The authors make four suggestions for doctors (and adult children):
Don’t focus too much on safety: For many frail elders, safety is not their primary goal. They may be willing to trade off risks (of, say, a fall) for independence. Think about reducing harm rather than eliminating all risk. If, for instance, an apartment is filled with trash, think about reducing the clutter, not necessarily making the home perfectly clean.
Use persuasion: Many physicians are most comfortable giving instructions. But with these patients, gentle persuasion may be more effective. Build trust. Don’t tell a frail elder she must let someone in to help. Ask instead, “What concerns you about letting someone come into your home to help?”
Make home visits: It’s a good way to build the patient’s trust and perhaps begin to allow other members of a care team or community volunteers to enter the home as well.
Plan for the worst case: Work with the elder and her family on advance care planning.