The Conversation Project, a public engagement initiative with a simple and transformative goal — to have every person's wish for end-of-life care expressed and respected. On their website, you'll find starter kit, a useful tool to help you have the conversation with a family member, friend, or other loved one about your, or their, wishes regarding end-of-life care.

Guest Blogger:  Kimberly Ebb, MD, Hospice and Palliative Care, UMass Memorial Health