Are you struggling with your aging parent or taking care of an older loved one? Aging can be overwhelming, but you and your loved ones don’t have to stop living life to the fullest, just because getting older throws you a curveball or presents challenges. If you have the right guidance, direction, navigation, and sound advice from the get-go, you, your family, and your loved ones don’t have to suffer. In today’s episode, Cathleen speaks with Dr. Leslie Kernisan who has written a book that will help you overcome the most common obstacles and address what’s most important for your parent’s health and well-being. Dr. Kernisan talks about some of the challenges adult children face when trying to help their aged loved ones and their workarounds, and how to put the power of smart choices in the hands of adult children.
Show Notes
Dr. Leslie Kernisan is a practicing geriatrician and the founder of the website and podcast Better Health While Aging. She has literally written the book we all need – When Your Aging Parent Needs Help, A geriatrician’s step-by-step guide to memory loss, resistance, safety worries and more. A clinical instructor at the University of California, San Francisco Division of Geriatrics, Dr. Leslie also offers online courses for adult children, in addition to the website and podcast.
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Cathleen Toomey
Dr. Leslie Kernisan
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Cathleen: The reason you probably listen to this podcast is that all of a sudden you have a lot of questions that you never expected, but how to help your parents as they age topics you probably never considered are now urgent. Is my parent experiencing memory loss? Are they safe at home? How do I help them without being pushed away? If there's one source of answers, it's with our next guest who has literally written a book called when your aging parent needs help. Tune in for an incredibly rich and interesting conversation and to get some answers. Stay tuned. Thanks to our show sponsor the Riverwoods Group, Northern New England's largest family of a nonprofit retirement communities where active adults find community, purpose, and peace of mind. Visit Riverwoodsgroup.org. Now let's hear from today's guest. Welcome to Seniority Authority. I'm your host Cathleen Toomey. As many listeners know I started this podcast because so many of my friends were approaching me when they had questions about their parents because I work in a retirement community, I would track down someone smart to answer their questions. This podcast is a way for me to help share answers with even more people and also a way for me to reach out to even smarter professionals like today's guest Dr. Leslie Kernisan practicing geriatrician and the founder of the website and podcast, Better Health While Aging. Dr. Kernisan has literally written the book we all need called When Your Aging Parent Needs Help, a geriatrician’s step by step guide to memory care, resistance, safety worries and more. A clinical instructor at University of California San Francisco division of geriatrics. Dr. Leslie also offers online courses for adult children in addition to the website and podcast. I wish I had her book six years ago and I’m just delighted to able to talk about her book and to share her knowledge with you. It is a total thrill to have you on the podcast today Doctor Leslie.
Dr. Leslie Kernisan:Oh, well, thank you so much for having me. Thank you.
Cathleen: Oh, this is delightful. I'd like to thank you for taking the time to write the book, how to help your aging parents and for setting up so many resources for adult children through your website. What prompted you to start this work on top of what was already a very busy private practice?
Dr. Leslie Kernisan:Well, so it's actually been a ever since medical school I knew that I wanted to combine clinical practice with something else that would make health care better. And I was especially interested in making primary care better. When I was in medical school. And then as a resident, I was thinking about primary care for the people who were most complicated and a geriatrician actually pointed out to me that the ones who had the most going on, not just medically, but you know, socially and in terms of the family dynamic, we're the older patients and maybe I should consider geriatrics. And so that was like a lightbulb moment for me. It's been a completely amazing fit. I think it's just the best of primary care geriatrics where it's both uh challenging to put together all the medical things, but also really rich the way people are at the stage in their life where their relationships with themselves are changing with their family members are changing and when a really holistic approach makes a huge difference. After I trained in geriatrics, I was studying how to make primary care for older people better. And I was actually studying quality measures, things we would do great doctors on because doctors often don't provide ideal care to older patients, even though there are a lot of things we know they could do. And then somebody asked me, I ran into somebody who was a writer and she said, oh we have a new website for boomers worried about aging Children. Would you like to answer questions? We're looking for doctors to answer questions. And I thought, well of course if there's a good resource, I want to tell patients and families about it and in my doctrine work, that's my favorite part is talking to people to help them better understand their health situation and what they can do and talking to families is a huge part of that. So when I saw the site, I wasn't impressed by the medical information they were providing. It wasn't written by geriatricians. But I felt like it was another light bulb that people were going online with questions that re and geriatrics knew how to answer and that just really changed my career. So I decided this is what I want to do I want to practice. But I also want to be that bridge to help people have better information and understanding because there are not enough geriatricians for us to care for every older adult and family who would benefit from our expertise. So I thought how can we share some of that with family members with older adults themselves? How can we empower them to get more of what they need from the health care system and sometimes avoid the common pitfalls that we know are there. So it was just a matter of figuring out how to do that. And since nobody wanted to give me the job doing it, I ended up creating the website and podcast myself and it's actually now most of what I do and my practice has been very small for these last few years as I keep it going.
