Aging people are people in transition. The loss of family members and friends, a change in living arrangements or finances, retirement, the loss of driving privileges, even the death of a pet are lifestyle transitions that require the entire family’’ attention. Ideally, our elders will ask for our help during times like these, but, as family members have learned, this may not happen. In fact, one aging parent might “cover” for the other, or one aging spouse may decline assistance from the other because he or she feels ashamed and powerless.
Know What to Look For
Things may seem normal on the outside. Some changes are barely noticeable. Once in a while we all forget details or put things off, but when a pattern of neglect develops, it may be serious. Remember, dementia (mental deterioration) is not a normal part of aging. Sharpen your observational skills, and look for patterns of consistent neglect within the following contexts:
- Basic tasks – difficulty in walking, dressing, talking, eating, cooking, climbing steps, or managing medications.
- Hygiene – infrequent bathing, unusually sloppy appearance, foul body and/or mouth odor.
- Responsibilities – mail is unopened, papers are piled up, checkbook is unreadable, bills are unpaid, bank account overdraft notices are accumulating, prescriptions are unfilled, phone calls aren’t returned, cooking pots and pans look burned, refrigerator interior has foul odor, food supply is low, home interior and/or exterior is unkempt, laundry is piling up, automobile has new dents.
- Health – weight loss, changes in appetite, problems swallowing, fatigue, burns, black and blue marks (possible signs of falling), hearing loss (look for signs of lip reading and talking loudly), seems withdrawn without reason, incontinence (bet-wetting), spilling and dropping things (check carpet for stains), complaints of muscle weakness, insomnia or excessive sleeping, dehydration.
- Isolation – lack of interest in outside friendships, activities, or hobbies, keeps curtains drawn day and night, has little access to transportation, lives in another city or state and lives alone.
- Attitude – sadness, display of verbal or physical abuse, talk of being depressed and feelings of despair, abuse of alcohol or drugs, paranoia, refusal to communicate, unusual argumentativeness, a recent emotional or medical crisis.
- Cognitive functions – consistent forgetfulness about where things are, getting lost while walking or driving, confusion, loss of reasoning skills, difficulty answering questions, inability to find the right word, use of repetitive words or phrases, severe personality changes, wandering, inability to recall names of familiar people or objects, inability to complete a sentence, forgetting how to use simple, ordinary things such as a pencil, forgetting to close windows, turn off the stove, and lock doors, loss of sense of time.
If some of these warning signs are present, and you are beginning to question your client’s ability to make choices and decisions, do not scare yourself and other family members into thinking that these are the early stages of dementia. Overreacting and jumping to conclusions create communication friction and unfounded anxiety.
Start the Conversation with your Loved One
Based upon your observations, if you have concluded that elder care issued demand immediate attention, it’s time to take the next step and talk about it. But “let the caregiver beware”. You are about to enter a potential minefield. Without knowing the most effective ways to initiate these very sensitive conversations with your elderly family members, the probability of them telling you to mind your own business, or telling you everything is fine when it is not, is almost guaranteed.
Many older people are incapable of running their own lives and homes, but often are reluctant to admit they need help. Failing eyesight, memory lapses, confusion, fatigue, sadness, drug and other substance abuses and appetite changes can account for a diminished ability to manage a home. There are definite signs that indicate some kind of assistance may be necessary.
The following is a handy checklist you can hand out to prospective clients or families or discuss over the phone during the initial sales call:
Inadequate Meals and Nutrition
- Does there appear to be a loss of interest in preparing well-balanced, nutritious meals?
- Are there unusual amounts of spoiled food in their refrigerator?
- Have food dates expired on staple foods such as dairy and meat?
- Are there many packages and cans of the same thing?
- Are there many dented cans and other containers?
Unopened or Piled Up Bills
- Is mail piled up unopened?
- Are there many more than usual magazine subscriptions coming to the house?
- Do some of the bills come from unrecognizable sources?
Recurring Memory Lapses?
- Are they missing doctor appointments or forgetting to make them?
- Are they making mistakes with their medication? Too much? Forgetting to take their pills? Confusing medications in original containers with those laid out on a daily basis? Repeat prescriptions from more than one doctor or pharmacy?
- Are foods left cooking on the stove?
- Have pots been burned?
- Do you notice unusual or frequent bruising and/or skin tears?
- Are medicines causing dizziness or loss of balance?
- Are they refusing to use a prescribed cane or walker?
- Are there loose rugs or uneven flooring areas in their home?
Lack of Interest or Feeling “Sort of Down”
- Have there been many peer losses recently?
- Has the sadness gone on for a long time?
- When was the last time they had a complete physical? Have you talked to the doctor?
- What kind of social activities do they engage in outside the home?
- Have you noticed a change in their driving capabilities?
- Do they get angry when you bring up a discussion about driving?
- Have you noticed changes in their agility, reflexes and eyesight?
- Have there been recent accidents?
A Marked Change in Behavior Patterns
- Is the home as neat and spotless as it used to be?
- Have they stopped attending church services or keeping beauty or barbershop appointments?
- Are they more irritable or otherwise moody, teary, sad?
Look for Conversation Clues
- Do they repeatedly bring up the same issues of concern for discussion that might be indicative of areas they need help with but are reluctant to ask for outright?
- Have neighbors or other relatives spoken to you of their observations?