When Older Relatives Shrug at Coronavirus Restrictions

Although the virus poses a heightened threat to older people, some of their middle-aged children feel they aren’t taking it seriously enough.

Lorenzo Gritti

By Julie Fingersh

I went hoarse shouting at my mother last week.

“You really got into your building elevator with someone else?”

She blamed the other person for standing in the middle of the elevator; I blamed her for getting in, putting herself at risk of catching the coronavirus.

By the time my 88-year-old father got to the phone, I remembered the researcher Brené Brown’s theory that vulnerability opens all doors. I would move my father by sharing my deepest fear.

I told him I loved him. I said the thought of losing him was devastating. I asked him, “Dad, are you afraid?”

He laughed. “What’s to be afraid of? If I get it, Sayonara!”

Despite the virus’s heightened risk to older people, my parents seem inexplicably casual about it.

And I’m not alone. From every corner of our new virtual community, in Zoom cocktail hours, Google hangouts and private message boards, I’ve been hearing from fellow members of the sandwich generation fighting to persuade older loved ones to protect themselves from a potential death sentence from Covid-19.

“My mother’s still going to the market and post office, even though she has an aide,’” said Claire Muirhead, a writer from Los Angeles who recently recovered from Covid-19. “She’s 90. She knows how sick I was, and still, there’s no stopping her. I’m beside myself.”

We have good reason to worry. According to the Centers for Disease Control and Prevention, eight out of 10 deaths reported in the United States have been in adults 65 years old and older.

“We can’t pretend this is not life or death,” said Tara Brach, a psychologist and author of “Radical Acceptance.” “This is the real thing. These are beings we love, and we’re scared we’re going to lose them.”

For some adult children, this means grappling with the anguish of not being able to see parents quarantined in nursing homes.

For those whose parents live independently, it is often a challenge to get our older loved ones to take the risks as seriously as we do. I caught my father-in-law, a radiologist, on his way out to play cards with friends in Boca Raton, Fla., one day before Florida issued its stay-at-home order.

“Just because they’re friends doesn’t mean they don’t have the virus,” I told him. He laughed and said, “We appreciate your concern.” And then he left for his game.

It turns out, according to experts, my approach was doomed to fail.

“If you go in with anxiety and with the very innocent and loving intention to control, every human being on earth will push back against that,” said the sociologist Martha Beck. “There’s something about being self-determined that is fundamental to being human.”

Also at play is a high-stakes role reversal in the parent-child relationship. “Earlier in your life, you were on the other side of this fighting-for-autonomy battle,” said David Fish, a therapist specializing in dialectical behavioral therapy. “Now aging parents are the ones struggling with limitations to their freedom and with others telling them what to do.”

The Age Positivity Effect

Part of the problem, according to Claudia Haase, a psychologist and the director of the Life-Span Development Lab at Northwestern University, is that older adults may not experience the same level of threat as younger people do.

“A massive body of scientific work has documented age-related shifts in the service of making negative emotions smaller and positive emotions bigger,” Dr. Haase says. “Older adults are often masters in turning their attention away from information that is threatening, upsetting and negative.”

The priority of older adults, Dr. Haase explains, is to make the most of their limited time on earth, and their highest value is social connection. “For them, being home alone with just their thoughts and nowhere to go can be a frightening place.”

And then there’s the fact that older adults may not see themselves as, well, old. “Older adults may not think of themselves as being at heightened risk for Covid-19 because old age carries a lot of stigma. There’s a huge reluctance to view oneself in those terms.”

How to Be Heard

So how do you explain your concerns to older relatives?

Dr. Brach believes it begins with self-understanding. “When you talk to them, ask yourself, what’s going on for you? Once you start to name what’s going on underneath under all the agitation, you get to your anticipatory grief: You don’t want to lose them.”

Dr. Beck recommends a simple, practical approach for coping, and managing anxiety, when older relatives don’t see the risks the way you do. “The idea is, you want to invert that — you have to manage your own anxiety first.”

She suggested being direct, providing solid reasoning and being clear about the consequences. “You tell them why you’re worried, and why you want them to do this thing,” she said. “It has to be rational. It can’t just be because ‘I know better and I say so.’”

And you may have to acknowledge the worst-case scenario. “So it might be like, ‘Mom, you’re living in Florida, and you’re going to the beach. I cannot stop you. But if you get sick, I can’t come see you. And if you die, you may die alone, and I won’t be there.’ This may sound harsh, but it’s true. Let them sit with the real possibility of what may happen.”