Cathleen: Well, I love this because you know, whoever advised you in medical school is exactly right. The most complicated patients are people who are older because they have multiple diseases and they have chronic diseases and things are starting to network and there's a lot to pay attention to. So they are the most complex but a lot also really rich.
Dr. Leslie Kernisan:The thing though, it's also this beautiful opportunity to come in and connect with people in a way that is so meaningful, but I'm sorry, I cut you off.
Cathleen: No, no, no. I was saying you can literally change their life by helping them to understand what they can change, what they can't change and how to move forward. And I love the fact that you're amplifying your answers to a larger group of people and hopefully that's what this podcast will help you do reach for people. What I thought was so distinctive about your book and what I loved, it's not a dense medical tome. So anyone who hasn't seeing the book, it is fabulous. It's a workbook, it's got chapters, it's got tools, it's got downloadable checklist. It's something you can scribble in and you can pass from family member to family member. I think it's very engaging as you provide samples of families and how they handle specific issues. What's been the response to this kind of format from people who have read your book?
Dr. Leslie Kernisan:Well, so far it's been very positive. I think we're still hoping to get more people to hear about the book because when you publish independently, that's often the challenge. But it's really built on the philosophy that I've used at better health while aging, which I've been writing now for I think I started the first articles in 2013 and they've mostly been written by me, but the idea was to have something really practical and actionable that spoke to the questions that I knew people often had for my personal experience and to help them take that next step. And so the book was sort of built with the same idea is that when I looked at books that were about helping aging parents, well, some of them are written by families who have been through the experience. Sometimes they're written by geriatricians or medical experts. And often the ones written by medical experts are either very medical and great dance as you are saying. Or they can be very long and narrative and kind of, you know, a history of the condition, the policies and that's very interesting to me personally. But I feel like if you're trying to solve a problem and figure out what to do next, it's not necessarily what's most practical. And some of them are memoirs. And I really wanted to give people a step by step guide that was sort of an expansion of what we could do in an article on better health while aging. So this was a question that we were getting over and over again, which is, you know, my mom has started doing this or that that's worrisome for getting this or getting lost or not paying bills or I'm worried or sometimes they didn't even have specific concerns that they just felt their parents shouldn't be living alone anymore, but she refuses to talk about it or make changes what can we do. We kept getting those questions over and over again and I could break down certain aspects of it in articles, but I felt like well I have an approach that I would use and I think I can turn into something that can walk you through the steps you might take and it's too long for an article so we should make a book and then we did add cheat sheets, symptom checkers, sample things to say lists of what ideally the doctors would do so that people knew what to ask for. And so this was, you know, the first time we've done something like it and my co-author Paula, who's an experienced author said, yeah, I don't think I've ever seen anything else like it, but I think it will be useful and so we did it.
Cathleen: It is and I love it because what I'm trying to do with this podcast is to provide practical information the end of every interview. What can people do today, tomorrow next week, how can they take this knowledge and put it to use. Another aspect I really love about your book is that at the very beginning and throughout you keep front and center the patient, the parent what their point of view is and you encourage adult children to approach with curiosity, not with judgment, not with I've got the solution but to really have those conversations which can be hard about how the parent is feeling. So you remain front and center connected to what's going on with the patient. And I think a lot of times when you've got adult children in this situation and I'm an adult child, I have an older parent, you can start thinking about what's the most expedient, what's the most practical, how can I figure this all out and then present the solution and you're forgetting what's most important, which is what do they think?
Dr. Leslie Kernisan:So maybe it might be helpful just to clarify for the audience. So the person I had in mind in writing the book was somebody who was at what I think of as the start of the journey, who has developed some concerns but hasn't yet got in the habit of providing a lot of hands on help and their parent is not yet in the habit of providing a lot of hands or of getting a lot of hands on help. And so the reason I wanted to call it when you're aging parents starts needing help and I was really thinking of that early part, but this approach of really focusing on the understanding how the person sees it and what matters to them is something that's really common in geriatrics, that I was taught in geriatrics fellowship, that I was especially taught during the palliative care portion of my geriatrics fellowship. And I felt very fortunate that I did that very early um during my geriatrics training and so palliative care and hospice work is again, a time when we need to talk to people about things that they find difficult and may not want to talk about and then we have to sort of change our habits as doctors because doctors, I think similar to adult children often get in the habit of I'm going to come in and I can see what needs doing and I'm going to tell you and you can do it, but it's actually not the best way to be a doctor and it especially doesn't work when there are matters that are really important to people or issues of identity or their feelings. And so in my geriatrics training, I was taught how important it is to start off by understanding where the person is at and how they see it.
