Should You Go to Your Aging Parent’s Doctor Appointments?

How can adult children help aging parents navigate office visits? / Photograph via Getty Images

     Listen to the audio edition here:

More than 60 million Americans are age 65 and older, and each one has a better shot at longevity if they regularly see a primary care physician. Those who need help getting to appointments, sticking with prescriptions, and following medical advice usually rely on their adult children for help. But the role reversal can be awkward — for the elder who has long been the caregiver and the worried offspring who doesn’t want to invade a parent’s privacy. We asked Dr. Nicol Joseph and Dr. Katherine Galluzzi, of Philadelphia’s PCOM Geriatric Services clinic, for advice on how to navigate this tricky transition with grace.

What are the signs that an adult child should start attending doctor’s appointments with a parent?

Joseph: Most people can go alone to their appointments well into their 90s and be perfectly fine. My own mom is in her 80s and she navigates the healthcare system better than I do, honestly. So don’t assume your parents need help just because they’ve hit a certain age.

Galluzzi: We had the privilege of caring for a woman who lived to 114. She was fully with it until two years before her final decline.

Joseph: But if you notice memory problems, like forgetting where they put their keys or forgetting to take their medications or what the doctor told them, those are risk factors. I’ve had families come in because mom, who was never late on a mortgage payment, is suddenly behind. Or a man who got lost walking a route he’d driven and walked his whole life. Those subtle declines can signal something bigger.

How do you broach the idea?

Joseph: You might say, “Mom, is it okay if I come to your next appointment? Two heads are better than one.” Framed that way, rather than as a confrontation, people are usually more receptive.

What happens during a typical geriatric visit?

Galluzzi: Most good primary care doctors will do an annual wellness visit for patients 65 and older. There’s also a “Welcome to Medicare” visit when someone first enrolls: an EKG, comprehensive lab work, a physical exam, medication review. The annual wellness visit focuses more on cognitive and physical function and advance care planning. We do the TUG (Timed Up and Go) test: We time how long it takes a patient to stand up without using the chair arms, walk 10 feet, turn around, and sit back down. If it takes more than 13 seconds, that’s a fall risk. It’s also a screening for initial frailty.

Does a person have to consent to having their adult child in the exam room?

Galluzzi: Always. Doctors have to sort out whether mom wants them there. It’s the law. It’s also about avoiding the infantilization of the patient.

If you’re sitting in on your mom’s appointment, and she says something you know isn’t accurate, what should you do?

Joseph: Contradicting a parent in the room, in real time, usually creates a shouting match. I’ll ask the patient to finish her version, then sometimes ask the child for their version too, so nobody feels like the other person is going behind their back.

Is mental health part of these visits?

Joseph: We screen for depression and anxiety alongside cognition, and we do nutritional assessments. Are they losing weight? Is it organic or related to mood or social isolation? A lot of the older generation still minimizes their symptoms.

Galluzzi: Patients hear the word “dementia” and think it means they’re crazy. But cognitive assessment is becoming more mainstream as more people live into older age. Part of our exam screens for anxiety and depression because we don’t want to erroneously label someone as cognitively declining when they’re actually just depressed.

You also look closely at medications. Why?

Galluzzi: We ask patients to load up a bag with every pill they take and bring it to their appointment. We have people who come in on 25 meds. I’m not exaggerating. Often, nobody is orchestrating their care. They’re seeing cardiology, nephrology, derm, and everyone’s adding a medication or two. Somebody has to sit down and ask which of these actually make sense together.

Joseph: A lot of times, a patient gets one medication, then gets prescribed something else for the side effect of that first drug, and nobody circles back to ask if the original medication is even still needed. It’s called a “prescribing cascade.”

Galluzzi: It’s okay to stop medications. I’ve had patients tell me, “My cardiologist has had me on this for 40 years.” Well, 40 years ago you weighed 250 pounds, and now you weigh 90.

How does HIPAA affect what you can and can’t share with an adult child?

Galluzzi: If the patient tells us it’s fine for their child to be in the room and hear what’s discussed, that’s tacit approval, and we document it in the notes.

Joseph: I’ve had patients specifically tell me not to tell their kids something.

Galluzzi: We raise our children to the best of our ability, hoping they share some of our values. And at some point, we turn a corner, and they’re the ones who may be put in a position of caregiving. I’m in my mid-70s now, and I ask myself: When am I going to turn that corner? I think a lot of us push that question off. But it’s an important one to ask.

This conversation has been edited for length and clarity.

This primary-care health series is made possible by a generous donation from PCOM.