Barbara Sparacino, MD, FAPA, Physician, The Aging Parent Coach, LLC
Barbara, can you tell us a little bit about your journey to becoming an expert in psychiatry, geriatrics, aging parents, and dementia? What sparked your interest in these fields?
Absolutely. My journey into geriatric psychiatry and dementia care was both professional and personal. As a psychiatrist, I was drawn to the complexities of aging—the way medical, cognitive, and emotional factors intertwine in later life. But what truly cemented my passion was working with families who were navigating the overwhelming and often heartbreaking transition from child to caregiver. I saw firsthand how much confusion, guilt, and stress this process creates.
The more I worked with these families, the more I realized there was a huge gap in guidance and emotional support. While we have protocols for treating dementia or managing medications, there was far less focus on helping adult children navigate the shifting family dynamics, difficult decisions, and emotional toll that come with caring for an aging parent. That's what led me to create The Aging Parent Coach—to fill that gap and provide the education, strategies, and reassurance that so many people need during this stage of life.
What are some of the biggest challenges and rewards you've encountered in your career working with aging individuals and their families?
One of the biggest challenges is watching families struggle without the right information or support. I've seen adult children consumed by guilt, uncertainty, and exhaustion because they're trying to do it all without a clear plan. There's a lot of misinformation about aging and dementia, and when families don't know what's normal or what's next, they end up making decisions in panic mode instead of from a place of preparation.
But the greatest reward? Helping people feel more in control. I love seeing the relief on someone's face when they realize they're not failing. They just needed better tools. When a family leaves a session saying, "I feel so much clearer about what to do next," or when a caregiver tells me that a simple shift in their approach has made conversations with their parent less combative, that's why I do this work.
You mentioned providing written summaries for patients experiencing cognitive loss. What are some other ways you adapt your communication style to effectively engage with patients at different stages of cognitive decline?
Communication has to meet people where they are. Someone in the early stages of dementia may still be able to engage in complex conversations, while someone in later stages might respond better to simple, reassuring language and non-verbal cues. Here are a few strategies I use:
* Short, clear sentences - Processing slows down, so it's important to be concise.
* Visual aids - I use checklists, calendars, and color-coded reminders to reinforce key points.
* Tone and body language - Patients pick up on emotional cues even when words don't register. A calm, warm tone can reduce anxiety.
* Repetition and routine - Repeating key information in the same way helps with retention.
* Written summaries - For families, I provide step-by-step written plans so they don't have to rely on memory alone.
In your experience, what are some common misconceptions or misunderstandings families have about dementia, and how do you address these in your practice?
There are so many, but three stand out:
1. "They’re just being difficult." Families often think a parent with dementia is being stubborn when, in reality, they’re losing the ability to reason through problems. I help families shift from frustration to empathy by explaining how the disease changes the brain.
2. "If they have good days, they must not really have dementia." Dementia isn’t linear. Some days, cognition is sharper than others. This doesn’t mean they’re "faking" or that the diagnosis is wrong—it’s just how neurodegeneration works.
3. "There’s nothing we can do." While dementia isn’t reversible, quality of life can still be improved. Simple environmental changes, structured routines, and communication adjustments can make a huge difference.
Caring for a loved one with dementia can be emotionally and physically demanding. What advice would you give to caregivers on how to prioritize their own well-being while providing care?
You can't pour from an empty cup. I tell caregivers this all the time. Burnout doesn't just affect you—it affects your ability to care for your loved one. Here's what I recommend:
* Set boundaries. You cannot do it all. It's okay to say no and ask for help.
* Schedule respite time. Even short breaks matter, whether it's a walk outside, a coffee break, or a support-group meeting.
* Drop the guilt. You are not failing. Dementia is progressive no matter how much love and effort you give.
* Get support. Therapy, coaching, and caregiver groups can help you process emotions in a healthy way.
Caregiving is a marathon, not a sprint. You need to pace yourself.
Navigating difficult conversations about driving, finances, or living arrangements can be challenging for families with aging parents. What strategies do you recommend for approaching these sensitive topics with empathy and respect?
I always say, the earlier, the better. These conversations go much more smoothly if they're proactive instead of reactive. Here's how to make them less combative and more productive:
* Start from a place of respect. "I want to make sure we're planning together, not making rushed decisions later."
* Use questions instead of statements. "How do you feel about driving lately?" instead of "I think you should stop driving."
* Offer choices. People are more likely to accept change when they feel like they have a say in it.
* If necessary, involve a third party. Sometimes, a doctor, attorney, or counselor can provide a neutral voice that carries more weight.
You mentioned the importance of involving family and caregivers in treatment. How do you navigate situations where family dynamics are complex or strained, and how do you ensure everyone feels heard and supported?
Caregiving often brings out long-standing family tensions. One sibling might be doing everything while others are in denial. To navigate this, I encourage: * Structured family meetings - Everyone gets a voice, but the focus stays on solutions. * Clear role assignments - Not everyone will provide hands-on care, but financial or emotional support is still valuable. * A neutral third party if needed - A mediator or coach can help resolve conflicts when emotions run high. The goal isn’t for everyone to agree 100% - it’s to create a plan that prioritizes the parents’ well-being.
Technology is rapidly changing the landscape of healthcare. Are there any specific technological advancements or tools that you've found particularly helpful in your work with geriatric patients?
Absolutely. Some of the most helpful innovations include:
* Medication-reminder apps that help families track doses.
* Wearable fall-detection devices for seniors living alone.
* Telehealth for psychiatry and family coaching, which has made care more accessible.
* GPS tracking for dementia patients, reducing wandering risks.
Technology isn't a replacement for human care, but it's a powerful tool for making caregiving easier and safer.
Looking ahead, what are some of the emerging trends or challenges you foresee in the field of geriatric psychiatry, and how do you think we can best prepare to meet the needs of an aging population?
The biggest challenge? The sheer number of people aging. We’re facing a caregiver crisis, with too few professionals and family caregivers to meet demand. To prepare, we need: * More caregiver training & support programs * Better mental health care for aging adults * Policies that provide financial relief for family caregivers This is why education and advocacy matter so much.
Thanks for sharing your knowledge and expertise. Is there anything else you'd like to add?
Just this: You're not alone. Caregiving is hard, but there is help, support, and a path forward. You don't have to figure it all out on your own. Let's navigate this journey together.