Dr. Leslie Kernisan: Because when we understand that, first of all, we build a connection because people feel better when they are heard and when they get a chance to voice what is important to them and if we can reflect that back, that's really important. But also when we hear what matters to them, we can be more effective in making suggestions if we frame them as something that can help the person get something that matters to them. And even if we can't get them everything that matters to them often, what people want are things that maybe we can't deliver to continue to live at home alone with no assistance independently until the very end of their life or in hospice work. You know what people might want ideally, is to be cured of course we can still speak to that and acknowledge how we wish that were possible to and you know, how can we sort of move on to what might be next best or if that weren't possible, what would be most important and how can we support them in that? So, yeah, so that aspect of the book really comes from my training and again, what I often tell people is I think I'm not that extraordinary as a geriatrician or provider. The care I provide is very much like other geriatricians and that what I've tried to do though is turn it into approaches that are available to more people or give people a framework so they can start thinking about that too. So I have found over the years that people are often very intent on figuring out what should be done, but then I realized that they didn't have the tools to talk to their parents about how to do it. And so I got very interested in that. And again, when I thought about, well what do I do when there's an older person who might need help and seems reluctant, I don't start off telling the person, here's what they should do. I start off trying to understand how they see it because then that helps create a connection and then I can make suggestions. It's also really important because sometimes how they see it is so far from reality that it can be part of the evidence that maybe they have a memory or thinking problem that is interfering with their ability to judge the situation and make decisions about what they should do. And it's really important for us as geriatricians and I would say as family to to identify that because if that is the case, you're going to want to take a little bit of a different approach to how you encourage your parents to get help. And people basically have the right to make decisions about their life unless it seems like their memory or thinking have gone so bad, but they can't judge it properly. And if that's the case, it starts to become ethically and also legally more permissible for us to intervene even if they may not want us to. So, but again, that starts with the listening and so that's why we organized the book actually into three sections, the first taking stock, the second, taking aim and that they're taking action because I really want to help people slow down. They want to jump in and do something. But we felt like, well first you want to take stock of how your parents sees the situation, what they think, what matters to them and also the details of what's going on. So we have cheat sheets of safety things to check for cognitive symptoms to check for, you know, difficulties to check for because then you want to sort of digest that and think about a little bit, you know, and also inform yourself as to the different approaches you could take and that's the taking aim part before you step in and that enables a more thoughtful considered approach to stepping in.
Cathleen: I love that your book outlines exactly how to do this because I do think that people, we are all fixers and problem solvers and I do feel like we jump into taking aim before taking stock and taking action before taking stock are taking aim. What in your experience are the most consistent challenges that adult children face when starting this conversation or trying to help their aging parents. What things do they consistently run up against?
Dr. Leslie Kernisan:Well, there are a lot of them and say, you know, I think a very common one is their parents reluctance or resistance to either having conversations or considering changes. So that's really, really common. And I used to give a talk every now and then about helping resistant parents where I talked about how this is common in most older people because these are difficult changes to consider. You know, older people are themselves going through a journey of adjusting to their changing life and abilities, especially if people are getting worried about them. So coping with that is difficult and if the older person is actually having some memory and thinking problems, it becomes even more likely that resistance is an issue because just their insight and judgment and ability to perceive what other people perceive is happening becomes really different. So that's really common. Another common challenges that when it is brought up it results in arguments or unhappy feelings. You know, that conflict in relationship stress is often really difficult for people. Families are often disagreeing about what to do. Different siblings might have different ideas or if you have your other parent involved, which for many people is the case, you know, how to negotiate with the other parents. Some people have two parents and they're worried about both of them were one seems clearly having difficulty and the other one, you know, adult children might have a different idea than the caregiving parent has. And then I think really like not knowing what to do or how to get it done. And when people do bring it up to their parents, coctors, if they do, those providers often don't have I think the training and experience to provide assistance and you know, sometimes in a way, you know, almost get in the way. So I've had so many families tell me what we brought up to the doctor and they said, oh, it's just aging, you know, oh there's nothing to do or even, oh you shouldn't be telling me this. It's a HIPAA violation, which is not true. Actually, it's not a hipAA violation to tell, you know, doctors something because family caregivers aren't covered entities who are required to follow privacy laws. So there's also a system that even though it's so common for older adults to start to potentially need some help somehow the system is not equipped to make it easier for the older person and the families to get that help. So families are often also figuring out these systems, the medical system, the social service or long term care system and trying to navigate the challenges which you know, pains me because I feel like we should be making it easier. And I think eventually we will, but we're not, we're not there yet. So I would say those are some of them are those are the ones I hear about. Especially.
