Communication

My mom has early-stage dementia and it’s becoming unsafe for her to live at home alone. My husband and I think it’s best for her to move in with us, but how can we be sure? What should I consider before approaching her with this idea?

“Find a way of talking to your mom about it in an extended dialog,” says Gary S. Moak, MD, president of the American Association for Geriatric Psychiatry. “Wait for the opportunity. [When] she brings up something like ‘It’s hard to get around,’ ask what she would think about living with you.”

It is, however, just as vital to consider all sides of your plan. “Concerns about safety are important, but that’s only one value,” explains Dr. Moak. “Independence is a high value as well. This move could leave your mom depressed and resentful. There may be community-based home health services that could improve her safety at home.”

The other vital link in this decision is your mom’s doctor. “Is her impaired safety related to problems that might be treatable?” asks
Dr. Moak. “Getting the doctor’s opinion could be useful in actualizing this transition.” Finally, he suggests that “getting geriatric mental health professionals involved may help Mom move to a position of more acceptance.”

My 40-year-old wife has resisted sexual relations with me since her radical mastectomy and breast reconstruction about eight months ago. I'm sensitive to her feelings, but have become frustrated. What do you recommend?

Your wife's hesitation may involve several obstacles. "Psychologically, this is a huge issue and it must be handled delicately," advises Mary Jane Minkin, MD, board-certified obstetrician/gynecologist and clinical professor at Yale University School of Medicine. Remember that the surgery—lifesaving a procedure as it may be—has most likely left your wife with psychological as well as physical scars.

By bringing the issues out in the open, you hopefully can work through them together. The object is to make your wife as comfortable as possible in all ways. "Acknowledge that this is an intimate matter," says Dr. Minkin. "The most important thing is to say, ‘I still love you and want you.' Encourage her to express whatever anxiety she has. Get her to say, ‘I'm concerned about this and embarrassed about that.' If you need a counselor, that's okay, too."

Beyond your wife's possible self-image issues, there could be physical causes for resistance. For instance, chemotherapy often causes vaginal dryness. This is a subject, Dr. Minkin notes, that women are reluctant to discuss. She recommends the use of vaginal lubricants, such as the non-hormonal product Replens. "If there are other physical issues," adds Dr. Minkin, "she should talk to her healthcare provider."

When I go to my elderly father's home, I find "free" stuff he's ordered. He explains he gets this stuff when he orders a magazine or the like, and upon canceling the subscription, he keeps the premium for nothing. But it doesn't appear as if he's canceling anything. Is this common behavior? How can I get him to stop?

A dialog is a key first step to curbing this relatively common behavior, indicates Allan A. Anderson, MD, a geriatric psychiatrist and board member for the American Association for Geriatric Psychiatry, based in Cambridge, MD. But, he adds, success may depend upon your father's level of competence. If he's of sound mind, Dr. Anderson suggests you remember "there's a strong psychological component to getting gifts. Try to open up some concern that there may be monies going that he doesn't realize. You could end up with a parent saying, ‘Thanks, but this is my life, back off!' Or, it may open up more dialog."

If there's more of an impairment, several steps are worth pursuing. Certain websites—including www.fcc.gov/cgb/donotcall/ and http://preference.the-dma.org—will help remove your father's name from mailing lists. You also could ask him to sign over power of attorney to give you more control of his finances.

But, even for those who are not impaired, Dr. Anderson notes, "this [behavior] could be a sign that there's increased loneliness or isolation. Maybe something can be provided by the family as a substitute. This is a wake-up call that Dad doesn't have enough outlets." He adds that what could help are "more family visits and other social outlets, [such as] community organizations, adult daycare or senior programs."

My mom's been getting a lot of annoying solicitor phone calls lately. How can I tell her how to get rid of them, or to get them to stop calling?

The first step, says Federal Trade Commission spokesman Mitch Katz, is to “put your mom on the National Do Not Call Registry. Either you or your mother could call the FTC toll free at (888) 382-1222 from her phone and answer specific questions through an automated system.

"Or," Katz adds, "you can register online at www.donotcall.gov. You’ll get an e-mail back with your info and a request to send back a confirmation e-mail, so there are two steps online.”

Your mom should notice a change within a month. Registering on the list will “cut down on ninety percent of those calls. It won’t eliminate them because survey calls, political calls and charitable organizations are all exempt.”

If your mother still gets telemarketer calls after that, “she should ask to be put on the caller’s do-not-call list,” says Katz. “Every company is required to have one.”

If the matter still isn’t resolved, she can file a complaint by calling 877-FTC-HELP.

My mom's in her 80s and still drives, though I don't think she does it well. What are telltale signs of her being a bad driver and how can I get her to stop—or at least curtail—her driving?

There are several warning signs to look out for, says Sharon Brangman, MD, member of the American Geriatric Society and chief of geriatrics at SUNY Upstate Medical University in Syracuse, NY. “Unexplained dents in the car, fender benders, unsafe lane changes, being hesitant at intersections, not going the right speed, the stereotypical leaving the directional signal on for miles. These are all hints,” notes Dr. Brangman. “Also, memory problems; she might be getting lost in familiar places.”

There is, without a doubt, no easy fix for this. “It’s a tough situation,” Brangman admits. “Driving is such an indication of independence.” In terms of curtailing her driving though, you have to take into consideration Dr. Brangman’s caveat: “The less frequently you drive, the more difficult it is to remain comfortable behind the wheel.”

But there are strategies to use when discussing the issue. Dr. Brangman suggests you put a positive spin on public transportation or the occasional hiring of a car service. “Appeal to the economics of it,” she says. “Economics of no insurance and car upkeep and gas costs, and that money being diverted to a car service. Or appeal to your mom’s sense of ethics and morality; she doesn’t want to hurt someone else or herself. That line of reasoning can sometimes help.”