They may be afraid to tell you they are having trouble
By Joanna Nesbit for Next Avenue
While their 84-year-old father recovered at a rehabilitation facility after landing in the hospital with symptoms of a mini-stroke, the Jones (not their real name) siblings took the opportunity to do some cleaning at his house.
Opening the fridge, they were shocked to find layers of mold, hardened food and multiple jars of the same item in varying states of decomposition. They knew solo living had become challenging for their dad, but they didn’t realize the extent of the decline.
“The two biggest reasons for geriatric decline are depression and dementia,” says Amy Fuchs, elder care consultant and licensed clinical social worker in Saddle River, N.J. Depression can set in when older people feel isolated and lonely, and often may be grieving the recent death of a friend.
“Their friends are dying around them, and they’re also fully aware they can’t do what they used to do,” Fuchs says. Early dementia may be subtle and tricky to spot if you don’t live nearby and see your parents regularly. It might look like bouts of confusion, as the Jones siblings thought.
Often, it takes a medical crisis to spearhead conversations about new needs. But you’ll likely notice signs indicating your parents aren’t as independent as they once were. Elders who want to remain in their home may not admit they need help for fear of being encouraged into an assisted living situation. But letting things go too far can precipitate a crisis situation.
Here are seven common signs to watch for:
Piles of unpaid bills. Fuchs says bill-paying is one of the first tasks aging parents lose track of, and their adult children may not realize bills aren’t being paid. Letting unpaid bills pile up can be a sign of dementia setting in, but can also be a sign of disorganization and life getting in the way. It’s important to determine what’s going on.
The house looks grimy. You may notice grime and clutter because regular house tasks and tidying up gets harder as people lose mobility and vision. Your parents may not be able to see the dirt. Additionally, if “they can’t bend down anymore, they just leave things that fall, so things pile up,” Fuchs says. Depression-era people often don’t want to spend money to hire a house cleaner (and may not want you to spend yours either), but a cluttered house is a tripping hazard.
A lack of fresh, healthy food. You may notice spoiled food in the refrigerator, as the Jones siblings did, or you might realize the fridge lacks fresh foods such as fruits, vegetables and meats, says Chris Bowker, executive manager of the home care division of AgingCare, a Naples, Fla.-based organization that provides information for caregivers. If your parents have begun subsisting on boxed and canned food, that can be a sign that taking care of themselves is getting harder, he says. Also, watch for unexplained signs of weight loss.
Missed medications. You’ll need to check more closely for this one, but Fuchs says it’s another common sign she looks for, right behind bill-paying. Take a look at your parent’s pill box to see if a dose or two has been skipped. “That’s a sign they’re forgetting to take their meds,” she says. Missing doses or taking too many at one time can be dangerous.
A distinct smell. Personal hygiene becomes a lower priority for a variety of reasons — mobility, dementia or keeping up with laundry. Some older people may not be bathing for fear of falling. They also commonly have problems with undiagnosed urinary tract infections (UTI). “Between not bathing or UTI issues, usually there’s a distinct odor of urine from incontinence issues that drives the realization seniors need help,” Bowker says.
Unexplained bruising. If you see a bruise on your mother’s arm or leg, it could mean she’s fallen and isn’t telling you. “Seniors tend to bruise more easily, so the signs show up more,” Fuchs says. She recommends checking your parent’s arms and legs if possible. Experts also recommend watching for elders holding onto walls or furniture as they walk through the house. This can be sign they’re unsteady on their feet and would benefit from a cane or walker.
The car has new dings and dents. As we age, our reaction time slows, and turning your head while driving to monitor blind spots gets harder. Dementia can also be the culprit behind fender benders or sideswipes in a parking lot. If you spot some troubles on the exterior of your parent’s car, it may be time for a conversation about driving.
Extending time at home
When aging parents want to stay in their own home and worry that their grown kids don’t want the same for them, they may not initiate conversations about waning independence skills. But extra help from a family member, volunteer or a paid caregiver can extend independence and aging at home with less risk.
Older adults might simply need help with meals, personal care, transportation or light housecleaning. Have a kind, but candid, discussion without controlling the conversation, recommends AgingCare’s editor-in-chief, Ashley Huntsberry-Lett. Find out which tasks feel more difficult these days. Ask how you can help.
While older adults are still capable of independence — they’re alert, oriented and able to make decisions — it’s important to let them make those decisions, even if you don’t agree with them, Fuchs says. Choose what’s not negotiable. For example, it might be OK to live with some mess but not to neglect the bills every month.
To learn about resources in your parents’ community, start with Eldercare Locater, a public service of the U.S. Administration on Aging. The nonprofit Family Caregiver Alliance also helps families locate local services with a state-by-state navigator. AgingCare provides a wealth of information for caregivers, helping them find answers and share information as well as connecting them to community-specific resources. Presbyterian Manors of Mid-America communities also provide information and resources to assist families with decision-making.