Cathleen: If you're getting smarter help us reach more minds, leave us a review on apple podcasts so others know we're legit tell. your friends to follow us on social or subscribe to our newsletter at Seniority Authority dot org. I think you've touched on something that is really runs deep is the emotional weight of these kinds of conversations and these disagreements between siblings or with different parents. This is significant and weighty issues that you're talking about independence and control and safety and responsibility. So these are not easy conversations and you know, your average adult child hasn't been trained to have these conversations.
Dr. Leslie Kernisan:No, I mean even though this is very common, most people have no idea how to go about it. And then I will say that, you know, for people like me and I've talked to other people with expertise in this other geriatricians or geriatric care managers, you know, or social workers, we all find that even those of us who have training in it when it's our own family, it's very hard. So even when you know more about what could or should be done, the actual doing of it is difficult because yes, there it's a real challenge I think in the relationship dynamic and it brings up, you know, worry and anxiety about the future. We see somebody we love changing and we worry about what that means for them and we worry about what that means for us in terms of our efforts to help them. And I think it often makes us worry about, you know, what about when it's us who are the older person, you know, what will our life be like at that time or what would happen if we were changing? You know, would we be able to get help the way we wanted to? So I think, yeah, it brings up a lot for people and then it's just time consuming, I think to have the conversations and to figure out what to do next and people are already living very busy lives.
Cathleen: That is absolutely, it's absolutely true and its people want information and solutions quickly. There's not a quick fix, there's not one right path. Can you comment on dynamic between adult children who are trying to help aging parents and this concept of the parent helps the child helps the parent and the parent resents being cared for. Is there any recommendation that you have as to how to approach that? So it can be a a better connection or representation?
Dr. Leslie Kernisan:Yeah. So one of the things we've heard from people a lot over the past few years have been running some helping older parents programs now for over three years is that for them, a real shift was realizing that it's a process and that it's not something that's going to happen quickly. And so part of the process is that we're going to offer assistance and support to an older person, we ideally also educate ourselves. So we know more about what to look for because sometimes family members are worried about things that uh, first of all maybe are not that big a deal, like it's not possible to have perfect safety for an older person without really imposing on their autonomy and dignity. And so sometimes people need to realize that they're going to, especially if their parent is in their right mind, they may have to accept that their parent is willing to take risks that they wish they wouldn't. And our job is to accept that, you know, in a company that with that. So I think when people realize that the point is not to quickly get them to a place of perfect safety and perfect outcome, but that it is to accompany them on this journey and some of your parents journey is going to be getting over their own discomfort or frustration at how their life is changing and we may not be able to take away all their frustration. We can learn techniques that make it better, like not trying to explain away right away why they shouldn't be frustrated, you know, and giving them space to be validated. That yeah, these are changes that can be scary and can be hard and we're here for you and we wish things could be different and we're not sure. But we're going to stay with you and we're going to figure it out together. But once people reframe a little bit what their role should be, that it's not to be the fixer or keep them 100% safer, you can be the researcher who finds out more about what's going on and what could be done and learns ways to suggest that and maybe to recruit in more help if it becomes necessary and you can be there to hear your parents and see them and bear witness to their victories and successes and there are going to be some and also too often there are other challenges that we wish they didn't have to go through. So a lot of people tell us that once they realize that it's not going to be done quickly, you know, and that it can take several conversations for their parent too come to terms or explore something. Or if they have a lot of memory and thinking problems, they may never come to terms with it. One of the things we teach people if it seems like they really are having memory and thinking problems but that we can still acknowledge how they feel about it and find other ways to support them, other ways to bring things that are meaningful to them. Those are some of the things that that I think can help. So if people go into it thinking there must be a way I can do it so they won't ever resent me at all that a that is an extremely high bar. But here are things you can say that will help diminish that resentment. Here's how you can support them when they're feeling that resentment and frustration. Here's what you can tell yourself so that you don't take it on yourself, that it's not that you're doing something wrong if they aren't happy, that they may need to leave their house. Now, maybe they don't need to leave the house, we're going to explore. You know, we can show you how to explore all the options because sometimes it is possible to support people and living at home for longer. Sometimes even till the end and it may not be so I think just shifting that mindset of what you're supposed to achieve as the adult child, you know, is something that people tell us helps a lot.
