Polypharmacy in the mix of parent care global trends
Parent care is increasingly a concern among many people around the world. No, we’re not talking about parent carers — parents who look after their disabled children, often into adulthood — but the need to look after your own parents as they age.
Setting the scene
It may surprise you to hear this, but this ‘parent care’ is a growing trend in many countries. A few years ago, we were worrying about capacity in long-term care facilities. Even with their long history of family care for older people, countries like Japan were trying to increase capacity to support their rapidly aging population. Now, however, we appreciate that older people want to stay at home for as long as possible. Fortunately, improvements in home care have meant that this is possible. Indeed, this is now so important that it has a name: ‘aging in place’.
Nobody is arguing that this is a bad thing. However, it is also important to recognize that for the adult children of older parents, it can also be worrying. They may or may not be near enough to rush round to render assistance in the event of a fall. They may also have children of their own who need care and attention. They are the ‘sandwich generation’, caught between the needs of both parents and children, and often feeling like they are failing both.
Identifying trends
It is worth looking at some of the trends and issues that are developing around the world. These include:
· The use of technology to enable older people to live at home for longer
Increasingly, technology and adaptations are supporting ‘aging in place’. We are all familiar with stairlifts. However, the current crop of technology and devices stretches into smart home devices and telemedicine, as well as wearable health monitors.
· The expansion in availability of ‘remote monitoring’ for older people
Wearable health monitors play an important role for many people. These devices enable healthcare professionals and family caregivers to keep an eye on older people, enabling them to ‘stay safe’ even when living alone. They can even check medication adherence at a distance.
· Changing patterns of family life
There are some mixed trends on family life. On the one hand, more people live further away from their parents, meaning that remote monitoring is an essential. On the other hand, there has been a rise in the number of multi-generational households. This can make life easier by providing childcare on tap — but it can also be a way of caring for older parents.
· Changes in community provision
There is a growing focus on holistic healthcare and overall wellbeing for older people. Social engagement programs have expanded, along with community-based support programs. There has also been increasing support for caregivers, including respite care options.
· Growing financial pressures of care for older people
The costs of long-term care can be significant. This is especially true for people with dementia, who can expect to live a considerable time in residential care. At the same time, of course, we are all aware that pensions are going less far, and that final salary schemes are a thing of the past. Security into older age is no longer a given.
· The widespread use of multiple medications (polypharmacy) to manage multiple conditions
As people age, it is natural that more things ‘go wrong’, and they may develop several different health conditions. This leads polypharmacy, the use of multiple medications. This can have various complications and issues attached to it, as I have written about before. These include in particular adverse drug reactions, drug interactions and non-adherence.
· Increased risk of falls and other side effects
Some medications, such as those for blood pressure, can increase the risk of falls. Older people may already have more problems with balance, and are also more likely to be seriously hurt if they fall. Polypharmacy is particularly associated with cognitive impairment and functional decline. This is because some medicines contribute to muscle weakness or fatigue, making it harder to maintain musculature through exercise.
A complex picture
There is no question that caring for older parents at home can be challenging. It is also unquestionable that many people prefer that option to residential care of any kind. This means that these issues are not going to go away any time soon. We as a society need to find ways to manage them that ensure that the ‘sandwich generation’ does not become so squashed that they cannot function.
