Caregiving for older adults

A caregiver can be a family member, a partner or a friend of someone who needs help. These facts can help get a caregiver started.

The average person today can expect to live to about 80 years old, a number that will likely continue to rise. But with age comes new challenges, both physical and mental.

Often, a friend or family member is called in to help. Millions of Americans provide care for older spouses, parents, relatives and friends. It can be a daunting job — with a lot of learning on the fly. This guide can help make a roadmap for the years ahead.

In this article:

What happens to the aging body

Aging affects every system in the human body, and while some of those changes aren’t that serious, others are good to watch out for.

• Hearing loss is one early form of aging. Even when it is mild, it may contribute to feeling isolated. Hearing aids for mild to moderate hearing loss can now be purchased over the counter (OTC).
  
• Falls are a major risk. About a quarter of people aged 65 or older fall each year. Balance and coordination are undercut by loss of muscle, while osteoporosis can cause the bones to lose density and be more prone to break—particularly in the hip, spine and wrist. Ask a health care provider about treatment options that might help, such as medications or assisted walking devices, and consider grips and no-slip pads around the house. In addition, a MinuteClinic^® provider can provide treatment for osteoporosis.
• Heart disease is a leading cause of death in the United States for this age group. So it’s critical people get screened for heart conditions. This can reveal whether someone needs to monitor their blood pressure and watch for signs of heart attack and stroke.
• Toileting is a natural but awkward aspect of aging. Changes in the large intestine can cause constipation. People who suffer from constipation can make a few changes to help with relief: staying hydrated, eating a high-fiber diet and consulting with their health care provider about OTC high-fiber supplements and laxatives. The bladder also becomes less elastic in older age, and incontinence can arise from many causes. Adult briefs, protective undergarment guards or pads can provide some support. A health care provider can talk through other options, or visit a MinuteClinic location to discuss constipation and incontinence concerns.
• Depression symptoms are very common among older adults. Some estimates suggest about 32 percent of those over the age of 65 suffer from depression, and it can contribute to a decline in a person’s physical health. If a loved one shows significant signs of possible emotional distress — these include shifts in eating habits, mood or weight, and inattention to personal hygiene — consider talking to a mental health expert who specializes in treating older adults. A MinuteClinic licensed therapist can provide mental health support.

Aging in place: Making the home safer

Only about 40 percent of homes in the United States are considered ready for aging in place. That means the home, at a minimum, has a step-free entryway, a bedroom and full bathroom on the ground floor.

“Everybody wants to stay where they feel comfortable,” says Laura Gitlin, a caregiving expert, author and research sociologist at the College of Nursing and Health Professions at Drexel University. If staying home is the choice, she recommends a home safety assessment from an expert. It’s easy to miss little things with big impact, she says.

If the home has stairs, for instance, it should have secure handrails on both sides. In the bathroom, consider grab bars by the toilet and the bath, a walk-in shower with a built-in seat, and an elevated toilet seat. Living spaces should be clean and free of clutter, with throw rugs and furniture with sharp edges removed, and no-slip or no-skid mats placed on wood and tile floors.

Automatic switch-offs on the stove can help protect against kitchen fires. Food safety is another concern, says Gitlin. “As people age, their sense of smell diminishes, and vision may be poor, so there may be things that are out of date, moldy.”

Navigating the pharmacy 

Managing medications is a key part of being a caregiver. Some pharmacies, such as CVS Pharmacy®, allow people to link their pharmacy profile. When this happens, someone can see when prescriptions are ready, order refills and manage medications all in one place. 

Pharmacists offer a range of services that can help caregivers support their loved one’s health. These professionals can administer vaccines and can help answer questions on OTC medications and hearing aids. And of course, they fill prescriptions and consult on medications.

If the person being cared for takes many different medications, consider creating a schedule of each medication. It should contain the dosage, purpose, special instructions and a physical description of the pill. A caregiver can work with pharmacists to sync all prescriptions to a single pickup day. Save even more time by using pharmacy delivery services.

What to know about Medicare

Medicare is a federal program to help people aged 65 and older get health care. People can get help choosing a Medicare plan. 

Medicare has recently added to its support for family caregivers. Among new initiatives, doctors, clinical psychologists, nurse practitioners, physical therapists and other health care providers can now be paid to train family caregivers to do things like give injections, manage medications or change bandages.

For people over 65 years old who have a Medicare Advantage plan, they may have access to an OTC supplemental benefit. This allows them to redeem benefit dollars for OTC medications and other items (depending on their plan), including cough syrup, toothpaste, vitamins and more, at participating retailers.

What to ask during medical visits

If a caregiver is taking their charge on medical visits, it’s important to ask questions. What to ask will depend on what kinds of health challenges they have, but it’s always a good idea to ask two questions: “Are there any danger signs I should watch out for?” and, “What should I do in case of an emergency?”

Beyond that, the caregiver can keep a list of questions that they’ve worked to compile with their charge. Some examples include the following:

• Are there any activities to avoid?
• Are there specialists that should be consulted?
• How will the condition progress?
• What side effects might come from any medications?
• What symptoms should be expected?
• When to reach out for medical help?