Cathleen: This is already resonating with me and I am a fixer and have four siblings and two parents who are 88 and it's you do want to fix things and you do want to make things better. But I hear what you're saying and I think there's a big discussion between honoring your parents autonomy and their choices and understand they have a right to make a decision you don't agree with and keeping them safe and realizing that there is one of your chapters says the ideal is usually hard and rarely attainable. So helping get to that point where you provide your parent as much autonomy as possible and understand that in your words you can't keep them perfectly safe.
Dr. Leslie Kernisan:No, but since you mentioned that chapter why the ideal is hard to attain. So this is a really important issue that comes off Russian geriatrics and that I tried to address a lot in the book. But one of the reasons why the ideal may be hard is because there's often a question of whether the parent has is actually in their right mind enough to be able to make decisions to jeopardize their safety or otherwise make choices that strike other people as really unwise. And so it's a really important thing to tease out because if people have what we call, you know in medicine and also in the life they have decision making capacity. They can make decisions, you know, for themselves, even if other people don't like them or consider them un advisable. But if they are slipping mentally and a certain number of older parents are actually developing memory and thinking problems, then they don't necessarily get to decide to continue to do things that are very unsafe. Now, that doesn't mean you can step in right away and make them do things they don't want to, there are legal protections to defend people's autonomy. But if it really does seem like they are slowly losing their memory or thinking abilities are then at some point, families are going to have to push a little bit more to intervene because if you're not providing appropriate care for your health, for your housing, for your safety, then that's considered self neglect, which is a form of elder abuse that is re portable. And so we also mentioned that in the book and not that there's a perfect answer to help people sort it out. But I think that's one of the many challenges as people are trying to determine how much of it is, I need to accept their wishes, right? When people ask you that, I say, well, a very important question is, do you think they are slipping cognitively? Because if they are what we also explain the book is a lot of people go through a stage where their decision making capacity is in this borderline area, right? Where we can see there are changes. And even having a diagnosis of early alzheimer's or early dementia doesn't mean you have to stop driving, doesn't mean you have to give up control over your life. But it does mean that the brain is changing and you are going to have more and more difficulty managing those. And we expect that with time people eventually lose the ability. So at some point other people will have to to take that on. But when people ask so I have to accept what they want. I say, well, hold on, hold on. If you have seen signs of memory and thinking problems, changes and you think they really don't understand and perceive the risks because we know that people who are having those progressive memory and thinking on changes will become unable to perceive the risk then at a certain point, you know, no, you don't necessarily accept let's make the time because they're no longer able. And what you need to do is seek out help from your parents, health providers and from others to help get that capacity assessed so that you can have a better understanding of whether it's time for you to step in or at what point. And it's also very relevant because when it comes to power of attorney documents which enable people to step in to help with health care decisions or with financial decisions often they only become depending on how they're written, they may become effective if the person is incapacitated. So that capacity question becomes extremely important.
Cathleen: It really does. It makes a huge difference. And I have so many favorite parts of this book. It's hard to choose a favorite. But one of my, one of the chapters I really love is your chapter six, which is the workarounds for common obstacles because so, you know, as the author of this book, you're really walking the road with us and you're not just writing here is the ideal plan from the I am the geriatrician and I have decided this is what you should do. Your really walking the life and saying, here are ways to get around some of the challenges including the fib lit. Do you want to explain what the fib lit is?