Radical Acceptance

When all else fails, Dr. Brach espouses the art and power of radical acceptance, both for our loved ones and ourselves.

“There has to be a letting go, because ultimately, you cannot control them,” she said. “They’re responsible for their living and dying.”

Once we understand that, Dr. Brach said, “You say to yourself, ‘I am afraid. I am helpless. I am feeling the grief of what could happen.’ And this is where the real pain is. You put your hand on your heart and offer compassion to the place in yourself that is helpless and fears the loss.”

The act of physically putting your hand on your heart is vital, Dr. Brach said, to coming to peace. “There’s a network of neurons in the heart area. When there’s warmth and pressure on it, it actually calms the sympathetic nervous system and reduces the fear centers in the brain.”

And what about those anxious, racing thoughts?

“We need to remember that just because this feels like it’s a catastrophe doesn’t necessarily mean that it is,” Mr. Fish said. “What you’re upset about right now is your imagination. It’s not what’s actually happening. Our minds are really good at anticipating consequences and making them very present for us, which is useful, except when it’s not.”

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When Older Relatives Shrug at Coronavirus Restrictions

Keep Your Brain Healthy, Lower the Risk of Alzheimer’s

More than 5 million Americans suffer from Alzheimer’s disease, a progressive, incurable condition that robs them of their memory and often changes their very personality.

A new documentary airing on PBS at 10 p.m. Eastern time on Jan. 25 examines the disease and what will be needed to confront it.

Alzheimer’s: Every Minute Counts, produced by Twin Cities PBS (the parent of Next Avenue), features interviews with doctors, researchers and caregivers. The focus is on the urgent need for more research, especially as the large boomer generation ages.

One of those interviewed is Dr. Rudolph Tanzi of Harvard Medical School, a longtime Alzheimer’s researcher.

The video below consists of special footage that does not appear in the documentary. Its creators have provided Next Avenue with this exclusive clip. Watch as Tanzi shares his advice to encourage brain health — and possibly decrease your risk of Alzheimer’s. No. 2 on his list of top tips will surprise you.

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Keep Your Brain Healthy, Lower the Risk of Alzheimer’s

Medicare Drug Program Putting Seniors, People With Disabilities At Risk

Ten years ago, a sharply divided Congress decided to pour billions of dollars into subsidizing the purchase of drugs by elderly and disabled Americans.

The initiative, the biggest expansion of Medicare since its creation in 1965, proved wildly popular. It now serves more than 35 million people, delivering critical medicines to patients who might otherwise be unable to afford them. Its price tag is far lower than expected.

But an investigation by ProPublica has found the program, in its drive to get drugs into patients' hands, has failed to properly monitor safety. An analysis of four years of Medicare prescription records shows that some doctors and other health professionals across the country prescribe large quantities of drugs that are potentially harmful, disorienting or addictive. Federal officials have done little to detect or deter these hazardous prescribing patterns.

Searches through hundreds of millions of records turned up physicians such as the Miami psychiatrist who has given hundreds of elderly dementia patients the same antipsychotic, despite the government's most serious "black box" warning that it increases the risk of death. He believes he has no other options.

Some doctors are using drugs in unapproved ways that may be unsafe or ineffective, records showed. An Oklahoma psychiatrist regularly prescribes the Alzheimer's drug Namenda for autism patients as young as 12; he says he thinks it calms them. Autism experts said there is scant scientific support for this practice.

The data analysis showed widespread prescribing of drugs such as carisoprodol, which was pulled from the European market in 2007. In 2010 alone, health-care professionals wrote more than 500,000 prescriptions for the drug to patients 65 and older. The muscle relaxant, also known as Soma, is on the American Geriatrics Society's list of drugs seniors should avoid.

The data, obtained under the Freedom of Information Act, makes public for the first time the prescribing practices and identities of doctors and other health-care providers. The information does not include patient names or the reasons why doctors prescribed particular drugs, so reporters interviewed the physicians to learn their rationales.

Medicare has access to reams of data about its patients, their diagnoses and the medical services they received. It could analyze all of this information to determine whether patients are being prescribed appropriate drugs for their conditions.

