In Part I of Tough Conversations About Family Health, I discussed the benefits of using holiday time to create a family health tree. But when family members visit or come home, you can also be faced with some new or ongoing health issues. Maybe your child has gone off to college and on this first visit home you note significant weight gain (or loss). Maybe you notice signs that a senior family member is developing cognitive changes.
Out of love and concern, you may be tempted to have a tough conversation with individuals regarding your observations. In which case, tread carefully. There are ways to gently ask questions and find out if the person is even aware of these changes, or if they need help but are uncomfortable asking for it.
A family member has gained a significant amount of weight
Remember that some women gain weight right away in early pregnancy, so if that’s a possibility steer clear of comments. If your son or daughter has come home with some heft, you might ask them about the food options at school and whether they are finding those choices optimal.
You can see if they are getting any exercise by asking about sports activities, gym use or if they’re involved in any team sports. Frame the discussion around health and your willingness to teach some basic cooking skills. Offer to buddy up with them to take a class or go for a run, while they’re home.
If a family member has been steadily gaining weight over the years, or has a sudden significant weight gain, you can use creating the family health tree to start the conversation. The weight gain could be due to a health issue they haven’t shared, or medications that they’re taking. If it seems connected to lifestyle choices, you can offer that you also want to improve your health and are concerned about your own habits. Just starting the conversation may be enough to nudge talk about lifestyle change.
A family member has been diagnosed with diabetes or heart disease but seems to be ignoring sensible eating practices
What home cook or chef doesn’t want the whole family appreciating and enjoying delicious holiday food? Still, this is a great time to consider reconfiguring some of your special recipes and lowering the sugar, salt or fat.
Make a few healthier versions of some holiday favorites. If you know about newly diagnosed diabetes or other serious lifestyle-related conditions, call the individual ahead of time and suggest your willingness to accommodate their needs. They may not be making special requests so as not to create more work for you. Support them without judgement.
You think your close family members are living an unhealthy lifestyle but you get pushback on your “healthy holiday theme”
One of the biggest problems we are facing in the U.S. is escalating rates of obesity. It cuts through every age group and fuels serious diseases like diabetes, cancers, and heart disease. We celebrate too many occasions with treat foods. If you count up all the holidays, birthdays, and other milestone events that occur in our lives, we have truly lost the meaning of what “a treat” really is.
Don’t isolate individuals but rather emphasize the joy of getting together and involve the whole family in a healthier holiday theme. Use smaller serving utensils and even smaller plates to control portion sizes of the more decadent holiday dishes. Consider plating the food yourself and then suggesting that people get up if they really want a second helping.
Serve a salad, fruit and healthy vegetable side dishes on the table, family style, so those are the featured dishes on the table. Limit caloric drinks by making tea and sparkling water the main beverages. Get everybody up from the table for a walk or some activity before serving dessert. Serve healthy “creamers” for coffee or brew zero-calorie flavored coffees.
You notice a family member’s physical or cognitive deterioration and you want to make sure they’re aware and seeking help
Even when we approach family members with the best of intentions, these types of discussions can be incredibly difficult. The person can be in denial, in financial straits and unable to afford help, or simply want their privacy. You may be able to gently find out some drivers of the physical changes (a medical condition, lack of nutrition knowledge, lifestyle challenges, or financial challenges) by expressing simple concern.
Cognitive changes may not be obvious to the person, especially if they have no one living with them. The National Institute on Aging recommends that you carefully present some small observations to the person, like noticing that they seem to have trouble recalling certain details. Offer concern because quite often there can be untreated medical conditions causing these changes; they’re not always due to dementia or Alzheimer’s disease. The earlier the intervention, the better the likely outcome and resolution.
If it is early dementia or Alzheimer’s disease, you may need to step in or create a family team to help the individual navigate some early screening tests and medical decisions that have to be made. Decide if you can reach out to their healthcare provider and offer to help.
Your aging parents clearly need some help in the home or it may be time to change their living circumstance
If your parents live far away and have routinely been coming to visit you, their home situation may come as a surprise. You notice significant clutter, maybe they haven’t cleaned in a while, or maybe they can no longer navigate the stairs. Possibly you’ve been aware of these issues, but now with other family present, you feel you have more support to tackle these issues. Do lean on family and enlist their support if your parents need to hear some tough talk.
Introduce the concept of a part-time or full-time caretaker, weekly housekeeping, or a service to help to organize and streamline their home if you or your family can’t assume that burden. Eldercare locator, a public service of the U.S. Administration on Aging, has excellent resources. If they need to move into an assisted living or adult community, enlist the help of their healthcare provider to present those choices.
You feel a family member is a danger on the road
This is one of the toughest conversations you’ll have with an older relative. Impaired driving can harm the driver and other innocent victims. You will be taking away the ability to do independent errands, stay involved in social activities and impact their self-esteem and sense of personal power. It may help to involve the primary healthcare provider in this particular discussion. They can deliver the recommendations in a more objective and clinical fashion.
You need to work very hard at offering alternative solutions. Take into account finances which may allow for a driver, taxis, Uber, bus or other transportation options. Find out if there are designated senior shuttles in the area. Some may be subsidized. AARP offers a list of options and seniorliving.org has an online form that you can fill out to find solutions. Agingcare.com also covers a number of possible transportation alternatives.
A close family member has a terminal illness but has not shared with you directly
How do you balance love and respect of privacy? Recognize that the family member may be finding it very difficult to share or ask for help. He or she may feel like they are imposing or somehow giving up and relinquishing their own power. They may also feel that they can never repay you. It’s important to respect privacy when you attempt to offer support or help. Experts also suggest that you not offer your two cents about hope or a cure. You _can _ask how they are feeling, taking your cue from their responses. Ask if you can do something for them specifically: help them shop, tidy up their house, cook for them or with them, or simply mention that you have free time if they want you to visit.
A sensitive dance might have to happen as you forge an empathic, helpful and supportive relationship, and remember that taking this on can also be stressful for you.
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Known as The HealthGal, expert contributor Amy Hendel is a popular medical and lifestyle reporter, nutrition and fitness expert, columnist, and brand ambassador, as well as a health coach. Trained as a physician assistant, she maintains a health coach private practice in New York and Los Angeles. Author of The Four Habits of Healthy Families, you can find her on Twitter @HealthGal1103 and on Facebook at TheHealthGal. Her personal mantra is “Fix it first with food, fitness, and lifestyle.”