Dr. Leslie Kernisan: Yes, definitely explain the fib lit so this is another thing that people often tell us they wish they had found out about sooner. So, a fib lit is also sometimes referred to as a therapeutic deception or therapeutic lie or you know, in one book I saw it referred to as a loving deception. So it's not telling the whole truth or sort of altering the truth in the service of helping the older person gets something that is really necessary to take the next step for their health and well being and safety. And it's really only something that I recommend people consider. Again, if they think they're really have been signs of memory and thinking problems. And so that's why in the taking stock section of the book, we share signs that memory and thinking really are significantly changing because people are often unsure. Is this normal aging, you know? Yeah, something more substantial. And so I put a lot of that in the book, a symptom checker of science to check for the information to bring to the health provider and what the health provider is supposed to do. Because not all memory or thinking problems mean that the person has something you know more permanent and significant, such as the beginning of alzheimer's or another dementia. But there are things that people are supposed to check for. So especially if you feel like your parent is showing signs of impaired memory thinking and impaired judgment, then it becomes ethically more permissible to maybe not tell the whole truth or maybe even a just the truth in the service again, of helping them get something that's important. So any parents or older person who has been declining in independence, especially if their memory or thinking are playing a role, but even otherwise should get a medical evaluation for that medicine cannot provide all the solutions because often what people need are changes to their social supports, you know, changes to what's supporting them at home and in their activities and possibly some supervision and the doctor's office usually does not provide that however, if people are changing in their abilities, there is usually an underlying health issue and it's important that it get evaluated so that we know what we're dealing with. And also because there might be something that maybe could be changed or fixed. Now I tell people that especially once parents get to be the age of your parents the late 80's I find its fairly rare that we find something that we can fix and their memory and thinking get entirely back to normal. Sometimes it happens but you know less so especially the problems have been slowly getting worse but they may be on medications that make them worse than they otherwise would be because I have another health issue that is making their memory and thinking worse and we want to check for those because again the goal is to help people think the best they can feel the best they can and also have the best mobility and the best capacities because that's what enables them to live their best life. So getting that medical evaluation is important. Older parents may not want to go, especially if they're having memory or thinking problems that tends to make them more resistant and so a fib lit might be that even though the real reason you're taking them is to get the doctor to check out their memory might tell them that it's just for a flu shot or would ideally tell them that it's for some reason that is likely to sound appealing to the parent, Maybe you tell them that it's for your health and you'd like for them to come along too. Or you tell them that doctors are offering us, you know, especially evaluation to help people continue to live independently. So people often say that it's a shift for them to realize that you don't need to tell your parent, but the whole truth all the time because often it's counterproductive and that I can be okay to leave things out or to fudge things. But we want people to do this in a thoughtful way where they really considered it and thought, well, if I tell the truth, these are all the disadvantages and if I fudge it, this is what I can get and it should really be for them, not for you, it could be an advantage for them, not for you. And again, it's something to consider if you think they're becoming mentally impaired.
Cathleen: And I do think that this generation of our parents, they have tremendous respect for doctors. And so as a personal example, I know my dad could and has been hospitalized for dehydration because he's not drinking enough water, I can tell him he's not drinking enough water. But if his physician or health provider says you have to drink more water and in order to stay out of the hospital, you need to drink more water it has a different message. So I think that's also important is to realize that not every visit to the doctor is going to be some new calamity. It could help you. It could say here's something really easy that you can do that will help your kidney function or something simple you can do that will improve this measure on your blood panel so I think understanding that your medical provider is there to help you fight some of the challenges you're having, they can help you not necessarily give you more bad news is also a good way to approach it.
Dr. Leslie Kernisan: Yes. Yes. No. Absolutely. And leveraging what you can sources that are reassuring or influential is an important part of the strategy.
Cathleen: And my other question is how often are siblings a complication versus a complement to the situation? And what's your advice on that?
Dr. Leslie Kernisan:Yeah. So siblings, I would say anecdotally. I mean, now I think I've been hearing from families through the website for many, many years and we've been, you know, running are helping older parents program for three years. And then there's, you know, my small in person panel and I would say unfortunately I feel like siblings are kind of a challenge or difficulty at least half the time, if not more. But in some families, they are really an asset. And I do think some families can make a shift from it being an issue to working together better. So the sort of suggestions that that I have is is first of all I tell people to not underestimate it and that if there are any tensions or issues, I really encourage people to try to address those and get those out in the open early because the further along, the more challenging the situation gets. And unfortunately often over time the situation with the older parent becomes more challenging in terms of more going on or more need for support from the family or you know, new problems to kind of to solve the further things get along usually the more tension that puts on everybody and the harder things are, the more any underlying conflicts or difficulties in the sibling dynamic, the more they're going to come out. So I tell people this is a long game and if you can put the time and energy into addressing this and working on that relationship, doing it early often pays off a lot down the line. So you may unearth some things that enable your sibling to be much more helpful and you'll have less conflict or at least it may be better than having it all come out later on. So I also encourage transparency. So often people are, may be reluctant to be fully transparent with their sibling because they don't want to create the problems and that's again where I feel like, well actually this is a time to sort of invest, you know, both in working on that relationship with your parent, but with your sibling and for some families, just a few sessions with a trained professional either like a trained family mediator, there often underlying resentments from a long time ago, right about more for the parents about who got more from the parents, about who the parent like better about, you are always telling the rest of us what to do. Nobody ever listens to me, none of that is going to get better as the challenges with the parents amp up. And so I encourage people if possible, to have some conversations early to clear out the error, especially to clear out anything that is getting in the way. And then the other thing we hear is that often there's one child who is very involved in the others are doing relatively little and that builds up a lot of resentment in the person who's doing a lot. Actually, sometimes the others who are at a distance resented too because they feel like they're not being, you know, kept in the loop or I often don't realize just how hard it is in the day to day, but you know, again, like communication skills, right? How to think about how to bring up what you need in a way that is constructive and effective because it is more constructive to say, hey, here's what's happening and here's what I need or can we talk about ways that we could find a way forward than to say you never call, even though that might be true. Now if that feeling is weighing on you, there can be more constructive ways to share the feeling. And this is, again when I think you, even though it's an expense, you know, the time with a trained therapist who can help everyone voice their feelings in a way that's constructive so we can move on because ultimately sometimes family members are just not sure how to help. And the person who's doing a lot is they can be so tired that it can be very hard for them to figure out. How do I bring other people along in a way that's that's effective.