But officials at the Centers for Medicare and Medicaid Services say the job of monitoring prescribing falls to the private health plans that administer the program, not the government. Congress never intended for CMS to second-guess doctors - and didn't give it that authority, officials said.

"CMS's payments don't go to physicians, don't go to pharmacies. They go to plans, which is how our oversight framework has been established," Jonathan Blum, the agency's director of Medicare, said in an interview. The philosophy "really has been to defer to physicians" about whether a drug is medically necessary, he said.

Asked repeatedly to cite which provision in the law limits their oversight of prescribers, CMS officials could not do so.

The Office of the Inspector General of the Department of Health and Human Services has repeatedly criticized CMS for its failure to police the program, known as Part D. In report after report, the inspector general has advised CMS officials to be more vigilant. Yet the agency has rejected several key recommendations as unnecessary or overreaching.

Other experts in prescription drug monitoring also said Medicare should use its data to identify troubling prescribing patterns and take steps to investigate or restrict unsafe practitioners. That's what state Medicaid programs for the poor routinely do.

"For Medicare to just turn a blind eye and refuse to look at data in front of them . . . it's just beyond comprehension," said John Eadie, director of the Prescription Drug Monitoring Program Center of Excellence at Brandeis University.

"They're putting their patients at risk."

Although Medicare hands responsibility to private insurers, experts say they are ill-equipped for the task. Insurers have access solely to the prescriptions for their members - not to a provider's prescriptions across multiple health plans.

Only Medicare can see that.

"A red flag can turn out to be nothing, or it can turn out to be something really, really horrible," said Kathryn Locatell, a California physician who specializes in geriatrics and elder abuse. "You won't know unless you flag it."

In lawsuits and disciplinary records, state and federal authorities cite a number of reasons that doctors prescribe improperly. Some run mills where patients get prescriptions if they pay cash for a visit. Others have relationships with drug companies that influence what they prescribe. Regulators say some doctors choose inappropriate medications under pressure from families or facilities.

Research also shows that doctors often don't keep up with the latest studies and drug warnings.
ProPublica's examination of Part D data from 2007 through 2010 showed that, in many cases, Medicare failed to act against providers who have been suspended or disciplined by other regulatory authorities.

Doctors barred by state Medicaid programs for questionable prescribing remain able to dole out the same drugs under Medicare. So can dozens of practitioners who have been criminally charged or convicted for problem prescribing, or who have been disciplined by state medical boards.

The Part D records detail 1.1 billion claims in 2010 alone, including prescriptions and refills dispensed. ProPublica has created an online tool, Prescriber Checkup, to allow anyone to search for individual providers and see which drugs they prescribe.

About 70 providers each churned out more than 50,000 prescriptions and refills in 2010, the data show, averaging at least 137 a day.

A few had high tallies because they work in institutional settings, such as nursing homes, or operate busy clinics. In other cases, doctors said they think the prescriptions of their colleagues were attributed to them. They acknowledged in interviews that their numbers should have sparked questions.

Some families say they, too, think Medicare should be paying closer attention.

When 79-year-old Mable "Nanny" Webb's family put her in a nursing home near Fort Worth in 2004 to rehabilitate her back, she came under the care of Adolphus Ray Lewis, who would later become one of Medicare's busiest prescribers.

Records show that the Texas medical board temporarily restricted Lewis's license in 1998 for improper prescribing of painkillers and that he was sued repeatedly for malpractice. But Webb's family didn't know that.

While under Lewis's supervision, Webb developed a urinary tract infection that went untreated and was given a painkiller in doses that were excessive and dangerous for her condition, court testimony shows. Within a month, she died.

Webb's relatives sued. During the 2008 trial, Lewis admitted responsibility for her death, testifying that he had not reduced the dosage ordered by a nurse he supervised.

A jury ordered Lewis to pay $1.6 million in damages to Webb's relatives. They later settled for a lesser amount - one of at least eight malpractice settlements in cases involving Lewis since the mid-1990s, according to court records and interviews.

Yet Lewis continued to prescribe, racking up nearly 99,000 Medicare prescription claims including refills in 2010, fifth-most in the country. He wrote 46,000 more under Medicaid that same year. He declined to comment for this article.

Webb's granddaughter, Michelle Wheeler, said that though it's too late for her family, information about a doctor's drug choices could help others decide who should care for their loved ones.

"Everybody should be able to know that," she said.

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Medicare Drug Program Putting Seniors, People With Disabilities At Risk