Ask the doctor for written materials or a summary of what was discussed to take home. The caregiver may also need to access their charge’s health information later. Ideally, the charge can provide verbal permission to do this when they’re in the doctor’s office. In some cases, they may consider speaking to an attorney about whether getting medical power of attorney is appropriate. This is called medical power of attorney.

Lastly, make sure that preventive care is part of the conversation — and stay up to date on vaccines.

What to do in a crisis

A medical crisis is tough for both the caregiver and their loved one. A solid plan can help relieve some of the stress. Knowing what to look for, where to go and who to call should be homework before any crisis.

The caregiver can talk to their charge and family to discuss possible legal steps. For example, establishing medical power of attorney gives a caregiver the power to make medical decisions for their charge when they can no longer make these decisions themselves. That allows the caregiver to talk to nurses and doctors when their charge can’t.

“Having a copy of these as a caregiver is just critical,” says Gitlin. “You can show them on the spot.”

Medical records and organization

As a person’s health gets more complex, it’s helpful to keep good records. Create a list of all health care providers, their phone numbers and their role in care. It’s useful to keep medical records from the past year, especially if the person is seeing different specialists or health care providers.

It may also be helpful to seek legal advice to learn and understand the proper steps to take in specific situations.

Memory care

Problems with memory can also spring up. As people age, they may begin to forget familiar words and have a harder time multitasking. That can also make it more difficult for them to remember important parts of their daily routines — including taking medications. If this is a problem, pharmacies can set up easy-to-read, printable medication schedules to serve as reminders. This might be helpful in the earlier stages of memory loss.

For an increasing number of older Americans, mild memory loss will give way to dementia. In 2022, 4 percent of adults over 65 years of age and just over 13 percent of those over 85 had a dementia diagnosis. Alzheimer’s disease is the most common form of dementia. Beyond memory loss, it can reduce other mental skills and lead to personality changes such as agitation, suspicion or inappropriate behavior.

When a loved one can no longer be left alone and a family caregiver is struggling to keep up with their needs, more advanced support may be needed. Memory care facilities can keep the person with dementia safer from risking harm to themselves or others.

There are many questions to ask when considering memory care for a loved one, says Gitlin. What’s the staff-to-resident ratio? Do the staff have specialized dementia care training? Are they trained to identify potential triggers for agitation? Do they use nonpharmacologic approaches to calm residents? The goal is to find a place that has the right qualifications — and feels like home.

Emotional dimensions: Parenting a parent

“Any caregiving is tough. But when the roles reverse, it can be very challenging emotionally,” says Gitlin. She suggests practicing patience whenever possible. It can also help to set boundaries on caregiving duties and get outside support so a caregiver doesn’t burn out.

It can be especially useful to get outside support for toileting and bathing, particularly when a son is caring for a mother or a daughter is caring for a father, says Gitlin. “It’s a whole balancing act of preserving a parent’s dignity and personal control and yet providing the help they may need.”

It’s important to talk early on about financial resources. Another tricky topic is how to handle doctor visits and medical decisions. It can take some time to negotiate ways to have a three-way conversation with the doctor about the person’s health, says Gitlin. Establish how to talk about the patient’s condition and decide the best course of treatment or action.

Remember that parents may feel embarrassed to receive help from their children. So kindness and respect can help them preserve their dignity. It’s also OK to ask them for the same in return.

The importance of a social life

Both caregivers and their loved ones should watch out for loneliness. Older adults may see their social circles get smaller, and less mobility also means getting out less. For caregivers, their many demands can make it hard to find time for friends.

Take loneliness and feelings of isolation seriously. In the long run, they can lead to more serious problems, including heart disease, cognitive decline and other mental health issues.

Caregivers should try to make time to do things they enjoy and connect with the people they love. Local support groups and online caregiving forums can also help. The National Institute on Aging provides tips to caregivers for taking care of themselves, including how to know when they need help and how to ask for it.

Creating a social life for a charge help both a caregiver and their charge. Check with insurance plans to see if they cover a companion or sending the charge to adult day care. Look into lists of services and various options online.

Which social interactions are the most rewarding will depend on the person. Someone with dementia, for instance, might have trouble following a conversation in big groups, says Gitlin, so one-on-one interactions might be better. “There isn't one best practice for everybody,” she says. “It is highly individualized.”

Resources for caregivers

A first step may be just to recognize that they have become a caregiver. “To recognize and self-identify as a caregiver is important because then you can look for services,” says Gitlin.

To find those services, she suggests consulting a geriatric social worker. They can point to available resources from nonprofits and health plans. They might also learn about the person being cared for to understand the impairments and the disease, then help suggest a plan. These conversations can happen in person or over the phone.

“I think it’s important to understand that caregiving can be episodic. It can be short term, and it can be long term,” says Gitlin. “And the needs of caregivers will change.”

Materials provided are for informational purposes only and do not constitute legal advice. This content should not be taken as a substitute for seeking advice of legal counsel or another qualified professional.

This content is for informational purposes only and is not medical advice. Consult your health care provider before taking any vitamins or supplements and prior to beginning or changing any health care practices.