Cathleen: And I think thats a great piece of advice because think one of the things we're trying to resolve and with your book and with this podcast and what your work is, how do we help each other with this situation? And people who are, have been doing whatever they've been doing professionally for awhile are used to finding answers and it's not intuitive where to find answers. And I feel like your book puts a lot of knowledge, power and smart choices into the hands of readers. It really walks them through solutions to almost anything you can throw at the situation. What have you heard from readers about your book so far?
Dr. Leslie Kernisan:I think we mostly hear from people who like it, you know, we have, I think over 50 5 star reviews on Amazon and a lot of enthusiastic views were very fortunate to have a pretty large audience at better health while aging, who visit the site and on our email list, and so they've been, they've been enthusiastic, so, but I'm always eager to hear from more people, and also, you know, to think about how to make the next version better. So, I think I'm very happy with this as a start. I am a fixer and I want to help people fix things, since I'm always thinking about what's the next thing that could make it a little bit better. And, you know, the book is short because what we were trying to teach people was a kind of framework and the foundation for doing what they're going to need to do, which is learn to keep, you know, cycling through another round of, you know, learning more about your parents, learning what might be possible, and trying to implement a next step. And so, I think ultimately, you know, this is really a journey and it's about relationships, and so we speak to that a bit in the book also, is that you're not going to get to perfect safety quickly. This is an opportunity though for you to learn more about your parents and for you to accompany somebody threw a challenge, which, you know, I think ultimately is the most beautiful thing that any of us do in life is to connect with other people and go through an experience together, and that what you can't necessarily get your parent the outcomes you want for them all the time. But you can learn to be a better companion to them on their journey and a better companion to yourself in terms of how you think about yourself and how you take care of yourself and a better companion to your siblings, potentially. And even if you're not going to be perfect boom partners on it, because that's not what happens, you know, can this be an opportunity to come together a little bit more? Hopefully, you know, because that's what we want out of it instead of it turning into something that really divides and separates families, which sometimes it does and I think that's in part because families maybe didn't get enough encouragement and support early on in it's not obvious to know how to connect with people and fix difficult relationships.
Cathleen: Absolutely. So I have two final questions and it’s been a great conversation. I always ask my guests what advice they would give our listeners right now who want to help their parents other than buying your book, which I love and I have to admit I chased you down to interview you because I'm a huge fan and the link to the book is in the show notes. But what would you encourage people who are thinking about this journey to do today or tomorrow or next week?
