"Coping with Ageing Parents"
by Margaret Safran
Our last function on Sunday 15 June was extremely well attended. We were delighted that over 100 people came to hear our Panel Discussion on "Coping with Ageing Parents." We were very grateful to have an eminent panel of Dr. Paul Valent, Psychiatrist; Mrs. Miriam Suss, Social Worker and Dr. David Fonda, Gerontologist chaired by Dr. Jack Felman, Vice President of Second Generation Inc.
The Australian Jewish News published an excellent article on Friday 27 June, 1997 on page 15. Here is a reprint of the article.
The only question that adult children need to ask while struggling with the difficult decision to put an aged parent into a nursing home is: "What is the best for that person today?"
According to head of Caulfield General Medical Centre's and Alfred Hospital's Aged Care Services, Professor David Fonda, "you must not confuse your own guilt with the care of the parent."
But, he continued, it was very important to seek second and expert opinions because, "more than the non-Jewish community, you have to live with the guilt which the Jewish community imposes on you for not caring for your loved ones. Therefore you need to understand that you are making the right decision."
Professor Fonda was speaking earlier this month at a forum on "Coping with Ageing Parents," organised by Second Generation of the Holocaust Inc.
The subject clearly touched a lot of people in the community. Audience members provided their own heart-wrenching stories: a father who's obsession with conspiracy theories was affecting his relationship with his wife and children; an 86-year-old mother who was severely depressed and not being sufficiently helped with anti-depressant medication; a woman forced suddenly to cope with a mother who had a stroke and a father with dementia who could not obtain help when she needed it; children whose parents had told them they never wanted to go into a nursing home but now clearly needed its services.
Professor Fonda said some of the comments he heard made to people who had to make a decision to place a family member in a nursing home were "disgraceful, inappropriate and, more importantly, unfair". The guilt "heaped on" people who made an entirely appropriate decision to put a loved one in a home which could provide better care than in the community, was very depressing, he said.
"Nowadays you can't get into a nursing home without the person having a geriatric assessment and therefore if the decision is made, it is made by health professionals who deem it is appropriate and in the best interests of the care of the person to go there. Hopefully this will kelp people feel far more comfortable with the things they have to do."
Professor Fonda, who is on the boards of both the Montefiore Homes and Jewish Community Services, said Montefiore Home's Ashwood facility for old people suffering from dementia, was often described by unthinking people as a "horrible place". But it provided "probably the best care for people with dementia in Victoria," he said. "It happens to be not a nice place to visit because there are people there who have dementia and it is not nice to go there."
But Professor Fonda also defended the rights of elderly people to make their own decisions, and spoke out against "negative stereotyping" of the aged. Sometimes adult children had to just be patient and hope their parent would eventually seek help or listen to their concerns. But if the parent was behaving in a way which threatened their own or others' lives, an application could be made to the Guardianship Board, he said.
Professor Fonda outlined some of the common causes of problems in old age including: longer recovery time from accidents or illness, side effects of medication used to treat unrelated conditions, depression, loss of memory, bladder and bowel complaints, imbalance and falls and psycho-social problems.
Medication was the most common cause of deterioration, he said, and should be reviewed regularly by the GP or another doctor who may be able to see problems which build up over a long time. Loss of memory may be exacerbated by some medications, he said.
Depression, which affected 30% of elderly people (including many Holocaust survivors) was the most unrecognised common problem. Medication and therapy could help significantly.
Some 25% of elderly people suffered incontinence but over 50% would never seek help. This was a tragedy, Professor Fonda said, because many cases were reversible and most could be improved to make a person "socially continent".
Professor Fonda said people had to recognise the multiple levels of interacting phenomena which affected elderly people.
"The best advice I can give an ageing community is to keep fit and active, physically and mentally," he concluded.
Other speakers at the forum included Jewish Community Services acting Director Miriam Suss, psychiatrist Dr. Paul Valent, and general practitioner Dr. Jack Felman.
Mrs. Suss provided some statistics about ageing in the Melbourne Jewish community. About 25% of the community was over the age of 65 and about half of Melbourne's Jews over the age of 60 had lived under the Nazi regime.
Mrs. Suss said many survivors who had never spoken about the Holocaust were willing to do so, despite the pain, if they felt it would help their children or grandchildren. She said there was no question that the Holocaust affected the second and even third generation of a family, even if it was never spoken about.
She called on the children of Holocaust survivors to realise that they may need some outside help in coping with their ageing parents.
"We cannot be the considerate, caring person our parents need when we need our own help."
Mrs. Suss outlined some of JCS's programs to help the aged and their families and carers, including the new Shoah Project, aimed at helping survivors of the Holocaust, their families and their carers.
Dr. Valent discussed some of the psychological issues facing ageing Holocaust survivors and their children.
He said survivors of the Holocaust were often particularly fearful of illness and hospitals, as people in the camps who went into hospital died an unnatural death. For this reason they would often not admit to illness or allow themselves to be treated, seeing even an injection as a step to being killed. Doctors, even Jewish doctors, were not regarded as friends.
"In old-age there is a tendency for old memories to come back and recent memories to fade away. The person actually believes and hallucinates the experience of being in the camp," Dr. Valent said.
While some Holocaust survivors wanted to continue to repress their memories, along with the guilt, shame and regret, in old age, others wanted to go back and make sense of their lives and were more open to talking about what they had experienced.
"It's never too late to say certain things but some of you may have to accept that it will never happen," Dr. Valent told the audience.
Dr. Felman, who is Second Generation of the Holocaust Inc. vice-president, discussed the role of the GP in caring for the aged.
He said there were no easy answers when it came to the care of aged parents, particularly Holocaust survivors. It was useful for children to accompany their parents to the doctors. While adult children could not force their parents to allow them to do so, there was nothing to prevent them making a separate appointment with the doctor to discuss concerns. This could be "very useful", particularly if the child knew the parent was not taking prescribed medication, he said.
Dr. Felman also called on those present to join Second Generation of the Holocaust Inc. if they wanted and needed more forums such as these.
At the end of the evening Dr. Felman presented JCS president Michael Dubs with a cheque for $5,000 on behalf of the Second Generation of the Holocaust Inc. to assist with the Shoah Project. Mr. Dubs said the cheque was a fantastic vote of confidence in JCS' ability to help the survivors of the Holocaust and their families.