Dr. Leslie Kernisan:Yeah, I would say maybe even today, but I really feel and we talk about this in our courses, but the serenity prayer, you know, writing it out and putting it in front of you, you know, grant me the serenity to accept the things I cannot change the courage to change the things I can and the wisdom to know the difference. I mean these are really going to be words to live by on this journey because as you go through this journey of your parents, there are going to be things you're going to have to accept and then they're going to be things that you're going to try to change and your job is not necessarily to get them change is to make a good thoughtful attempt to try and that comes from again, learning about what to aim for and thoughtful ways to step in and so along with that, I think starting to practice one, the conversations, the listening, starting to practice talking to your parents, not the perspective of let me get something done or tell them something, but of being curious, like let me learn more about what matters to you, or about how you see the situation or about what you were thinking or about what you enjoy and how can I create a moment of understanding and connection where really I understand and connect with you and people sometimes talk about the role reversal that happens in this and it's definitely part of the process, but I think very early on you can think of yourself as those conversations are for you to be of service to your parent if you're worried about your parents and you think they're declining your parent may no longer be able to be of service to you the way they were, although they would love to feel like they were of service to you. So if you can bring up things that help them feel like their service to you, that's great because every time you help them feel better about themselves, you the situation that is really important and will help you make changes later on. So when practicing that listening and curiosity, practicing again, the acceptance, like asking yourself well how much of this is maybe something that I could accept, and it's not always going to be easy to know, like if your parents seem to be doing something really unsafe, should you accept that, right? Do something, There's a middle ground are the book tries to help people, you know, pick their way through that. But then also with practicing acceptance, I think working on your own resilience and ability to tolerate challenging uncertain situations is really important. It's going to help you with your own health and aging because I think as we age, we end up having to cope with uncertainties and challenges. So, I think, you know, a meditation practice or a practice that helps people sort of accept things that are frustrating, you know, that the more people practice that is going to come in handy because lots of things on this journey are going to feel frustrating, you'll do lots of work and suggest something to your parents and the first time they'll say no, the doctor won't help you when they should have, your sibling may help you should up like they should have. So I think it really helps to start building that resilience and in a way, you know, again, being a good companion to yourself through this, which is I'm going to learn more. I'm going to try, I'm gonna try a little better in this next conversation. My parents, I'm going to try to see if I can find out something or make a next step happen for my parents. And that is what I can do is to be thoughtful about how I walked this journey and that is going to be enough even though you may not end up with the safety or exactly what you wanted for your parents or for yourself because it's an unpredictable journey. But that would be what I would tell people is to start really thinking about the curiosity about your parents and re thinking like what you're always going to be. I don't expect it to be easy and done soon. I wish I had imagined. I have not found one. If you find one, Cathleen please, I will let you know. And this is the next best, you know, and the surrounding for it, right, equip yourself for this because it's an amazing thing to accompany people through a challenge, even though in the moment we're often like uh I wish I weren't doing it. But it's just an amazing opportunity to learn about ourselves and them.
Cathleen: That's a fabulous perspective. I love that perspective. And final question, What's next for you?
Dr. Leslie Kernisan:Oh well what is next for me right now? So I do I didn't think I was going to end up like running a web sites, but but I do. So what's next for us right now is so I started this year kind of as a follow up to the book and also to the helping older parents program that we already had. I've started a new course called helping older parents with early memory loss. So it's really designed for families who have a parent who has memory loss or other thinking problems and are still fairly early in the journey, are still trying to figure out how to get their parents to address safety issues or make certain changes. It's that early stage where everyone's figuring out just how much the older person might have to change about what they're doing. So we decided to do that because I've run a program more broadly for people helping their older parents for three years and we found that not everybody, but a lot of people's parents have cognitive issues. So I decided to create something that was a little bit more focused on that. So we just launched the first version of it earlier this year in april and we're trying to refine it and that's probably going to be the focus for for this year. And then eventually I would love to also do some workshops or sessions because we've had so many older adults reach out saying well what should I do to prepare my family? So I love that next year, you know, if I ever need help right? I really love the idea of that too. But for now we're really focusing on seeing if we can help a little bit more specifically for families who have a parent with memory loss or thinking problems and and if people want to know more at betterhealthwhileaging.net we usually have some announcements about what's going on and there's a courses tab where people can sort of learn more about what we're offering. But most of our readers just read the articles and if they sign up for our email list every two weeks I send out a helpful article that usually I've written. I have fellow geriatrician who is not helping me right articles and so we always love to have people join us for that as well.
Cathleen: Awesome. Well that is Dr. Leslie Kernisan, thank you so much for joining the podcast. Her book is called when your aging parent needs help. Her website is betterhealthwhileaging.net please buy her book, go to our website. Sign up for our email list. I am a big fan. If you have questions for us, please send them to info@seniorityauthority.org and we'll reach out to dr Leslie, thank you so much for coming on the show today.
Dr. Leslie Kernisan:Thank you Kathleen and thank you so much for what you're doing and for having this podcast. I think it's just a huge area of need and I know so many people are going to learn from you. Thank you. Thank you.
Cathleen: Thank you. Well, that's our show for today. If you enjoyed it, please visit our website SeniorityAuthority.org to submit questions either for Dr. Leslie or for future shows and to listen to archived episodes, spread the word business on facebook and subscribe on your favorite podcast platform and until next time enjoy the chance to get smarter about growing older. Thanks to our show sponsor the Riverwoods Group, Northern New England's largest family of nonprofit retirement communities where active adults find community purpose and peace of mind visit RiverwoodsGroup.org. That's our show for today. Did it spark a question if so, send us your questions at SeniorityAuthority.org and we'll track down the answer. Meanwhile, don't forget to subscribe like us on facebook. Follow us on youtube and rate us on your favorite podcast platform. Until next time. Let's get smarter about growing older.